The Canada Medical Record V 28.1900

r

CANADA

MEDICAL RECORD

JANUARY. 1900.

Original Communications.

PYOPERICARDIUM FOLLOWING PLEURO¬
PNEUMONIA-PERICARDIOTOMY—
RECOVERY.

By J. BRADFORD MCCONNELL. M D. (1)

Associate Professor of Medicine and Neurology, and Professor of Clinical Medicine,
U Diversity of Bishop's College, Montreal.

The fact that but a few cases of purulent pericarditis,
with its treatment by pericardiotomy are on record seems
sufficient justification for placing the details of this case
before you.

The following history of the case is condensed from the
detailed daily record : The patient, Charles D., occupation ;
jeweler, aged 33 years, was first seen on April 12, 1897. The
previous day be had been seized with chills and a severe pain
at the lower part of the left thorax in front, which radiated
towards the umbilicus. It continued to increase in severity,
and was accompanied by cough and fever. Two months
previous to this time he had suffered from an attack of La
Grippe, from which he had fairly well recovered, except the
cough, which continued off and on up to the time of the pre¬
sent attack. At the first examination the pain appeared to
be in the region of the diaphragm on the left side >
and diaphragmatic pleurisy was suspected. The pain was
increased by coughing and by deep breathing. Pain was
also complained of in the infraclavicular region, on front.
Pulse was 120; respiration, 24; temperature, 103° F.

(1) Read at the Montreal Medico-Chirurgical.Society, Oct. 15, 1897.

t

2

MCCONNELL : PYOPERICARDIUM.

There was also headache. Other than diminished respira¬
tory sounds, no abnormal physical signs could be made out;
powders containing caffeine, acetanilide and codein failed to
relieve the pain, and a hypodermatic injection of morphine
and atropine was required. On the 14th the pain had not
diminished. Respiration, 28 ; pulse, 104 ; temperature, 104° F.
There was dullness on percussion overthe upper lobe of the left
lung, diminished fremitus at the base behind and a grazing
pleuritic friction sound. Cough not severe, well marked
rusty viscid sputum. Ice-water compresses were applied,
and internally liq am. acet. fl. ext. ergot, acidi boric, Tr.
Camph. Co., Syr. Limon and aq. Camph. Morphine and
atrop'ne, hypodermically, had to be given daily. On the
15th tubular breathing was present in the upper lobe in
front. On 17th this condition was much the same, with
dullness on percussion at the left base behind, and increased
vocal fremitus throughout the left lung. On the 20th
symptoms had all abated and lung was clearing. There
were rales at the base before and behind.

On the 21st he complained of a pain at the left margin
of sternum, respiration, 48 ; pulse, 11 2 ; temperature,
100 3-5°. A pericardial friction murmur can be heard over
the heart; heart sounds distinct, clear and normal. On the
23rd no friction murmur could be made out. Pulse, 116;
respiration, 44; temperature, 98°. Each alternate systole
gave a peculiar accentuated flapping sound. This dis¬
appeared on the following day, rhythm normal. Coarse
rales are heard more or less generally over left lung.

On the 24th and 25th pain was complained of at right
base in front, and a pleuritic friction sound was well marked
there. Sinapisms were applied, and he required almost daily
hypodermatic injection of morphine, atropine and digitalin.
He had occasional vomiting attacks.

The general condition remained the same until the end
of the month. There was now evidence of an extensive
iccumulation in the pericardium. Temperature remained
normal, pulse averaging 120 and respiration 36. From the
1st of May to the 10th the effusion gradually increased •
he now had difficulty in swallowing; the act caused him

i

MCCONNELL : PYOPERICARDIUM.

severe pain at the cardiac end of the stomach and lower end
of oesophagus. The pulmonary condition had now cleared
up—there was but little cough—and there is no marked
dyspnoea and no chills nor febrile attacks nor sweating.

The physical signs on the 12th were as follows: De¬
cubitus on back and left side. Cannot lie on right side.
There was diminished movement on the left side and below the
fourth rib, the interspaces were widened and pressed to a
level with the surface of the ribs. No heart impulse is
visible. The epigastrium is somewhat prominent. Palpa¬
tion does not give evidence of any impulse of the heart; the
interspaces from the 2nd to the 6th are tense. The upper
margin of the first rib could be felt to its sternal attachment,
a symptom of these cases pointed out by Ewart. No fremi¬
tus could be made out on the lower two-thirds of the front
or side of the left chest, it was diminished behind, but in¬
creased at the apex on front and behind. Percussion shows
extensive dullness radiating from the cardiac region. At the
4th rib it extends from inches to the right of the ster¬
num to i inch to the left of the left nipple. The line of
dullness then slanting down to the fourth intercostal space in
the axilla. It extends from the upper margin of the 2nd
costal cartilage to the liver, which is depressed about 2
inches. Three days before the date of this examination a
square patch of dullness existed to the left of the spines of
the vertebrae from the 9th to the 12th, described by Ewart as
the posterior patch of pericardial dullness, but it had now in¬
creased and extended into the axilla, and up as high as the
angle of the scapula. There was probably some pleuritic
effusion as well, as the dullness extended down to the 10th
rib in the axilla. The sternum was absolutely dull as was
also the fifth right intercartilaginous space, the line of dullness
curving outwards to that of the liver, the cardio-hepatic
triangular area of resonance being quite obliterated. By
placing the rod of the phonendoscope over the heart and
rubbing with the finger, vibrations were perceived which en¬
abled the heart to be outlined in its normal position, and of
normal size, thus differentiating it from the dullness of the
surrounding effusion. The liver dullness could also in the

4

MCCONNELL : PYOPERICARDIUM.

same way be distinguished from that of the pus accumula¬
tion. Traube’s semi-lunar space was quite obliterated.
Stethoscopic auscultation revealed the heart sounds very in¬
distinct and muffled, the 2nd pulmonic sound was accen¬
tuated. No respiratory sounds at left base in front up to
fourth space nor below the axilla, feeble behind, tubular at
the angle of the scapula and along the edges of the verte¬
brae down to the 8th. No tubular breathing could be made
out below the right mamma, exaggerated respiration at the
apex. A creaking sound is heard in the left infra axil'ary
region, most distinct during expiration. The patient could
not swallow solids, and liquids caused pain, and they were
sometimes regurgitated through the nose. No rales, and
the patient has no cough. On the 13th pulse, 144; respira¬
tion, 40; temperature, ioj°; a hypodermic injection of
morphine, atropine and digitalin was given in the evening.
On the 14th a.m. paracentesis pericardii was performed ; no
anaesthetic was given. Before the operation, P. 132, R. 28,
T. 97 4-5°. I was assisted by Drs. F. G. Finley and H. S.
Shaw. The trocar entered in the 5th left interspace
inches from the sternum. Sixty ounces of creamy pus was
removed. He experienced marked relief. The pulse re¬
mained regular and of good volume, and after the operation
had slowed down to 92, R. 32. The pus was submitted for
examination to Dr. MacPhail, who reported that the diplo-
coccus of Fraenkel was found in pure culture, reacting to all
the usual tests for this micro-organism. No other species
was found.

The following day he developed a mild conjunctivitis,
and later a small ulcer appeared at the lower part of the right
cornea, which healed within a week. The heart sounds were
now quite distinct and regular, no abnormal signs present. A
pain in the cardiac region in the evening required a hypo¬
dermatic injection j and this was required almost daily,giving
rest and improving markedly his general condition.

On the 18th the heart sounds were less distinct. A
cardiac dullness extended from right edge of sternum to y 2
inch to left of left nipple, and from 2nd space to liver on
right, and joined the pleuritic dullness on the left. The pulse

MCCONNELL: PYOPERICARDIUM. 5

and respiration became more rapid up to the 22nd, when
the cardiac dullness equalled what it was at the time of aspir¬
ation eight days previously. No heart sounds could be heard,
and the cardiac dullness did not extend over two inches to
the right of the sternum. On the 22nd May, assisted again
by Drs. Finley and Shaw, pericardiotomy was performed.
Morphine y, atropine 1-150 and digitalin I-IOO were given
half an hour before ; a mixture of chloroform, 2 parts, and
ether 1 part was used. It was given cautiously by Dr. Finley,
and not pushed to deep anaesthesia. The interspaces were
wide ; but it was not thought necessary to excise any of the
ribs. An incision an inch long was made in the fifth inter¬
space, its outer end extending to about 2 inches from the left
edge of the sternum ; the intercostal muscles retracted from
the incision, leaving a free opening, through which could be
seen the distended pericardium. It felt hard, and was pul¬
sating, giving the impression of being a dilated auricle or
ventricle, a small exploratory trochargently pressed through
allowed a few drops of a thick pus to appear. The pericar¬
dium was then seized with a mouse-tooth forceps and incised ;
when pus welled out freely, in it were several large fibrinous
flocculi. The quantity measured 66 ounces. The air would
rush in and out with each act of the heart’s beat; the peri¬
cardium was about y of an inch from the ribs. The open¬
ing was now behind the fifth rib, and the pericardium required
to be seized with forceps and pulled down to put in the drain¬
age tube. For this purpose, a portion of a soft rubber catheter,
No. 12, was used. The rounded extremity readily entered
the cavity. It was retained with a safety pin and rubber ad¬
hesive plaster, and packed around and covered with sublim¬
ated gauze, and, over this, jute. The sternum and all the left
side of the chest, except the lowest part in the axillary line,
was now hyper-resonant. The heart sounds were distinct,
and the pulse had remained regular.

At the first dressing, next day, it was found that a large
quantity of purulent fluid had escaped, passing through the
thick dressings, clothing and sheet into the mattress. On
the 24th, the respiration was 36, P. 130, T. 100-4-5°; but
there was no pain nor cough, nor distress, and he was taking
nourishment freely. The temperature was normal the next

6

McConnell : pyopericardium.

day, and remained so. The wound was cleansed daily with
hydro-naphthol solution ; none entered the cavity of the peri¬
cardium ; but the space between the pericardium and chest
wall required washing out, and at each dressing, airol was
freely dusted in. The drainage tube entered about 2 inches
into the pericardial sac. After removing the dressings, a
continuous puffing in and out of air through the chest opening
occurred, caused by the heart’s movement, which could be
readily seen. The discharge gradually ceased, and by the
1st June had almost entirely stopped. The tube was short¬
ened from time to time, the cavity gradually closing after it
There was a keen tendency for the outer wound to heal, which
required firm packing with the sublimated gauze to prevent
it. The phonendoscope on the left side revealed one pre¬
ponderating sound only, the puffing through the opening in
the chest. There is dullness in the infra-axillary and infra¬
scapular regions; respiratory sounds very indistinct in the
same region.

On the l ith of June the tube was removed, and a small
piece of sublimated gauze placed in the outer wound daily, to
allow the cavity beneath to fill out before the intercostal
opening closed. By the end of the month the parts had en¬
tirely healed, and, on July the 3rd, all dressings were finally
removed. P. 132, R. 24, T. 98 2-5°. Heart sounds now
clear, but distant in character. The patient has been taking,
since the operation, Iron Quinine and Stychnine, and has
steadily Improved and gained in weight, and presents a
marked contrast to the emaciated condition which obtained
at the time of operation. He has been walking about the
room for about a week; the ankles are very much swollen each
evening ; this gradually disappears during the night. In about
three weeks this ceased entirely.

Although not bearing on the case, it may be noted that
the patient passed through a subsequent attack of pneumonia
from July 30th ro August 7th, 1897, the consolidation occupy¬
ing the lower and middle lobe of right lung.

At the present time (Oct. 15th, 1897)—as you may as¬
certain by examining the patient—he is in a fairly norma 1
condition, and weighs more than before he became ill. There
is an appreciable dyspnoea on exertion, and when talking

MCCONNELL : PYOPERICARDIUM.

7

continuously. Chest measurement is equal on either side
(15# inches). There is no visible impulse, nor can the
heart’s beat be felt on palpation, unless the tip of the finger
is pressed into the cicatrix of the incision wound. There is
moderate hypertrophy, but none of the usual signs of ad¬
herent pericardium other than a slightly marked diastolic
shock. The heart's sounds are normal, but somewhat fre¬
quent, averaging 85 beats per minute. Vocal fremitus is
diminished in the lower half of left chest, as also are the res¬
piratory sounds.

The number of recorded cases of suppurative pericar¬
ditis appears to be very limited, and especially so the number
of cases in which the treatment by inci-ion and drainage
has been adopted.

A case was recent'y reported by Bohn ( Dnitsch Med-,
Wochtnschr, Nov. 26, 1896) somewhat similar to the present
one. It followed La Grippe and pleuro pneumonia. The
pericardial sac was opened one month after the beginning
of the disease, and over a litre of pus removed. He was un¬
able to introduce a drainage tube, and had to drain with
gauze. The sac was washed out with a solution of boracic
acid. The opening in the pericardium closed in three weeks.
Three months after the pericardiotomy the heart and lungs
were in nearly a normal condition, He speaks of his as the
fifteenth case on record. Eight of these recovered. Of the
seven deaths one resulted from the irritation of the irrigat¬
ing fluid ; one from the degenerations of heart muscle; one
had aural abrasions; the other from such complications as
pneumonia, empyema and nephritis.

In the journal of the American Medical Associatioti,
June 26, 1897, Dr. Frank W. Garber, of Muskegon, Mich.,
reports a case of traumatic origin. Only about an ounce of
pus was removed, the patient recovering. A resumi of the
literature on the subject is given by him. It was in 1819
that pericardiotomy was first performed. He says Romero,
of Barcelona, operated on two cases. Two recovered. In
an article by Delorme and Mignon, Revue de Chirurgie,
October, 1896, a resume of which appears in the Montreal
Medical Journal, April, 1896, it is stated that puncture of the
pericardium was first proposed by Riolan in 1646.

8

MCCONNELL : PYOPERICARDIUM.

In 1840 Schier performed paracentesis in pericarditis
due to cancer. The patient lived for six months after.
The first case of tapping the pericardium in the United
States was in 1852 by Dr. Warren, of Boston, and the
first authentic case of incision and drainage in purulent peri¬
carditis is reported in the Berliner Klin. Wochenschrift,
1881, 5th No. The patient was a boy, ten years of age, by
paracentesis several ounces of pus were removed ; later, inci¬
sion and drainage led to recovery.

The operation of pericardiotomy was first performed in
England by Dr. Samuel West in 1883. The case recovered.
He refers to 79 cases with 36 recoveries. In 1885 Michaeloff
operated, the patient dying a short time after the operation-
Gussenbauer, in the same year, had a successful case;
after incision, drainage and irrigation, the ribs were revealed.

Davidson reports two cases in the British Medical
journal, March, 1891 ; two boys aged seven and six were
treated this way, one recovering.

Beckman and Stall report a successful case ; Bronner, one
which terminated fatally. Scott, in the New Zealand
Medical Journal , July, 1891, reports a successful case where
irrigation with 15 to i.oco carbolic was part of the treatment.

Edwards, in the International Medical Magazine, June,
1896, operated on a child six years of age, purulent pleuritic
effusion and death followed.

Eiselberg, of Utrecht, reports a case of traumatic purulent
pericarditis. Three tappings failed to give permanent relief.
They occurred at intervals of a few days, and one litre was
removed each time. The fourth costal cartilage was removed
a few days after, and two litres of sero-purulent fluid contain¬
ing fibrinous clots were noted. He irrigated the borders
of the pericardium, which were stitched to the outer wound,
to prevent infection of pleura. He injected iodoform and
glycerine emulsion daily. Tube was removed in 17 days,
and, 4 weeks after, the wound had completely cicatrized.

William Pepper, J. H. Mussen and John B. Deaver, of
Philadelphia, in the University Medical Magazine for Feb.,
1894, mention a case in a man, following influenza, where,
paracentesis and the incision and drainage were performed.

McConnell : pyopericardium. 9

Improvement was temporary only. The patient died two
weeks after the operation.

• Wilson, of Nashville, Tennessee, operated on one case of
serous effusion in the right fifth intercostal space.

R. Siewers, of Finland, in 1894 reported nine cases; four
successful.

Medical Press and Circular, January 27th, 1893, Koerte
mentions the removal of a litre of pus from the pericardium
from a girl of seven years ; the patient died.

Ferier, in 1890, had collected 22 cases with 20 deaths, in
16 of purulent effusion, 11 aspirated died ; the remaining 5
were incised, 3 recovering.

Musser, in his work on medical diagnosis, reports a case
of tuberculous pericarditis, were 64 ounces of fluid was found
in the pericardium at the autopsy ; he had previously been
tapped.

The most recent case was one by Drs. Shittuck and C.
B. Porter (Boston Medical and Surgical Journal , May 6th,
1897) in a man 26 years of age. Purulent pericarditis fol¬
lowed pneumonia, aspiration was followed by rapid reaccu¬
mulation, incision and drainage led to complete recovery.

From this brief resume of the literature, it will be seen
that it is not very extensive, and one cannot very readily
separate the cases of simple serous effusion where the treat¬
ment was by paracentesis or incision, from those of purulent
pericarditis. If Bohm’s statistics are correct, then the case
will be the nineteenth on record where pericardiotomy has
been resorted to in purulent pericarditis, with seven recov¬
eries.

The points of interest in this case are first, the causation
by contiguity of an active pneumococcis growth in the lung,
with the comparative absence of symptoms of sepsis ; not
only did the heart accommodate itself to this large accumul¬
ation but gave slight evidence of distress, and there was but
little constitutional disturbance in the way of fever ; the
derangements resulting were apparently only mechanical.

The quantity is the largest for an accumulation of pus yet
recorded ; larger amouuts of serous and seropurulent collec¬
tions have been described.

Louis, in 36 cases, found 9 serous, 5 sero sanguinolent

-'to MCCONNELL : PYOPERICARDIUM.

13 sero-purulent, 7 purulent, reports the quantities removed
as ranging from 200 to 1,000 gms. and in one case 1,500,
The rapidity of the re-accumulation of the pus is also note¬
worthy. An important point in diagnosis is illustrated in this
case, which I have not yet seen mentioned ; it is the advant¬
age afforded by the phonendoscope in helping to distinguish
pericardial effusion from dilatation and from pleural accu¬
mulations. In this case, and doubtless in all where the
effusion does not force the heart too far from the chest (if it
ever does so), one could with the phonendoscope readily
make out the heart in the midst of the effusion, while the
latter was outlined by percussion. In a recent case of large
left hemorrhagic pleuritic effusion also, out of the uniform
flatness of percussion one could clearly locate the heart, which
was not pushed to the right, although 86 ounces were removed
by aspiration, doubtless owing to the age of the patient and
the rigidity of the attachments which retained the heart in
its normal position. This is one advantage of the phonen¬
doscope which is worthy of further investigation. I found
in this case and Mothers that the phonendoscope is less to
be relied upon than the stethoscope. Misleading sounds
resembling crepitus or grazing are produced by the instrument
itself when not in perfect contact with the surface, as over the
ribs in one emaciated, and in a recent case of double pneu¬
monia, tubular breathing was not revealed by the phonen¬
doscope, although quite distinct with the stethoscope.

It is of surgical interest also in the case, which I believe is
the rule, that one can rapidly remove the accumulation
without any risk of heart failure symptoms. The avoidance
of the internal mammary artery—which descends half an inch
from the edge of the sternum—and the pleura are among the
chief points for consideration in incision or tapping. The
latter is considerably pushed aside by a large accumulation,
and normally recedes towards the left from the upper border
of the fifth costal cartilage. They are both avoided by select¬
ing a point \ x /t to 2 inches to the left of the sternum. The
general results have so far been fairly good for incision, and,
doubtless if the diagnosis and operation are made earlier,
the mortality in these cases will be much less than in the past.

MCCONNELL : PYOPERICARDIUM.

II

Delorme and Mignon have collected 1O2 cases; 61 died ;
82 were punctured, with a mortality of 65 per cent., and 18
incisions with 38 per cent, mortality.

A case is recently reported by Menetrier and Reneau, of
purulent pericarditis due to the pneumococcus, where pneu¬
monia was not present, and where a primary pericarditis
was suspected.' The autopsy revealed only bronchitis the
primary source, then an enlarged mediastinal gland, from
which the pericardium received the infection.

One of the most recent contributions on this subject is the
paper by J. B. Roberts, A.M., M.D., Philadelphia, which was
read at the meeting of the American Surgical Association,
May, 1897, which should be read by all surgeons contem¬
plating this operation (published in the December No., 1897,
American Journal of the Medical Sciences). The author con¬
siders it mostly from the point of view of its surgical treat¬
ment. He strongly advocates incision in all cases of pyo-
pericardium, and, even where the effusion is serous, most
cases should be treated preferably by incision rather than
cardiocentesis.

He says it establishes diagnosis in dubious cases, avoids
cardiac injury, saves the pleura from puncture, affords com¬
plete evacuation of effusion, permits extraction of thick pus
and membranous lymph, and gives opportunity for disinfec¬
tion of the sac when that is necessary.

In most of the methods of operation hitherto employed
there is danger of wounding the pleura by the puncturing
needle. Hence, Dr. Roberts advises exploring through the
upper part of the left xyphoid fossa, and if pus is found, to
incise the pericardium after resecting the 4th and 5th costal
cartilage on the left side ; a sort of trap door is made and
turned upwards utilizing us a hinge the soft tissue in the
third intercostal space.

Dr. Roberts gives a classification of thirty-five cases on record
of incision of the pericardium, with operator’s name and results.
The following is a resume of it: Hilsmann, 1844, recovery ;
Langenbec, 1850, recovery ; Rosenstein, 1879, recovery ;
West, 1882, recovery; Partzevsky, 1882, death ; West, 1883,
death; Savory, 1883, death; Scott, 1883, recovery; New-

12

HEBBERT : PROCEDURE IN POST MORTEM

man, 1885, death; Mikhailov, 1885, death; Gussenbautn,
1885, recovery; Rouse, 1887, recovery; Underhill, 1887,
death; Larkin, 1888, death; Halsted, 1890, death; Delorme,
1890, death; Davidson, 1890, death; Davidson, 1890, re¬
covery; Teale, 1890, death; Deacon, 1890, death; Sievers,
1892, death ; Korte, 1891, death ; Eiselberg, 1894, recovery;
Edwards, 1892, death ; Jacobson, death ; Gabszewiez, 1892,
recovery; Robinson, 1893, recovery ; Marsh, death; Klef-
berg, death; Bohm, 1894, recovery; Allen, 1892, death ;
Stoker, 1892, death; Bjorkman, 1895, recovery; Porter,
1895, recovery ; Garber, 1897, recovery.

PROCEDURE IN POST MORTEM MEDICO¬
LEGAL EXAMINATIONS.

By CHARLES A. HEBBERT, M. B. C. P.. London, F. L. S., Lecturer on

Anatomy, etc.

Case III.

The next case in this series is that of a fracture of the
base of the skull, the result of a blow on the point of the jaw
by the fist of an assailant.

This was one of two similar cases occurring within a
short period, and has been selected for illustration for the
reason that the fracture is not complicated by any other
fracture which might have been caused by a fall on the
ground—a condition present in my other case.

The injury was the result of an altercation in the street
between two working men, the assailant a burly powerful man
of six feet in height, and the victim, though muscular, some¬
what smaller and weaker. Several blows were exchanged.

The description is as follows :—

The body was that of a young man, 25 years old, of
spare muscular power, 5 ft. 6 y 2 in. high, with dark hair and
brown moustache. Eyes brown in colour and pupils moder¬
ately dilated. Rigor mortis present; hands clenched. The
left eye was ecchymosed, and at the external angle there was
an irregular lacerated wound 5 /& in. in diameter. There was
clotted blood in both ears. On the left cheek, opposite the
angle of the mouth, there were two abrasions 1 in. and in.

MEDICO-LEGAL EXAMINATIONS. 1 3

respectively in diameter (caused probably by contact with
the ground on falling).

Head.—T he dura mater at the vertex was apparently
normal, the sinuses containing some black fluid and clotted
blood.

On removing the brain an hjemorrhage about the size
of a half crown was noticed over the 2nd left frontal con¬
volution, and some smaller superficial haemorrhages over the
crura cerebri and pons varolii. The substance of the
brain was superficially injured, but beyond that the sub¬
stance was apparently healthy. The lateral ventricles con¬
tained some blood-stained serum.

On examination of the base of the skull, two linear
fractures were discovered, one in each middle fossa, running
diagonally from the centre of the anterior surface of the
petrous bone to the body of the sphenoid. Each cavernous
sinus was opened, and blood had also escaped into the inter¬
nal ear and external auditory meatus on either side. The
glenoid fossa is immediately below the centre of the fracture,
which ran backwards through the petrous bone and forwards
through the great wing of the sphenoid. There was also
fracture of the basilar portion of the sphenoid.

Heart. —There was old pericarditis and some thicken¬
ing of the mitral valve. The walls flaccid, and the cavities
contained some black fluid blood.

The Lungs. —The larnyx and trachea and bronchi
showed some softening and swelling of the mucous mem¬
brane, and the lungs were markedly congested and odema-
tous; otherwise normal.

The Stomach contained about one pint of black
coagulated blood. This had evidently drained into the
pharynx through the basilar portion of the sphenoid from
the cavernous sinus and pterygoid plexuses, and had
been swallowed. The other organs were somewhat congested,
but the substance was in each case apparently normal. All
the organs gave the characteristic odour of alcohol.

The case ended fatally about 12 hours after admission
to the hospital, the man never completely recovering con¬
sciousness.

*4

HEBBERT : PROCEDURE IN POST MORTEM

The principal point of interest in this case was that it
illustrated the injury suffered by the knock-out blow on the
point of the jaw, the blow most devoutly to be desired by the
pugilist either for infliction on his opponent or avoidance by
himself. The injury is two-fold ; it may, as in this case and
in another under my observation, be fracture of the base of
the skull, and, in addition, injury of the brain substance. Or
it may, and probably is, in such cases as recover consciousness
within a reasonable period, be simply due to a sudden severe
shock to the centre of vitality, the medulla oblongata, the
complete unconsciousness being due to the suspension of the
functions controlled by the nceud vital. The examination
of the skull and lower jaw will show that the long axes of the
condyles of the jaw being prolonged backwards will meet
at the basion, the centre of the anterior border of the foramen
magnum.

Immediately in front of this point the medulla is situ¬
ated, and the issuings of the pneumogastric, glossopharyngeal,
spinal accessory and hypoglossal nerves are closely adjacent.

Now, a blow delivered on the point of the jaw or slightly
to either side of the point would be directly transmitted up.
wards along the thickened oblique ridges to the rami and
thence to the condyles, and in consequence of their oblique
direction backwards and inwards, the force from either side
would centre directly at the important point of the basion.
I believe this will explain the temporary annihilation of con¬
sciousness from the terrible blow. The injury has fortunately
only been occasionally fatal, and, as this case would indicate,
when only fracture complicates the shock to the nervous
system.

In my other case the injury was more severe, a portion of
the left petrous bone being driven inside the skull. There
was no escape of blood into the pharynx, and the case was
further complicated by a fracture of the occipital bone by a
fall on the pavement. The man died during removal to the
hospital, a distance of 100 yards or so. It was, in fact, a
distinctly accurate “ knock-out blow ” deliberately inflicted,
and the death could only have been due to the sudden and
severe direct shock to the brain, i. e., the medulla. Post-

MEDICO-LEGAL EXAMINATIONS. 15

mortem, but little haemorrhage was found, and that only
superficial.

There was no reason to suppose that the injury in the
first case was anything but the result of a clumsy “ upper cut ”
given by a man unaware of his own strength, but it well illus¬
trates the danger of such a blow, and by how much the
more dangerous when given with skill and deadly intent.

Selected Article.

BLISTERS IN PNEUMONIA.*

By JESSE EWELL. M.D , RucltewvlU3. Va.

When I announce my subject to be ‘‘The Use of the
Blister in Pneumonia,” I feel that, at once, you regard me
as an unqualified crank; or, at least, a Rip Van Winkle of
no recent type.

That 1 came from, or near the mountains, is true; and
that I champion a remedy almost as old as the hills, is
equally true; and still it is a conviction, on my part, that
my medical brethren are allowing a most valuable remedy
to lie idle; that brings me to the front to claim for a short
time your kind consideration and attention.

There can be no doubt that the Cauthidal Blister was in
general use in the profession one hundred years ago, and
to-day it is used only by a few moss grown individuals like
myself. This, to many minds, is prima f icie evidence that,
being “ no good," as a rem;dial agent, it has been consigned
by the profession to oblivion. I deny this impeachment,
and, as an example to the contrary, I would point out the
to-day fashionable cold water treatment of Brand. 1 his
was no new treatment one hundred years ago, for James
Currie (a friend of Burns and editor of his poems) wrote his
medical reports on the effect of water, cold and warm, as a
remedy in fevers and other diseases. Vincent Priessnietz,
the founder of hydropathy, was a German, and, though not
a doctor, is said to have treated three thousand patients in
two years, and only lost two cases. Yet, after cold water
had been tried for many years by the profession, it was laid
aside, to be brought to the front again by Brand ; and is so
popular to-day that I think some of the younger members

* Head br title at request of author before the Medical Society of Virginia, dur¬
ing Its l’airtieth Annual Session, in Kictnuond, Va., October 21-2U, l&O.

16 EWELL: BLISTERS IN PNEUMONIA.

of our profession seriously contemplate laying aside the time-
honored saddle pockets, the insignia of the country doctor,
and go armed simply with a watering-pot and a rose
sprinkler.

Since we have concluded that pneumonia is a germ dis¬
ease, it is especially easy to spend our time in bacteriology,
and lose sight of the fact that we have inflamed lung to
treat, regardless of what may be the cause of the inflamma¬
tion. When the hurried breathing, short cough and high
temperature assures us of this fact, the application of a
blister will often work wonders.

In the language of the older writers, I will say that
“ blisters draw both the nervous and circulating fluid to the
seat of their own immediate action, and thus relieve irrita¬
tions and inflammations of the internal parts ; ” and I agree
with them in thinking that the serous discharge results in the
unloading of the inflamed parts in close proximity.

I know the old writers drew fine lines as to the proper
time to apply a blister in pneumonia ; my own experience,
and that of my medical friends who blister at all, would lead
me to say, without hesitation, that the proper time is just as
early as possible. As soon as you find you have a case of
pneumonia to treat, blister at once ; and oftimes, on your
second visit, you will find that a third visit is not required.

If, however, as is sometimes the case, the disease re¬
fuses to yield to this rude onslaught, examine the chest again
carefully, and it may be you will find inflamed lung tissue
at some point too remote to be benefited by the blister you
have already applied. When such is the case, do not hesi¬
tate to apply as many blisters as would seem to be indicated.
However, as the effect of a blister is to reduce both the tem¬
perature and pulse (and sometimes both drop), I rarely
apply a blister larger than 6x6, though I often order that,
when removed, it shall be applied to some other part of the
chest, and have thus drawn as many as three blisters on a
patient in twenty-four hours. As ugly as a raw blister looks,
and however much the patient and friends may object to its
first application, there the opposition ceases, and I have had
patients to call for the blister to be applied.

That a blister may add to the irritation, and thus ex¬
cite additional inflammation and make your patient worse,
there can be no doubt; but this is the fault of the treatment
which the blister receives rather than the fault of the blister
itself. My plan is this :

I use the blistering plaster, or ceratum cantharides,
U. S. P., which I spread on a piece of cloth of suitable size,

EWELL : BLISTERS IN PNEUMONIA.

17

and usually cover the face of it with very thin gauze. While
the gauze retards the action of the plaster to some extent, it
is of use in preventing any portion of cerate from adhering
to the skin when the plaster is removed, to which is some¬
times due the strangury which follows a blister. Strangury
but seldom occurs, and may be prevented in subjects
especially liable to it by the use of demulcent drinks,
beginning with the application of the blister. The skin
should be free from grease, and should be wet with spirits
of camphor, which is supposed to lessen the tendency to
strangury. A compress and light bandage will hold the
plaster in position. The directions to the nurse are—to wait
from two to four hours, as may be most reasonable, and then
only raise one corner of the plaster, and if fine watery
vesicles are to be seen, to remove the plaster and apply
dressing. When no vesicles show, press the corner of the
plaster back and examine again in from thirty to sixty
minutes, until it is ready to come off. If doubt rests on the
mind of the nurse as to whether it has drawn enough, let it
remain till there is no longer a doubt.

Then comes the dressing : I direct that all dressings
should extend at least one inch beyond the edge of the
blister all around, so that if it should slip a little the blister
will not be exposed to the air. I prefer to first dress
it with cabbage leaves, or with the leaves of the wide leaf
plantain; and these should be softened by dipping in hot
water and laid on the blister several layers in thickness ; a
compress and bandage completes the dressing. These
leaVes should be exchanged for fresh ones every four hours,
and always applied as warm as is comfortable. They de¬
velop up a better blister than any other dressing, but if not
obtainable, a poultice may be used from the first. When a
sac forms holding as much as half a drachm of serum, it
should be carefully opened with scissors or needle.

After twenty four hours I direct the leaves to be laid
aside and a poultice to be used instead. This should be
made of fresh milk, thickened with flour; it should be thin
enough to pour into a bag made of soft white cotton and the
end sewed up to prevent the contents from escaping, and
the side to be applied to the blister well greased with hog’s
lard.

These poultices require to be changed every six to eight
hours only, but should not be allowed to sour or to get cold
and stiff. When patient has been convalescent for thirty-six
or forty-eight hours, the blisters may be healed by the
application of simple cerate on a cloth. Before one dressing

18 PROGRESS OF MEDICAL SCIENCE.

is removed the other should be ready and waiting, as air is
painful to the raw surface and should be avoided- Some¬
times a blister heals under the dressing before the patient is
convalescent; when the tendency is in this direction, you
can re-apply plaster for ten to thirty minutes, or a little
blistering salve may be mixed with three times its bulk of
lard, and used to grease the poultice once or twice.

All this detail may be very tedious, but I think it worth
remembering.

I practiced medicine for years before I ever used a
blister, but now I agree with a good many of my older
brethren, and believe that a blister in pneumonia gives the
patient the best chance to get well. I do not rely on blis¬
ters alone, but use such other remedies as are commonly
used by the profession. But when I see in a newspaper, as I
often do, that such and such a life (a bright one perhaps) has
gone out, another victim to pneumonia has been laid low, I
often wonder if a blister has been used. Should I lose a
patient with pneumonia without having applied the blister,
my conscience would tell me I had not done iny duty.

Now, I have no statistics to offer you, for country doc¬
tors do not keep records of their cases as they should, but I
find no patient too young and none too old to be treated
and benefited by the blister. And, laying aside my modesty
for the moment, I can boast of the recovery of as unfavor¬
able cases as falls to the lot of any one, and these re¬
coveries are due, in a large measure, to my creed, “ In
pneumonia, blister early and often.”— Virginia Medical Semi-
Monthly.

Progress of Medical Science.

MEDICINE AND NEUROLOGY.

IN CHARGE OP

J. BRADFORD McCONNELL, M.D.

Associate Professor of Medicine and Neurology, and Professor of Clinical Medicine
University of Bishop's College; Physician Western Hospital.

THE FAILURE OF ANTISTREPTOCOCCIC
' SERUM.

Dr. Wm. Clark in Cleveland Medical Gazette writes
as follows on the subject;

With the advent of antidiptheric serum and its success¬
ful place in the therapeutics of the majority of the profession.

MEDICINE AND NEUROLOGY.

19

came the attempt to produce serum for the cure of that class
of diseases caused by streptococcic infection ; and great hopes
were entertained that we had at last found a remedy power¬
ful enough to cure such diseases as puerperal fever, cerebro¬
spinal meningitis, etc., which have always been a thorn in the
flesh.

During the past year reports have been published by
the score from all parts of the country, some highly eulogis¬
tic of the serum and many reporting it valueless.

It has seemed to the writer that, in those cases in which a
favorable report was made, too little was ascribed to the
stimulating and antiseptic treatment of the physieian, and
too much to the serum. ;Upon the intelligent use of the
serum is dependent its value. In some cases too little is
used.

The writer has noticed in many of the reports of cases
in which this remedy was used an utter disregard has been
paid to ascertaining whether the cases were of streptococcic
infection or not. Particularly was this true in reports of
puerperal fever and cerebro-spinal meningitis. In puerperal
fever a sterile swab should always be introduced into the
uterus and smears taken for examination, while in cerebro¬
spinal fever, lumbar puncture should be performed, and the
serum examined for the active disease-producing agent. If
then, the streptococcus is found to be the cause of the dis¬
ease, the serum can be used with some prospects of success.

When we reflect that in puerperal fever the woman may
be infected by the colon baccilus, Klebes-Loeffler baccilus,
scarlet fever, erysipelas and the various pus-producing organ¬
isms, and that in spinal meningitis of a typical form the con¬
dition is not produced by the streptococcus but by the
diplococcus intracellularis, meningitis of Weichselbaum, we
can readily see how ineffective this agent might be in those
cases. It has come to be a conceded fact that there are
kinds and classes among the chain-baccilli, just as there are
kinds and classes among all other things ; and the serum
made from one kind of streptococcus is no more a protective
against ravages of another kind than antidiphtheretic serum
is protective against yellow fever.

Undoubtedly there were some cases reported in which
the serum was of value, and possibly of great value ; but
they were cases of infection by the same kind of streptococ¬
cus as that used in producing the serum, and in which no
general streptococcic infection existed.

One disadvantage in using this serum is its quick loss
of power. Sometimes within a period of six weeks after its

20

PROGRESS OF MEDICAL SCIENCE.

first production it has lost nearly all its efficacy. Another
is the inability to form a correct estimate in the majority of
cases of how much to use.

The writer deprecates the hit or miss method of using
this agent—the giving of it on the presumption that if it does
no good, it will do no harm—on the grounds that, first, it is
not scientific, and, next, there is no remedy in general use to¬
day that could be discredited by the same general and
indiscriminate use.

The writer holds the opinion that at present the value
of the antistreptococcic serum is limited, but hopes that
some timp in the near future a serum will be made that
will have the same definite value and results as that of anti-
diptheretic serum.

THE TREATMENT OF DIABETES MELLITUS.

The discovery by Claude Bernard of the glycogenic
function of the liver apparently threw a flood of light upon
the origin of this disease, and has dominated the treatment
of the affection for the last quarter of a century, until within
a comparatively recent period. The aim has been in all
cases of glycosuria to eliminate starches and sugars from the
diet and to keep these patients upon a strictly non-diabetic
diet. Theoretically, this elimination was supposed to lessen
the amount of sugar in the blood and thus lessen the toxemia.

The delightful simplicity of this theory commended it
to therapeutists, but a study of considerable proportion of
these cases in which starches and sugars have been almost
eliminated from the diet has shown that they did not do
nearly as well as those who were allowed a moderate amount
of these substances. The further study of these cases has
shown that the whole question in diabetes is not apprehended
in the elimination of sugar. We have differentiated glyco¬
suria, so-called, from diabetes, recognizing that the former
is not nearly so serious a disease as the latter, but that
no hard and fast line can be drawn between the two con¬
ditions, as there are cases which partake somewhat of the
character of glycosuria and others of diabetes, while occa¬
sionally these conditions are interchangeable in the same
patient. A further study of these cases shows that there
are other elements than the mere sugar production which
enter into the clininal picture. As a rule, the diabetic has
an excessive appetite, with a craving for starches and sugars.
This is due to the enormous elimination of sugar and a
consequent demand of the system for water and for mate¬
rials for the manufacture of sugar. Even if his diet is re-

MEDICINE AND NEUROLOGY.

21

stricted in the matter of starches, he will still consume a
larger quantity of food than the average individual. It may
well be questioned whether the restriction of diet to protein
substances is not beneficial, from the fact that it reduces the
whole quantity of food taken. As a result of an ingestion
of large quantities of food, there is frequently set up in the
alimentary tracts of these patients fermentation, with occa¬
sional attacks of diarrhea, alternating with constipation, the
latter being favored by the enormous watery drain from the
kidneys.

The latter treatment of diabetes does not aim to cure the
affection by eliminating starches and sugars from the diet.
Undoubtedly the older writers believed that if all carbohy¬
drates could be eliminated from the diet and kept out of it for
a sufficient length of time the patient would recover. The
latter conception of the disease regards all this as error, and
looks upon all confirmed cases of the disorder as largely
incurable, but which with medical attention will live for years
leading fairly useful and comfortable lives. The main thing
to be avoided by a diabetic is excessive consumption of food,
by which the organs of digestion are overtaxed and their
function disturbed. The diet should be a mixed one, in
which the carbohydrates are considerably reduced, but in
which they are not altogether eliminated. The quantity of
food taken should be just sufficient to meet the needs of the
patient; it should be apportioned carefully for each meal,
and under no circumstances should the patient be allowed to
over-indulge. Careful attention should be directed to the
alimentary tract, and fermentation or the results of constip¬
ation should be carfully eliminated. In all severe cases in
which there is alimentary disturbance, lavage of both stomach
and bowels should be employed.

Medicinally there is comparatively little treatment, but
antipyrin combined with bicarbonate of sodium does favor¬
ably influence the general condition of the patient, and has
some action in diminishing the production of sugar. Iron
and arsenic are useful as tonics, and liberal quantities of
water should be allowed, which dilutes the urine and washes
out the accumulated sugar from the blood.

THE MEDICAL TREATMENT OF TUBER¬
CULOSIS.

The Journal of Tuberculosis , July, 1899, contains the
following resume of Schulz’s paper on this subject. In-
this age of rapidly extending lists of drugs and the preval-

22

PROGRESS OF MEDICAL SCIENCE.

ence among the profession of a state of therapeutic nihilism
in regard to their use, one is led to sympathize with the re¬
action against drug treatment when viewing the full extent
of our capabilities in respect to their use in this wide-spread
affection, and to realize that to a large extent in regard to
our therapeutic resources generally, when antitoxin and sur¬
gery are not available, climatic and hygienic measures, hydro¬
therapy and probably electricity are the physician’s chief
resource.

Schulz, of Greifswald (Deutsch. Med. Wochensch., May
25, 1859) says that generally speaking the remedies used
against tuberculosis vary little from one century to another.
It frequently has happened that a remedy advocated by the
profession has been discarded by the latter only to be taken
up by the public.

Aside from a few synthetic chemical remedies and
certain exotic newly discovered plants, the materia medica of
phthisis is old. On account of the malignancy of tuberculosis
the number of remedies which have been used in its treat¬
ment is of course very great ; but all of them may be grouped
under two heads.

The first division is composed of remedies directed
against the disease itself which have actually shown them¬
selves to be possessed of real therapeutic efficacy.

The second group, on the other hand, comprises all sub¬
stances which have no real efficacy against the disease, and
which have been given oftentimes with intent to deceive the
patient and encourage false hopes, and which through the
influence of suggestion may appear to produce benefit at
times.

The author attempts to enumerate all the articles of the
materia medica which have been recommended for phthisis.
•For convenience he divides these remedies into two groups,
one of which comprises such drugs as benefit the organism
at large while the other is limited to remedies having special
indications.

He enumerates drugs once officinal but now used only
by the laity, and other plant products no longer thought of
by physicians in connection with phthisis but which once
enjoyed great favor among the members of the profession.

Some of the substances mentioned by him are agrimony,
chelidonium majus, marrubium vulgare, pulmonaria officinalis,
sticta pulmonaria, and so on through an endless list of plants,
a number of which have entered into the formulae of secret
remedies, popular “ teas,” etc.

The use of fats, including milk, for phthisis is old.

MEDICINE AND NEUROLOGY.

23

Goat’s milk, Kumyss, neat’s-foot and olive oil, cod liver oil,
etc., have all had extensive vogue in particular ages and
regions, and the principle of using substances of this sort has
become universal.

Among chemical alteratives which have been extensive¬
ly used for phthisis are iodine, arsenic, mercurials, gold,
sulphur, phosphates and hypophosphites.

Gases have been used medicinally by inhalation—
oxygen, nitrogen, hydrogen, ozone—without any resulting
advance in therapeutics.

The balsams so-called are of especial interest in the
treatment of phthisis, and the Balsam Peruvianum is perhaps
the best known in this connection ; the fact that its active
ingredient cinnamic acid and its sodium compound are largely
used in the treatment of phthisis through the labors of Land-
erer is resarded by the author as a step in the direction of
national therapeutics.

Tar and creosote and allied substances enjoy a wide
vogue in the treatment of phthisis at the present time.

Schulz now comes to the discussion of serum therapy
and organotherapy. Under the former head tuberculin and
several sera have been extensively tried, including the
use of extracts of lung tissue.

The author next discusses those remedies which fulfill a
single indication such as expectorants, haemostatics, antihy-
drotics, antipyretics, etc., etc. Under expectorants, antimony
and other nauseants, and sal ammoniac are mentioned. For
haemoptysis an endless number of remedies has been used
without any exhibiting special excellence. For colliquative
sweats a large number of remedies has lately been brought
forward, such as thallium acetate, chloralose, camphoric acid,
cotoin.

Most of the remedies in use against phthisical diarrhoea
are old—bismuth, opium and astringents.

Antipyretics have been used in great variety. This
group includes quinia, salicylic acid, benzoate of soda, alcohol.
They were not very successful in bringing down the temp¬
erature, while the more modern antipyretics, however
effective, are not adapted for continuous exhibition.

Schulz concludes by saying that when all these curative
and symptomatic remedies fail to yield a hopeful result, we
have to prescribe for the pain, and to that end must make
use of narcotics, sedatives and hypnotics.

24 PROGRESS OF MEDICAL SCIENCE.

THE RELATIVE TOXICITY OP COCAINE AND

EUCAINE.

Dr. H. H. Peck (Journal of the American Medical As¬
sociation, September 9th) says that his experiments lead
him tothe following conclusions :

1. The action of cocaine is inconstant; one never knows
whether the symptoms occasioned by like quantities of the
drug, in animals or individuals, under like circumstances, will
be similar or dissimilar.

2. The action of eucaine is constant. The symptoms
occasioned by the use of like quantities in aninnls under like
circumstances, and, so far as the author’s experiments have
gone, in different individuals also, are the same.

3. The first action of cocaine on the heart is that of a
depressant, and on the reepiration it is that of a mild stim¬
ulant, the after-effects being, on the heart, that of a decided
stimulant, and, on the respiration, that of a decided depres¬
sant

4. The first action of eucaine on both the heart and
respiration is that of a stimulant, the after-effects being those
of a decided depressant.

5. Cocaine causes death in animals by paralyzing the
muscles of the respiratory apparatus, the heart’s action con¬
tinuing in a feeble way for a brief period after breathing
ceases.

6. Eucaine causes death in animals by paralyzing the
muscles of the heart and of the respiratory apparatus, which
cease to operate simultaneously.

7. Eucaine in toxic doses nearly always causes nausea,
and occasionally vomiting.

8. Cocaine is much less nauseating and scarcely ever
causes vomiting.

9. Eucaine is decidedly a diuretic, causing renal dis¬
charge in a majority of instances in which a toxic dose is
used.

10. Cocaine is not a diuretic to any appreciable extent,
renal discharge having occurred in only one instance in
connection with all the author’s experiments.

11. The pupils of the eyes, in nearly all cases of cocaine
poisoning, do not respond to light, and the eyes are more
or less bulging from their sockets.

12. The pupils of the eyes, in most cases of eucaine
poisoning, do respond feebly to light, and the eyes rarely
bulge from their sockets.

13. The action of toxic doses of eucaine is more like
that of a paralyzing, tetanoiding, convulsion producing agent

MEDICINE AND NEUROLOGY*

25

than of an anaesthetizing one, the plantar and cremasteric
reflexes nearly always responding.

14. Toxic doses of cocaine cause general anaesthesia in
connection with the other symptoms in the majority of
cases.

15. True tetanus of all striped muscles of the limbs, and
Cheyne-Stokes breathing nearly always occur with the use
of cocaine, but seldom does either occur when eucaine is
used.

16. Cocaine is at least three times more toxic than beta
eufiaine, and alpha eucaine is as toxic as cocaine.

17. Boiling does not destroy the efficacy of cocaine,
but it does modify it, and boiling in no degree lessens the
efficacy of eucaine.

The above deductions have been made only after many
experiments in connection with each individual point. The
author his observed many interesting features in connection
with the relative worth of these drugs as local anaesthetics,
but his paper does not treat of this phase of the work. There
is much experimental work yet to be done in this connection,
the results of which he will present at some future meeting.
IV. Y. Med Jour.

DIET IN TYPHOID FEVERS.

By FRED O. SauRTLEFF, MX)., Los Angreles, CaL

Much has been written both pro and con in reference to this
or that article of diet in the management of typhoid fever. It is a
settled fact that the food must be fluid, highly nutritious and easy
of digestion, for the maintenance of nutrition is imperative in this
wasting disease. Milk is probably the most extensively used, and
will form the main article of diet so long as fever lasts. I have used
milk in nearly all its various forms in the care of my cases, from
frozen or boiled sweet milk to butter milk, from sweet milk, milk
with lime water, to that partially digested with pepsin or pancreatin
when digestion was enfeebled. The tendency in milk diet is to
overfeed by forcing too large quantities at one feeding, and thereby
causr a disgust for that diet upon which we have pinned our faith.
It one insists upon an absolute milk diet, not infrequently will you
find your patient has gone without it rather than take it. They
fret under its administration, dig stion is interfered with, curds
swarming with bacteria of decomposition are found in the in¬
creased diarrhoeal discharges, plus the bacteria of typhoid fever
already existing, hence the object which we wish to attain so far as
it is possible (that of rendering the gastro-intestinal tract aseptic)
is defeated from the outset by error in diet. I have often been
puzzled as to what to subsiitute for milk in this class of cases until
the stomach became more tolerant. I have tried various farin¬
aceous substances, and discarded them on account of the increase
of flatulency they almost invariably produced.

26

PROGRESS OF MEDICAL SCIENCE.

For some time past I have tided my patients over their criticat
period by tablespoonful doses of liquid peptonoids every two
hours, giving nothing else in the way of nourishment but the above
remedy. I cannot speak too highly of this elegant preparation
where digestion is below par as a highly nu’riiious food that will
not curdle upon the stomach, or leave a residue in the intestinal
tract. It is a slightly stimulating food, consequently your cases as
a rule will require less alcoholic* stimulants, a great desideratum in
some cases. I do frequently carry through my cases of typhoid
successfully where no other article of diet is given from the time I
make the diagnosis until convalescence is firmly established, and I
call the attention of the profession to it for that class of ca«es Sn
which milk cannot be taken .—Southern California Practitioner.

HEROIN TO RELIEVE COUGH AND CHEST-
PAINS IN TUBERCULOSIS.

Dr. A. W. Beketoff ( Amer . Jour. Med. Sci., August,
1899) has made use of heroin in the treatment of twenty-
five patients suffering from tuberculosis, in dose of one-tenth
of a grain in powder or pill. In about fifteen minutes after
its administration cough ceases, and sleep is possible. The
respiration, especially when increased by coughing or pleuri¬
tic pain, is slower and deepened. In case of disease of the
heart, or oxygen-hunger from encroachment upon the res¬
piratory area (large cavities), this remedy is of little or no
value. It has but little influence upon the circulation as
regards either frequency or fullness further than that respira¬
tion is benefited. It relieves chest-pain, and so favors sleep.
Insomnia due to mental excitement is not markedly relieved.
It is well borne, even if digestive disturbances exist. It is
indicated in the treatment of hemoptysis because of its bene¬
ficial action on cough. Patients do not become readily
accustomed to its action, and it may be administered for a
month without necessity arising for increase of dose.— Vir¬
ginia Medical Semi-Monthly.

TREATMENT OF MIGRAINE.

Dr. Henry Hanford, in an article on migraine and the
vasomotor theory, speaks of the treatment as follows : “ It is
well known that when, with headache the extremities are
cold, some relief is obtained by warming the hands and feet
at the fire. In many cases the recumbent position is required
in addition. In a large class of patients the attack may be
cut short by many hours by going to bed, applying hot
bottles to the extremities, and taking a hot drink (as soon as
the stomach will retain it)—some hot tea or milk. A glow

MEDICINE AND NEUROLOGY.

27

soon pervades the surface, and the spasm is relaxed. Relief
so obtained is not very liable to relapse. After a few hours
the ordinary duties of life may be resumed, and, although
sleep is the best completion of the cure, its place may some¬
times be taken by a good dinner. I believe this treatment,
when it can be carried out, to be far superior to any drug
treatment, although it may be aided by a good dose (thirty
to sixty grains) of bromide potassium. It is a curious fact,
and may be taken as the exception which proves the rule,
that a few patients find that the recumbent position aggra¬
vates their pains, and often prefer to spend the night in an
arm chair rather than go to bed. And also, in the last
stages, moving about sometimes seems to hasten the end of
the attack more than remaining quiescent.”— Edinburgh
Medical journal-

BLOOD-LETTING.

The backward swing of the pendulum is somewhat anti¬
cipated in regard to bleeding by Briscoe in the Clinical Jour -
nal for the September issue.

He states that the condition of the system indicating
blood-letting is expressed by the word suffocation.

Local conditions may require bleeding as alveolar
abscess, ordinary inflammation, chronic inflammation, thecal
abscess or any tissue requiring the relief of tension.

He states that every surgeon should carry some kind of
venesecfor in his pocket.

The states of the general system denoting venesection
are included in the following conditions :

When you find the venous system gorged in primary
affections of the lungs or in the secondary congestions, as in
heart disease, or from paralytic conditions, as in apoplexy,
you cannot be wrong in bleeding ; you relieve the venous
system as well as the heart, and allow the circulatory appar¬
atus to right itself. The objection sometimes made that the
patient is too weak, as indicated by the pulse, is futile, since,
owing to the small amount of blood which reaches the left
ventricle to be propelled onwards, the pulse is naturally
small.— Charlotte Medical Journal.

THE SERUM TREATMENT OF TYPHOID.

A London correspondent of the Interstate Medical Jour¬
nal for July writes that the main point of interest centres
round the serum-treatment experiments which are being con¬
ducted in different parts of the world. One of the late com-

28

PROGRESS OF MEDICAL SCIENCE.

missioners, Prof. A. E. Wright, of the Army Medical School,
Netley, took advantage of his visit to the typhoid districts of
India to avail himself of the opportunity of inoculating certain
British troops against this dread enemy of the soldier on
foreign service. It appears that in the “ West Riding” regi¬
ment, stationed at Bangalore, 250 of the soldiers volunteered
to be inoculated with the typhoid serum as a protectionary or
prophylactic measure. When at Rawal Pindi, Dr. Wright
addressed the “ Queen’s ” regiment on the advantages of
inoculation, mentioning that 1,500 soldiers annually fell ill
with enteric fever, and that one out of five dies. Out of 200
attendants at the Maidstone Asylum in Kent in the south
of England, ninety-five persons were inoculated and none
contracted fever, while of those who refused to undergo the
process nineteen suffered from the disease. At Khartoum,
of eight young subalterns six consented to inoculations, and
the other two agreed to take their chance; of these latter, one
was very ill with typhoid, the other died; the inoculated
officers escaped. Professor Wright also inoculated the troops
in garrison at Lucknow, 300 of the Third Hussars and 120
Cameronians. Diligent experiments are being made with the
typhoid serum in more than one physiological laboratory in
this country.— N- Y. Med. Jour.

SURGERY.

I * CK VRGS

ROLLO CAMPBELL, M.D.,

Lecturer on Surgery, University of Bishop’s College ; Assistant-Surgeon, Western Hospital;

AND

GEORGE FISK, M.D.

Instructor in Surgery, University of Bishop’s College ; Assistant-Surgeon, Western Hospital

OPERATIONS IN GASTRIC ULCER.

Dr. Leonard A. Bidwell {American Journal of Medical
Sciences , September) recapitulates as follows the class of cases
of gastric ulcer in which an operation should be done : 1.
In all cases of perforation at the very earliest possible mo¬
ment ; also in subphrenic abscess. 2. In cases of haemor¬
rhage (a) when there is continual oozing of blood, especially
if the stomach is dilated, and (/>) in cases of repeated severe
haemorrhage. 3. In cases where there are severe pain and
vomiting unaffected by treatment, and which are producing
progressive emaciation. 4. In cases of dilatation of the
stomach from contraction within or from adhesions outside

SURGERY.

2 9

the stomach. The operations to be performed are : In class
I, laparotomy and suture of the ulcer ; in class 2, gastrotomy
and suture of the ulcer with a purse-string suture, combined
with gastro enterostomy ; in class 3, gastro-enterostomy, in
order to give physiological rest to the ulcer; and in class
4, either gastro-enterostomy, or, if the pylorus is affected,
pyloroplasty or pylorectomy. As the surgery of gastric
ulcer is a comparatively new subject, the author has had, so
to speak, to make a case in its favor. It has been his
endeavor to show that no patient ought to be allowed to die
either from perforation or from haemorrhage from a gastric
ulcer without a surgical effort being made to save him ; that
the earlier such effort is made the better the chance of success,
and, finally, that surgery offers much hope of success in other
cases which resist the art of the physician.— N. Y. Med Jour .

THE SPHERE OF DRAINAGE IN SURGERY OF
THE APPENDIX.

W. S. McLaren divides cases of suppuration about the
appendix into two classes : the first comprises those in which
the abscess is localized, being shut off from the general cavity
by adhesions ; the second includes those more serious cases
in which the pus has entered the general abdominal cavity.
Cases of the first class are simple abscesses, and should be
treated like abscesses of any other region. In these cases
drainage is a perfectly proper, though sometimes unneces¬
sary, procedure. In cases of the second class drainage is
irrational, because it does not drain and because any foreign
body must add to the already-existing irritation. Filling the
abdomen with saline solution is considered to be rational,
because it dilutes the poison which is generated during the
few hours immediately following operation, and vastly in¬
creases the area of the peritoneum, which is called upon to
resist that poison. Two cases are reported in which this
method was used ; there was an abundance of pus in the
general cavity, which was washed out with peroxide of
hydrogen ; the abdomen was then filled with saline solution
and the abdominal incision closed. Both patients made
good recoveries.— N. Y. Med. Rec. — Med. Review.

THE PREPARATION AND AFTER-TREATMENT
OF CHILDREN FOR OPERATION.

By FREDERIC N. WILSON, M.D.

Much has been written in our text books and by
numerous other writers of the general and special technique

30

PROGRESS OF MEDICAL SCIENCE.

of operations upon children, but the preparation and after-
treatment, except in a very general way, have been rather
neglected. It is with the object of urging greater care and
consideration of these points that this paper is written.

The two most important dangers to be avoided are
dietary disturbances and hemorrhage. I place the dietary
disturbances first, because they are very often the most diffi¬
cult to overcome. When it is possible to select the season
for operation, cool weather should be our first choice, for less
gastro-intestinal disturbance may be reasonably expected
then. It is of the greatest importance when a child is not
taking its feeding well, or its food is not agreeing with it, as
evidenced by vomiting or diarrhoea, or both, or loss of weight,
that some modification should be made and a diet found
which the child will retain and digest, so that after operation
we are likely to be spared the necessity of further experi¬
menting in that direction. In breast-fed babies clock-work
regularity in feeding will, with perhaps a little temporary
medication, place the patient in suitable condition. In bottle-
fed babies I have seldon found one who could not take and
digest some one, or two alternating, of the following pre¬
parations :

I. Egg-water. The white of one egg to four (4) ounces
boiled water, to which is added njjxv aromatic spirits of
ammonia.

For older children : The whites of two (2) eggs to six
ounces of boiled water; add nj;xxv aro. spts. amo.

II. Fresh condensed milk in the proportion of one (1)
part with ten (10) to one (1) part with six (6) of boiled
water, the proportions all depending upon the age and
digestive ability of the child.

III. Sterilized milk. Temperature of 212 0 F., for
fifteen (15) minutes.

IV. Pasteurized milk. Temperature 170 0 F., for fifteen
(15; minutes.

V. Peptonized milk . The cold process is preferable, the
result being less bitter. To a pint of fresh milk is added
soda bi-carb. gr. x. Ex. Pancreatin gr. v. The process of
peptonizing is allowed to continue for three (3) or four (4)
minutes, the milk is then placed on the ice to stop the pro¬
cess. When the milk is warmed for consumption it becomes
still further peptonized.

VI. Top milk, barley malt water, sterilized water, equal
parts. The barley malt water is prepared in the following
manner:

To two ounces of barley (Robinson’s preferred) is added

SURGERY.

31

30 ounces of water, boil ten minutes, then add 26 ounces of
cold water in which has been dissolved half a teaspoonful of
extract of malt. This is allowed to stand 15 minutes, is then
heated again for 15 minutes, and after straining is ready for
use.

VII. Mutton broth.

VIII. Expressed beef juice in proportion of one (1) part
with four (4) to one (1) with eight (8) of boiled water. This
often slightly increases the number of stools.

If the mother’s milk is sufficient in quantity and quality,
breast feeding should be insisted upon, provided the child is
able to nurse, some cases of hare lip and cleft palate being
the chief exceptions.

There being no food for nursing babies so good as
breast milk, provided the child does well upon it, it certainly
would be most irrational to change the feeding at time of
operation, when it is to be expected that for a few days at
least digestion is going to be a little below par. The
gastro-intestinal tract can often be placed in a more recep¬
tive and tolerant condition by one or two washings of the
stomach with warm boiled water, at a temperature of 105 °,
to which has been added a few grains of soda bi-carb and
soda borate. This may be combined with rectal irrigations
with warm water, containing a little soda borate, or with
normal saline solution. During these few days of preparation
when the condition and disease willadmit ofsuch a delay, the
patient should be kept out in the open air as much as possi¬
ble, provided the weather is suitable, and it is only in cases of
pulmonary complications with the weather cold and damp
that confinement to the house is to be recommended. A high
temperature, except in these pulmonary cases, is not a con¬
tra-indication to out-door life ; in fact, I believe it is actually
indicated, provided the child is properly clothed. Very
young children do not stand hemorrhage well; but, aside
from an attempt to get the patient in the best possible general
condition, there is not much to be done in the way of pre¬
paratory treatment. Some have advocated the intra-venous
injection of normal saline solution before operation, but this
procedure seems to me rather to favor bleeding by distending
the blood vessels and also by increasing the blood pressure.
If the saline is used before operation it is preferably intro¬
duced high in the bowel in small quantity, when absorption
will take place as the blood needs it.

The examination of the urine, a procedure often
neglected in children, is quite as important as in adults, for
the knowledge of an unexpected kidney lesion might often

32

PROGRESS OP MEDICAL SCIENCE.

modify the course pursued at time of operation as well as the
anaesthetic used.

The immediate preparation of the patient should be quite
as carefully carried out as in the adult, though in a rather less
vigorous manner. Shaving, not so much with the idea of re¬
moving hair as with that of removing the superficial epidermic
scales, should always be done. The skin should then be
thoroughly washed with green soap, using a piece of ordinary
gauze ; this is then carefully washed off and the skin is ready
to receive the mascerating poultice. In my experience
green soap has often proven too irritating, and I now use
white castile soap rubbed into wet gauze and applied for six
to eight hours. This gauze is then removed, the skin washed
with plain water, followed by alcohol and then the bi-chlorid
gauze poultice 1-1000 is applied. This is allowed to remain
till the patient is on the operating table. There the same
washing with soap, this time green soap being used, followed
by alcohol to thoroughly remove the soap and fat, and then
bi chlorid complete the preparation of the field of operation.
Ether, so often used to remove the soap and fat, I have dis¬
carded since once seeing a baby collapse immediately follow¬
ing the pouring of ether over the abdominal wall. The child’s
bowels are best emptied by a soap enema four hours before
operation.

The time of giving the last feeding varies with different
men, and has seemed to me often to be too far removed from
the time of operation, and it has been my practice to’give a
child solid food eight hours before operation, or, if an infant,
milk five hours before and plain beef soup two hours before.
Hot soup is readily absorbed by the stomach, furnishes addi¬
tional fluid for the blood, is decidedly stimulating, and in my
experience has never complicated the anesthetic.

On the ta£le, I cannot too strongly urge the necessity
of protecting those portions of the body not immediately con¬
cerned in the operation with dry wraps of flannel or cotton.
In operations below the chest a flannel shirt should always be
worn and kept dry, the limbs wrapped in cotton and ban¬
daged. Dry sterilized towels are always to be preferred to
wet antiseptic. Many patients, adults as well as children,
taken from a warm bed, placed upon an operating table,
given an anaesthetic which lowers the body temperature,
covered with wet towels, allowed to lie in a bath of irrigating
fluid without any attempt being made to keep the body
temperature up, have been sent back to bed suffering from
shock which might have been avoided by protecting the body
with warm dry clothing. Why we should expect a sick
person breathing a temperature-reducing gas to withstand

SURGERY.

33

such influences, which would be trying, to say the least, to a
person in good health, is beyond comprehension; and I am
very sure the number of cases of pneumonia, nephritis and
death which can be justly charged to this lack of care must
be very considerable.

The immediate after-treatment consists in stimulation
of heart and keeping up of body temperature. Strychnine
and caffeine head the list of drugs, while hot normal saline
solution supplies heat and fluid. If the abdominal cavity is
open and the patient is in need of stimulation, there is no
method so quick and effective as to pour into that cavity a
quart or more of hot sterilized normal saline solution, tem¬
perature 115 0 . If we cannot use this method, the high rectal
irrigation, preferably continuous or as an enema, of saline
solution at the above temperature is advisable for those cases
where infusion cannot be done. The difficulties of doing an
intra-venous infusion in a small child are not imaginary. To
the hot rectal enema one to four ounces of strong coffee is
often a valuable adjunct.

The child once in bed (the foot of which may be raised
to increase the cerebral blood supply if necessary) should be
wrapped in a warm flannel blanket carefully pinned so that
no portion of the patient can possibly become uncovered
except the face. The object of the flannel blanket applied
in this way is two-fold ; first it prevents loss of body tem¬
perature by radiation, flannel being a poor conductor of heat,
and second it guards against the possible immediate contact
of hot water bottles which, in spite of the serious and painful
accidents which have occurred from their use, I consider a
very valuable means of supplying heat, and I heartily re¬
commend it. The distressing burns which have not been
infrequent have always been due to carelessness and lack of
attention, and I see no reason to condem a method, as some
have done, when the fault lies altogether in the unskillful
application of it.

Vomiting, which so often complicates convalescence, is
best treated by withholding all feeding by mouth until the
stomach is in condition to digest food. I have found tea¬
spoonful doses of hot water, plain or with essence of pepper-
'mint, decidedly carminative, and all my cases receive this at
first whether they vomit much or not at all. If vomiting is
long continued, even this is stopped, the patient’s mouth
kept cool and clean with diluted solution of listerine, a mus¬
tard paste, I to 8, placecj over the epigastrium, and food and
fluid supplied by rectal feeding.

Peptonized milk, liquid peptonoids, and normal saline

34

PROGRESS OF MEDICAL SCIENCE.

solution have in my hands proven to be the most satisfactory.
Whether the child vomits or not, the first food it receives
by mouth is either mutton broth or egg water, for I have
found these to give rise to less disturbance than milk in any
form, and it is only when I feel sure the stomach is capable
of digesting the latter that I give it, and then very cautiously
at first. In the after-treatment, as well as preparation, I
consider fre.-h air of great value, and as soon as all danger of
pulmonary trouble, i. e., either bronchitis or pneumonia, is
over, 1 .send the cases out of doors at least a part of every
day provided the weather is suitable, care being taken to see
that the flannel underclothing is worn, light or heavy, accord¬
ing to the atmospheric temperature.— The Post-Grxduate.

THE PREVENTION OF POST-OPERATIVE
THROMBOSIS IN THE VEINS OF THE
LOWER EXTREMITIES.

The author directs attention to the occasional occurrence
after certain operations on the abdomen, such as laparotomy,
resection of the appendix, and the radical cure of hernia, of
thromboses of the superficial, and it may be also the deep veins
of the lower limb, which thrombosis is frequently observed
in t■ • e trunk if the femoral vein, and may extend into the
external iliac vein. This complication, which, when it occurs,
usually presents itself in the second or third week after an
operation which in other respects has, as a rule, been most
successful, cannot fail to cause anxiety on account of the risks
of embolism of the pulmonary artery, and of pulmonary in¬
farction and necessitates an unduly prolonged confinement of
the patient in bed. The author holds that this thrombosis is
not in most cases the result of infection, but that it is due either
to retardation of the circulation in the veins of the lower ex¬
tremities, or to local changes in the walls of these vessels. With
the object of preventing this serious complication, the author
makes it a rule in his surgical pratice, after every operation on
the abdomen and for hernia, to elevate the lower end of the
patient’s bed. If the organs of the patient be absolutely or
relatively healthy, the elevation need not exceed 4 inches,
but should be increased for exhausted and anemic patients,
and those already affected with varicose veins. In a case of
an anemic patient suffering also from weak heart and varicose
veins, or of one who has been previously affected with throm¬
bosis in the lower extremity, the end of the bed is raised on
wooden blocks each about 20 inches in height The eleva¬
tion, if in this degree disagreeable to the patient, should be
commenced at 4 or 6 inches, and afterwards be gradually

SURGERY.

35

increased. If, after the operation, the blood tension be low,
and the heart’s action weak or irregular, the author would
endeavor to increase the force of the circulation, and to
strengthen the heart by subcutaneous infusion of salt solution,
and by suitable tonic and stimulating medication. Much
improvement is attached to high elevation of the foot of the
bed, and such treatment is strongly advocated, not only in
surgical practice, but also in cases,—such, for instance, as
enteric fever, chronic entero-colitis, and chronic peritonitis,—
in which an anemic condition, general exhaustion, and a
morbid state of the blood, may favor the development of
venous thrombosis of the lower extremity. — Dr. Lennander,
in Centbl. f. Chir. Brit. Med. Jour., Post-Graduate .

A NEW ABSORBABLE LIGATURE MATERIAL.

The author reports the clinical results of his experience
with a new absorbable ligature and suture, which he finds to
be absorbed a little more slowly than catgut, but to be
capabl. of absolute sterilization. The ligature is made from
the ligamentum nuchae of the reindeer by dividing it in the
direction of its fibres The process of preparation is the fol¬
lowing: Removal of fat in ether, soaking in juniper oil for 14
days, removal of oil with ether and alcohol, soaking for two
days in a one-third percent, sublimate solution ; preservation
in alcohol. Bacteriological examination and the clinical
test of 83 major operations have proved the absolute sterility
of this material, and that it is absorbed as soon as desirable.
Dr. Sneguireff. in Centble. f. Chir., Am. Jour. Med. Soc.,
Post- Graduate.

TREATMEN 1 OF BURNS AND OTHER SURFACE

WOUNDS.

In a recent issue of the Railway Surgeon, Dr. G. Arch-
dall Reid states: “ I venture to place before the profession a
method of treating surface wounds so simple and obvious
that I think it must have been tried before. Briefly, I do not
place the surgical dressings on the wound, but on a light wire
cage or support, which thus, while permitting them to afford
protection, prevent them acting as foreign bodjfs. The wire
support is easily manufactured. If the wound be on a flat
surface—as the chest—a stout wire of suitable length is bent
into such a shape that when placed over the wound it sur¬
rounds the latter, but rests everywhere on uninjured tissue.
On this wire as basis is woven a wide network of lighter
wire, so that a shallow dish of wire work, shaped somewhat

36

PROGRESS OF MEDICAL SCIENCK

like the wound, but larger, results. If the wound be on a
limb a cylinder of similar wire work is made in two parts,
which is hinged together so that the cylinder may be easily
applied to or removed from the limb. The circumference of
the shallow dish and the ends of the cylinder are padded by
wrapping some soft material—carbolized wool, for instance—
round the thick supporting wire. When in place the ap¬
paratus may be covered by any dressings the surgeon chooses,
and is retained in place by strappings or bandages.

“ On one detail of the treatment it is necessary to insist
with the utmost emphasis, the surface of the wound must be
kept absolutely clean. It should be gently sponged daily,
twice, thrice or oftener, if necessary, with some mild anti¬
septic fluid, such as boric acid or weak (i in 40) carbolic
lotion. Otherwise the discharges coagulating on the surface
form a cake under which pus is retained, and which proves
in experience more hurtful than any other foreign body. In
order as much as possible to prevent the discharges drying
and caking, I usually cover the supporting cage with wet
lint, and the whole with waterproof. If, in spite of precau¬
tions, the lymph does cake, it may be softened by’ soaking in
olive oil and then removed.”— Interstate Med. Jour.

THE INTERNAL DERANGEMENTS OF THE

KNEE.

The internal derangements of the knee may be classified
as ffollows : (1) Loose bodies; (2) detachment or displace¬
ment of the semilunar cartilages; (3) enlargement with
nipping of hypertrophied synovial fringes, and (4) elonga¬
tion of the ligamentum patellae. In all these derangements,
except the last, it may sooner or later become necessary to
open the knee-joint if a radical cure is to be obtained.
Walsham believes that the knee-joint may be opened with
a freedom equal to that of opening the peritoneum, but like¬
wise an equal amount of care for strict asepsis should be
taken in opening the joint as in the peritoneal cavity. He
calls especial attention to the five following points; (1) Pre¬
paration of the patient, e. g ., rest in bed three days to a week
previous to operation, with the limb in a splint, regulation of
bowels, etc., aftd careful asepticising of the skin ; (2) arrest of
all hemorrhage; (3) accurate suture of the synovial mem¬
brane and capsule; (4) postoperative absolute rest for the
limb ; (5) early passive movements and massage. As to the
treatment of elongation of the patellar ligament, it is best to
transplant it further down the tibia by the use of an ivory
peg.— Interstate Med. Jour .

Jottings.

In the Northwestern Lancet of 15th November, 1899,
Dr. Fliesburg, of Minneapolis, published the report of fifty
cases of membranous croup with 38 recoveries and 12 deaths.
Of the fatal cases, two were instrumental, viz., one
tracheotomy and one intubation. The treatment adopted
in all cases was the same. It consisted of hydrochlorate of
apomorphise. one fifth of a grain; calomel, twenty grains;
bi-carbonate of soda, half a drachm. To be divided into
twenty powders, and one to be given every hour dry on the
tongue. Equal parts of turpentine, eucalyptol, carbolic acid
and Cologne water, to be poured into hot water, letting the
child inhale the vapor under a thin blanket made into a
canopy. On the second day the powders should be dimin¬
ished to every two hours. On the third day the improve¬
ment is nearly always so marked that they can be discon¬
tinued. Then give a mixture every three hours in appropriate
doses for age, containing pilocarpine, codeine, hydrochloric
acid and syrup of tolu. During convalescence give a tonic
of iron, quinine and strychnine.

When the os uteri is rigid and tense, try:

R Sol. cocaine, 5 per cent. 1 drachm.

Atropine. 1 grain.

M. Sig. Apply to external os, and, if possible, to the
inside of neck of womb.

In five minutes you will have a good dilatation, and the
parts will lose all their rigidity, and labor terminate readily
and without danger of laceration. Also applied to the per¬
ineum in rigidity, it acts most kindly. Applied to the
rectum where there is a tense, hard sphincter ani, to prepare
for exploration by speculum or finger, will greatly facilitate
the operation and give comfort to the patient.—D r. Ball,
in Medical Brief.

Onions are a kind of all-round good medicine. A
whole onion eaten at bed time will, by the next morning,
break the severest cold. Onions make a good plaster to re¬
move inflammation and hoarseness. If an onion is mashed
so as to secure all the juice in it, it will make a most remark¬
able smelling substance that will quiet the most nervous
person. The strength of it inhaled for a few moments will
dull the sense of smell and weaken the nerves until sleep is
produced from sheer exhaustion. It all comes from one
property possessed by the onion, and that is a form of
opium.— Winnipeg Lancet.

TKI3

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price , $c.oo ptr annum in advance . Single
CopieSy io cents .

Make all Cheques or P.O. Money Orders for subscription, or advertisin g parable %•
JOHN LOVELL & SON, 28 Sr. Nicholas Street, Montreal, to whom all business comma*
nloations should be addressed.

All communications for ilie Journal, books for review, and exchangee, should bm
Addressed co the Editor, Box 2174, Post Of.ice, Montreal.

Editorial.

THE WAR IN SOUTH AFRICA.

It is safe to say that we know vastly more about South
Africa than we did three months ago. Aside from the general
interest which we take from our British loyalty in the war
now raging there, we have the special reason of being an
active participant in it. For the first time in our history we
have sent Canadian troops to assist the Mother Country.
Their progress has been eagerly watched, and day by day
the papers are searched to see if they have had their “ bap¬
tism of fire.” Active hostilities, we know too well, mean
death to some and wounds to others. But there is as a rule
in all wars an enormous death rate due to sickness, most of
it being caused by malaria. It is therefore, a matter of in¬
terest to know the character of the climate where the war is
now raging. The climate of South Africa is, according to all
writers, one of the healthiest in the world. So far the en¬
gagements which have been fought have resulted in the loss
of a large number of lives, and rendered thousands non effec¬
tive from wounds. The general health of the troops has,
upon the whole, been excellent, though at the time of writing
we see reports of deaths due to enteric fever. Still, upon the
whole, it would seem as if the present war might be largely free
from that enormous death rate which so commonly has accom¬
panied large armies in the field. This, if it turns out to be
the case, may be attributed to the extremely healthy climate

EDITORIAL. 39

but also, we believe, to the great advance that has during
the last twenty years been made in sanitary science.

As large numbers of the troops were immuned from
enteric fever before leaving Britain and on the voyage out to
the Cape, it will be an interesting fact to learn, as un¬
doubtedly we will, hpw far the hypodermic injection of the
anti-toxin has been successful. The configuration of South
Africa plays an important part in making it a healthy
country. It strongly resembles a series of steps. The Coast
plateau is six hundred feet above sea level, the Southern
Karoo is twelve hundred feet, the Central Karoo twenty-five
hundred feet, and the Northern Karoo four thousand feet.
That portion which borders on the coast is the least healthy
for Europeans. In Cape Colony rain generally falls in the
early winter. The first three months of the year are the hot¬
test, but almost rainless. On the East Coast, where Durban
is situated; rain generally falls in the summer. This is said
to be the rule in the interior, where the winters are said to be
clear and dry, with slight frost at nights. There is a great
contrast between the climate of the Southern Karoo and the
Coast plateau. In the former it is dry, with considerable
variations in temperature. The mean maximum range of the
thermometer is 87 F. in January and 36 F. in July. The
Northern Karoo stretches to the Orange River, and has an ex¬
tremely dry climate, the rain fall in some parts being only
two weeks, and the general average about ten inches. “ The
Transvaal is an elevated plateau with a very healthy climate.
Pretoria is at an elevation of forty-five hundred feet, and
Johannesburg of five thousand feet above sea level. In spite
of this elevation the summer heat in these places is very
great, and dust storms are frequent.”

As an evidence of its antagonism to epidemic disease, it
is said to be one of the few portions of the world which never
has had an invasion of cholera or yellow fever. It would
seem, therefore, as if the present war might be free from
epidemic enteric fever, dysentery and diarrhoea, which are
truly called the scourge of armies. We need hardly point out
how valuable this is to our forces, for it will largely confine
the non-effectives to those who have unfortunately been
wounded- Such a healthy climate will facilitate much to
their recovery.

40

EDITORIAL.

THE VEIL A CAUSE OF A RED NOSE.

Rosenbach, in the Berliner Klinische for October 9,
1899, states that abnormal redness of the nose is often due
to wearing a veil in winter. The knowledge of this fact may
prove useful to physicians when consulted for this disfigure¬
ment of the features, often a sore blemish where all else is
beautiful. He says the discoloration is most pronounced at
those points where the veil presses most on the nose. It is
partly due to the mechanical action of the sharp and rough
texture upon a sensitive skin, and to the watery vapor
that collects within its meshes and prevents evaporation.
Blood is thus driven from the tip of the nose to adjacent
parts, whose blood-vessels in consequence become enlarged
and conspicuous. This is aggravated if the veil is kept on
when passing from a co'<^ to a warm atmosphere. The
alterations tend to become permanent the longer the veil is
worn without airing. Sometimes the cheeks are similarly
affected. The treatment consists in, of course, discarding
the offending covering, and, for a time, sharp winds and
great cold. If this is impossible, avoid going rapidly from a
cold to a warm atmosphere. Gentle massage should be
practised, and applications of a thin layer of lanolin, vaseline
or cold cream. This should be followed by the dusting of
the part with talc or starch powder. When the use of a
veil is necessary, it should not extend below the nasal
orifices, so as to permit the escape of watery vapor. It also
should be light in texture and worn as loosely as possible.

INTERNATIONAL CONGRESS OF MEDICINE.

The thirteenth meeting of this Congress will be held in
Paris, August 2 to 9, 1900. The French Executive Com¬
mittee have issued a circular to the profession in Canada
through their Secretary, Dr. J. T. Loranger, of Montreal,
giving the terms of membership and the names and addresses
of the secretaries of sections. Any physician may be ad¬
mitted to membership on the payment of five dollars, which
must be remitted to Dr. Loranger or Dr. Starr, Toronto,
when a membership card will be sent them. It is advised

EDITORIAL.

41

that members when remitting should state the special section
to which they desire to belong. Communications (title)
should be sent to the secretary of the particular section to
which it belongs before the 1st of May, 1900. The list of
these is too long for us to publish, but the name of the one
desired may be obtained from Dr. Loranger, Montreal.

Every inhabitant of Montreal must have been struck
with the number of foggy days which we experienced last
autumn and early winter. The fog was unusually dense,
and on several occasions might be admitted to have been not
by any means a bad sample of a London fog. It was
yellow in color and very dense—obscuring objects at a dis¬
tance of a few feet. Such a condition of the atmosphere
might, with activity on the part of the Civic authorities, be
greatly ameliorated. Fogs cannot be done away with, but
it is admitted that their character may be improved—they
may be made white—and not allowed to become yellow and
black. This can be done by the City compelling every fac¬
tory to consume its own smoke. Montreal has become a
great manufacturing centre, and has almost always a heavy
cloud of smoke hanging over it. When in the city the atmos¬
phere may seem clear, but cross to St. Lamberts, and view it
from there, and one will see the dirty atmosphere we are
compelled to inhale. This is a matter of very considerable
sanitary importance. Fogs of any kind are serious to those
liable to bronchial complaints, but, when the fog is mixed
with millions of particles of coal dust, their seriousness is
very greatly enhanced.

The New York Post-Graduate says it will be a bad day
for medical science when the skeptic ceases to exist. We
are called upon to believe so many things and to accept
them at once that many are commencing to hesitate before
accepting everything as Gospel that is proclaimed by
microscopists and bacteriologists. It is still thought by
many, in spite of all that has been written, that it is at least
doubtful if the origin of disease is to be found only in the
initial activity of germs. This state of matters bacteriological

42

BOOK REVIEWS.

has been brought about by the statements of Dr. George
Wilson, of Edinburgh, in his address on “ State Medicine ” at
the last meeting of the British Medical Association held at
Portsmouth. In fact, he has raised a hornet’s nest about his
ears by some of his statements on bacteriology. In his
address he stated that “bacteriologists are not sure of their
tuberculous bacillus, and it is a moot question whether the
bacillus which is found in milk, and which is labelled as the
tubercle bacillus, is not cow dung bacillus. A distinguished
bacteriologist has admitted it. I venture to reiterate it.”
Of course, Dr. Wilson’s competency in this special matter is
called in question, but, true to his national instinct, he does
not seem loathe to take up the gauntlet which has been
thrown down to him. Incidentally, Dr. Wilson calls atten¬
tion of bacteriologists to the fact that, in his opinion,.
Jenners’great discovery of the preventative power of vaccina¬
tion has really no proper analogy with many of the serum
treatments to which it is sometimes said to bear a real
analogy. This question is one of intense interest to the pro¬
fession, and the fight will be watched with eagerness by
both contending parties.

Book Reviews.

A Treatise on Surgery. By American Authors. Edited by
Roswell Park, M.D., Professor of Surgery in the University of
Buffalo, N Y. New condensed edition in one royal octavo
volume of 1262 pages with 625 engravings and 37 full-page
plates in colours and monochrome. Cloth, $6 net ; leather
$7 net. Lea Brothers & Co., Philadelphia and New York.

I his is a condensed edition of the two-volume form published
in 1896, and the author has taken advantage of this opportunity ta
revise the work to date, making it a thorougnly modern text book
reflecting the methods of teaching developed by large experience.

The great demand for the work in its two volume form which
greeted its first appearance in 1896 warranted the belief that a
somewhat condensed edition in a single volume, and at a corres¬
pondingly lower price, would add to its popularity. It is no small
task to gather a comprehensive and authoritative expression of
modern surgical knowledge. The labor of condensing this Urge
and exhaustive work has been splendidly performed, for with great
discrimination the editor has culled the essential facts without in

BOOK REVIEWS. 43

the least endangering the value of the book by rendering it too con¬
cise.

That two editions of a work should be simultaneously extant
is a novelty worthy of comment. Practitioners and many students
desiring the fuller information in the two-volume edition will
naturally prefer it, but the condensed edition maintains the con¬
venient division into general and special surgery, and thus pre¬
serves the conformity of the work with the surgical courses rapidly
becoming universal, and it will answer the needs of students as
well as of those who desire a comprehensive and practical single¬
volume work on the subject. The reduction in price is propor¬
tionately much greater than the reduction in matter, and is an
advantage which purchasers will appreciate, and one which has
only been rendered possible by the exceedingly wide sale already
achieved.

The illustrations are excellent and well selected. We predict
new popularity for an already very popular book. R. C.

Bacteriology in Medicine and Surgery. A practical
manual tor physicians, health officers and students, by
William H. Park, M.D., Associate Professor of Bacteriology
and Hygiene in the University and Bellevue Hospital Medical
College, New York. In one i2mo. volume of 688 pag-s, with
87 illustrations in black and colors, and two full-page colored
plates. Just ready. Cloth, $3 net.

There was a time when every physician was held to be
possessed ol the whole body of medical knowledge. He knew in
part, he pretended in part, and the rest was imputed to him.
Not every physician cau be a bacteriolo Jst, nor is it desirable
that he should, but he must know the science if he cannot
practise the art. He must know the drift of the teaching and
have a knowledge of the work that has been done and is being
done in the laboratories, and its application to his business of .pre¬
venting sickness and healing his patients. This book by Dr.
Park teaches just these things. It contains in regular order all
that a physician or health officer or student need know, and it has
in addition a certain literary quality which gives interest to the
reading and a sense of clearness which prevents the statements
being either loose or inexact. The book is in no way a compila¬
tion, and one has the feeling that the writef by much labour has
a just appreciation of the difficulties of the various processes so
pleasantly described. To go over in review all the chapters would
be to cover the whole field of bacteriology, and such cognate sub¬
jects as ‘‘Immunity,” “ Infection,” “ Disinfection” and the various
relations of bacteria to disease.

The book is not large ; it is cheap ; it is easy to read; it
conveys a correct impression, and is satisfying to all ordinary wants.

In the next edition “Symmetrically sealed” will not appear.
There will be a reconciliation of the statement at page 104, what
animal parasites have to do with syphilis and the description of
Lustgarten’s bacillus at page 311, and words like “ autopsied” will
not be employed. A. McP.

BOOK REVIEWS.

A Laboratory Manual of Physiological Chemistry. By
Elbert W # Rockwood, B.S., M.D., Professor of Chemistry and
Toxicology in the University of Iowa. Illustrated with one
Colored Plate and Three Plates of Microscopic Preparations.

5x inches. Pages viii.—204. Extra Cloth, $1.00, net.
The F. A. Davis Co., Publishers, 1914-16 Cherry St., Phila¬
delphia. f

The want of a trustworthy and reliable manual of Physio¬
logical Chemistry has long been felt by the average student. There
are few text books of Physiological Chemistry that are adapted to
his needs.

Dr. Rockwood's volume should fairly realize the student's
expectations, for it is thoroughly practical.

The author has succeeded in bringing together, within a
small compass, the essential facts of medical chemistry. These
facts are embodied in three hundred and forty experiments. A
♦ great deal of space is devoted to the methods of analysing the
various secretions and excretions of the body. The practical ex¬
ercises have been ?elected with great care and judgment, those on
the examination of the gastric contents being especially valuable
and up to date.

Clearly, the author has done his best to impart accurate in¬
formation through the student's own observation.

We relrain from pointing out some trivial errors, lest we should
seem to disparage a carefully written book, which we trust will meet
ivith the approval of all teachers of physiology, who consider the
laboratory method of instruction superior to the didactic. A.B.

Notes on the Modern Treatment of Fractures. By

John B. Roberts, A.M., M. U., Professor of Surgery, Phila¬
delphia Polyclinic. Publishers, D. Appleton & Co., New York.
This excellent little volume is made up of a series of essays
issued at various times by the author, subject to some alterations
to bring them into accord with his present views. We fully agree
with Professor Roberts that in no part of surgery is there more
need for practical common sense methods, untrammelled by ancient
therapeutic dogmas, than in the ever varying conditions in frac¬
tures. Many false doctrines in the treatment of fractures are ex¬
posed, and valuable suggestion made to facilitate diagnosis as the
use of the open incision or the Rdentgen rays. The importance of
positive methods of maintaining apposition of the fragments, as by
wire nails, wire suture and tenotomy, with substitution of a plastic
plaster of paris splint for an ill-fitting manufactured wood or metal
splint, is certainly to be heartily endorsed.

As a whole, the work is one showing much observation with
original research and independent thought, which makes it very
valuable to the practitioner, although hardly complete enough to
satisfy students. Many useful hints are given to simplify the
adaptation of splints and splinting, while emphasis is placed on
the value of securing opportunity for frequent massage of the
muscles of a fractured limb and of the useless applications of
lotions. G.F.

BOOK REVIEWS.

45

Thorington, Refraction and how to Refract. Include
ing sections on Optics, Retinoscopy, the Fitting of Spectacles
and Eye-Glasses, etc. By James Thorington, A.M., M.D.,
Adjunct Professor of Ophthalmology in the Philadelphia
Polyclinic and College for Graduates in Medicine; Assistant
Surgeon at Wills* Eye Hospital; Associate Member of the
American Ophthalmological Society ; Fellow of the College of
Physicians of Philadelphia; Member of the American Medical
Association ; Ophthalmologist to the Elwyn and the Vineland
Training Schools for FeebT-minded Children; Resident
Physician and Surgeon Panama Railroad Co., at Colon
(Aspinwall), Isthmus of Panama, 1882-1889, etc\ Two hun¬
dred illustrations, thirteen of which are colored. Octavo, 301
pp., net, cloth. P. Blakiston*s Son & Co.,^012 Walnut
street, Philadelphia, Pa.

In this excellent book on refraction Dr. Thorington gives, in
an interesting and essentially practical manner, all that is neces¬
sary to enable the student of ophthalmology to obtain a firm grasp
of this intricate branch of the science.

While the work is not voluminous, it is remarkably clear and
complete, and, though intended for beginners, contains much
information that is useful to older ophthalmologists.

It is especially of value to students in that the writer teaches
dogmatically the known facts pertaining to the estimation and
correction of errors of refraction, and does not wander off into
long discussions on disputed points.

Dr. Thorington is to be congratulated on having set forth so
clearly and systematically what is known about refraction at the
present time.

G. H. M.

Hygiene of Transmissible Diseases. By A. C. Abbott,

M.D. W. B. Saunders, Pub., Philadelphia. Price $2.00.

This is a most comprehensive hand book, strictly adhering to
the title; it is not a general treatise upon hygiene, but treats of a
special part of the subject—transmissible diseases.

The plates, especially the photogravures of the different
specific organisms, are very good. The work is very concise, yet
sufficiently descriptive. There is no overcrowding; everything is
readable and to the point.

The subject of Quarantine is treated in a very terse and clear
manner.

An up-to date description of all the transmissible diseases is
to be found within its 300 pages, as well as the very best and mo£t
practical means of prevention.

It is a book which will commend itself to student and prac¬
titioner alike as being concise, yet supplying all important informa¬
tion sought after in a work of this sort.

A. J, R.

46 BOOK REVIEWS.

Physiology, A Manual for Students and Practi¬
tioners. By Howard D. Collins, M.D., Assistant to the
Attending Surgeon of the Roosevelt Hospital; Assistant
Demonstrator of Anatomy, College of Physicians and Sur¬
geons (Columbia University), New York, and Wm. H. Rock¬
well, jun., M.D., Assistant Demonstrator of Anatomy, College
of Physicians and Surgeons (Columbia University) New York;
Member of Association of American Anatomists. Series
edited by Bern B. Gallaudet, M.D., Demonstrator of Anatomy
and Instructor in Surgery, College of Physicians and Surgeons,
Columbia University, New York ; Visiting Surgeon, Bellevue
Hospital, New York.

This volume is intended to meet the needs of medical students
who, in the short time allotted to the study of physiology, are
expected to assimilate only the main facts of the science.

As an elementary text-book it will be found useful. Its style
is clear, and the information it imparts is more reliable than that
contained in the many cram books on physiology, which are so
popular among students. Unfortunately, the work is not free from
inaccuracies. Thus we are told that the change from fibrinogen to
fibrin, under the action of fibrin-ferment, does not take place
unless paraglobulin be present. Now, it is well known from the
researches of Hammersten and others, that paraglobulin neither
helps nor hinders coagulation.

On reading the volume through, we have found some ambi¬
guous statements which no doubt will be amended in a future
edition. A. B.

Musser's Medical Diagnosis.— A Practical Treatise on
Medical Diagnosis. For the use of Students and Practitioners.
By John H. Musser, M.D., Professor of Clinical Medicine,
University of Pennsylvania, Philadelphia. New (3d) edition
thoroughly revised. Octavo, 1082 pages, with 253 engravings
and 48 full-page colored plates. Cloth, $6.00, net; leather,
$7.00, net.

To critically examine a work of over one thousand pages
inside of two or three weeks is an impossibility by one largely en¬
gaged in general practice, and this is the position we find ourselves
with regard to Musser's Diagnosis. We have, however, examined
more of it than we thought possible when we began, so fascinated
did we become. We read chapter after chapter, till well on in
the early morning, and then felt reluctant to close its pages. This
examination enables us to say that we regard it as one of the best
works on Medical Diagnosis yet published. It is a complete prac¬
tical guide to the modern science and art of diagnosis. To those
members of the profession who have for even a few years been out
of touch with modern clinical work, as conducted at our large
city Hospitals, such a work as Musser's Medical Diagnosis is an
eye-opener. It demands a place on the book-shelf of every one
who desires to be a good diagnostician.

F. W. C.

BOOK REVIEWS.

47

The Surgical Diseases of the Genito-Urinary Tract,
Venereal and Sexual Diseases. —A Text-book for Stu¬
dents and Practitioners. By G. Frank Lydston, M.D., Professor
of the Surgical Diseases of the Genito-Urinary Organs and Sy-
phiology in the Medical Department of the State University of
Illinois: Professor of Criminal Anthropology in the Kent Col¬
lege of Law ; Surgeon in-Chief of the Genito-Urinary Department
of the West-Side Dispensary. Fellow of the Chicago Academy
of Medicine ; Fellow of the American Academy of Political and
Social Science; Delegate from the Uni:ed Slates to the Interna¬
tional Congress for the Prevention of Syphilis and the Venereal
Diseases, held at Brussels, Belgium, September 5, 1899, etc.
Illustrated with 233 Engravings, 6^4 x 9 % inches. Pages
xvi-1024. Extra Cloth, $5.00 net. Sheep or Haif-russia,
$5.75 net. The F. A. Davis Co., Publishers, 1914-16 Cherry
Street, Philadelphia.

The publication of Dr. Lydston’s book will in all probability
be received with more than ordinary interest, for the reason that
the writings of the distinguished author have always b*en read with
great appreciation by those of the Medical and Surgical profession
who have made Genito-Urinary and Venereal Diseases their special
study. This being the case, we agree with the author when he
states in the preface that the issuance of the work at this time
“ hardly requires either apology or explanation.” The writer is
so frank in his style that the volume makes exceedingly pleasant
reading without in the least wearying the peruser. From a passage
in the very brief preface we would infer that the author, in treating
of the various subjects embraced in the volume, had not always con¬
fined himself to the “beaten pathway” followed by his prede¬
cessors, as he says : “ I have embraced the opportunity herein
afforded me for airing a few heresies of my own.” Every topic of
importance that has any connection with the subject is given as
much space as its importance warrants. The first chapter deals
with “ Genito-Urinary and Sexual Hygiene ” and the second with
il Urinalysis in its Surgical Relations,” and the chapter on “ Go¬
norrhoea (in the male) occupies 47 pages. The important subject of
stricture is very ably dealt with, and takes up 93 pages. Space
will not allow of our referring to other chapters which are equally
interesting and valuable. To those of the profession who know Dr.
Lydston as a practical surgeon and writer, it is unnecessary to
commend the work. His name is a sufficient guarantee to the pro¬
fession. The print and binding are up to the usual standard of
the publishers, while the numerous illustrations are admirably exe¬
cuted. The general index, which is elaborate and comprehensive,
is placed at the end of the book. The work is admirably adapted
to the uses of the general practitioner, and we can strongly recom¬
mend it to the profession.

R. C.

48 PUBLISHERS 1 DEPARTMENT.

A Text-Book of Materia Medica y Therapeutics and
Pharmacology. By George Frank Butler, Ph.G., M.D.,
Professor of Materia Medica and Clinical Medicine in the
College of Physicians and Surgeons, University of Illinois. J. A.
Carveth & Co., Toronto, Canadian Agents. Cloth, $4.00;
sheep or half morocco, $5.00, net Third Edition, thoroughly
revised.

The rapid changes which have taken place within the last few
years in the Armamentaria of the medical profession requires fre¬
quent revision of works of this class. When this work first made
its appearance three years ago, its arrangement was made on a new
basis. It embodied the synthetic classification of drugs based upon
therapeutic affinities, believed by the author to be the most philoso-
sophical and rational, as well as that best calculated to engage the
interest of those to whom the study of the subject is wont to offer
no little perplexity. This arrangement would seem to have been
well received, for within a very limited time two editions have
been exhausted. We are not surprised at this—for, having examin¬
ed the work very carefully, it commends itself to our judgment
as being an excellent Text-Book for the class room, and equally
good as a standard volume for the book-shelf of the practising
physician. We find the pharmacological section very complete,
exceptionally lucid. Much of the rubbish with which the drug
market is flooded is, we are glad to say, not noticed, and only such
of them as have proved of unquestionable value are be found within
its pages. 4 ‘ Untoward Action” and u Poisoning” are treated under
separate heads. By the former it is intended to record the effect
of medicinal doses in developing certain symptoms dependent more
or less upon idiosyncrasy, but not necessarily assuming the aggra¬
vated form incident to toxic doses. Comparing the first with the
present edition, we find that an immense amount of labor has been
expended upon it, with the result of placing the work in every way
up to date and well deserving of the support of the profession.

F. W. C.

PUBLISHERS DEPARTMENT'.

We learn with pleasure that Messrs. Wm. R. Warner dr* Co. have re¬
ceived a silver medal and diploma, the highest award at the late National
Exposition, held in Philadelphia. It will also no doubt prove very gratifying
to their many patrons to know they are prescribing remedies of such recognized
therapeutic superiority.

CANADA

MEDICAL RECORD

FEBRUARY. 1900

Original Communications.

THE REFLEX SYMPTOMS OF RETROVERSION
OF THE UTERUS.

By A. LAPTHORN SMITH. B.A., M.D., M.R C-S . Enar-
Follow of the British and American Gynecological Societies; Gynecologist to tho
Montreal Dispensary; Surgeon-!n-Chief of the Samaritan Free Hospital for
Women ; Surgeon to the Western Hospital; Professor of Clinical
Gynecology in Bishop’s University; Consulting Gynecologist
to the Women’s Hospital, Montreal.

Although I have operated upon and, with a few excep¬
tions, cured one hundred and thirty-five cases of retrover-,
sion with adhesions by performing ventrofixation, and eighty
cases of retroversion without adhesions by Alexander’s
operation of shortening the round ligaments, I am not yet
satisfied, for I am convinced that there are yet several
hundreds of women in this province alone who are suffering
from this disease with its numerous symptoms. These
women could be cured almost without risk by one or the
other of these two operalions. I say almost without tisk,
because when there are adhesions and the abdomen has to
be opened, and perhaps a diseased ovary has to be removed,
even then there is only a risk of about one per cent.
While, if there are no adhesions and we can put up the
uterus with the bi-manual manipulations or by means of the
sound and hold it up by shortening the round ligaments,
this operation has been so perfected that there is absolutely
no danger at all. During the first years after it was in¬
troduced there were many hernias and sometimes a death.

5 °

smith: retroversion of the uterus.

bat these accidents are no longer to be feared in the hands
of operators of experience and with our present rigorous
asepsis.

In this short paper I propose only to call attention to
the symptoms, and especially the more obscure ones, by
which this condition can be recognized. We must suspect
its presence, and then search for it by a vaginal, preferably a
bi-manual examination, whenever a woman comes to us
with the following symptoms :

1. Bladder troubles manifested by frequency of micturi¬
tion caused by the pressure of the cervix against the neck
of the bladder. When the fundus goes backwards the
cervix, as a rule, points forwards.

2. Troubles in the rectum, either pain during defeca¬
tion or obstinate constipation even when the patient's bowels
have been made liquid by means of purgatives, the uterus
acting as a rubber valve, the more the woman bears down
the tighter it closes. Sometimes there is dysentery or
rectal tenesmus due to the pressure of the heavy fundus on
the rectum which ends by ulcerating it; even when there is
nothing in it the patient feels as if the bowel was full
This is one of the obscure symptoms and must be searched
for, as the woman will, as a rule, tell us that she is con¬
stipated, and it is only by questioning her that we will ascer¬
tain that her movements are liquid. When this condition of
the stools is present, we will surely find either a stricture of
the rectum or obstruction from the retroverted fundus,

3. Disorders of the brain and nervous system. The
great sympathetic nerve, contrary to the cerebro-spinal
system, has its brain at the lower end of the spine, just about
the place where the retroverted fundus will lie upon it, so
that with every movement the woman makes, the great
sympathetic receives a blow or impression which is conveyed
to the brain, causing headaches and neuralgias in other
organs, the heart, lungs, liver, stomach and bowels. More
than once I have had patients who vomited constantly until
the cause was discovered in a retroverted uterus, the vomit,
ing'stopping at once on replacing the displaced organ.

.*4* . ff!

smith: retroversion of the uterus. 51

4. Disorders of intelligence. When the irritation has
lasted a long time the nutrition of the brain suffers seriously t
and the patient may even loose her reason. I can recall at
least a dozen cases in which the women themselves told me
that they were ashamed of themselves for being so disagree¬
able to their husbands; the kinder their husbands were to
them the worse they treated them. Two months ago a lady
came to me from British Columbia to consult me on account
of nervous attacks. She did not know the cause of them»
but she assured me that if I did not discover it, and cure her,
her husband would leave her, so disagreeable towards him
had she become. Her father assured me that she had
formerly been of a sweet and gentle disposition, and that a
great change had taken place in her since a few years. She
presented such a pale and worried appearance that I at once
suspected that she had a retroversion, and, on examining her,
my suspicions proved to be well founded ; there was a large
and heavy uterus with the fundus lying in the hollow of the
sacrum. A few days later the round ligaments were
shortened, and, after three weeks, she assured me that she
felt quite differently. Another woman, whose history lies
before me as I write, stated that for nine months previously
she had been having strange ideas ; for instance, she had an
almost irresistible impulse to throw herself out of her bed¬
room window; she was, therefore, afraid to go up to her
room unless some one went with her. Also, when she had
a knife in her hand there was a great temptation to drive it
into her heart or to cut her throat with it, so that she had to
throw it down and run away from it. I at once suspected a
retroversion, looked for it and found it. As it was firmly
fixed, I had to open the abdomen and do ventrofixation*
The very next day on my visit to the hospital she expressed
her gratitude, saying: “ Whatever you did you have re¬
moved that cloud from my brain; my trouble has gone.”
On asking her if she had much pain from the operation, she
replied that “ That was of no account compared with the
sadness which before had overpowered her.”

5. Dyspareunia and sterility. Of the two hundred and

52 SMITH : RETROVERSION OF THE UTERUS.

fifteen women who were operated on for displacements,
about three-quarters or about one hundred and fifty were
married, and nearly all of these complained of pain on
coitus. This is not surprising when we remember that the
uterus is directly in the road of the male organ, and only
about an inch or two from the vulva. Moreover, it is
swollen and exceedingly tender, several patients having de¬
scribed their pain as being similar to the throbbing of a whit¬
low. When a woman is irritable and angry with every one,
ft is easy to understand that she will not be pleased with her
husband for causing her such severe pain as coitus under
these conditions implies. As for the sterility, about twenty
babies have followed the eighty Alexander operations, but
only two or three have followed the much larger number of
ventrofixations, this being due to the fact that when there is
fixation the tubes are always diseased. I did not think that
the forwards or backward position of the cervix was of so
much consequence to fecundation until I had seen pregnancy
follow immediately, and without any other treatment, in
women, who had been married many years without having
children, after placing the cervix in its proper place. One
young woman who had been having illicit intercourse dur¬
ing several years without any consequences because she had
a retroversion began to suffer so much pain that her physi¬
cian sent her to me for an Alexander. The operation
succeeded so well that on her return to her lover she
immediately became pregnant and had a normal delivery.

6. Symptoms due to the uterus, ovaries and tubes.
Dysmenorrhce'a and menorrhagia. Almost all these women
suffered from dysmenorrhoea caused by the pronounced con¬
gestion of the genital organs. The blood is pumped into
them by the arteries, but cannot get out by the veins because
they are twisted and compressed. The endometrium be¬
comes varicose and swollen, causing both a painful obstruc¬
tion to the escape of the blood and a profuse flow. The
ovaries become so inflamed that ovulation causes excruciating
pain.

7. Miscarriages. When a woman has had several mis-

smith: retroversion of the uterus.

53

carriages at the third month which are not due to syphilis, we
will almost surely find on examining her that she has a re¬
troversion* A few months. ago I was called by Dr. Grant
Stewart to a case of retention of urine due to retroversion of
the pregnant uterus. She was suffering terribly, and a mis¬
carriage would soon have come on ; her physician tried to get
the uterus up, but found it firmly wedged below the promontory
of the sacrum. Although I placed her in the genu-pectoral
position, it was only after a quarter of an hour’s firm pres¬
sure with my finger that I was able to dislodge it from be¬
tween the utero sacral ligaments. 1 need hardly add that
all her symptoms disappeared the moment that the uterus
was replaced. Another woman who was sent to me by Dr.
King, of Compton, was pregnant about three months*
and the fundus filled the pelvis, the uterus being bent on
itself and the cervix being flattened against the symphisis
pubis- It was impossible to get the fundus up without
opening the abdomen, which I did, and then performed a
ventro-fixation. She had a normal confinement, and the
womb has not fallen since.

We used to think that it was a sort of moral rape to make
a vaginal examination of an unmarried woman, but now
we know that virgins suffer from displacements quite often,
and that their suffering cannot be remedied without re¬
moving the cause. While writing these pages a single
woman of thirty came to my office complaining of dysentery,
for which she had consulted me three years ago, at which
time I did not examine her, and as I did not do her any
good she left me and passed through the care of several other
physicians without any benefit. This time, however, she in¬
sisted that I would examine her, as she felt sure that her
womb was the cause of her trouble. And she was right, for
on making a vaginal examination I found it completely
turned. To-morrow morning I have to operate on another
girl who consulted me for dysmenorrhoea, which compels her
to remain in bed one day every month, and her period lasts
seven days, and is profuse. She was so tender that it was
Impossible for me to examine her without an anaesthetic.

54 SAYRE: CHRONIC JOINT DI8EASE.

With one I ascertained that she had a retroversion, which was
easily replaced with the sound. I intend to dilate, curette
and shorten the round ligaments at one sitting.

In conclusion, I would advise every family physician to
make an examination, either with or without an anaesthetic,
so as to assure himself whether there is a retroversion of the
uterus, not only in those cases in which the symptoms point
directly to the uterus, but also when there are reflex symp¬
toms which might possibly be due to this cause.

250 Bishop St., Montreal.

Selected Article.

THE DIFFERENTIAL DIAGNOSIS ,BETWEEN
CHRONIC JOINT DISEASE AND
TRAUMATIC NEUROSES.*

By REGINALD H. SAYRE, M. D„ New York.

Those who have had extensive experience with disease
of joints realize how difficult it is at times to decide whether
or not a joint is involved when the symptoms of imflamma-
tion are ju t beginning to make themselves manifest, and that
frequently several examinations of the patient may be. neces¬
sary before an exact diagnosis is arrived at. They also
realize how frequently such cases are treated for rheumatism,
growing pains and neuralgia for months before the deformity
becomes so prominent as to force the true nature of the
disease upon the observer. It is usually supposed, however,
that, after deformity and disability have taken place, the
picture is so marked as to make it impossible to fall into
error, and that such cases need only to be seen in order to
be recognized.

My experience, however, leads me to differ from this
view, as I find certain cases in which there is no joint inflamma¬
tion present, symptoms so nearly approaching those of
arthritis that they have been treated by men of large exper¬
ience as if the joints were involved. I believe these mistakes
in diagnosis are usually caused by failure to get the complete
history of the case in the first place, by too superficial exami¬
nation in the second, the patient’s clothing not being

* Read before the New York State Medical Association, October 26, 1899

SAYRE: CHRONIC JOINT DISEASE.

55

sufficiently removed to enable the physician to make a proper
investigation ; and, third, by a lack of attention to minor
symptoms which, properly interpreted, would prevent the
observer from reaching an erroneous conclusion.

Many cases of inj'ury are followed by pains and dis¬
orders of the nervous system, and this not only in instances
when the injury has been caused by a railroad accident, or
been received in consequence of the carelessness of some person
who can be held responsible for the damage, but when the
patient alone is to blame and the possibility of legal redress
does not enter into the question. That a traumatic neuritis
is set up in these cases there can be no doubt, and the
variety of neurotic complications that may follow such an
injury is most surprising. At times also there are neurotic
disturbances, the result of misplacement of the viscera, which
may be classed as traumatic neuroses, though the trauma is
merely that of abnormal pressure on a nerve or an abnormal
stretching of its fibres.

In many of these cases, among symptoms that are
present are pain in the neighborhood of a joint, accompanied
by a limitation of motion in the joint, and more or less marked
deformity, the physician being called upon to determine the
nature of the disturbance which has given rise to these
symptoms.

Has the patient Pott’s disease or not ? Has there been
a. fracture of the vertebra, or is tuberculosis or malignant
disease of the spine present, or is the difficulty simply a
neuritis set up by a traumatism and aggravated perhaps by
inherited tendencies, a rheumatic diathesis, or an exhausted
state of the nervous system ? Are the atrophy and disability
and distortion of a limb the result of hip disease or not ?
Does a patient require rest and protection for the joint, or
should vigorous exercise be prescribed ? These problems
are extremely difficult to answer, and in many instances can
be answered correctly only by the most careful and thorough
examination of the patient’s previous and present condition,
taking into account the history of the case and noting on
*nore than one occasion the attitude of the patient, the location
of the pain, the presence or absence of muscular spasm, the
range of temperature for several days and at different times
In the day, the presence of motor or sensory disturbances in
other parts of the body, and finally by taking careful note of
the patient’s mental condition.

One of the distinguishing points between a nerve inflam¬
mation and an inflamed joint is the rapidity with which

56 6AYRE ; CHRONIC JOINT DISEASE.

symptoms of an injury to a nerve follow the trauma which
produced it, while it may be months after the injury that
manifestations of joint inflammation are marked enough to
attract attention. While atrophy is a prominent and constant
symptom in chronic inflammation of the joint, and makes its
appearance usually before pain is at all pronounced in its.
character, yet it does not follow the onset of a marked
traumatism so speedily as in the case of injury to a nerve.

Another of the most important factors in discriminating
between a traumatic neurosis and a chronic inflammation of
a joint is the subnormal temperature that is usually present
in the former, just as it is in various diseases accompanied by
marked depression of the vital forces. There seems to be a
lowering in tone throughout the entire system, with a cor¬
responding decrease in the body heat. In chronic inflamma¬
tion of a joint, however, there is usually a slight increase in
temperature, say to 99 0 F., and one of the best guides to
the activity of the destructive process going on in the bone
is found in the reading of the thermometer. The local tem¬
perature also is apt to be much depressed after an injury to
the nerve supplying this part, and at times an extremity or
a part of an extremity will show a lowering in the surface
temperature of one or two degrees below that of its fellow,
or of other parts of the body. On the contrary, if an inflamed
joint be at all near the surface, the increase in its temperature
is usually sufficient to be detected by the touch, should a
surface thermometer not be at hand. I would draw attention
here to the fact that we may have a lowering of surface
temperature in an extremity which has been kept at rest for
a long time, either in bed or in a splint, while a joint in this
extremity, as the knee or ankle, for instance, shows a marked
increase of heat, and this distinction must be kept in mind
in making a diagnosis between these cases and those of
local subnormal temperature due to nerve involvement.

One of the early, probably the very first, symptoms of an
inflamed joint is involuntary spasm of the muscles controlling
that joint, and, as the disease goes on, this spasm becomes
more and more pronounced. One of the peculiarities of this
spasm is that passive motion within a certain limited range
may often be made with entire absence of pain or resistance,
while efforts at voluntary motion on the part of a patient, or
motion greater in extent than that which the severity of the
inflammation permits, at once excites muscular spasm and
gives the appearance of complete ankylosis. Nature does
not oppose motion of a joint so long as that motion fails to

SAYRE: CHRONIC JOINT DISEASE.

57

inflict injury, but as soon as it begins, to cause irritation the
muscles that control the joint at once spring into action in
their effort to relieve and prevent the pain which is caused
by the motion. If an anaesthetic is given in such a case the
sensibility of the nerves is destroyed, and the muscles in
consequence fail to control the movements of the joint, be¬
cause they are no longer stimulated, and the physician is
hereby deprived of the very symptom which would have
been of vital importance to him had he made use of it in¬
telligently. In many so-called “ hysterical joints,” and in
these neurotic cases of which I speak, there may be a simula¬
tion of ankylosis and of muscular spasm, but careful observa¬
tion will usually enable the physician to distinguish this from
the true spasm of joint disease. By engaging the attention
of the patient in other things and noticing the position of
the joints meanwhile, motions will often be observed in
joints supposed to be ankylosed. At times the patient may
be induced to move the joint by placing the body in a
different position from that in which the movement has
usually been attempted, and then attempting to secure motion
of some other joint, the movement of which will act on the
joint under examination, the patient meanwhile having the
attention concentrated on efforts to move the other joint,
about which there is no question as to the diagnosis.

In cases of joint injury the location of the pain is to be
borne in mind, and it may be a help toward excluding joint
disease if the patient locates the pain in different places at
different times, and at points other than those where the
nerves supplying the affected joint should come to the
surface. In spinal cases a tenderness along the whole length
of the spinal column is almost proof in itself that the case is
neurotic and not ostitic, the pain of bone inflammation being
almost always confined to the distal extremities of the spinal
nerves; or, if the pain is felt in the back, it is only in a
limited area. Should the patient be awakened at night,
especially just as he is dozing off to sleep, by sharp pains
that cause a loud, sudden cry, it is almost certain that
inflammation of bone is present. The general appearance
of the patient will often aid greatly in eliminating bone
inflammation. The expression of certain neurotics can hardly
be described, but, their appearance once recognized, the
picture is as typical as the expression of melancholia or
mania.

In some neurotic cases there will be found a peculiar
oedema of an extremity which, being associated with great

53

PROGRESS OF MEDICAL SCIENCE.

tenderness, may give rise to the supposition that a bone
abscess is present, but a distinction can generally be made
by the observation that the pain is not so localized as in a
bone abscess, and extends frequently along the course of
some nerve, and may at times be accompanied by nodosities
of this nerve, changes in the color of the skin, purple or blue
spots which may be elevated, and at times by patches which
are very painful.

From the numerous other cases that have come under
my observation I would say that in taking a differential
diagnosis between chronic joint disease and a traumatic
neurosis, the following points were chiefly to be noted :

1. A neurosis is apt to follow injury sooner than is dis¬
ease of a joint.

2. The temperature is usually subnormal In a neurosis
and elevated in inflammation of a joint.

3. The local temperature is usually much lower in case
of a neurosis than in disease of a joint.

4. Atrophy progresses more rapidly after injury to a
nerve.

5. True muscular spasm is not present except in joint
disease. It may be simulated, however.

6. True night cries are pathognomonic of .joint disease.

7. The appearance of the patient, if indicating a dis¬
ordered nervous system, may aid in the diagnosis.— N. V.
Med. Rec.

Progress of Medical Science.

MEDICINE AND NEUROLOGY.

IN CHARGE OP

J. BRADFORD McCONNELL, M.D.

Associate Professor of Medicine and Neurology, and Professor of Clinical Medicine
University of Bishop’s College; Physician Western Hospital.

SORE THROATS.

There are some people who suffer from recurrent
attacks of sore throat, tonsillitis and pharyngitis on the
slightest exposure or imprudence throughout the winter
season. The doctor is called in, prescribes tincture of iron,
chlorate of potash, tincture of guaiac, salicylate of soda, etc.,
with a gargle, and soreness and swelling abate, the patient
no longer needs to clear the throat every moment, but the

MEDICINE AND NEUROLOGY.

59

structures do not return to a normal condition, some passive
congestion remains, and soon another attack is precipitated.
{'’^ This liability to repeated attacks of sore throat is not
altogether seasonal. IV; any persons entirely escape or are
stricken, suffer acutely for a few days and rapidly recover, to
hear no more of the malady. Frequent attacks of sore throat
are due to disease of the blood. Morbific matter accumu¬
lates in the blood and makes a breach at a point favorable
to rapid congestion and exudation. The throat furnishes
just such a locality. Its tissues are normally very sensitive
and easily congested.

The treatment of sore throat of the chronic and recur¬
rent variety requires something more than the local use of
gargles and remedies to allay feverishness and restore the
secretions ; prophylaxis must be secured by the use of reme¬
dies to put the blood in a healthy condition. Its quality,
volume and rate of circulation must be brought up to
the standard of health. We believe that Ecthol will do
this more satisfactorily than any other remedy. It increases
the number, promotes the integrity and stimulates the
movement of the red blood corpuscles, a vital factor in
improving nutrition and circulation generally. Under its
"use the blood stream is accelerated in a normal manner,
bathing and vivifying the tissues, yet preventing conges¬
tions.

Locally, Ecthol is used as a gargle either pure or in
combination with Listerine, carbolic acid, hydrogen peroxide
or other antiseptics, and has a very beneficial effect, check¬
ing any bleeding, reducing inflammation and hastening
resolution.

Old sore throat cases are often very troublesome, the
patients being neurotic, anemic and morbid generally, and
we hope the profession will try this remedy, which has
shown itself to be not only curative but prophylactic -in
aggravated cases of recurrent sore throat .—Medical Brief.

TREATMENT TO INCREASE MAMMARY SECRE¬
TION.

From “Sajou’s Annual and Analytical Cyclopedia of
Practical Medicine,” we quote as follows :—

“ The bowels should be regulated by proper dieting
and massage or exercise rather than by laxatives, and it is
highly desirable that there should be at night uninterrupted
sleep for six hours for mother and child. Galactagogues
are valueless in the majority of cases, most of them exerting

6o

PROGRESS OF MEDICAL SCIENCE.

practically no influence upon the gland. Occasionally a
slight stimulating effect may be noted, but this lasts only a
short time, and the organ soon lapses into its former tor¬
por. Beer, ale, porter, and other malt liquors, especially
alcoholic beverages, are more hurtful than beneficial, and
what improvement may show itself is due mainly to the con¬
fidence in the beverage taken, through the agency of auto¬
suggestion. The quantity of milk may be increased, but its
quality is compromised, especially when poor beer is con¬
sumed by the mother. It encourages the production of fat
at the expense of the casein or milk sugar. Pure malt may
be substituted with great advantage.

PNEUMONIA TREATED WITH ANTI-
PNEUMONIC SERUM.

Fanoni (N. Y. Med. Jour., Vol. 70, No. 9) has studied
the effects of Professor Pane’s anti-pneumonic serum in six
cases of pneumonia. The quantity of serum used in these
cases was from a minimum of 20 cubic centimeters to a
maximum of 120 cubic centimeters. In some of them only
the serum No. 1 was used, in others only the No. 2, while
in still others both strengths were used. The resolution in
these cases was as follows :

First case, eighth day, by lysis ; second case, sixth day,
by lysis ; third case, tenth day, by lysis ; fourth case, seventh
day, by crisis ; fifth case, seventh day, by lysis ; sixth case,
sixth day, by lysis.

From his own experience, and that of his confreres in
Italy, the author draws the following conclusions :

1. That Pane’s anti-pneumonic serum is the rational
remedy in pneumonia, as it constitutes the specific treatment,
the same as Behring’s antitoxin does in diphtheria.

2. That injections with this serum are not painful, are
simple to administer, and do not produce any general or local
reaction.

3 . That serum over five months old is no longer active
and produces no results, although it does no harm : and, after
it is four months old, it begins to lose strength, and the
amount given after this time should be increased in propor¬
tion as the date of the preparation of the remedy is removed
from the date of administering up to the fifth month.

4. That the serum will not do harm, even if given in
doses of ICO to 150 cubic centimeters in twenty-four hours.

5. That the serum in all these cases under my observation

MEDICINE AND NEUROLOGY.

61

has shown wonderful efficacy, not only in producing rapid
improvement of the general condition, but in hastening re¬
solution in case it is given early in the disease.

6 . That in any lobar pneumonia, especially if the prog¬
nosis is grave, it is the duty of the physician to use this
serum, and if he fails to do so there is no excuse for such an
act, except ignorance of the work that has been done in the
field of the serum therapy of pneumonia .—Memphis Medical
Monthly. s

THE TREATMENT OF SHOCK.

Experiental work upon the pathology of shock shows it to
have as an essential element a paresis of the vaso-motor
nervous system. The maintenance cf vascular pressure by
contracting the peripheral arterioles is the most efficient
means of overcoming the condition. The efforts of surgeons
have been largely addressed to the heart, as the symptoms
seem to be referable to that organ. Experimental study
shows that a heart that is only partially filled with blood
beats rapidly and feebly. The physiologist teaches that the
veins of the body are capable of containing the entire blood
supply ; indeed, those of the abdominal region alone are said
to have nearly sufficient capacity for this purpose, or, at least,
they may contain a quantity which seriously impairs the.
integrity of the circulation. A marked fall in the peripheral
resistance results in a rapid and correspondingly feeble heart’s
action. This is not to be met by stimulating the heart, as by
such means we only aid in emptying the arterial system.
The aim should be to use those remedies which caused a
prompt contraction of the peripheral arterioles, and so restore
the altered balance of the circulation .—Medical Review.

THE CAUSE OF OLD AGE.

Prof. Mechnikoff, whose fame rests upon the Mechni-
kovian theory of phagocytosis, has recently come forward
with a theory of old age, based upon the omni-important
leucocyte. He states that there is a sort of social distinction
among the leucocytes, some of these being common, or, as we
might translate it, plebeian, while others are noble. The
common cells are found in all the organs, and may be trans¬
formed at any time into connective tissue cells. The noble
cells are those which may form part of the parenchyma of
any of the organs. Old age is essentially a strife between
these two forms, in which the common type, or connective

62

PROGRESS OF MEDICAL SCIENCE.

tissue builders, gains the mastery ; and thus we have a re-
p'acing of normal tissues by connective tissue structures, or
a sclerosis. The theory has an element of the picturesque,
though as a practical working hypothesis it will probably not
be of great value in overcoming the effects of age and of ad¬
vancing sclerosis. Modern science appears to be looking for the
fountain of youth with all the enthusiasm of Ponce de Leon.
—Medical Review.

DIAGNOSTIC AND THERAPEUTIC IMPOR¬
TANCE OF THE X-RAY IN MEDICINE
AND SURGERY.

Among the diagnoses which may positively be made
by the X-rays are : Early diagnosis of aneurysm of the
aorta ; determination of the boundaries of the heart in em¬
physema ; determination of apparent and real hypertrophy
of the heart. With the aid of the fluoroscope abnormal
rhythm of the heart and the effects of drugs upon it can be
carefully studied. The differential diagnosis between
tumors of mediastinum and aneurysms of the aorta can
absolutely be made. Aneurysms of the various arteries and
the calcification of these various arteries can be made out.
Respiratory tract : Tumors and foreign bodies in the larynx,
Tumors, foreign bodies, gangrenous areas in the lungs,
exudate into the pleural cavity, thickness of the pleura
and pneumothorax are all distinctly to be made out. Gastro¬
intestinal tract : Foreign bodies in the esophagus, stomach
and bowel can be detected, and the differential diagnosis
between the tumors and diverticula of the esophagus made.
Furthermore, abnormalities in the shape and position of the
stomach can be made out by means of inflation, or the intro¬
duction of sounds and bismuth. Tumors of the omentum,
the bowel, the pancreas and the liver have been made out.
Urinary apparatus : Stone in the bladder and the kidney and
tumor of the kidney. Head : Fractures of the skull, splinters
of bone and tumors in the brain, foreign bodies in the eye
and in the nose, empyema of the frontal sinuses and of the
antrum of Highmore. The importance of the X-ray in purely
surgical cases needs no explanation here. Therapeutically, the
author has good reports of the effect of the X-ray in cases of
neuralgia of the facial, occipital and intercostal nerves. In some
cases joint and muscle rheumatism were favorably influenced ;
in others they were not. In the treatment of certain affections
of the skin, notably lupus, eczema and psoriasis, excellent

MEDICINE AND NEUROLOGV.

6 3

results have been obtained. The depilatory action of the
X-ray has found a use in cosmetic medicine. The therapeutic
effect of the X-ray in pulmonary tuberculosis has up to the
present time been nil. All in all, the X-ray has to be con¬
sidered rather as an aid to diagnosis than as a therapeutic
agent of the first rank .—Medical Review.

HYDROTHERAPY IN THE PREVENTION AND

CURE OF PULMONARY TUBERCULOSIS.

In Knopfs recent work, “ The Prophylaxis and Treat¬
ment of Pulmonary Tuberculosis,” the author calls atten¬
tion to the value of hydrotherapeutic measures in the pre¬
vention and cure of pulmonary tuberculosis. He especially
emphasizes the value of using cold water externally. The
manner of application as suggested by the author is to pre¬
cede the application several days by a dry massage of the
skin, followed by inunction. Following this, friction with
pure alcohol is recommended ; then half alcohol, half water,
and, lastly, friction with water alone. This is then followed
by the cold sponge bath, the affusion, and last the douche.
It is essential to follow this treatment with vigorous friction,
so that a good reaction will take place; otherwise the treat¬
ment will do more harm than good.

The value of the cold morn ing bath for both old and young
is inestimable. Its universal application in conjunction with
a correct dietary and a moderate amount of systematic exer¬
cise would do much toward the eradication of the tendency
to disease, and also to the cure of many diseases in their in¬
cipient and chronic stages. This form of treatment was
known and systematically practiced by many of the ancients,
with the result that they were a vigorous and energetic
people.

The cold sponge or friction bath is a most efficient
measure for energizing the circulatory processes and estab¬
lishing a permanent healthy circulation in the skin and other
excretory organs. The elastic step and buoyant air
exhibited hy one who has reacted properly to his morning
bath is evidence that there is great energizing power in cold
water. Great care must be exercised, however, in the use of
this excellent remedy in the treatment of the very young;
and in feeble and aged individuals, for upon their power to
react depends the value of the application. For those who
react poorly, a good way is to see that the room in which the
application is to be made is warm and free from draughts

64 PROGRESS OF MEDICAL SCIENCE.

of air; the patient should also be warm and comfortable
before beginning the treatment, otherwise reaction will not
take place.

In the cases just referred to, the cold friction sponge is
an excellent means of obtaining a good reaction. The
attendant should be equipped with a mitt made of some
rough material which, when rubbed over the skin, will pro¬
duce considerable friction. The mitt is dipped in cold water
and rubbed vigorously over a small area of the skin until a
good reaction results ; the part is then dried by means of a
Turkish towel, and immediately covered. Other parts of the
body are then treated until the whole surface of the body
has been gone over. A feeble person can stand the water
much colder when this form of treatment is employed than
when ordinary hand friction is used. The friction dilates
the peripheral vessels, allowing more blood to flow through
the skin, thus causing a feeling of warmth in the part, while
at the same time the sensory nerves are being stimulated .by
the cold water.

Many diseases other than tuberculosis can be prevented
and cured by means of the simple, inexpensive and universal
remedy. Every physician should instruct his patients how
to fight for health; for a vigorous warfare must be waged
against the almost countless foes which are lurking on every
hand, seeking a favorable opportunity to pounce upon us,
and in many instances make ns victims of some lingering
disease .—Modern Medicine.

SURGERY.

I'f CHKRG3 OP

ROLLO CAMPBELL*, M.D.,

Lecturer on Surgery, University of Bishop’s College ; Assistant-Surgeon, Western Hospital;

AND

GEORGE FISK, M.D.

Instructor in Surgery, University of Bishop’s College ; Assistant-Surgeon, Western Hospital.

CELLULOID SUTURES AND LIGATURES.

Pagenstecher (Deut. Med. Woch.) takes a good thread,
boils for half an hour in a I per cent, solution of soda, washes
in boiling water and dries between sterile compresses. It is
then soaked in a solution of celluloid and passed again
through the same solution. Afterward it is sterilized by

SURGERY.

«5

steam under pressure and preserved for use either dry of in
an alcoholic solution of bichloride of mercury. The threads
have a smooth surface, never tangle, cannot absorb secre¬
tions, and are easily tied. Pagenstecher uses these celluloid
threads to the exclusion of silk, and the use of catgut for
ligatures has been greatly reduced. The results have been
good and the saving considerable .—Buffalo Medical Journal.

THE DIAGNOSIS OF JOINT TUBERCULOSIS.

The writer found that nearly 31 per cent, of all joint
diseases applying at a dispensary for special orthopedic dis¬
eases were cases of joint tuberculosis.

One of the most important things in the successful treat¬
ment of tuberculosis of joints is an early diagnosis.

That heredity plays in many an important part is true.
-Frequently children are affected by a tuberculous disease of
•the joint from a tuberculous father, the mother apparently
in good health or having slight anaemia. Rheumatism of
the joint, particularly in young children, is the most frequent
condition with which this disease is confused. Rheumatism
of a single joint is an exceedingly rare disease, especially in
children. Most of such cases when followed carefully are
found later in the hands of specialists being treated as tuber¬
culous. The symptoms upon which the diagnosis mostly de¬
fends in joint tuberculosis are spasms and atrophy. The
spasm of the muscles is tetanic in character, and occurs very
.early in disease. This is followed soon by wasting of the
muscles; no matter what joint is affected with tuberculosis,
these two symptoms are always present. In the spine,
particularly in the lumbar region, it is one of the earliest
symptoms, often before the occurrence of deformity, spasm
of the psoas and iliacus may be detected. In hip disease
the adductors are among the first, and in the knee joint the
ham string tendons are frequently contracted at a very early
stage. The use of Roentgen ray is of use only in advanced
tuberculosis. The appearance of the cartilages and bones
being irregular and roughened very differently from the clear
and distinct outline of photographs in cases of chronic syno¬
vitis. In specific arthritis, by means of the X-ray, the de¬
posits of fibrous tissue may sometimes be detected. These
will obscure the normal outline of the joint, but there will not
be the roughened, irregular and worm-eaten appearance of
tuberculous disease. A picture should also be taken of the
sound joint on the opposite side in the same position as the

66 PROGRESS OF MEDICAL SCIENCE.

diseased joint for comparison. Examination of the blood,
in cases of suspected tuberculosis of the joint, is of assistance,
as marked anaemia or leucocytosis is frequently a forerunner
of a tuberculous outbreak in a joint. The differential diag¬
nosis of tuberculous disease of the joint is so important that
the author tabulates the points of differentiation between
non-tubercular chronic synovitis, tubercular chronic articular
arthritis and specific syphilitic arthritis.

NON-TUBERCULAR CHRONIC SYNOVITIS.

I. Marked effusion, capsule thickened. 2. Joint out¬
line enlarged and obliterated. 3. Motion nearly normal.
4. Reflex muscular spasm absent. 5. No atrophy. 6. Pain
absent. 7 . Night cries absent.

TUBERBULAR CHRONIC ARTICULAR ARTHRITIS.

I. No fluctuation, capsule not thickened. 2. Joint out¬
line distinct and clear. 3. Motion limited. 4. Reflex mus¬
cular spasm present. 5. Marked atrophy. 6. Night cries
present.

SPECIFIC SYPHILITIC ARTHRITIS.

I. Slight effusion, capsule thickened. 2. Joint outline
distinct, enlarged. 5. Atrophy slight. 6. Pain moderate upon
motion. 7. Night cries absent.— Dr. jas. R. Young , Jour,
of Tuberculosis ; St. Patti Med. Jour.

BIERS’TREATMENT OF EARLY JOINT TUBER,

CULOSIS.

Biers’ method of treating early joint tuberculosis is
attracting considerable notice, and is worthy the attention
of the general practitioner because of results claimed and
because of its simplicity. The treatment consists simply in
ligating the member above the affected joint with an elastic
bandage of medium width. This is applied several times a
day for a period varying from ten minutes to one hour, the
bandage being only sufficiently tight to impede the venous
circulation. The curative principle of the method seems to
be in the fact that the locally increased carbonic acid gas and
an increased phagocytosis attacks the micro-organisms. The
results of this treatment have been so prompt and so uni¬
versally good in tuberculous joint disease, and so decidedly
negative in joint disease due to other causes, that it is con¬
sidered to be of great value for diagnostic purposes. It is
said that if considerable relief is not given after two or
three applications, it may be assumed that the joint is not
tuberculous.— Memphis Medical Monthly .

SURGERY.

67

THE TOBACCO-POUCH SUTURE.

Doyen has lately been extending the application of the
pucker string suture to abdominal surgery, using it on the
appendix, intestine, stomach and Douglas’ sac after ab¬
dominal hysterectomy, and now Quervain, after extensive
tests on the cadaver, announces that it is stronger than the
Lembert suture, and is peculiarly adapted to the peritoneum,
when the latter is movable and the opening is of moderate
size. The ends can be tucked in and the thread drawn tight
like an anus, or the edges can be left out and the stitches
taken with longer stretches on the outside, which forms a
particularly strong and effectual method of suturing organs
invested externally with serosa, such as the intestines and
gall-bladder. He is confident that one trial will convince all
of the remarkable advantages to be gained from this suture
on the peritoneum.— Journal American Medical Association .

STERILIZATION OF THE SKIN.

Senger {Archiv. fur. klin. Cftir., vol. 59, p.425) gives the
results of a long series of experiments conducted by him in
order to discover the best method of sterilizing the skin. He
finally adopted the following technic : (1) Mechanical clean¬
sing of the skin with ordinary soap and water just as hot as
it can be borne—about 40 0 to 45 0 C. (104 0 to 113 0 F.).
This scrubbing should last at least five minutes. (2) Bathing
or rubbing the hands with alcohol (40 to 60 per cent.). (3)
Washing the skin for two minutes with a warm 2 to 5 per
cent, solution of hydrochloric acid. (4) Washing the skin
for one minute with a warm per cent, solution of perman¬
ganate of potash. (5) Washing the skin with sulphurous
acid until it is decolorized. The whole process takes about
ten minutes. Senger insists upon having the solutions warm,
claiming that their antiseptic action is much increased by the
heat. By this method he has been able to obtain sterility in
almost every instance in which the skin was tested by scrap¬
ing. He objects to this method of making the test, however,
on the ground that it is not as accurate as when small snips
of the skin are imbedded in the culture material. When
tested in this way the skin was found to be sterile in about
75 per cent, of the recent experiments. This is far in advance
of the results he was able to obtain by any other method.—
Medical News, Nashville Jcur. of Med. and Surg.

68

PROGRESS OF MEDICAL SCIENCE.

THE BEST METHOD OF INTESTINAL
ANASTOMOSIS.

J. H. Barbat, in the Journal of the American Medical
Association of July 15, 1899. gives an experimental study of
the results of different methods of intestinal anastomosis
made in dogs. Circular interorrhaphy, he thinks, should
always be the operation of election in restoring the continuity
of the intestine, as it is the only method which restores the
bowel to its natural condition, and it is the operation which
should always be selected when no contraindication exists.
His experimental work shows it is possible to make a safe
and satisfactory end-to-end anastomosis. With practice a
surgeon can, with nothing but a needle and thread, sew a
divided bowel together and obtain a result which will almost
equal that obtained by the use of the Murphy button. The
button is superior to any suture method yet devised. The
Murphy button and Frank coupler give the same anatomic
result, but the button is safer than the coupler. Contraction
following end-to-end anastomosis is usually due to faulty tech¬
nique. A perfect Murphy button, properly introduced, is the
quickest, safest and most reliable means of uniting the severed
i n testine.— Medicine.

A NEW RECTAL DRESSING.

J. R. Remington, in the Chicago Medical Recorder for
July, 1899, speaks of the necessity of careful attention to the
dressing and after-treatment in surgery of the rectum. Much
of the pain and swelling which follow the application of a
ligature or the cautery can be prevented by the use of pro¬
perly constructed rectal tampons. If these are made of simple
gauze or cotton, the pain attending their removal is consid¬
erable, the tender granulations are broken off, and there is
considerable hemorrhage. They retard the healing and favor
the absorption of septic material. The tampon devised by
the writer consists of a central rubber tube three-fourths of
an inch in diameter and four and one-half inches long.
Covering and attached to this are layers of gauze and cotton
sufficient to furnish a tampon of the desired size. The whole
is then covered by sterilized sheet rubber. The advantages
which he claims for such a tampon are that there is no pain
on its removal, and that it leaves the wound in a condition
which makes defecation practically painless.— Medicine.

SURGERY.

69

CURLED HORSEHAIR IN PLACE OF A
SCRUBBING-BRUSH.

W. S. Forbes, in the Pettnsylvania Medical Journal for
July, 1899, says that ordinary curled hair forms one of the
best mechanical devices for cleansing the skin that has yet
been discovered. In its preparation about three drachms
of curled hair is employed, and this is easily shaped by the
hands into a loose pad about the size of the hand. When
desired, the flattened mass may be held together by stitching
with sterilized silk, catgut or other aseptic material, but this
is optional, When once fashioned, it will hold its shape
without change. It cannot cut or tear the skin, and it is
easily cleansed with boiling water before and after each
surgical operation. A solution of bichloride of mercury, 1
to 100, and steam to ioo° do not act upon it. It may be
kept in alcohol after being sterilized, and is thus always
ready for use. It is cheap and efficient, and is far superior to
the scrubbing-brush of tainted memory.— Medicine .

CHRONIC ULCER OF THE LEG.

I have laid down this rule : An ulcer situated above the
middle of the leg is syphilitic, regardless of history. I make
it a rule to examine the heart, lungs and kidneys in all
cases, as disease of any of these organs interferes with the
local treatment. For instance, if the heart is diseased, passive
congestion and oedema of the lower extremities are of fre¬
quent occurrence. Proper attention, then, to this organ,
when compensation is possible, will greatly facilitate getting
rid of the ulcer. But simplicity, cleanliness and the proper
time to interfere are the sheet anchors in all cases. But, as
to drugs. I have as yet to find one which will equal pure car¬
bolic acid.— John B. Corsiglia, New York Medical Jour¬
nal , N. Y. Med. Rec.

SURGICAL HINTS.

Examine the urine in all cases of pruritus, eczema, gan¬
grenous lesions, furuncles and anthrax. A certain proportion
will show the existence of diabetes.— Remember how fre¬
quently constipation aggravates prostatic obstruction. Some
prostatic cases are immensely benefited by careful attention
to this important detail.— In appendicitis, when the pain
keeps on increasing, the pulse remains rapid, and the tem¬
perature remains high, delay in operating will soon be con-

70

PROGRESS OF MEDICAL SCIENCE.

sidered, and very justly so, as amounting to malpractice.—
Slight rises of temperature after an operation, even in
cases which give no septic results, warn the surgeon that he
is probably erring in some way, and that his methods and
material should be pretty thoroughly overhauled.— Make A
1IAB1T OF washing your hands in vinegar or dilute acetic
acid before touching septic cases. Slight cuts and abrasions,
whose presence was not suspected, are thus revealed, and
you may better protect yourself.— In dislocation OF ONE
SIDE of the jaw the chin is deflected away from the dislo¬
cated side. In bi-lateral dislocation the chin is advanced
forward. In the former the face is distorted, while in the
latter there is a peculiar expression of fear and distress.—
It is sometimes very difficult to remove foreign
bodies broken off under the finger-nails. The best way
is to apply carefully a ten per cent, solution of caustic
potash and scrape away the softened portion. This is
repeated until the foreign body is exposed.— Seventy-
FlYE GRAINS of PICRIC ACID dissolved in two ounces of
alcohol, to which a quart of water is added, makes an ex¬
cellent application for burns. There is nothing which dead¬
ens the pain better. It should not be used after granulation
begins to take place.— After a blow upon the head, the
hardened margin of a blood extravasation is sometimes
mistaken for a protruding edge of fractured bone. If in
doubt, press gently upon the spot steadily and continuously.
If it is an extravasation it will gradually become pitted by
the pressure.—A STARCH bandage will not set so fast as a
plaster one, but except for this it will do everything that
may be done with the latter. Wet your bandage slightly
before applying it, and then spread the starch paste over
every layer. It has the great advantage that the materials
for it are found in every house.—I f YOU EXPECT to use a
thcrmo-cautery during an operation, see that your assistant
wraps the handle in a sterilized towel before handing in to
you.— Don’t spend half an hour in carefully sterilizing your
hands, and then wipe them on any old towel that is lying
around. Work with wet hands if you can’t obtain a sterile
towel.— An enlarged prostate often projects, as it were,
into the bladder, thus increasing the length of the urethral
canal. Hence an instrument must often be introduced
farther than usual in order to reach the urine.— LOOK AT
THE FOOT when a patient complains of enlargement of the
femoral lymphatics. A suppurating ingrowing toe-nail or
any other septic condition of the toe or foot is probably at

SURGERY.

71

fault If this is properly attended to the glands will soon
subside.— Large glands in the neck of adults or old people
are very apt to signify that a malignant process is taking
place in the neighborhood ; hence it is always well to ex¬
amine the mouth, the tongue, the nose, and the throat care¬
fully in such cases.— In general operative work, it is
always useful to have two kinds of artery forceps, pointed
and blunt-jawed. The pointed artery forceps are most useful
for vessels in and near the skin, as they crush less tissue.
The blunt-jawed forceps permits more rapid and efficient
haemostasis in the deeper tissues.— IN THE TREATMENT OF
FRACTURES of the long bones, it is practically impossible to
bring the broken surfaces end to end in perfect approxima¬
tion. Our object is simply to accomplish this as nearly as
possible, and in the lower limbs to secure such extension as
will result in a bone of normal length.— AFTER AMPUTA¬
TIONS never wait to apply an artificial limb beyond the time
when the stump is well healed and the patient is strong
again. Disuse of the stump for too long a time makes it less
able to stand the artificial limb. The only exception to this
rule is when the operati on was done for malignant disease,
where early pressure and concussion might favor a return.—
In INJURIES OF the SKULL requiring operation, it is well to
remember that the prognosis depends a good deal upon the
region involved. Thus in a series of over eight hundred
cases it was found that the mortality was one to sixty when
the anterior brain was affected, whereas it was one to thirteen
in injuries of the central and posterior regions, and one to
four and a half in those situated at the base.— Internat. Jour,
of Surg., N. Y. Med. Rec.

INJURIES TO THE BRACHIAL PLEXUS AND

ITS BRANCHES IN DISLOCATIONS OF
THE SHOULDER.

In injuries of the shoulder a guarded prognosis should
always be made, unless the surgeon is quite confident that
nerve injury can be excluded. It is by no means infrequent
for a surgeon to be called to the dislocation of a shoulder
that may or may not be complicated by fracture. The diag¬
nosis is easily and quickly made, the bone is replaced in its
socket, and a retentive apparatus applied, and the patient is
informed that the outcome will be favorable. When the
bandages are finally removed, it is found that the arm is
quite helpless, or even if there remains good motion in the

72 PROGRESS OF MEDICAL SCIENCE.

fingers and fair strength in the grasp, that the elbow cannot
be carried from the side and the motion at the shoulder-joint
is very limited. On examination the shoulder is fouhd to
be very much flattened ; sometimes a considerable groove
is noted between the acromion process and the head of the
humerus. The result from an operative standpoint is good ;
the head of the humerus is found in the glenoid cavity, but
the usefulness and range of motion of the arm is very greatly
impaired. From the patient’s standpoint the results are
anything but satisfactory, and far from what he was led to
expect when the probable consequences of the injury were
first explained to him.

These untoward results are due to injuries of one or
more cords of the brachial plexus or to some of its branches.
The injury may have been caused by the displaced
bone, or by the violence of the original injury, or to a
combination of both of these. If the injury is to the
brachial plexus or some of its cords, there may be paralysis
of a considerable portion, or even all, of the muscles of the
arm. There may be contusion with a restoration of function
in a comparatively short time, or such contusion may be
followed by a more or less extensive traumatic neuritis. This
early paralysis from contusion may be overlooked in the
pain and swelling incident to the original injury. If the
neuritis and a paralysis involved the whole or a single trunk
of the plexus, it is usually not difficult of recognition. The
safest prognostic guide in these cases is sensation ; if it is
absent and returns early, usually an ultimately favorable
prognosis can be given, but this should be guarded by the
statement that weeks or months may elapse before there is a
restoration of motion in the paralyzed muscles. This is due
to the fact that contusion is followed by neuritis, which
results in a degeneration of the nerve. In simple traumatic
cases we may generally look for a regeneration in the course
of time, which will be aided by massage and electricity. In
only a few of these cases is the paralysis permanent.

The most insidious and difficult of diagnosis is injury to
the circumflex nerve, which is the one most frequently in¬
volved in simple dislocations. This nerve is a branch of the
posterior cord of the brachial plexus. It passes through the
quadrilateral space, bounded by the teres major, under
head of triceps and subscapularis muscles, and by the surgi¬
cal head of the humerus, where it divides into a smaller
anterior and larger posterior division. It supplies the teres
minor and deltoid muscles, and is the nerve of sensation for

SURGERY.

73

the skin covering that muscle. It sends an articular branch
to the joint, which is the pathway of trophic influence. An
injury to this nerve means a serious impairment to the use
of the joint. The traumatism which has dislocated the joint
has resulted in a chronic synovitis, and more or less patholo¬
gical disturbance in the joint. At this time, to have its
trophic nerve supply cut ofl is an additional misfortune, and
one which frequently leads to chronic inflammation. Ad¬
hesions form, and with the atrophy of the deltoid muscle
which accompanies the adhesions there is marked impair-;
ment of the movements of the shoulder.

To determine injury to the circumflex, it is necessary
to carefully examine the sensibility of the skin over the
deltoid. If tactile sensation is impaired over this region, a
guarded prognosis should be made, as months must elapse'
before the nerve regenerates. The adhesions and joint
troubles which follow injuries to this nerve are persistent and
aggravated to a degree unknown in simple contusion or dis¬
location of the joint without nerve injury. We would lay
especial emphasis upon this matter, as not infrequently mal¬
practice suits following shoulder injuries are brought because
the patient is led to believe that the outcome of the injury
would be much more favorable than proved to be the case.
— Medicine.

GUAIACOL AS A LOCAL ANESTHETIC.

Guaiacol is being used extensively, especially in England,
as a local anesthetic in operations upon the nose, throat and
ear. It is said to be quite as efficient and to be much less
dangerous than cocain. There is no hyperemia following
its use, but its action is slow; it causes considerable smart¬
ing, and its odor is disagreeable .—Medical Review.

Therapeutic Notes.

R Dest fennel oil...... oj.

Chloral hydrate. gr. xxxv.

Borax . gr. xv.

Wash the feet night and morning.

Iodine in Treatment of Chronic Eczema of the

Hands.

The Revista de Medicina y Cintfia Practicas, quoting
the Therapeutische Monatshefte, attributes the following

formula to Edlefsen :

R Iodine. gr. I

Potassium iodide. gr. 4

Glycerine . gr. 180

M. Sig. To be applied every night, and the hands
covered with compresses.— New York Medical Journal.

Itch Ointment.

In a series of experiments at the St. Luke’s Hospital,
Paris, to determine what will cure itch in the shortest time,
forty-one different preparations were employed. One of
these, the following ointment cured in the smallest number

of days :

R Sublimated sulphur. 3 ij

Subcarbonate of potash. 3 j

Adeps simplex. 3 viij

M. Sig. Apply morning and night.

The writer of this has been in the habit of adding to the
above the oil of bergamont, three dram?, thus adding to
the flavor and potency of the ointment.— Modern Medicine.

In nephritis with scanty urine and high arterial tension,
nitro-glycerine in doses of of a grain three or four times
a day. It may be given either in solution or tablet triturates.

R Spiriti glonoini. f. 3 iv.

Sig. One drop in water three or four times a day, or

R Spiriti glonoini. gtt i.

Sacchari lactis. q. s.

Alcohol . q. s.

Misce et fiant tabellae No. 1.

THERAPEUTIC NOTES.

75

Sig. One tablet three times a day.

In "cases of nephritis with arterial relaxation, feeble
heart, renal congestion, the following is valuable:

R Symphorolis (sodium sulfocafflate) 3 iv.

Fiant tabellae No. xxiv.

Sig. One tablet three times a day.

For the control of uterine haemorrhage in threatened
abortion the following is recommended :

R Hydrastinae hydrochloratis. gr. iv.

Pepsini saccharati. 3 i.

Misce et fiant chartulae No. xvi.

Sig. One powder every two hours.

Among the most recent remedies recommended for
asthma are suprarenal extract, orthoform and oxycamphor.
Suprarenal extract is best given in five grain tablets, but is
also useful in solution for application to engorged nasal
mucous membrane.

R Extracti suprarenalae haesmostatici 3 i.

Aquae destillatae. fi ii.

M. Sig. Instill a few drops into each nostril several
times a day.

R Orthoform. .3 ii.

Fiant in chartulae No. xii.

M. Sig. One powder used by insufflation twice daily.

R Oxycamphorae (50 per cent, sol.) f. 3 iv.

Elixiris aromatic!. f. 3 iii.

M. Sig- A teaspoonful in a wine glass of water twice
or thrice daily.

In pyogenic inflation of the bladder the internal ad¬
ministration of urotropin is now considered our most
efficient remedy. It is particularly useful in cases with
prostatic enlargement and inflammation.

R Urotropin... 3 iv.

Fiant cachetae No. xxiv.

M. Sig. One cachet three times a day, two hours after
meals.

For irrigations of a chronically inflamed bladder and
prostate, potassium permanganate against colon bacilli;

74

THERAPEUTIC NOTES.

4

corrosive sublimate against the staphylococcus, streptococcus
and tubercle bacillus. Copper sulphate against the gonococ¬
cus. Silver nitrate against all, except the tubercle bacillus^
The following is about the proper strength :

R Potassi permanganatis. gr. viii.

Aquae destillatae. O iv.

R Hydrargyri chloridi corrosivi. gr. iv.

Aquae destillatae. O iv.

R Cupri sulphatis. gr. viii.

Aquae destillatae... O iv.

R Angenti nitratis..... gr. xvi.

Aquae destillatae... O iv.

M. Sig. In using these, warm gently, and use by irriga¬
tion.

Hay Fever.

R Acid (boric).. gr. xx.

Menthol. gr. iv.

Glyco-thymoline. 3 U*

Sol. eucain B. 4 per cent., q. s. ad. 3 *j-

Sig. Use in atomizer.

This treatment is to be used in the most obstinate cases
where there is much irritation of the nasal mucous mem¬
brane.— Alexander Rixa.

Varicose Ulcers.

R Zinc oxide. 20 party

Gelatine. 80 party

Glycerine. 20 parts.

Water...q. s. ad. 200 patjs.

—Carl Beck.

't

Diphtheria.

»

The local treatment is taken care of by means of a
camel’s hair brush dipped in the following:

R Hydrargyri bichloridi. gr. iss.

Glycerini. 3 vj.

Hydrogen dioxid. 3 ij.

Sig. Use every hour or two, according to the severity of
the case.—-D r. M. A. Albe, in Cleveland Medical Gazette,
Vol. XIV., No. 3.

THERAPEUTIC NOTES.

77

Diarrhcea of Typhoid Fever.

R Acidi sulphurici aromatici. 3 ij.

Ext. hamatoxylin. fld. 5 ss.

Spirit camphorae. 3 ss.

Syrupi zingiberis.q. s. ad. 3 iij.

M. Sig. Two teaspoonfuls when the stools exceed four
in twenty-four hours-— Prof. Hare.

To Relieve the Pain in Cystitis.

R Ext. hyocyami. gr. j.

Camphorae monobrom. gr. ij.

Morphin sulphat. gr. ss.

Cocoa butter..q. s.

M. Et. ft. suppos. No. j.

When Uraemia Threatens.

Use the hot pack over the kidneys, and give:

R Pilocarpine. gr. ss-j.

Hydrochloric acid dilute. 3 ij.

^Vquae d 1st...................q. s. ad. ^ ij.

M. Sig. Teaspoonful every three hours.—N. A.
Kremer, in 7 he Medical and Surgical Monitor , Vol. II.,
No. 6.

Croup.

The following prescription, suggested by Joseph Holt,
of New Orleans, has been tried many times with the

happiest results:

R Chloral... gr. Ixxv.

Potassii bromidi. gr. xlv.

Ammonii bromidi. gr. xxx-

Aquae cinnamomi. 3 ij-

Sig. Teaspoonful, and repeat in twenty minutes if not
relieved.

This is intended for a child about 7 years old. For
younger children the dose is slightly diminished. The
chloral relieves the spasm of the larynx, and the bromides
allay the nervousness ; so that the patient is soon asleep, and
wakes the next morning as well as usual. The first dose
generally gives relief. This prescription is of no benefit in
true or membranous croup.— Practitioner, 1899, Ixiii., 356.

Threadworms.

In the treatment of threadworms large injections must
be used, and in view of the difficulty of dislodging the worms

78

JOTTINGS.

from the appendix, and their possible presence in the small
intestine, the injection should be combined with the admin¬
istration of drugs by the mouth- The vermiform appendix
is a common habitat of oxyuris vermicularis in children-—
Still, Medical Record.

Urticaria.

Mr. Skinner, pharmacist to the Great Northern Hospital,
recommends the following formula for allaying the itching

burning sensation of urticaria :

B Liquoris hamamelidis. 3 ii.

Salis maris. 3 ss.

Aquae destillatse... O i.

To be applied freely.

He also speaks highly of the following cold cream:

B Adipis benzoinat. 3 iv.

Cerae albae . 3 ss.

Cetacei . 3 i.

Boracis. 3 ss.

Glycerini. 3 i.

Aquae colon iensis. 3 iiss.

Therapeutic Gazette ,

Jottings.

The best method for testing albumen in urine, and one
which gets rid of the difficulties attending Heller’s nitric acid
test in the form of rings at the junction of acid and urine, is
the foilwing :

Place one drachm of strong colorless nitric acid in a
test tube, then carefully allow about 1-2 drachm of distilled
water to float on top of the acid by means of a pipette.
The urine is now allowed to trickle through the layer of
water, which washes it, and when it comes in contact with
the acid a white film of coagulated albumen will be seen
free from any coloring matters. This method is quite simple
and free from error. In all cases when the urine is cloudy, it
must be filtered before applying tests.

Dr. E. E. Clark, in an article in the Med. Standard\
urges the importance of the general practitioner recognizing

JOTTINGS.

79

the gravity of middle ear suppuration. Many a child has,
through early neglect, contracted a chronic suppuration of
the ear that later sent it to an untimely grave because of
the extension to contiguous structures.

The causes, course of the disease and symptoms are
given.

In the treatment great importance is attached to the
inflation of the Eustachian tube and middle ear. The catheter
is rarely used. The use of Bishop’s improved inflator is ad¬
vocated.

Any nasal or naso-pharyngeal abnormalities should be
corrected.

Dr. D. S. Humphreys, of Greenwood, Miss., writes to
the Med. Record as follows : “ I was called some time ago to
remove a cotton seed from the nostril of a three-year-old child,
which I did very easily and quickly by the following method :
The nose-piece of an ordinary Politzer’s air-bag was inserted
into the nostril on the side opposite to the offending sub¬
stance and the bag suddenly compressed, when out, half way
across the floor, flew the cotton seed.

“ It is an ideal method, as the screaming of the frightened
child closes the posterior nares and forces the air back through
the other nostril.”

Never give a child a bath immediately after a meal.

Headaches at the menopause, with the flushes followed
by perspiration, are relieved with gelsemium.

In giving cimicifuga in the treatment of chorea, remem¬
ber that a decoction of the root is the most active form.

Thyroid extract in mammary cancer lessens the pain
and the discharge, and seemingly has an inhibitory action on
the malignant growth.

In eczema of the scalp in young children, give berberis
aquifolium. It is nearly a specific. The application of bismuth
and lanolin externally will assist materially.

Take five parts of camphorated chloral, 30 parts of
glycerin, and 10 parts of the oil of almonds, saturate a piece
of cotton with this and apply into a painful ear, and it will
cure as if by magic.

THE

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price , $1.00 per annum in advance . Single
Copies , io

Make all Cheques or P.0. Money Orders for subscription, or advertising, payable to
JOHN LOVELL & SON, 28 Sc. Nicholas Street, Montreal, to whom all business eomiMv
locations should be addressed.

All comniunicatfons for the Journal, books for review, and exchanges, should t>|
addressed to the Editor, Box 2174, Post Office, Montreal.

Editorial.

VACCINATING A NATION.

It would at this period of the world’s history seem a
piece of folly on the part of anyone to deny the efficacy of
vaccination on the arrest of smallpox. Yet, there are not
a few who are guilty of this supreme act of folly. To such
we would commend the facts contained in this brief editorial
which are obtained from an article by Dr. George G. Groff,
and which appeared in the Medical News for November last.
At the conclusion of the war with Spain, the Americans on
taking over fully the government of the Island of Porto Rico,
found smallpox epidemic. At the end of January, 1899,
the Governor-General ordered a general vaccination of the
inhabitants- For some reason not quite clear to us, it was
thought not advisable to buy the vaccine from the United
States, so it became necessary to start a " vaccine farm.”
At first all animals were tested with tuberculin, but no re¬
actions were obtained, so it was concluded that tuberculosis
does not occur among the unconfined cattle of the Island.
The animals were not stabled either before or after inocula¬
tion. The lymph was collected upon points, dried, wrapped
in bundles of one hundred and dated, and mailed daily to

EDITORIAL.

81

tfie vaccine stations. The result was simply astonishing, and
may be put down as a record breaker in stamping out the
disease. Letters were sent to all physicians and to all the
alcaldes asking their cc-operation. This action resulted in
the people appearing on the date ordered and submitting
themselves to vaccination.

The instructions to public vaccinators required them (i)
to wear clean white clothing and to disinfect their hands
before operation ; (2) to scrub each subject’s arm with soap
and water and then with bichloride solution ; (3) to use as
scarifiers either needles kept in 1 to 40 carbolic solution (one-
vaccination only with each needle) or a lancet dipped in 1 to
20 carbolic solution and passed through an alcohol flame
before vaccination ; (4) to make two scarifications on each
subject, the vaccine point to be wet with sterile water, rubbed .
thoroughly over the scarifications and allowed to drv thor¬
oughly ; (5) to visit every vaccinated person a second time,
and either give a certificate or re-vaccinate, and (6) to report
daily upon the work of the day and the needs of the morrow.

, Every post surgeon was made an inspector of vaccina¬
tion, and required to enforce the instructions to vaccinators,
and to report daily to his director. The director, in his
turn, reported weekly to the chief surgeon. In three work¬
ing months 800 000 people were vaccinated at a cost of
$32,000, and at the date of writing, October 20, Dr. Groff
says that not a single case of smallpox was known to either
the civil or military authorities in any part of the island.
The work was accomplished without a disturbance of any
sort, though some natives had excuses to offer for not coming
out promptly on the call of the alcalde.

If our virus were always employed with the scrupulous
technique practiced in Puerto Rico, the anti-vaccinationists
would soon perish for want of modern instances. Municipal
health authorities might also derive some advantage in the
same direction by importing a few alcaldes.

82, EDITORIAL.

DR. WILLIAM OSLER TO MEDICAL STUDENTS.

On the occasion of a professional visit to Columbus re¬
cently, the distinguished Canadian teacher and author.
Dr. William Osier, delivered a clinical lecture before the
students of the Ohio Medical University. It is needless to
say that the students and the physicians present greatly
appreciated the opportunity of hearing him. His closing
remarks were of such a character as to be of interest to the
profession in general, as well as to students.

“ Gentlemen, the most unhappy day of my life was when
I sold my brains to the publishers. For a long time they had
been after me to write a text-book, but I resisted. I never
thought text-books so very much. I was tired of them, and
thought I was fitted for something better than writing a
text-book, but finally I consented. I must have had
neurasthenia or something else, and I beg your pardon for
ever having consented to write a book. I have been sorry
for students ever since, and trust when Osier goes out of
vogue some one will have ready an easier text.

" I am very glad indeed to have met you all. I never
meet a crowd of medical students but I think of Abernethy’s
remark, ' Good God! What will become of you all V I
know what will become of you. You will all do well.
The medical profession is one in which every man can make
a success, that is to say, he can be successful if he will work
hard, study hard and take an interest in his patients, not
that they are patients, but because of his duty to mankind,
will succeed. Practice not only with your head but with
your heart also.

“ Avoid professional jealousies and bitterness. ’ Gad,
doctors ar^ worse than parsons in engendering ill-feeling
among themselves. When you locate, look up all the
respectable doctors and leave your card. Tell them that
you are going to locate, and that you expect to deal squarely,
and you will find they will treat you right. Shut up
at once the patient who would tell you of the faults of a
professional brother. They will go to another and say the
same of you. If you go with the seamy side out, the same

PUBLISHERS’ DEPARTMENT.

95'

Paraesthetica and Periodic Paralysis The following have been
rewritten: The Plague, Malta Fever, Diseases of the Thymus
Gland, The Liver Cirrhoses and Progressive Spinal Muscular
Atrophy. The articles extensively revised are: Typhoid Fever,
Yellow Fever, Lobar Pneumonia, Dengue, Tuberculosis, Diabetes
Mellilus, Gout, Arthritis Deformans, Autumnal Catarrh, the
Diseases of the Circulatory System, more particularly Hypertrophy
and Dilatation of the Heart, Arterio Sclerosis and Thoracic
Aneurism, Pancreatic Hemorrhage, Jaundice, Acute Peritonitis,
Acute Yellow Atrophy, Haematoma of the Dura Mater and
Sclerosis of the Brain.

The articles have been condensed here and there, so that with
the numerous additions the book is not increased in size. The
division of each subject is indicated in large type, which
accentuates and confines the subdivisions in a way to aid the
study of the subject, and will be found very useful to the student.
Illustrations, colored and otherwise, are numerous, and add greatly
to the attractiveness and usefulness of the book. A prominent
feature is the large number of differential tables which are found
throughout the book in connection with the more important sub¬
jects.

We notice an error which might confuse the beginner in the
table showing the diagnosis between Pleurisy with effusion and
Primary Lobar Pneumonia. Pleurisy is said to have sputum con¬
taining the pneumococcus and pneumonia not.

Dr. Anders has presented us with a first-class text-book en¬
tirely up to date, giving evidence of a thorough consultation of all
the modern advanced works and most recent literature, and we
know of no better work on the Practice of Medicine for both
student and practitioner than his.

J. B. McC.

PUBLISHERS DEPARTMENT,

THE ART AMATEUR FOR FEBRUARY.

It has bicome evident, according to The Art Amateur , that the only way
to raise the necessary money for The Dewey Arch is by a popular national sub¬
scription, to which everybody may contribute; and the magazine, in its
February number, undertakes to be the first periodical to start such a subscrip¬
tion. “ It will accept all sums, large or small, will publish the donors 9 names
and the amount of their subscriptions, and will bank the money received until
such time as it can be used for the actual construction of the Arch." It adds
that, 11 It is now for the press in general to follow or lead."

“The erection of The Dewey Arch," The Art Amateur says, “ will be a
first step in the adornment of the metropolis, and will furnish a much-needed
object lesson for the entire country." We cannot afford to dispense with any
means of popular education which has been found indispensable by other great
nations. The multiplication of colleges, picture galleries and museums, though
greatly to be desired, cannot have such an influence upon the masses as the dauy
view of an imposing monument, such as the Arch, magnificently decorated with
sculptures whose meaning is apparent to every passer-by, will be when finished*

PUBLISHERS’ department. •

96

v The Sloane Museumin London, with iu wreck of a famous Reyno’ds and
the best preserved series Hogarths extant, is described in The Loudon Lttttr
by Montague Marks. There is 44 A Talk on Miniature Paintings” by 1 W.
Theodore Wust, and a series of amusing miniatures by the same clever artist,
illustrating episodes in the life of a certain New York art critic. Mr. William
Patten writes of iC Illustrations in the Magazines.*’ As to Art in the Home,”-
a paper by Mr. John W, Van Oost the edhor, which was read at the last
Architectural League Dinner, makes many pertinent suggestions, notably this:
That “good taste is cheap when you’ve got it, but'mighty dear when you
haven’t.** “ The Ceramic Decorator ” and the oiher departments are well
filled as usual. The color study is “The Call to Dinner,” by Henry Mosler ; \
In all respects this is an admirable number. (John W. Van Oost, publisher,
23 Union Square, N. Y. C. Price, 35 cents.)

LITERARY NOTES.

The Living Age promises a paper on Robert Louis Stevenson’s Letters, by
Augustine Birrell, in its issue for February lo* There could scarcely be a more
delightful combination of author and subject.

4< The Ghost of Dr. Harris,” a hitherto unpublished sketch by Nathaniel
Hawthorne, will be reprinted in The Living Age for February Io from The
Nineteenth Century .

A series of South African Reminiscr nces, by Sir John Robinson, formerly
Governor of Natal, is begun in 7 he Living Agt for January 27. Natal, from a
womanpoint of view, will be presented in a paper called u Natal Memories,”
by Lady Broome, in The Living Age for February 10.

A b ographical sketch of President Loubet, by Emily Crawford, will
appear in The l iving 4 ge for February 3. It gives an intimate and charming
view of the French President in his personal and family relations.

SANMETTO AS AN INTERNAL REMEDY FOR GENITO¬
URINARY COiNDiriONS.

While fully realizing the suoerfluity of further testimonials concerning a
remedy so well and favorably known to the entire medical p ofe>sion as is
Sanir.etto. yet as I possess an extender knowledge of its reliability based on
*eve»al years* clinical experience and on the treatment of hundreds of cases in
which it has proven itself eminently fiited to lighten the cares pf the genito¬
urinary suigeon, I am perhaps invested with a certain authority which should
permit me the privilege of adding my meed of praise. In all the inflammatory
conditiors cf the genito urinary tract, from the meatus to the pelvis of ihe kidney,
the administration of Sanmetto is invariably beneficial. It not only renders the
urine bland ami umrriiaiing, but abo exeris a specific action on the inflamed
tissues, soothing and restoring the tonicity of the parts. Its tonic action on the
prostate is of such a nature that it proves of equal advantage in cases of either
hyperpla ia or of atrophy, and there is no remedy so uniformly successful in the
treatment of atonic impotency or pie senility. I have found it of inestimable
service in the preliminary preparation of cases requiring surgical interference,
and, combined with salol, use it cunstan ly to secure urinary anti sepsis. I am
fully of the opinion that Sanmetto represents all that could be hoped for or de¬
sired as an internal remedy for genito-urinary conditions.

H. R. Weber, M.D.,

Univ. Md. School of Medicine, 1886,

Member Am. Med. Assoc., etc.

Chicago, III.

CANADA

MEDICAL RECORD

MAROH. 9900

Original Communications.

THE SYSTEM OF TRAINING MEN IN THE
FIRST AID TO THE WOUNDED.

A LECTURE GIVEN BY SURGEON-LIEUT COL. CODD, R. C. D.

TO A CLASS IN “ B” SQUADRON, R. C. D., AT WINNIPEG.

Officers and Non-Commissioned Officers :—

I have been requested by the officer commanding to give
you to-day a lecture on the subject of “ The First Aid to the
Wounded,” but as I lectured pretty fully to you on this parti¬
cular subject last winter, I think I better term my lecture on
this occasion “ The System of Training Men in the First Aid
to the Wounded,” giving its history briefly and a few practi¬
cal remarks on the subject.

The method of attending to the sick and wounded in
the British Army goes back to the year 1745, and even
earlier than that, but in that year Sir John Pringle, then
Surgeon-General, organized a system for Regimental, Field
and General Hospitals. The first appointments of medical
officers and hospitals in the field was in the Peninsular War ;
these were under the control of Sir John McGregor, then
P. M. O.

At this time there were no Ambulance Corps, in fact
the assistance to the wounded in any way must have been of
a most primitive nature. The improvements since, as you
will observe as I proceed, are very great and of a modern
nature.

In 1812 a Corps called the Royal Waggon Train was
organized for conveying the sick, but this was also used for

98

codd: first aid to the wounded.

commissariat purposes, which proved unsatisfactory in regard
to helping the sick, and was consequently disbanded in the
year 1833.

In 1854, at the outbreak of the Crimean War, a Hospi¬
tal Conveyance Corps was organized, which consisted of non-
effective men, such as pensioners, convalescents and servants.
These men, however, were not properly trained and proved
unsatisfactory, and disbanded.

There were other methods tried for the assistance of the
wounded, but none appeared to work satisfactorily. In
1855 the first Medical Staff Corps was organized, but this
again was apparently badly trained for the purpose, being at
the same time employed for general hospital purposes ; this
did not suit the requirements, and was done away with after a
very short trial.

In connection with hospital training and nursing at this
date, I must not omit to mention the valuable services of Miss
Florence Nightingale, who offered her services to the War
Office to proceed with her staff of thirty-eight nurses to the
Crimea and nurse the sick and wounded. Her offer was
accepted. Miss Nightingale and her assistants did most
noble work in relieving the sufferings of the wounded soldiers,
which was recognized throughout England and France by a
subscription of £20,000 to found The Nightingale Home for
training nurses. Miss Nightingale was, I believe,'the first
English lady who entered upon the work of hospital nursing,
which has now become so popular in civil life and hospitals.
This same year the Army Hospital Corps was established as
a complete military organization ; this was the real beginning
of an Ambulance System ; the members were trained for
three (3) months in hospital duties before joining this Corps.
Then in 1858 there was a Royal Commission, under Sir
Sidney Herbert, to report upon the general sanitary state of
the army and re-organize the Medical Service as well as es¬
tablishing a practical medical school for training medical
officers, through which all medical officers had and have now
to pass for appointments in the army.

In 1873 the Regimental System was abolished and
medical officers placed in one department, which system, I

codd: first aid to the wounded. 99

presume, will be thoroughly established in our Dominion
Service in the near future.

In 1883 General and Field Hospitals and Bearer Com¬
panies were established by Lord Morley, and in 1884 the
officers of the Medical Department and the Army Hospital
Corps were termed the Medical Staff Corps.

There is also the British Red Cross Society, an excellent
organization which has for years past done great service in
the wars in South Africa and other campaigns. This Society
has lately permitted a branch to be established in Canada,
which, no doubt, would be of great assistance to us in the
event of any war.

A Volunteer Medical Staff Corps was formed in Eng¬
land in 1886, and is instructed by a staff from the Regular
Service. There is now in London the Volunteer Ambulance
School of Instruction, which is an excellent institution, and
open to any medical officers who desire to qualify in ambu-
ance work.

Then, again, there is also in England the Militia Medical
Staff Corps, which was organized in 1891 ; they are trained
annually and receive pay. The officers rank from Surgeon-
Lieutenant to Surgeon-Major and Non-Coms, to that of
Sergeant.

This I may say is a synopsis of the history of hospital
and ambulance organization.

To be proficient in their duties, I need not tell you, it
is necessary to undergo considerable instruction and training,
which in this Corps involves upon me to teach you to the
best of tny ability and as circumstances from time to time
may permit. In the first instance it is necessary for the
ambulance man to understand something about the anatomy
of the human body, the location of the most important inter¬
nal organs and blood vessels ; this will be taught you by lec¬
tures and illustrations on charts. During the present term I
propose to instruct you on the anatomical outlines of the
human body, the principal organs, the heart, larger blood
vessels, and the circulation of the blood, the lungs and
a brief description of the nervous system. You will require
to know the nature of the principal wounds a soldier is likely

IOO

CODD : FIRST AID TO THE WOUNDED.

to receive, how to dress them and arrest bleeding. Fractures,
how to treat them on the held, bandaging, what to do in
emergency cases, i.e., poisoning and drowning, will be taught
you. These subjects are all instructive to officers as well as
men. I think every officer should know something of how to
act in a case of emergency, and have some knowledge of am¬
bulance work, more especially that which pertains to the
actual work on the field, such as the mode of collecting the
wounded and their conveyance from the field and their dis¬
posal afterwards.

In this particular respect I might first describe briefly
the medical equipment for the field in war time. This con¬
sists of field and stationary hospitals, bearer companies,
ambulances, medical and surgical supplies and appliances
according to the nature of the country, climate and probable
length of the campaign. These would all be collected at the
seat of mobilization under the charge of the P, M. O., who
is responsible to the Surgeon-Major General. The P. M. O.
appoints Surgeons to the different corps or units in the field ;
these have charge and control of the bearer companies and
ambulances placed at their disposal.

At the field hospital there is a staff of medical officers,
the number being in accordance with requirements.

The stationary hospital on the line to the rear and the
general hospital at the base are supplied with the medical
staff proper, and are under the control of the Surgeon-Major
General and the general officer commanding.

The transports necessary for hospitals, hospital supplies
and conveyance of the sick and wounded to or from any dis¬
tance is performed in the British Army by the Army Service
Corps, but in Canada at present we have to depend on other
means,generally local, for this purpose.

From the actual battle field to the base or extreme rear
there is what is called three (3) lines of assistance for the
wounded. The first line of assistance is that of carrying off
the wounded to the collecting station. This is done by a
non-com. officer and bearers under the direction of a surgeon.
This station is placed in as protected a position as possible,
and the wounded receive temporary relief. From here they

CODD: FIRST AID TO THE WOUNDED. IOl

are conveyed by an ambulance or stretchers to the dressing
station, which is placed about 2,000 yards in rear of the fight¬
ing line. Here one or two surgeons, ten men and a cook o r
the Medical Staff Corps are stationed. This constitutes the
first line of assistance. From here the wounded are con¬
veyed by rail or road in Ambulances to the field hospital,
which is placed beyond the range of fire. Here are stationed
an ample number of surgeons and members of the Medical
Staff Corps. This constitutes the second line of assistance .
From this point those who are very severely wounded are
forwarded to the base or general hospital, and others re¬
tained for a temporary time under treatment and sent back
to the front. At the general hospital are the superior officers
of the Medical Staff and others. Medical Boards are held
here, and the wounded are either returned to the front or sent
to their homes or a hospital for their future care.

In this lecture I have endeavored to give you as far as
I can a fairly correct history of the organization of Hospital
and Ambulance Corps, and in the latter part a description of
how to handle and treat the wounded on the field. This is
partly from my own experience and otherwise, which I hope
may be of some use as a guide and help to the inexperienced
who may in the future have to undergo the responsibilities
in field work in the time of war.

PROCEDURE IN POST MORTEM MEDICO¬
LEGAL EXAMINATIONS.

By CHARLES A. HEBBERT, M.R.OP., London, F.L.S.,

Lecturer on Anatomy, Faculty of Medicine, University of Bishop’s College.

Case IV.

The following case is one of presumed abortion, and is of
interest as showing one of the difficulties encountered by
medical jurists—that of deciding whether the death was due
to criminal interference or to natural causes.

The body was that of a female, aged 26 years, 5 ft. 1 in*
in height, hair brown, eyes blue, pupils dilated. The body
was thin and the eyes sunken in the orbits. Rigor mortis

102 HEBBERT : PROCEDURE IN POST MORTEM

was present, and there was some green discolouration of the
abdomen and parietes. There were no marks of external
violence, and the external organs of generation were intact.
A small amount of purulent fluid was escaping from the
orifice of the vagina.

The skull was of medium thickness, butshowed nothing
abnormal.

Brain. —There was some injection of the pia mater, and
the cerebro-spinal fluid was increased in amount. On section
of the brain, the puncta cruenta were marked. The sub¬
stance was firm and apparently normal.

Heart. —The pericardium was normal. The cavities
were distended with black fluid blood, and decolourised clots
were found among the musculi papillares. The edges of
both tricuspid and mitral valves were fringed with small
recent vegetations. The muscular tissue pale.

Lungs. —There were no adhesions and no excess of
fluid in the pleural cavities. The bases of both lungs
shewed pneumonic engorgement.

Peritoneum. —The cavity contained a large amount
of purulent fluid. Both the visceral and parietal layers were
acutely injected and covered by a layer of fibrinous lymph.
This deposit was noticed over spleen, kidneys and liver.
The uterus and appendages were also coated by a similar
diphtheritic membrane, more especially marked on the
anterior surface of the left ovary. It was found on sub¬
sequent examination that a cyst of this ovary had ruptured
externally, the edges being covered by a thick diphtheritic
membrane. This was one of several cysts on the same
ovary, the walls of all being lined by pyogenic membrane.
The right ovary was shrivelled and atrophied.

The walls of the vagina were somewhat rugose, the
mucous membrane soft and swollen, and of a dark red colour,
and covered by a muco-purulent discharge. The uterus
measured 3^ in. long, 2 in. wide, the body being 2 in. long
and cervix 1*4 in. The os uteri was eroded, the mucous
membrane of the cavity was soft, thick and covered by a
blood-stained membranous deposit on its posterior wall, the
decidua, adherent to the extent of about 1 in. in diameter

MEDICO-LEGAL EXAMINATIONS. 103

The fallopian tubes were much distended and filled with
pus.

The stomach was normal internally, containing some
semi-digested food. The outer surfaces, as the other ab¬
dominal organs, showed signs of recent peritonitis. The
mucous membrane of the intestine was somewhat swollen
and softened and injected.

Liver. —Enlarged and fatty.

Kidneys. —Capsules adherent, cortex diminished, shew¬
ing some cysts on the surface; both organs generally con¬
gested and dark in colour.

Spleen.—M uch enlarged and congested.

Bladder —The trigonum was injected, but otherwise
the walls were normal.

The reason for reporting this case is, as before said,
that it is illustrative of one of the most formidable questions
to be answered by a medical jurist, involving as it did in this
case the liberty of a surgeon. The outside evidence was
strong that abortion had been procured, and the post mortem
proved that the woman had been pregnant. However,
there was no sign of injury to the genital organs, and the
death was distinctly due to general peritonitis set up by
pelvic peritonitis, caused by the rupture of a cyst of old
standing which had became purulent. That the infection
had proceeded from the inflammation of the uterus was
very probable, and that the inflammation of the uterus was
the result of a criminal operation was open to strong sus¬
picion ; but, when the question was propounded as to whether
it was directly or indirectly the cause of death, the answer
had to be an uncertain one, corresponding to the Scotch
verdict—Not proven.

Selected Article.

THE HOME TREATMENT OF CONSUMPTION.

By WM. OSLER, M.D.,

Professor of Medicine, Johns Hopkins Uniyersity, Baltimore.

BEAD AT THE SEMI-ANNUAL MEETING OF THE MEDICAL AND CH1BUBGICAL FACULTY
OF MARYLAND AT WESTMINSTER, NOV. 14TH, 1899.

In the city, from the country or from small towns, I not
infrequently see persons with pulmonary tuberculosis whose
circumstances are such that change of climate or life in a
sanitarium is out of the question ; and when we reflect for a
moment on the enormous number of cases of phthisis and the
trifling accommodation offered in sanitaria, the practical
problem whieh confronts us is, how best to treat the 95 per
cent, of cases necessarily confined to their homes. Cannot
these poor victims reap some benefit from the recent ex¬
perience of the profession ?

The usual surroundings of a consumptive are only too
well known to all of us. In a majority of cases the treatment
is desultory, unsystematic and directed to symptoms alone.
It is not too sweeping an assertion to say that of the 8,000
or 10,000 cases of consumption in the city of Baltimore to-day,
few live under a definite regime. Last spring 1 saw in rapid
succession two cases which impressed upon me forcibly the
familiar fact that our theoretical knowledge of this disease
has, as is so often the case, not reached a practical working
basis. In a small house in South Baltimore I saw a young
man, aged eighteen (one of five children), who had had tuber¬
culosis for at least nine months. Nothing could have been
more unfavorable than his surroundings, though the people
were of the mechanic class, and of good intelligence. The
room was stuffy, ill-ventilated, with both windows closely
shut, and the temperature of the room, heated by a small
stove, was nearly 80 0 . He had been in bed for at least
three months, with much cough and a great deal of expectora¬
tion, some of which was visible on the floor, as it did not
always reach the spittoon. He had high fever, loss of ap¬
petite, and was being fed on panopeptone and beef extracts.
The room had a good exposure, and I suggested to the
young man to have the bed removed to the window, to be
well covered up, and to rest in the sunshine during part of

OSLER : HOME TREATMENT OF CONSUMPTION. IOj

every day. The reply was that it would kill him, and I
could see by the mother’s looks that she was of the same
opinion. The doctor, too, I am afraid, regarded me as a
fanatic. In the same week I saw a similar picture in a differ¬
ent setting, a young girl who had been in bed for many
weeks, with high, irregular fever and a rapidly-progressing
disease. I could see that the suggestion of an open-air course
of treatment was extremely distasteful, but she was induced!
to go to the Adirondacks, where she has done very well.

Arrest or cure of tuberculosis is a question entirely of
nutrition, and the essential factor is so to improve the resist¬
ing forces of the body that the bacilli cannot make further
progress, but are so hemmed in that they are either prevented
effectually from breaking through the entrenchments, or, in
rare cases, they are forced to capitulate and are put to the
sword. Of the measures by which the general nutrition of
the body may be encouraged and improved, the first and most
important is:

Fresh Air. —For more than two centuries the clearer-
headed members of the profession have known that an open-
air life sometimes cures a case of phthisis. One of the earliest
and most interesting cases of this kind is reported by John
Locke, the philosopher, in his “ Anecdota Sydenhamiana.”
“Mr. Lawrence, Dr. Sydenham’s Nephew after a fever fell
into a Cough, & other signs of an incipient Phthisis, (the
Morbific matter being violently translated in upon his Lungs)
and at length the Diarrhoea colliquativa came on: then ye
Dr sent him into ye Country on Horseback, (tho he was soe
weak yt he could hardly walk) & ordered him to ride 6 or 7
miles ye first day, (wch he did) aud to encrease dayly his
Iourney as heshd be able, untill he had rid 150 miles: When
he had travelld half ye v/ay his Diarrhoea stopt, & at last he
came to ye end of his Iourney, & was pretty well (at least
somewhat better) & had a good appetite ; but when he had
staid at his Sister’s house some 4 or 5 days his Diarrhoea came
on again ; the Dr had ordered him not to stay above 2 days
at most; for iff they stay before they are recovered this spoils
all again ; & therefore he betook himself to his riding again,
and in 4 days came up to London perfectly cur’d. The same
course hath ye Dr. put others upon, especially in Pulmonick
Diseases, & wth ye like Success when all things elce had faild
him : & he was not ashamed to own yt he was fain to borrow
a cure from this way now & then when he found himself
puzzled with some lingering Distemper not reducible to a
common & known (sic) Disease.”

This reminds one of Dr. H. I. Bowditch’s description of

I06 OSLER : HOME TREATMENT OF CONSUMPTION.

the ride which did him so much good when as a young man
he was supposed to have lung trouble.

The quality of the fresh air in our large cities may not be
very good, but it is the best a large proportion of our patients
can possibly get to breathe, and it is a great deal better than
the atmosphere of the overheated, ill-ventilated rooms in
which a majority of them live.

I give the following directions : Take the almanac and
•count off the hours of sunshine. In winter cut off two hours
in the morning and an hour in the evening, and for the rest
of the day the patient is to be out of doors. If there is no
possible arrangement for life out of doors, the patient is to be
■in a room with a southen exposure with the windows wide
open. The bed is to be moved into the sunshine. If there
is a balcony or a veranda with a good outlook towards the
south, it should be arranged for the patient; if not, a sheltered
protection can be put up in the yard at a very moderate cost.
On a well-padded lounge, covered with a couple of thick
blankets, well wrapped up, the patient sits or reclines all day,
coming in only to attend to the calls of nature. Only on
blustering, stormy or very rainy days is the patient to remain
in the house. No degree of cold is a contraindication. This
continuous open-air life, at rest, is the most powerful influence
we possess to-day against the fever of tuberculosis. It may
take a month, it may take two or even three months before
the temperature reaches normal, but it has been one of the
many valuable lessons which we have learned from Dr.
Trudeau, that in the fever of consumption the patient should
not only be out of doors, but at rest, taking no exercise. The
bedroom of the patient should be thoroughly ventilated, and
the patient should be accustomed gradually to sleep with the
window open.

Secondly Food .—The stomach controls the situation in
pulmonary tuberculosis. In any long series of cases the
patients who do well are those who can take plenty of food.
An important cause of the lack of appetite and feeble digestion
is the persistent fever, and we often find that as the tempera¬
ture falls the appetite improves. It is easy to lay down rules;
very hard to carry them out. Each case must be dealt with
■separately, but as large a quantity of food as possible should
be given. Overfeeding or stuffing, when possible, should be
practised, and the patient should be encouraged to pay as
little attention to his subjective gastric sensations as possible.
We rarely can carry out the autocratic, cast-iron method fol¬
lowed at Nordrach, which insists that a patient who has
vomited a meal shall, nolens volens, eat another very shortly

OSLER: HOME TREATMENT OF CONSUMPTION. 107

of the same character. For some time I have been urging
the patients to accustom themselves to taking raw eggs, be¬
ginning with one three times a day, and increasing one a
week until they took, if possible, twenty or twenty-four daily.
For the hyperalimentation this is probably the simplest and
most satisfactory diet. It has been carried out with marked
success by Dr. Ely, of Rochester, who literally prescribes
eggs by the dozen. Broken into the egg-cup, sprinkled with
a little pepper and salt, the egg can be readily swallowed
without breaking the yolk. It is most important to get the
patient accustomed to taking the natural foods. Milk and
cream and butter, meat and eggs and oysters should consti¬
tute the main part of the diet.

The medicinal treatment of cases may be divided into—
first, the use of stomachics, bitter tonics and certain digestives ;
secondly, remedies such as codliver oil, hypophosphites and
creasote, the benefits of which are chiefly in promoting
general nutrition, and, thirdly, remedies for the relief of cer¬
tain symptoms, as cough, pain, night sweats, etc.

In December last a young woman came to me from one
of the towns in the State with well-marked tuberculosis.
Her grandmother and two of her father’s brothers had died
of consumption. She had a cough off and on for three years,
and for more than a year she had a great deal of fever, had
lost very much in weight and had had profuse night sweats.
She never had had any vomiting. When I saw her she had
high fever (temperature 103 0 ), and there were signs of ex¬
tensive disease at the right apex—flattening dullness on
percussion with resonant rales as low as the fourth rib. There
were signs of involvement of the right apex behind, and
there were a few crackling rales at the apex of the lower lobe
on the left side behind. She was short of breath, and looked
thin and pale. Her weight was 109 pounds. I gave her
directions such as I have indicated, and she has given me a
brief statement in her own words of her progress in the
eleven months. She writes as follows (November 10): “ When
I begun treatment, the first day I sat out was December 11.
1898 ; don’t know just how cold it was, but could see the
river from our porch and they were skating. In winter
usually had breakfast about 8 and went outdoors about 9.
When I begun was not well enough to walk much, was so
short of breath ; after sitting out for some weeks would walk
up and down porch an hour before sitting down. I spent a
good deal of my time reading ; became so interested in my
book at times forgot how cold it was. The first two weeks
I took three eggs a day, one at 10 a.m., another at 3 and an-

108 OSLER: HOME TREATMENT OF CONSUMPTION:

other before going to bed ; then six a day, two at a time;
and continued to increase till I got up to fifteen a day ; con¬
tinued that number for two months or more, then took twelve
a day for three months, then nine. For breakfast I had oat¬
meal and cream and toast, or small piece of beefsteak and
coffee ; dinner at 12, drank one glass of milk and ate any¬
thing that was on the table in the line of meats or vegetables
(provided I liked them); seldom if ever eat desserts. Went out
immediately after dinner and remained there until sundown ;
more eggs at 3 and supper at 6; another glass of milk, and
with that a small piece of meat, as a rule, and bread. Eggs-
again at 9. and go to bed between 9 and to. Wassittingout
one day when the thermometer registered 10 0 below zero.
When it felt like snow or rain remained indoors. I kept this
up till the weather was warm and then went driving, took
eggs along and stayed out in country till dinner time ; drove
out again late in the evening, and after my return home would'
sit out till after 10 o’clock. When I begun treatment had
bad cough, expectorated a great deal and no appetite. The
cough began to get better, and after about four months I
coughed very little; now, so rarely and expectorate so very
seldom that it is hardly worth mentioning. When I consulted
you last December wiighed 109 pounds; now tip the scales
at 132 pounds. I have improved steadily and gained in flesh-
gradually from the above date.”

This very practical story illustrates what could be done
by many patients, Lasc spring I happened to be in the town-
in which this girl lived, and I fortunately thought of her and
paid her a visit. She lived in a small two-story house, with-
a narrow balcony on the first story behind, and here at half¬
past eleven one morning I found her carefully wrapped up.
She looked a different girl, and the report indicates that she
has done remarkably well. At the time of my visit she was-
without fever, but there were still numerous moist rales at the
right apex.

Since writing the above I have seen this patient (December
1), who looks remarkably well, has a good color, is free from-
fever, has no cough, no expectoration and weighs 133 pounds.
Luckily I dictated a note on the condition of the lung at the
time of her first visit, otherwise I should not have believed
the extent of the change. The resonance is still impaired,
the flattening is marked beneath the right clavicle, the breath
sounds are harsh, the expiration prolonged, but there are
only a few dry crackling rales on coughing or on deep¬
breathing. There were no signs at the apex of the lower lobe
of the left lung behind.

MEDICINE AND NEUROLOGY.

IO9

Two additional points of interest may be mentioned. She
has not had a doctor, and she has not had a dose of medicine
except an occasional dose of paregoric for the cough. She
took creasote for a short time, but afterwards gave it up.
shortly before she visited me her physician died, and I did
not know, until my visit to her, that she had not been under
any professional care. She could not have done better had
she been at the Adirondacks under Dr. Trudeau.

A rigid regimen, a life of rules and regulations, a domi¬
nant will on the part of the doctor, willing obedience on the
part of the patient and friends—these, with the conditions we
have discussed, are necessary in the successful treatment of
pulmonary tuberculosis .—Maryland Med. Journal.

Progress of Medical Science.

MEDICINE AND NEUROLOGY.

IN CHARGE OP

J. BRADFORD McCONNELL, M.D.

Associate Professor of Medicine and Neurology, and Professor of Clinical Medicine
University of Bishop's College; Physician Western Hospital.

EARLY RECOGNITION OF PULMONARY
TUBERCULOSIS.

Knopf.* The negative result of the examinations of the
sputum has little or no significance, since the tubercle bacilli
appear in the expectorations only after disintegration of the
tubercles has taken place. The use of Koch’s tuberculin as a
diagnostic aid is not without its dangers. This procedure
sometimes causes an unexpected generalization of the latent
disease, with fatal results. The etiology plays quite an im¬
portant role. Man is more disposed to consumption than
woman; the poverty-stricken more than the wealthy; accord¬
ing to some, red-haired individuals more than those having
blond, brown or black hair. Vocation, age, heredity, asso¬
ciations, previous ailments, are all important points to be
noted in the anamnesis. Coughing spells brought on by a
mere change of position, or by an extra respiratory effort,
hemorrhages, slight or profuse, persistent elevations of tem¬
perature, increased through exercise, loss of weight, are sus¬
picious symptoms. Murat describes, as an early symptom,
the recognition on the part of the patient of a vibration of the

Jour A. M. A., Dec. 9,1899.

IIO PROGRESS OF MEDICAL SCIENCE.

affected portion of the lung during loud and vigorous talking.
Attention must be paid to the upper air passages. Papillon’s-
examinations with the Potain sphygmomanometer showed
that an arterial pressure less than 13 cm. frequently indicated
incipient tuberculosis. Chief stress is laid upon the physical
examination, inspection percussion and auscultation. The
agglutination process has not, in the hands of the author,
yielded very satisfactory results, though he predicts for |it
better results upon perfection of the technique .—Medicat
Review.

LA GRIPPE.

GlLCREEST.* La Grippe is a contagious, infectious
disease caused by a specific germ first described by Pfeiffer in
1892. The disease is air-borne and propagated mainly
through human intercourse, as has been proven by numerous
epidemics in prisons, barracks, etc. The pathologic lesions
presented by uncomplicated la grippe are of a character
common to all infective diseases, i.e., parenchymatous degen¬
eration of various organs. There are three distinct forms of
lagrippe: 1. Simple without complications. 2. Complicated
with serious pulmonary affections. 3. Complicated with
digestive and nervous symptoms. The complications are
innumerable, including affections of the eye, ear, lungs, pleura,
heart, genito-urinary tract, etc. Farson has observed an in¬
crease in the number of cases of appendicitis during grip
epidemics. The author reports two cases of the severe ner¬
vous type, both of which are recovering. We have no specific
for la grippe, so that each case must be treated symptomati¬
cally with reference to the complication. “ To allay pains and
soreness and restore free elimination from the skin, kidneys
and intestines, are the indications which should guide us in
our therapeutic applications .”—Medical Review .

A NEW METHOD OF TREATMENT WITH
MERCURY.

A. BLASCHKO.’f’ On the theory that mercury, when
applied to the skin, finds its way into the organism through
the process of inhalation, Blaschko undertakes to reach
this end by a specially prepared mercurial preparation,
which does not have the disadvantages of the grey salve.
The preparation is a sort of cotton cloth, which is impreg-

• four. A. M. A., Dec. 9, 1899.

+ Berl. klin. Woch., Nov. 13, 1899.

MEDICINE AND NEUROLOGY. Ill

nated with a 90 per cent, mercurial salve. This is called
mercolint The material is so well prepared that no trace
either of the salve or of the mercury can be observed.
Shirts are made of this material, which the patient wears next
to the skin day and night. When the shirts become white,
which takes about four weeks, the mercury has all been ab¬
sorbed. These garments can be made of varying strength
up to 50 per cent, mercury. The author has used this means
of giving mercury in his clinic for some time with gratifying
results. The advantages of this method over the inunction
cure are obvious. Especially is it advantageous in small
children and babies, pregnant women, etc. Such shirts can
be worn for many months, and would save the patient re¬
peated inunctions cures, with all their discomfort and dis¬
advantages .—Medical Review.

DRY HEAT OF HIGH DEGREE AS A THERA¬
PEUTIC AGENT.

C. E. SKINNER* has employed dry heat, up to 500° F.,
in the treatment of various diseases. The apparatus used
and the exact method of its application are fully described,
together with the report of a number of cases showing the
mode of procedure in each affection. He has found that
hot air is a pain-relieving agent of unequaled value in those
conditions where its application is indicated and possible,
because of its constant effectiveness, rapidity of action, and
the absence of deleterious after-effects. In rheumatism its
action is so profound in connection with judiciously chosen
drugs that it may almost claim a positive curative power
of its own, and may be said to be the most powerful con¬
tributory agent we know. It is capable of stimulating
tissue repair to a remarkable degree, as is demonstrated by
its effect upon sprains. It is capable of influencing most
happily septic inflammation of serous membranes, as shown
by its action in peritonitis and pleurisy. It will many times
at least give us the power of economizing nervous energy by
relieving pain and other more or less dangerous conditions
in pneumonia, thereby enabling us to refrain from sedatives
and cardiac stimulation, and thus save for the patient ner¬
vous energy, which will sometimes be sufficient to tide him
over a crisis by which he would otherwise be overwhelmed.
The addition of hot air to our armamentarium will enable us
to increase by a large percentage the sum total of our power
over disease .—Medical Review.

* N. Y. Med. Jour., Oct. 28, Nov. 25. Dec. a and 9,1899.

112

PROGRESS OF MEDICAL SCIENCE.

TREATMENT OF TAPEWORM BY USE OF

MORPHINE INJECTED INTO THE PRO¬
TRUDING PART OF THE PARASITE.

By J. w. BUMS) M<D«t
Editor Iowa Medical Journal t Keokuk, Iowa.

The attempt at removal of tapeworm by any of the
taenicides is followed by a large number of failures which,
by the method which I have used in two recent cases, might
be converted into successes.

It is a very common occurrence for the parasite under
such circumstances to drop down into the lower part of.the
intestine and reattach itself with the sacrifice of a consider¬
able portion of its caudal extremity. I have sometimes been
able, by copious injections of water or saline solutions, to
bring away the head of the worm, but far more frequently
have I succeeded only in breaking off the worm.

Recently it occurred to me, while attempting to remove
one of these pests, fiften feet of which were visible and ten
feet invisible, that I might take advantage of the latter por¬
tion by properly medicating the protruding part. I there¬
fore, after tying a string moderately tight around the worm
about three inches below the patient, injected above the
string, directly into the substance of the worm, one-half grain
of morphine ; the protruding part was then evered w h
scissors just below the ligature, and the three or four inches
remaining were passed up through the sphincte
there about ten minutes.

A large injection of water was then given, and the upper
portion of the worm passed entirely montionless and ap¬
parently dead.

Since reporting this case in the Iowa Medical Journal
I have treated one other case the same way, and with the
same results.

Most varieties of tapeworm have a pair of longitudinal
vessels passing from one extremity to the other, through all
the segments, and toxic substances injected into the body of
the worm are taken up by them and reach every portion of
the parasite.

The mistake is often made of simply prescribing some
remedy with directions for the patient to use. Only a small
percentage of successes can thus be expected.

The only proper method of treating tapeworm is about
as follows :

The patient does not fast or have any preparatory
treatment whatever, except that he eats no breakfast on the
morning of the day of treatment. At about 9 a. m. he is
given a dose of infusion of pomegranate, or what is far

MEDICINE AND NEUROLOGY.

1 13

better, of tannate of pelletierine, with one or two drops of
croton oil. The patient should be kept at rest, generally
under the personal observation of the physician, for two or
three hours, when movements of the bowels will most likely
occur and the whole or part of the worm be passed. If only
a part protrudes, then the hypodermic should be used as
above described.

LACTATION IN A MALE INFANT.

G. M. Blair reports the case of a boy with highly de¬
veloped mammae as large as a walnut. Pressure caused milk
to exude. The external genitals were normal except that
only one testicle appeared in the scrotum. The child’s
general condition was bad, and he suffered from vomiting and
emaciation.

REMOVAL OF A HAT-PIN FROM THE STOMACH.

J. Halliwell reports the case of a woman, aged sixty
years, who accidently swallowed a hat pin about four and a
half inches long. It was removed by abdominal section four
days after. Operative details and recovery were without
unusual features.

THE PREVENTION OF HAY FEVER.

Dr. Alexander Rixa, a noted physician of New York,
has contributed an article to the Journal of the American
Medical Association upon the Prevention of Hay Fever,
which just at this time ought to be of much interest to
our readers. The practical part of the paper is the pro¬
phylactic treatment of the nasal passages of those subject
to this recurrent disease. About two weeks before the
ordinary time of attack the patient must begin with some
antiseptic, and Dr. Dixa believes that Hydrozone, a most
inoccuous and powerful germicide, being three volume of
peroxide of hydrogen, is best. To begin with he uses in
the proportion of 1 to 12 sterilized water, increased to the
strength of 1 to 4. In mostobstinate'cases, when there is still
some irritation in the nasal cavity, I give as an adjuvant the
following prescription:

R Acid borax, gr. xx.

Menthol, gr. iv.

Glyco-thymoline, 3 ij.

Sol. eucain B. 4 per cent., q. s. ad sij.

Sig. Use in atomizer.

As a rule this treatment was sufficient to subvert the
disease and keep the patient in comfort.

SURGERY

IN CHARGE 07

ROLLiO CAMPBELL, M.D.,

Lecturer on Surgery, University of Bishop's College ; Assistant-Surgeon, Western Hospital ;

AND

GEORGE FISK, M.D.

Instructor in Surgery, University of Bishop's College ; Assistant-Surgeon, Western Hospital

SOME PRACTICAL NOTES ON DISEASES OF
THE RECTUM.

L. H. Adler, jr., refers briefly to some practical points
in the consideration of some of the forms of rectal diseases.
Congenital malformations of the anus and the rectum occur
often enough to justify attention being called to the necessity
for every new-born child being carefully examined at the
time of its birth. In the treatment of suppurative process
in the neighborhood of the rectum, poultices should be
avoided and the affected parts laid freely open as soon as the
formation of the abscess is recognized, even before pus is
present. In all cases of fistula in ano it is to be remembered
that the sinus may be the result of a stricture of the rectum,
and the usual treatment directed for the relief of the fistula
will not result in a cure. A digital examination of the
bowel will usually prevent such an error being made. In
cases of fistula the internal opening in most cases is to be
found between the two sphincter muscles and not higher in
the rectum. In the treatment of fissure of the bowel the use
of opium should be avoided ; the best remedy is iodoform,
preferably in the form of a ten-grain suppository, of which
one should be carefully inserted into the rectum half an
hour before an expected movement of the bowels and
another immediately after the passage has occurred. All
hemorrhoids do not require operative interference; in the
formative stage frequent ablutions of the part with cold water
will allay, if not abort, inflammatory tendencies of the veins,
which otherwise finally lead to piles. Operation should not
be postponed until the acute inflammation has subsided ; it
is when the patient is suffering that consent will be most
readily obtained, and it is owing to such advice that patients
finally drift into the hands of quacks.— N. Y. Med. Jour .,
Medical Review.

SURGERY.

1 15

FOR THE REMOVAL OF FOREIGN BODIES
FROM THE NOSE AND EAR.

Sturrock (.British Medical Journal, November 25, 1899,
p. 1473) recommends the following mode of procedure : The
presence and approximate situation of the foreign body
having been ascertained, a piece of india-rubber tubing,
rather less in diameter than an ordinary lead-pencil, varying
in length from one to three inches, and attached to the
nozzle of a brass syringe, is introduced into the nostril or
meatus, as the case may be, and brought into contact with the
foreign body. The piston of the syringe is then pulled out
for a sufficient distance to create a vacuum in the tubing,
and thus to draw the foreign body into or against its free
end. The syringe is then withdrawn and with it the foreign
body attached to the tubing. In some cases it has been found
advantageous to dip the tubing into glycerin before insertion,
in order to diminish the chances of air entering between the
tubing and the foreign body.

DEVICE FOR WASHING OUT THE PELVIS OF
THE KIDNEY.

L. B. Tuckerman,in the Cleveland Medical Gazette for
July, 18^9, has devised a simple method of irrigating the
pelvis of the kidney. It consists of a No 6 French catheter,
an ounce bulb, and a common exploring aspirator with the
ordinary three-way stop cock, all connected by rubber tubing.
The catheter is introduced in the ordinary manner through
the Kelley speculum. It is necessary to use a stylet in the
catheter, passing the catheter up as far as possible without
force, then withdrawing the stylet a couple of inches, passing
the catheter farther, and so on, until the pelvis of the kidney
is reached ; then by exhausting the contents of the pelvis
of the kidney, they can be drawn into the bulb and inspected.
From the amount of fluid which is drawn into the bulb we
may judge of the capacity of the pelvis of the kidney. If
pus, and it be deemed advisable to wash out the kidney, the
bulb can be detached from the catheter, filled with boracic
acid solution or such other disinfecting fluid as the practi¬
tioner may deem best, and, by reconnecting and reversing the
stop-cock, the fluid can be injected into the pelvis of the
kidney, again withdrawn, until, as in washing other cavities,
the fluid comes away clear. To medicate the pelvis of the
kidney, the bulb can be filled with the proper quantity of
medicament, which in its turn is forced into the pelvis of the
kidney where it is left by the withdrawal of the catheter.

This device the author has used recently in the case of

1 16 PROGRESS OF MEDICAL SCIENCE.

a woman afflicted with pyelitis, with the right kidney plainly
palpable. The right ureter was occluded, or nearly so. In
two sittings he succeeded in passing a catheter up to the
pelvis of the kidney, and in the third sitting dilated the ureter
to No. 8 French. From the pelvis he exhausted an ounce
of pus, washed with boracic acid as above described, and
filled the cavity with a one-per-cent solution of ichthyol. At
the next sitting the ureter was found unobstructed and the
capacity of the cavity of the pelvis of the kidney reduced to
about three drachms. The patient is a hopeless case so far
as a cure is concerned, as microscopic examination of the
pus from both ureters shows tubercular bacilli, but she was
improved after the washing out of the kidney. In a case of
pyelitis of gonococcal origin, it seems rational to treat the
pelvis of the kidney by flushing.— Medicine.

GOITRE.

It has been my opinion for some years past that iodine
alone was the essential medical remedy for the removal of
such goitres as could be influenced by medicine, and with
this idea in mind I have, during the last four years, treated
three-fifths of my cases with iodine and two-fifths with the
thyroid preparation, and have found in thirty thus treated
that the patients who received the iodine improved more
rapidly than the others, and during the last three months
my patients have been taking iodine, only accompanied by
tonics as required. Few of them can take iodine steadily for
many weeks, without showing evidence of weakness; slight
anaemia is likely to follow, with increased rapidity of the
heart’s action ; often slight dyspnoea and headache with
diminution of bodily weight. The prescription is as follows :

• R Iodi (crystals). gr. ij.

Pot. iodid . gr. iv.

Spir. vini rect. 3 i.

Syr. simplicis.. 3 i.

Aquae destill. 3 ij.

M. S. A teaspoonful in a wineglassful of water one hour
after each meal time.

After about two weeks, sometimes from the beginning, an
iron tonic is given ; and, if the patients are weakening rapidly,
strychnine combined with calisaya and iron, the iodine being
discontinued fora week or two at a time. After three weeks
there is usually a perceptible difference in the size of the
goitre. In six months many of the goitres disappear, others
are reduced to from one-half to one-eighth their original size.
—Frederick G. Schaefer (Journal of the American
Medical Association , November 25th).

SURGERY.

II7

THE EARLY DIAGNOSIS OF TUBERCULAR
JOINT DISEASE.

L. W. Ely, in the Medical Record of December 16, 1899,
says that the late recognition of tubercular disease of a joint
is comparatively simple, but an early diagnosis is essential if
the case is to be cured with a return of function. In no class of
disease does the axiom that the eyes should be used first and
most and the hands last in diagnosis apply so well as in these
affections. A good history is needed also in arriving at cer¬
tainty in diagnosis. Tubercular disease is usually character¬
ized by gradual development, and the beginning cannot be,
as a rule, definitely fixed. With slight ameliorations it
gradually grows more severe ; there is frequently a history
of trauma. Pain and stiffness are two important symptoms.
Pain is rarely located in a certain spot, but in indicating it
the hand is usually passed over a certain region. It is worse
on motion, and is apt to come in paroxysms at night, when
the muscles holding the joints quiet are relaxed. Stripping
the patient is of the utmost importance ; this rule knows no
exception in men and children, and in women it should be
modified but slightly. Next, the attitude should be observed,
then the deformity and change in contour.

The joints most liable to tubercular disease in the order
of frequency are the spine, hip, knee, ankle, elbow, wrists,
and shoulder. This study is based on 453 cases of tubercular
joint disease observed at the Vanderbilt Clinic between
January 1, 1895, and January 1, 1899. The history of these
cases was negative in 309, in 76 heredity is not mentioned,
but in 68 a positive tubercular family history was obtained.
Sacroiliac disease, of which much has been written, is very
rare ; but one case appears on the record of the Vanderbilt
Clinic for four years. The author considers the symptom¬
atology of tuberculosis in the joints.— Medicine.

THE WAYS OF TREATING GONORRHEAL

JOINTS.

It will be admitted by most physicians and surgeons
that the treatment of gonorrhea! joints is most unsatisfactory.
The diagnosis is not always clear, but practitioners of ex¬
perience will generally bear out the assertion that the sudden
development of inflammation in a single joint, if accompanied
with a urethral discharge, or even if the latter has been for
some time suppressed, is sufficient to induce a strong pre¬
sumption of the specific character of the inflammation. Two
lines of treatment seem to offer fair results. One is strictly

IlS PROGRESS OF MEDICAL SCIENCE.

surgical, and consists of immediately opening the synovial
membrane under, of course, the most approved antiseptic
precautions, allowing the joint to drain, or, if necessary,
washing out the joint cavity, providing it is infected.
Another is that recommended by Christian Heath, who im¬
mediately places such patients in bed, applies belladonna and
glycerine freely to the affected joint, and gives quinine in five-
grain doses every six hours. He does not use splints, and
pays no attention to the urethral discharge .—Medicai Review.

OBSTETRICS.

IN CHANCE CF

H. Ii. REDDY, M.D., L. R. C. P., London,

Professor of Obstetrics, University of Bishop’s College; Physician Accoucheur Womens
Hospital; Physician to the Western Hospital,

PRECOCIOUS MENSTRUATION.

E. Perier mentions a child which began to menstruate
regularly at 9 months of age. When seen three months after
menstruation commenced, the breasts were well formed,
nipples protruding, pubes covered with hair, and labia ma¬
jors and minora well developed.

HYPEREMESIS GRAVIDARIUM.

Dirmoser believes that auto-infection from the intes¬
tinal tract is the usual cause of hyperemesis, and that the
etiological importance of hysteria is largely over-estimated.
He refers to the similarity of post mortem changes in hypere-
mesis and acute infection. Urinary analysis shows an increase
of indol, skatol, and other products of retrograde metabolism,
also albumin, acetone and peptone. Organic structural
elements are found in the urine, indicating a nephritis.
There exists an individual predisposition, probably owing to
the abnormal condition of the in'estinal canal. The best
treatment for this obstinate and often serious complication of
the pregnant state would be intestinal antisepsis, and the
author states that the results obtained from such treatment
will be published at a later period.

AMNIOTIC INFECTION BEFORE RUPTURE OF
THE MEMBRANES.

I.ehmann reports a case of undoubted infection of the
liquor amnii before rupture of the membranes. A thick and
extremely fetid fluid escaped as soon as they were artifi¬
cially punctured.

OBSTETRICS.

119

SEPSIS AS A CONTRIBUTORY CAUSE OF
PUERPERAL INSANITY.

Brush, American Med. Quarterly , limits his paper to the
consideration of insanity of the puerperium. Numerous statis¬
tics show that of cases of insanity in asylums, some six or seven
per cent, date from insanity of the puerperal period proper.
However, many of these cases come from psychopathic stock,
childbirth acting only as an exciting cause. If heredity is one
fundamental attribute, Brush appears to believe that sepsis is
the other ; that is, whenever hereditary can be excluded, we
must look upon the case as having had a septic causation.

Obstetricians of by-gone generations, such as J. Y.
Simpson and George T. Elliot, were believers in the toxic
origin of puerperal mania, which is not very remote from
the idea of sepsis. The most striking document in favor of
the sepsis theory is brought forward by Chapin, the
alienist, who states that since the introduction of antisepsis
in midwifery, there has been an enormous falling off in the
number of cases of puerperal mania. A similar falling off
has been reported from several insane asylums, although no
such decline was observed at the McLean Asylum, in
Somerville, Mass. The writer finds that the type of delirium
exhibited in most cases of puerperal mania agrees with that
form which accompanies intoxications. This is especially
true of the early weeks of the disease. A case is given
in which the mental symptoms are shown to be rather of
the nature of the delirium of acute infectious diseases with
its lucid moments, its noisy incoherent ravings, auditory
and visual hallucinations, together with the quick pulse, dry,
brown tongue, sordes, etc. The condition, however, goes on
indefinitely, while always preserving something of the stamp
of simple delirium..— Obstetrics.

TRANSMISSION OF STREPTOCOCCUS FROM
MOTHER TO THE FETUS.

Bonnaire reports two such cases. In the first the
mother was suffering from erysipelas at the fifth month of
pregnancy. The membranes had been ruptured three days
and putrid liquor amnii was discharging. The fetus was
expressed and died forty-eight hours later. Cultures of its
blood showed the streptococcus only. In the second case
the mother gave birth to a dead child just before she suc¬
cumbed to cerebro-spinal meningitis. Autopsy showed pus
over the cerebral and spinal meningitis, and exactly the
same lesion in the fetus. Cultures from both showed strep¬
tococci cultures of the blood were negative.

120

PROGRESS OF MEDICAL SCIENCE.

TUBERCULOSIS AND PREGNANCY.

Lambinon ( Journ . ctaccouchements. Sept. 24, 1899) gives
a brief compilation of the present state of our knowledge of
this association. In 1895 Charrin insisted that the toxins in
a pregnant woman suffering from an infectious disease would
necessarily affect her progeny ; this being especially true of
tuberculosis and pneumonia. Children born under these
circumstances gain in weight very slowly.

However, the fact has been cited that in orphan and
foundling asylums hereditary tuberculosis (which in theory
ought to occur more frequently than in children of the living),
does not cause an increase in the natural morbidity of chil-
hood in general.

But it is undeniable that now and then a case cf un¬
doubted congenital tuberculosis is reported. Lehmann,
Doleris, and Bourges and others have published well-
attested cases of this sort, explicable by no other hypothesis
than intrauterine infection.

Bar and Renon, Schmorl and Birsch and others have
found bacilli in the blood of the umbilical vein in cases in
which the mother was in a moribund condition from tuber¬
culosis.

Lambinon, however, looks upon such cases as medical
curiosities and exceptions which proved the rule. Practically
the child of tuberculous ascendants is not exposed to the
action of either the bacillus or its toxins. It may inherit a
delicate organization, such as would readily fall a prey to
tuberculosis, but that is all. A child born of a tuberculous
mother should be separated from her immediately after its
birth.

NURSING BY ALBUMINURIC WOMEN.

P. Budin and Chavane have observed five albuminuric
women immediately after delivery and four during the
months following labor. All of these nursed their children
without any unfavorable results to the infants themselves.
The albuminuria frequently disappears rapidly, and in any
event does not delay convalescence.

OBSERVATION ABOUT SORE NIPPLES.

According to Platzer sore nipples are caused through bit¬
ing and pulling, during the piocess of nursing. The best
treatment of fissures are applications of carbolic acid solu¬
tion. Ulcerations should be washed with corrosive sublimate
solution and dusted with dermatol. In mastitis nursing

OBSTETRICS.

12 I

must be interrupted, the breast compressed and ice bags
applied. Among 1000 nursing puerperae in Kermarsky’s
clinic, sore nipples were observed in 51.5 per cent.

PROPHYLAXIS OF ECLAMPSIA.

Knapp emphasizes the fact that eclampsia appears often
in quasi-epidemics—1. e., there are occasions upon which, for
some unknown reason, this affection is much more prone to
occur than otherwise. Our prophylaxis, however, is restricted
to cases which exhibit edema of the eyelids, skin of abdomen,
vulva, legs, etc., and in which albuminuria is present. There
are certain cases in which these gross features are absent,
and in which there is only a persistent malaise ; such cases
may lead up to an “ eclamptic aura ” and convulsions. In
the classes just enumerated, then, we have definite pro¬
phylactic indications.

But there are other cases in which everything appears
to be progressing favorably toward a successful parturition.
Suddenly there set in headache, nausea, vomiting and
gastralgia. There is a general sense of discomfort, psychical
excitability, and a train of nervous symptoms which herald
the early appearance of convulsions. To foresee a possibility
of eclampsia in cases which are devoid of advance signals, a
careful testing of the retina and field of vision should be
undertaken.

Broadly speaking the prophylaxis embraces avoidance
of psychical disturbances, avoidance of dietetic errors, and
protection from exposure. To secure these ends we must
insist upon rest in bed (complete), exclusive diet of milk with
diuretic waters (lithia), alvine evacuations secured artificially
if necessary. To secure diuresis we must be prepared to
resort to the salt solution. If there are actual renal lesions,
as shown by the presence of marked edema, hot baths and
the hot pack are indicated. As eclampsia is synonymous
with convulsions we can no longer speak of prophylaxis
after the first convulsive seizure has occurred.— Obstetrics .

TREATMENT OF PUERPERAL INFECTION.

A. W. W. Lea draws the following conclusions from a
series of 48 cases. A rise of temperature over 101.4 during
the puerperium, not obviously accounted for by other causes,
should lead to a thorough examination of the genital tract.
If no explanation is found, a uterine douche should be at once
given. If the temperature falls definitely within twenty four
hours, no further explanation is necessary. If, on the other

122 PROGRESS OF MEDICAL SCIENCE.

hand, the temperature remains high, and the pulse rate has
increased, the cavity of the uterus should be explored with a
sterile finger. When the initial temperature is great (103
or over) the uterus should be explored at once. When
clots or placenta are discovered, they should be removed by
the finger or curette, a douche given, and a gauze drain in¬
serted for twenty-four hours. There is no evidence that
curettage, if done with every precaution, favors the spread of
infection. In a large proportion of cases the infection is
rapidly checked. When there is a very virulent infection
early curetting affords the best chance of a successful result.
If curettage entirely fails, it must be repeated or not, accord¬
ing to the local conditions present. The prognosis, however,
is bad. In some cases if curettage fails, and there is no
evidence of general peritonitis or infection of the blood,
vaginal hysterectomy, if performed in good time, may be
successful. Anti-streptococcic serum should be given early
and freely in cases of proved streptccocci infection. It is of
little use in the advanced stages of the disease.

THE TREATMENT OF THE VOMITING OF PREG¬
NANCY AND PHTHISIS BY OXYGENATED

WATER.

Gallois (Sem. Med) has used oxygenated water in the
vomiting of pregnancy for the last three years, and has had
only two cases where it failed to cure. This treatment has
no effect on ordinary gastric vomiting, but Bonnel has had
excellent results with it in the vomiting of tuberculous
patients. It is doubtful how it acts; partly, perhaps, by
giving up its oxygen, and partly by neutralising the toxic
properties of some ptomaine.

INFLUENCE OF PREGNANCY UPON THE

TEETH.

Terrier states that caries is more rapid in its advance,
that the sensibility and friability of the teeth are increased,
that their chemical composition is altered during pregnancy.
These changes are caused by gingivitis of pregnancy, alter¬
ation of saliva, acid regurgitations from the stomach, general
modifications in the digestive and in the urinary apparatus
and increased excitability of the nervous system due to
pregnancy. He urges careful cleansing of the teeth and
treatment of caries and gingivitis early in pregnancy, while
the daily care of the teeth should be continued through
pregnancy and lactation.

Therapeutic Notes.

Scarlet Fever.

J. Lewis Smith recommends the following “diaphoretic,
diuretic # and laxative” mixture for scarlatinal nephritis:

R Potassi acetatis
Potassi bicarbonatis

Potassi citratis, aa. 5 ii

Infus. tritici repentis. ad. 3 viii

A teaspoonful every three or four hours for a child of
five years.

Whitla gives the following diaphoretic mixture for the

early stages of scarlet fever:

R Spiritus stheris nitrosi. 3 ii

Potassi citratis. 3 i

Liq. ammon. acet. 5 iss

Syrupi simplicis... 3 i

Aqus camphors, ad. 3 iv

M. Sig. A teaspoonful every three hours.

Widerhofer recommends the following for scarlet fever,

with throat affection:

R Potassi chloratis. gr. xx

Syrupi aurantii. 3 iii

Decoct, cinchons, ad. 3 iii

M. Sig. A teaspoonful every two hours.

Throat Spray.

Whitla uses the following spray for the throat in scarlet

fever:

R Glyeerini boracis . 3 iv

Glycerini acid, carbolici. 3 iii

Aquae rosae, ad. 3 x

Skin Lotion.

J. Lewis Smith recommends the following lotion for the
itching of the skin in scarlet fever:

R Acidi carbolici. 3 i

Tinct. camphors. 3 ii

Aqus purs. O i

M. Sig. Shake well, and apply over surface when
needed for pruritis.— your. Am. Med. Association.

1 24 JOTTINGS.

To Cure Itch in Two Hours.

R Sulphur . 3 ounces

Quicklime. 6 ounces

Aquae. 2 pints

Boil till combined, then allow to cool and settle ; de¬
cant and keep hermetically sealed.

Sig. Rub with soft soap for half an hour, then take
tepid bath for half hour. Then apply solution and leave on
for quarter hour, then take bath.— Med. Age.

Dr. Whitla, in the Therapeutic Review , says that one of
the best combinations in the treatment of baldness con¬

sists of:

R Pilocarp. hydrochloratis. gr. v

Otto rosae. njj viij

01. rosmarini. 3 iv

Linimenti cantharidis. 3 iv

Glycerini puri.. gj

01. amygdalae dulcis. . 3 ij

Spts. camphorae. . g iij

M. Sig. To be rubbed well into the scalp, night and
morning.

Hebra’s Corn Cure.

R Acid salicylici. gr. 15

Ext. cannabis indicae. gr. 8

Alcohoiis. "K 14

Aitheris . . tijj 40

Collodii fix.. nj; 75

M. Sig. Paint on thrice daily for one week; then
soak the foot in hot wattr and pick out the corn .—Medical
Record.

Jottings.

Chloride of sodium is strongly recommended by Perkins,
who claims to have used it in every case of ringworm that
has come under his obser* ation for the past sixteen years,
and in no case did it fail to give relief. In one of these the dis¬
ease had been of five years’ standing, and the cure only took
three weeks. The chloride of sodium in fine powder is
rubbed up with vaseline to make a moderately stiff oint-

JOTTINGS.

125

ment The affected part, if covered by hair, is shaved, and
the ointment is thoroughly rubbed in night and morning.
In a few days the part becomes inflamed, after which a
simple emolient is applied. Two daily applications of the
ointment for three or four days is usually sufficient to de¬
stroy the parasite over the area to which it is applied. The
simplicity of this method makes it particularly desirable,
and it would be interesting to know if other observers reach
similar results. There is a possibility that in our search for
new and rare chemicals as antiseptics that we are overlook-
ng some efficient and well-known older remedies.

The following method of treating chlorosis was ad¬
vocated by Sir Andrew Clark. With careful attention to
the diet and a tepid sponge bath, followed by brisk toweling
night and morning, he prescribed the following mixture:

R Ferri sulphatis. gr. xxiv.

Magnes. sulphatis. 3 vj.

Acid, sulph. aromat. 3 j.

Tinct. zingib. 3 ij.

Infus. gentian, comp, vel quassias q. s. ad. 5 viij.

M. Sig. One-sixth part twice daily, about 11 and 6
o’clock.

Occasionally this acid mixture produces sickness, dries
the skin and is otherwise ill-borne. In such cases he pre¬
scribed the following alkaline mixture :

R Ferri sulphatis. gr. xxiv.

Sodii bicarb. 3 ij.

Sodii sulphatis. 3 vj.

Tinct. zingib. 3 ij.

Spt. chloroformi. 3 j.

Infus. quassiae q. s. ad. § viij.

M. Sig. One-sixth part twice daily, at 11 and 6
o’clock.

Sometimes neither mixture agrees with the patient, in
which case he prescribed sulphate of iron pill with meals, and
a saline aperient on first waking in the morning. By this
plan Clark held that nine out of ten cases recovered in from
one to three months, and by careful attention to the bowels,
taking twice a week a pill composed of aloes, myrrh and
iron, the recovery probably would be permanent.— Practi¬
tioner.

126

JOTTINGS.

The Medical Press and Circular says; “ When there is
a frequent desire to pass water in elderly or nervous women,
or it runs away in the act of coughing, sneezing or laughing,
it is generally due to want of power in the vesical sphincter.
In such cases the tincture of cantharides will be found of
the greatest service if given in small doses of one minim in
water three or lour times a day.”

Indirect Cause of Cough.— The Charlotte Medical
Journal gives the timely advice: “ Always search well for
the cause of a cough. There are frequently cases of chronic
cough which have resisted all the usual remedies at the
hands of the physician, and which he in desperation prac¬
tically gives up when he advises the patient to change
climate or take a long sea voyage, when, if greater care were
taken in searching for the cause by the process of exclusion,
he would cure his patient. The relaxed or elongated uvula
is a frequent cause. Stringy tenacious mucus hanging from
adenoids in the naso-pharynx is a great cause in children.
Not infrequently foreign bodies in the external meatus are \
responsible; this reflex cough is readily demonstrated by
passing a probe along the floor of the meatus, which will, as
a rule, cause a tickling in the throat. An otitis media dis¬
charging pus through the Eustachian tube into the pharynx
is not to be lost sight of. Hypertrophy of the lymphoid
tissue at the base of the tongue constituting the lingual
tonsil when it presses upon the side of the epiglottis or the
anterior pillar of the pharynx is a cause of cough not often
thought of.”

Enuresis. —Dr. M. G. Price ( Louisville Jour. Surg.
and Med.) claims to have had much success with this rebel¬
lious trouble, and gives below one of the remedies used by

him:

R Tinct. belladon. gtt. v

Ext. ergot fluid... gtt. x

Tinct. nucis vom. gtt. v

M, Sig. Repeat four times a day.

Boric Acid Sugar for Thrush.— Escherich states
that the promptest and most effective method of curing
thrush and cleansing the mouth is to put a little boric acid
and saccharin on a sterilized rag and give it to the infant to
suck.— Jour. Am. Med. Association.

THE

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price , $1.00 per annum in advance . Single
Copies , io

Mike all Cheques or P.O. Money Orders for subscription, or advertising, payable to
JOHN LOVELL it SON, St. Nicholas Street, Montreal, to whom all business oommiv
nieations should be addressed.

All communications for the Journal, books for review, and exchanges, should be
addressed to the Editor, Box 2174, Post Office, Montreal.

Editorial.

MEDICAL OFFICERS AND THE CANADIAN

MILITIA.

The various Infantry Battalions forming the Canadian
Active Militia, up to the present time, consist of from four
to eight companies, with one or two of ten companies. The
strength of the eight company Battalions is in the neighbor¬
hood of three hundred and sixty-eight of all ranks ; one, how¬
ever, viz., the 1st Prince of Wales Fusiliers, has an authorised
roster of six hundred and sixty eight. These facts at once
show that they are all skeleton Battalions, with a compli¬
ment of officers sufficient to run it. when made up to its war
strength of one thousand men. The regimental system of
medical officers has been, and practically is, the one now
followed. A Surgeon-Major and a Surgeon-Lieut. or Cap¬
tain appeared on the strength of each Battalion up to 1894,
when Major-General Herbert, in making up the establish¬
ment list, dropped the Junior-Surgeon as unnecessary.
This action was resented by Commanding Officers, as being
injudicious, as it removed an officer who contributed to ex¬
penses, which unfortunately are high. When Major-General
Gascoigne assumed command of the militia this Junior

12 o

EDITORIAL.

Medical Officer was replaced—but without pay—unless in
camp„ and then he was to do duty only at alternate
camps. There is no doubt that alone, regimental medical
officers are inadequate for the duties required during a period
of active service in the field. Great Britain found this out
during the Crimean War, and the Army Medical Depart¬
ment, now the Royal Army Medical Corps, was the result of
this experience. There were, and are, peculiar difficulties to
be faced in our Canadian Militia, and though, as we will
shortly show, a change will soon come, it will be, and per¬
haps wisely, in a modified form. To Lieut.-Col. Neilson,
Director-General Medical Staff, to which position he was
appointed rather more than two years ago from the Royal
Canadian Artillery, is due a scheme which has much to com¬
mend it. He contemplates forming Bearer Companies at all
the large garrison depots, with field hospitals on the line of
the British service ; also a medical staff. He, however,
retains the Senior Surgeon, but removes the Surgeon-Lieut.
from the regimental strength, and gives them the option of
joining the medical staff, with a rise in rank. All others
joining take rank as Lieutenants, with promotion after a
stated service. Under ordinary circumstances, such astrength
is amply sufficient for all camp duties. The embodiment of
the active militia is, however, with a view of having a nu¬
cleus ready for augmentation on a declaration of war. Within
a few weeks after such a declaration, we should have in the
field a force of at least one hundred thousand men or more.
For such a force the proposed scheme would, we feel sure,
prove utterly inadequate. It may be argued that if war ever
takes place in Canada, it will be due to an imperial cause,
and, as we would be joined by a large imperial army, so
would the direction of medical matters come under the Royal
Army Medical Corps. But events in South Africa have
proved that this corps is very weak in numbers, and quite
inadequate to perform the duties it has been called upon to
perform. Forty years ago the British Army and Militia
Medical Staff together numbered about 1,350 officers, and at
the moment they have sank to under 900. This has been
largely brought about by allowing the Militia Regimental

EDITORIAL.

129

Surgeons to disappear, by death and age retirement. That
process has gone on so steadily that, from a former total of
about 250 Militia Regimental Medical Officers, they have
sank to a poor remnant of 24, most of them well on in years,
and naturally soon to follow their retired brother officers. The
result of this condition of things is, now that Britain has made
a heavy call on her militia, the Government find themselves
without their former Militia Regimental Medical Officers;
and with the Army Medical Corps fully occupied, is unable
to assign few or any of them to Militia Battalions. The
result of this condition of things is, that a host of civilians are
being recruited, so to speak, to take their place. A similar
state of things exists at the seat of war, where nearly two
hundred civilians are now employed. Any one who has had
any experience of military life knows that the duties of a
Military Medical Officer cannot be learned in a few weeks.
Moreover, military medical duties are a species of specialty,
and while the civilian medical man is learning them, the
corps to which he is attached suffers in no small degree from
th is want of knowledge. Army officers well know that in
any campaign the civilian element becomes a great source
of weakness. We readily admit that a unified medical
service has conserved force and thereby lessened expenditure,
but it would seem as if the theory has been carried to such
an extreme in practice as to strike at the root of the efficiency.
The present war in South Africa has exposed the evil, and
the day of reckoning has arrived. British medical men are
loudly clamouring, both for a large increase of the Royal
Army Medical Corps and a possibleVevival of the Regimental
Militia Medical Service, or a combination of both. The
lesson which we in Canada should draw from the present con¬
dition of the British Medical service is, that we should have
at our hands, for use when wanted, a large body of medical
officers. With this object in view, we would suggest that the
Junior Medical Officers of Battalions be not dispensed with.
We believe it would be good policy to retain them, while the
Bearer Companies, Field Hospitals and Medical Staff be
formed as intended, the whole strong enough to perform duty
with a force of one hundred thousand men in the field. The

130

EDITORIAL.

expense of retaining the Junior Regimental Medical Officer is
a mere bagatelle, and should not for one moment be considered
when the greater efficiency their presence would ensure is taken
into account. In the formation of the Bearer Companies and
Field Hospitals, Canada has been too slow. It is now
within a month of two years since Director-General Neilson
announced the scheme we have alluded to, and with the ex¬
ception of at Halifax nothing has been done. The late
General Officer commanding the militia, Major-General
Hutton, conceived the insane idea of establishing Bearer
Companies out of medical students at the various medical
schools in Canada. Had he consulted some who could have
given him good advice before taking the preliminary steps
towards their formation, his scheme would have been spared
the inglorious fiasco which met it. Had Director-General
Neilson’s programme been promptly put into action we
might have been able to send one or two Bearer Companies
and Field Hospitals to South Africa, where they would have
been quite as welcome as are the magnificent fighting
material from Canada now there and en route. No contingent
from the colonies has done more notable and valuable work
than the Bearer Companies and Field Hospitals from
Australia.

THE WAR IN SOUTH AFRICA.

The following extract from the British Medical Journal
of 24th February, written by Clinton T. Dent, of the Con¬
sulting Staff of Surgeons, will be read with much interest:

Penetrating Wounds of the Head.

Bullet wounds actually penetrating the skull and some
portion of its contents are numerous enough, and constitute
at first sight the most remarkable cases met with in the
military hospitals. First, with regard to the effects on the
skull itself : The range will, as is well known and as has been
determined experimentally, greatly influence the amount of
injury inflicted on the bone. Unfortunately reliable informa¬
tion can very seldom be obtained on this point. All who have
read the accounts of the engagements near the Modder River

EDITORIAL.

131

and at Colenso will recognise that the men can have had but
a vague idea of the range at which they were hit. At Colenso,
for instance, scarcely a Boer was seen, and there were tiers
upon tiers of entrenched positions. Usually the shortness of
the range is much exaggerated ; 250 yards is a common
estimate. There is no doubt, however, that the Highland
Brigade at Magersfontein were shot down at extremely close
quarters. Judging by the results of the experiments made
with modern small-bore rifles in England and Germany, the
bulk of the head injuries seen in hospital have been inflicted
at medium ranges, say 400 to 800 yards. This is really what
we should expect, for at close quarters the amount of damage
caused by a a penetrating wound of the head is so extensive
as to be probably fatal.

The more obliquely the bullet enters the skull, the greater
will be the amount of damage to the inner tables. If the
apertures of exit and entrance are both at a right angle to
the plane of the skull, both wounds may seem to be cleanly
drilled through the bone, and are scarcely to be distinguished
by external inspection. But in all cases the inner table will
be more or less broken up at the aperture of entrance ; and
if the skull is trephined there will be no doubt whatever as
to the direction of the wound. Even in a long wound frag¬
ments of bone may be found lying along the greater part of
the track. In not a few instances where trephining has been
done at the front a second operation has been found necessary
at the base, and much loose bone removed.

At very short ranges the skull may be burst open to a
greater or less extent in the manner which has been shown
experimentally to take place. Thus in Colonel Stevenson’s
work on Gunshot Wounds a skull is figured into which a small •
bore bullet had been fired at a distance of few yards. I have
not the work by me for reference, but believe the distance
was ten yards. The skull is seen to be most extensively frac
tured. The specimen is in the Museum at Netley to the best
of my recollection.

The observations made above relate to the calvarium, and
instances may now be cited bearing out the foregoing remarks.

I have to thank the surgeons for permission to give the fol¬
lowing sketches of the cases under their charge. Frequently
the patients as they are moved from field to base hospital or
on to hospital ships have been under the care of several
surgeons, and it is impossible to communicate with all. More¬
over often—too often indeed—the patients are shifted about
in the base hospitals, and it is far from easy to follow out a
particular case without giving much trouble to the much over-

132

EDITORIAL.

worked administrative staff. The following are examples of
injury at close range :

Private D., wounded at Modder River on December ioth,
1899. Entrance wound 2^ inches behind right parietal
etninence in a line drawn between that eminence and occi¬
pital protuberance. Exit through frontal bone in right side
close to longitudinal sinus. The bullet traversed at least
6 inches of brain tissue. The left arm was completely, and
the left leg partially, paralysed. There was evidence of
fracture of the base on both sides. Sanious discharge from
both ears and deafness. The fissure seemed to split the skull
in two in the vertical plane. A large flap connecting the two
bone wounds was turned down and the skull trephined on the
inner side of both the exit and entrance wounds. Many
fragments of bone were removed from dura mater, and also
blood clot and damaged brain matter. The scalp wound
united at once, save over the anterior crown of trephine,
where it was healing by granulation (on December 27th), and
where there seemed to be some tendency to hernia cerebri.
The deafness improved rapidly, and the discharge from the
ears, at first abundant, soon ceased. On December 27th he
could hear well ; no facial paralysis. The leg had recovered
power to a very considerable extent, but, as usually happens,
the footdrop was almost complete. The arm was still com¬
pletely paralysed. His memory and mental condition generally
were practically normal. Recovery seemed probable. Further
notes of this case are promised. Probably the cortex was
not damaged by the fragments of bone, but the motor areas
of the arm and leg were damaged by the track of the bullet
passing close beneath the cortex.

In another case of wound at undoubted short range the
bullet entered close to the longitudinal sinus in the occipital
vein, possibly even wounding it, and passing out through
the frontal bone, traversing several inches of brain matter.
The skull was trephined in front of the posterior wound, and
it was found that a fissure connected the apertures of entrance
and exit. Fragments of bone were removed and brain
matter. Free haemorrhage necessitated plugging the wound
posteriorly, but it was not certain that the haemorrhage came
from the longitudinal sinus. Forty-eight hours later the
bleeding recurred on the removal of the plug, and it was
replaced. Thenceforward rapid recovery’. The wound was
received on December 15th, and a month later the power
had almost entirely returned in the arm and to a great extent
in the leg, but there was still marked footdrop. The mental
condition was altogether satisfactory.

EDITORIAL.

133

THE APPENDICITIS QUESTION AGAIN.

The New York Medical Review of December 30, 1899,
says:

“To operate, or not to operate, in appendicitis ” is still
one of the absorbing questions of the hour. The physician
proper still leans favorably to the expectant plan of treat¬
ment, while the operator urges removal of the appendix in
all cases as being the only method of cure. The surgeon,
however, weighs the pros and cons for operation in each case,
and governs his action accordingly. Of course each patient,
and every attack of appendicitis, must be considered as an
entity, and no steadfast rules can be set down to govern all
cases. Certain clinical facts have been demonstrated so often
in the course of this affection that broad lines of action may
be formulated upon them. Briefly stated these are as fol¬
lows :

1. As we can never tell from the nature of a previous
attack c f appendicitis what will be the character of the next
seizure, or when, if ever, it will occur, a patient who has had
one mild attack should have this clinical observation clearly
stated to him, and the decision for or against operation left
with him. If a patient has had more than one attack, the
probability of a recurrence is much stronger, and the surgeon
may even urge an operation in the interval, the burden of
responsibility, in case of refusal, being placed upon the
shoulders of the patient. Under this head belong all those
cases in which, after the subsidence of the acute seizure, the
parts apparently return to their normal condition. Should
adhesions of the appendix to neighboring structures have
occurred, which in themselves cause pain and interference
with the general well being of the individual, there would
exist a further indication for surgical interference.

2. If, during the course'of an acute inflammation of the
appendix, there is manifested a distinct tendency to a regres¬
sion, we may safely wait for the subsidence of the attack,
and then consider the patient as outlined above. Such
regression is determined by careful observation of the triad
of symptoms, which in relative importance are : (a) Pulse

*34

EDITORIAL.

rate ; ( 6 ) local pain and rigidity of the abdominal muscles ;
(c) temperature elevation. If the pulse rate steadily declines
and the other two symptoms become less marked, the inflam¬
mation is regressing, and operative attack can be deferred.

3. But if there is a distinct progression as indicated by
an increasing rapidity of the pulse, and more marked local
pain and rigidity, irrespective of temperature elevation,
operation is urgently demanded.

4. Absce?s cavities call for immediate careful evacuation.

5. General peritonitis demands immediate operative in¬
terference, except when the general condition of the patient
forbids a formidable procedure. Such latter patients do
better if treated expectantly, and often enough these des¬
perate cases improve, and then their subsequent surgical
treatment depends upon the local condition.

These general principles of action will be found to govern
• the vast majority of cases. But one must never forget that
appendicitis does not always run a typical course, and in the
atypical cases the internist and the surgeon both must rely
on their past experiences to enable them to decide for or
against operation.

FIRST INTERNATIONAL CONGRESS OF MEDI¬
CAL DEONTOLOGY OR MEDICAL ETHICS.

This Congress will assemble on July 23rd next in Paris.
The first meeting will be held at the Palace of Congresses
and Social Economy, situated within the Exhibition grounds.
Subsequent meetings will be held at the Faculty of Medicine,
12 Rue de l’Ecole de Medicine, Boulevard St Germain. The
Congress will continue one week. It is divided into four
sections, before which will be discussed all or practically all
subjects which pertain to the Congress. Great Britain is
taking an active interest in this meeting. Canada has, of
late years, taken but little inteiest in what we may term
“ Medical politeness,” but it is hoped that Canadians, who
propose to be at the main International Congress in the
first week in August, will reach Paris in time to attend the
one on Ethics. Their presence would enable them to learn
how this subject is viewed by British and continental medi-

editorial;

135

cal men. If the views which may be promulgated meet with
their endorsement they subsequently might be presented for
adoption by our various Canadian Medical Societies. Cer¬
tainly the subject is one which commends itself to the older
members of the profession, especially in our larger cities,
where now-a-days medical ethics is rarely heard of, and but
little acted upon. The managers in Paris are making every
endeavor to arrange for the comfort of those attending, and
the Secretary has sent out circulars recommending agencies.
These undertake for very moderate prices to obtain rooms in
advance, from 6 francs per day up, and to meet the member
of the Congress at the station on arrival, look after the trans¬
port of the baggage to the lodgings, afford interpreters and
so on. Such, for example, are the Agence Desroches, 21
Rue du Faubourg Montmartre ; La Soctete des Voyages
Duchemin, 20 Rue de Grammont; Voyages Pratiques, 9 Rue
de Rome and the Voyages Modernes, Rue de L’Echelle, No.
j, Paris. All these different agencies are strongly recom¬
mended by the officials of the Congress.

Dr. J. G. Adami, of Montreal, is the member for Canada
of what is called “The Committee of Patronage.”

THE MINISTER OF MILITIA.

It must be a source of pride to all Canadian Medical men
that a medical man—the Hon. Dr. Borden—who is Minister
of Militia, has proved so efficient in the working of his depart¬
ment, in connection with the various contingents which
Canada has sent to the war in South Africa. Few could
have done as well, and certainly none better. The first con¬
tingent, collected as representative of our Militia from the
Pacific to the Atlantic Ocean, sailed from Quebec fourteen
days from the date of the issue of the first order for its forma¬
tion. We can form an idea—from this promptness—how hard
the Minister must have worked, and how ready for an
emergency is his department. We hope to, in time, see
some official recognition of this work. In the meantime, he
may be assured that the country and medical profession
recognize the splendid work he has done.

136

EDITORIAL.

Dr. Mayrand, of St. Andrew’s, died early in March at an
advanced age. He graduated from McGill College in 1847.
He was for many years the Surgeon of the nth Batt. (Argen-
teuil Rangers), and never missed going to camp with it, where
he often filled the position of Principal Medical Officer. He
retired in 1898 with the rank of Lieut.-Colonel. Dr. May¬
rand was an enthusiastic loyalist and militia officer. He was
a most genial companion, and was beloved by all who knew
him.

Dr. Albert Edward Senkler died at his home in St.
Paul, Minnesota, on the 10th of December. He graduated
at McGill University in 1863. He was a native of Brock-
ville, Ont., where the interment took place-

The British Medical Journal of January 24 says: “We
are informed that there is a movement on foot in Edinburgh
v/hich has for its object to procure for Dr. Osier, Professor of
Medicine in Johns Hopkins University, Baltimore, a call to
the chair of the Practice of Physic in the University of Edin¬
burgh rendered vacant by the death of Sir Grainger Stewart.”

Her Majesty the Queen has conferred the honor of
Knighthood upon Dr. Thomas Lauder Brunton, F. R. S.

PERSONALS.

Dr. illiara Osier (M.D., McGill, 1872) has been elected an
Honorary Member of the Royal Academy of Medicine of Ireland.

Dr. F. R. Wainwright (M.D., McGill, 1898), and lately one of
the Resident Medical Staff of the Montreal General Hospital, has
left Charlotte, North Carolina, and gone to England, with a view
of entering on practice there.

Dr. Norry Worthington, of Sherbrooke, has gone to South
Africa as Surgeon of C Battery, Royal Canadian Artillery.

Dr. Keenan, M.D., McGill, 1898, and lately one of the House
Staff of the Roytl Victoria Hospital, has been appointed Surgeon
of the Strathcona Horse, and sailed with it for South Africa on the
17th March.

Dr. Sutherland (M.D., Bishop’s, 1899), late House Surgeon
Western Hospital, has left for Great Falls, Montana, to act as
Assistant to Dr. Longtway (M.D., Bishop's, 1886.)

Book Reviews.

Histology and Pathology. By John B. Nichols, M.D.,
Demonstrator of Histology, Medical Department Columbian
University, and F. P. Vale, M.D., Assistant in Pathology,
Medical Department University of Georgetown, Washington,
D.C. In one handsome iamo. volume of 452 pages, with 213
illustrations. Cloth, $1.75 net . Flexible red leather, $2.25
net . Lea Bros. & Co., Pniladelphia and New York.

This work is the newest of Messrs. Lea’s excellent series of
pocket text-books, and illustrates the growing tendency to break
down the barrier between student and practitioner. Text-books
used to be written for students alone, for practitioners were
supposed to be done with books forever.

Another valuable principle recognized in this work is that
pathology, for the most part, is only histology gone astray. The
two are here included between one set of covers in a moderate
compass of less than five hundred small and well printed pages,
and all very attractive to the eye and to the hand.

No attempt is made to explain in words what can only be
learned in the doing, that is to say the book is not “ practical,”
because no book can be practical since practice is an affair of the
hand. It does contain, however, in a convenient form a good
statement of the observations and results acquired by hand¬
workers in both of these subjects, indeed everything which it is
lawful for a student or practitioner to know. Nor are the higher
problems in pathology left untouched, for there is interesting men¬
tion made of fever, immunity, susceptibility and other phenomena
of a like obscure nature.

The authors, Dr. Nichols and Dr. Vale, set for themselves a
definite task to present the essential facts of histology and pathology
in a concise and systematic way. They have insisted upon arrange¬
ment and convenience more than upon originality, and laying
aside disputed doctrines in pathology they have succeeded in pre¬
senting these two subjects in a concise and attractive way to those
who may require to learn them for the first time, or who may after-
wards desire to refresh the memory.

An illustration which illustrates nothing is of no value; if it
misrepresents, it had better be omitted. Many of the illustrations
fall in one or other of these classes. Some of the photographic
reproductions, especially of the nervous system, are as meaningless
as those in an English medical journal, and many of the drawings,
such as those of the intestinal ulcerations, take up much space with
no adequate benefit. The drawings and diagrams in the histology
section are really illustrative and illuminating. Last of all, the
book being designed for the pocket, it would be in harmony with
this design if the thirty one pages of catalogue at the end were
given up to something more immediately useful than a list of
Messrs. Lea’s publications, excellent as all these publications are.

A. M.

138

BOOK REVIEWS.

Operative Surgery. —By Joseph D. Bryant, M.D., Professor
of the Principles and Practice of Surgery, Operative and Clini¬
cal Surgery, University and Bellevue Hospital Medical College ;
Visiting Surgeon to Bellevue and St. Vincent's Hospital; Con¬
sulting Surgeon to the Hospital for Ruptured and Crippled,
Woman's Hospital, and Manhattan State Hospital for the Insanef
Vol. I. Seven Hundred and Forty Nine Illustrations, Fifty o.
which are Colored. New York, D. Appleton and Company,
1899. Price $5.co, Cloth. Sold by subscription.

This volume is a more than ordinarily excellent one. The
reviewer has for years used the second edition as a constant work
of reference, and has for some time been looking forward to the
appearance of the present (third) edition, w r hich the author has
entirely recast so that it would conform to the Surgery of to-day.
While the second edition, at the time of its publication, was unex¬
celled, the third, now to hand, is in every way superior to it.

The author's experience of twenty years' teaching of anatomy
and surgery is presented to the reader in such an explicit style that
the perusal of the various chapters is most pleasing, and in no
sense wearisome. The rapid strides made by Surgery in the last
few years has compelled the author to enlarge the work, thus neces¬
sitating the issuing of two volumes instead of one, as formerly. This
fact proves that the various subjects have been fully covered. The
subjects considered in this volume include general principles,
anaesthetics, antiseptics, control of hemorrhage, treatment of oper¬
ation, wounds, ligature of arteries, operations on veins, capillaries,
nervous system, tendons, ligaments, fasciae, muscles, bursae and
bones, amputations, deformities, and plastic surgery.

Everything is simplified and rendered clear ; details are well
explained, and technique is thoroughly elucidated, thus making the
comprehension of operative surgery a comparatively easy matter.
One of the special features of this work is the very thorough man¬
ner in which it has been illustrated, many of the figures being
colored. T his renders great service in making it possible to, with
ease, mentally grasp and fix the details of the many and complicated
operations. Taken altogether the work will prove invaluable as an
instructor to the student and a reliable guide to the operating
surgeon. The printing, paper, binding and execution of the illus¬
trations are of the best. We predict for the work a large sale.

R. C.

Essentials of Diseases of the Skin. By Henry W. Stel-
wagon, M.D. W. B. Saunders, Philadelphia. J. A. Carveth
& Co., Toronto.

The growing importance of skin diseases is well known, and
the arrangement in this book of questions and answers is of great
value to both practitioner and student; more so to the latter, as
it is of great help to those going in for examination on the subject.

The illustrations are very good, and the work has been care¬
fully prepared and fulfils the intention of its author.

J. M.J.

BOOK REVIEWS.

139

The International Text Book of Surgery. By Amer¬
ican and British authors. Edited by J. Collins Wa r ren, M.D.,
LL D., and A. Pearce Gould, M*D., F.R.C.S. Publishers, W.
B. Saunders, Philadelphia. J. A. Carveth & Co., Toronto, Ont.
The first volume of this splendid work, devote i chiefly to
general surgery, is certainly a credit to the editors, and again
demonstrates that the ever-widening field of surgery is best treated
by several authors. The body of the text is in large clear type,
supplemented by numerous short paragraphs in smaller type
where the subject matter is not so important—an excellent system
enabling the reader to review a subject more rapidly. The illus¬
trations and colored plates are numerous and good. The treat¬
ment of the various subjects is essentially modern, and antiquated
theories and methods are not rehearsed to the detriment of the
more satisfactory ones of to-day. The chapter on the technic of
asep'ic surgery is very good, showing as it does the reaction from
unnecessarily elaborate methods to a simple yet most complete
method. The treatment of ^ach malady is very fully considered
and must be most helpful. It is a work equally, beneficial to
student and practitioner as a complete modern reference work.

G. F.

A Practical Treatise on Materia Medica and Thera¬
peutics. By Roberts Eartholow, M.A., M.D., LL.D.
Pp. 866. D. Appleton & Co., New York, 1899. Tenth edition,
revised and enlarged.

Of Bartholow's work, which has been before the profession now
for twenty-three years, there is little new to say. The author, as
evidenced by this tenth revised edition, still writes as clearly and
succinctly as ever. To one reading the volume for the first time,
it is a marvel of compactness and completeness, with a welcome
absence of discussion, which, valuable as it may be to the ad¬
vanced pharmacologist, is irritating and confusing to a student
and unsatisfactory to the general practitioner. It is essentially a
practical work. Of the classification nothing need be said, it is
practical; and as no classification of drugs that is practical is per¬
fect, or being perfect is practical, it is perhaps as good as any,
although Cushny’s, of Michigan, based on that of Buchheim and
Schmiedeberg, of Strassburg, is perhaps preferable. The section
on alimentation is excellent, and brief enough to be easily carried.
Its vast importance merits its position in the book. An extended
review is impossible with the space at my disposal, but I am rather
surprised to see the chloride of iron and chlorate of potassium treat¬
ment still retained for diphtheria, while the subject of antitoxmes
is dismissed with three pages, and the statement that ‘a candid
survey of the whole field constrains him to say that the practical
outcome is short of the success which seemed warranted by the
pretentions put forward by the original promoters. 1 If this refers
to the whole field of diseases known to be of microbic origin, the
statement is, in our present stage of experiment, unfortunately
largely true, but the brilliant results in two or three diseases augur
well for ultimate success in others. Coming from a recognized

140

BOOK REVIEWS.

authority it is apt to convey a wrong impression to the student,
and I should be sorry to think that the labours of a Schaefer, Roux,
Pasteur, Ehrlich, Koch, von Riich and others had reached their
limit. A noticeable feature, which, while I do not think com¬
mendable, will be found very useful by the commencing prac-
tioner, is the frequency with which prescriptions are met with all
through the book. Under the heading Electricity—Public Supply—
the author mentions two forms of current available from public
mains—the arc and incandescent; this is probably a slip, as the
terms refer to the style of lamp and not the curient—what was
meant probably was the alternating and direct current. The former
is now used almost exclusively for both arc and incandescent
lighting, motor work, galvano cautery, etc. There is no mention
of the sinusoidal current.

Altogether, the book is a valuable aid to the study of an
intricate, intensely interesting, but much neglected subject. The
printing and binding are in the Appletons* usually perfect style,
but why do the ophthalmologists not rise up in their wrath and
insist on a dull-finished paper with a uniform black type, instead of
the polished rt fleeting surface with spider type that is at present
ruining the eyesight of thousands of readers? R. W.

Annual and Analytical Oyclopaedia of Practical
Medicine. By Charles E. de M. Sajous, M.D., and one
hundred associate editors, assisted by corresponding editors,
collaborators and correspondents. Illustrated with chromo¬
lithographs and maps. Volume IV. The F. A. Davis Co.,
Publishers, Philadelphia, New York, Chicago, 1899.

This Annual , we may again inform our readers, is arranged
on a plan quite different from anything heretofore issued. It will
be complete only in six volumes, two of which are coming out
annually. All the matter is arranged alphabetically, so that it is a
work to consult on any specific point rather than for the reading of
the diseases of any particular class or system. Thus, diseases of
the nervous system will be found scattered all through the six
volumes, and covering a period of three years before the subject
will be dealt with in full. When complete it will be a valuable
work of reference, as the articles are very exhaustive and well
written. Among the hundred sub-editors are the names of the best
writers in Europe and America, which insures reliable and author¬
itative treatment of the various subjects.

The text proper is printed in large type, and references from
the literature of the last 4 or 5 years is interspersed in smaller
type. Numerous and well-executed illustrations, coloured and
otherwise, add to the usefulness of the Annual.

Besides this volume a monthly journal is issued to subscribers,
which keeps the reader abreast of all recent progress, and these
bound, become valuable additions as references to the regular
volumes. We learn with pleasure that this Annual is receiving
warm approbation and extensive support from the profession. It
will prove a valuable book of reference for writers, teachers and
practitioners. J. B. McC.

BOOK REVIEWS.

141

The Nervous System and its Constituent Neurons —

Designed for the use of practitioners of Medicine and of students
of Medicine and Psychology. By Lewellys F. Barker, M.B., Tor.,
Associate Professor of Anatomy in the Johns Hopkins Univer¬
sity and Assistant Resident Pathologist 10 the Johns Hopkins
Hospital. With two colored plates and six hundred and seventy-
six illustrations in the text. New York, D. Appleton & Co.,
1899.

This is undoubtedly one of the most valuable contributions to
neurology which has appeared during the century, containing as
it does all the recent advances, sifted and comprehensively arranged,
in one neat volume, covering some eleven hundred pages Readers
of the New York Medical Journal will be familiar with some of the
contents of this work, notably the introductory chapters. These
articles appeared at intervals during two years from 1897. The bulk
of the book, however, is new material. “ In the first part of the
volume the newer conceptions of the histology of the central and
peripheral nervous organs are reviewed. In the succeeding chap¬
ters the attempt has been made to apply the neuron conception
—that is the cell doctrine—as consistently as possible in the ex¬
planation and description of the complex architectonics of the ner¬
vous system.”

The subject matter is included in six sections. The first five
cover some three hundred pages, and include the history of the
development of the neuron conception, giving the work of His,
Golgi Farel, Ramon J. Cajal and others ; the vital staining of nerve
elements, etc.

The external and internal forms of neurons and their histoge-
netic relation and the neurons as the unit in physiological and pa¬
thological processes are discussed in the second to fourth sections,
The bulk of the book, some 800 pages, is devoted to a consider¬
ation of the grouping and chaining together of neurons in a com¬
plex nervous system like that of man and mammals. In this section
there are five subsections: first, neurons connecting the sense
organs of the body with the central nervous system ; the neurons
within the central nervous system connecting the end station of the
axones of the peripheral centripetal neurons with other portions of
the central nervous system and neurons which in turn connect the
end station of the latter with still higher portions of the central
system : neurons connecting the central nervous system with the
voluntary muscles of the body ; neurons within the central nervous
system which enter into conductive relation with the lower rtiotor
neurons and throw the latter under the influence of other centres,
Projection commissural and association neurons of the telence¬
phalon. One can gain an idea of the scope of the work from the
above headings.

In these chapters an immense amount of work by numerous
investigators is represented which the author has introduced with
his own, and arranged and classified it so that an intelligent con¬
ception can be gained of the complicated distribution of the nerve
fibres throughout the body. To better understand the descriptions,

142

BOOK REVIEWS.

the work is profusely illustrated by original drawings and selections
from various sources.

Great credit is due both author and publishers for the excellence
represented in the printing, illustrations and scientific presentation
of an interesting but abstruse department of medical research.
The book must have a great influence in promoting a more wide¬
spread interest and giving information otherwise difficult to obtain
in regard to the latest developments of neurology.

J. B. McC.

Manual of the Practice of Medicine—Prepared especially
for students, by A. A. Stevens, A.M., M.D., professor of Pa¬
thology in the Woman’s Medical College of Pennsylvania.
Jnstiuctor in Physical Diagnosis in the University of Pennsyl¬
vania. Fifth Edition, revised and enlarged. Illustrated. Price
$2.00. W. B. Saunders, 925 Walnut St., publisher. Canadian
agents, J. A. Carveth & Co., Toronto, Canada.

In the multiplicity of the calls made on the medical student of
the present day, ponderous Text-Books cannot occupy the place
they did a decade ago. In Medicine as well as in Surgery there is
much that can be boiled down, the theoretical, largely giving way
to the practical. Nowhere can this be better learned than in the
out-patient department of a hospital, where the practical part of
medicine is ever in evidence. The author of this little manual is
an out-patient physician to the Episcopal Hospital. He is, there¬
fore, in our opinion well qualified to write a concise and practical
manual. The proof of his qualification is the little volume which
we most heartily commend to medical students.

F. W. C.

Braithwaite's Retrospect of Medicine, A half yearly
journal, containing a retrospective view of every dis¬
covery and practical improvements of the medical sciences.
Volume 120, July-December, 1S99, issued January, 1900. Lon¬
don, Simpkin, Marshall, Hamilton, Kent & Co., Limited.

We have to thank the publishers for a copy of this journal,
which courtesy we quite appreciate. When we began our profes¬
sional career nearly forty years ago, Braithwaite's Retrospect was a
standard publication, to be seen on the study table of all who de¬
sired to be au courcr’t in medical matters. It is the same to-day,
and fills a position not occupied by any other.

F. W. C.

Christian Science. An exposition of Mrs. Eddy’s wonderful
discovery, including its legal aspect, a plea for sick children
and other helpless sick. By William A. Purrington, Lecturer in
the University and Bellevue Hospital Medical College. New
York: E. B. Treat, 241-243 West 23rd Street, 1900. Price
$1.00.

Of all modern fads, none has, perhaps, attracted more attention,
or gained greater headway, up to a very recent period, than tl^at
known as 14 Christian Science.*’ The utter absurdity of many of

BOOK REVIEWS.

143

their claims has drawn attention to the general system, which has
been flooded with light. The result must be a natural death within
a very short time. In this beneficial work the volume before us
will play an important part, for it is a thorough expost of Mrs.
Eddy’s claims. That this expose is necessary is clearly proven by
Mr. Purrington’s book, which we commend to all those desirous of
posting themselves on this matter. F. W. C.

A Text-Book of Diseases of Women.— By Charles B.
Penrose, M.D., Ph.D., Professor of Gynecology in the Uni¬
versity of Pennsylvania; Surgeon to the Gynecean Hospital,
Philadelphia, illustrated. Third edition revised. Philadel¬
phia: W. B. Saunders, 925 Walnut street, 1900. Price $3.75.

In the introduction the author says : u I have written this book
for the medical student. I have attempted to present the best
teaching of modern gynecology untrammelled by antiquated the¬
ories or methods of treatment. I have in most instances recom¬
mended but one plan of treatment for each disease, hoping in this
way to avoid confusing the student or the physician who consults
the book for practical guidance. I have, as a rule, omitted all facts
of anatomy, physiology and pathology which may be found in the
general text-books upon these subjects. Such facts have been
mentioned in detail only when it seemed important for the elucid¬
ation of the subject, or when there were certain points in the path¬
ology that were peculiar to the diseases under consideration.” A
careful perusal of the work, which embraces 531 pages, shows that
the author has succeeded admirably in his endeavor. It possesses
three qualities : completeness, conciseness and clearness. In the
forty-three chapters everything has been thought of; nothing has
been left out. There is a whole chapter for instance on cancer of
the cervix, another on gonorrhoea in women, and another on the
menopause ; the last chapter treats exclusively with “ the effect of
the removal of the uterine appendages.” Gynecofogy is making
such rapid strides that any book which is more than two or three
years old is out of date unless it has been revised. Dr. Penrose
realizes this, and has thoroughly revised it since it first appeared
some three years ago. This is especially important on account of
the changes in treatment, which is constantly improving ; those who
consult this work will find that the advice given is in accordance
with ihe opinions held by the leading gynecologists of the day. It
is hardly within the province of a brief notice of the book to refer at
length to any of the opinions expressed by the author. But this much
we may say : that we wish every practitioner would read the chap¬
ters on lacerations of the cervix and cancer of the cervix, and on
hemorrhage at the menopause. We feel sure that by so doing they
might contribute very considerably towards stamping out cancer of
the cervix altogether. The chapters on the early operation for
tubal pregnancy and ovarian cysts are also very convincing as well
as important. Many other important points might be noticed, but
want of space prevents us particularizing further. The book should
be in the hands of every student and practitioner.

A. L. S.

144

PUBLISHERS’ DEPARTMENT,

PUBLISHERS DEPARTMENT.

LITERARY NOTES.

The Living Age announces a four-part story, called “ Misunderstandings,”
translated from the French of Madame Blanc, to begin in the number for
March 3. The " misunderstandings M referred to arise from the free and uncon¬
ventional conduct of an American girl in Paris, and the story is, in effect, a new
11 Daisy Miller” from the Parisian point of view.

Sir Walter Besant comes to the defense of Mr. Kipling from the furious
assault latety made upon him by Robert Buchanan, in an article entitled “ Is
it the Voice of the Hooligan ? ” which The Living Age for Feb. 17 reprints from
the Contemporary Review.

Mr. J. Cuthbert Hadden’s article on “ The Tinkering of Hymns” in The
Living Age for F^eb. 24 will strike a responsive chord in the hearts of all who
object to the mutilation of the classics of hymnology.

An article on The Intellectual Future of Japan, in The Living Age for
March 3, derives interest from the fact that it is the view of a native Japanese,
reprinted from a Japanese magazine.

The leading article in The Living Age for Feb. 24 is a thoughtful and dis¬
criminating review of Socialism in the United States from the Nineteenth
Century.

nANADA

MEDICAL RECORD

APRIL. 1900

Original Communications.

GYNECOLOGICAL NOTES.

By A. LAPTHORN SMITH, B.A., M.D., M.BC.S-. England.

Fellow of the British and American Gynecological Societies; Professor of Clinical
Gynecology in Bishop’s University; Gynecologist to the Montreal Dispen¬
sary ; Surgeon-in-Chlef of the Samaritan Hospital for Women ;

Surgeon to the Western Hospital, Montreal.

Abdominal Tumors Complicating Pregnancy .—Several
articles have lately appeared on this subject. The question
being discussed is this: When an abdominal tumor is dis-
covered during pregnancy, what course should we adopt
towards it ? This will depend very much upon whether the
tumor is giving any trouble or whether it is likely to do so
before labor shall have been ended ; also, whether the tumor
is an ovarian or a fibroid one ; and again, whether, if a fibroid,
it is interstitial or pedunculated. I have been called quite
frequently to advise in each of these cases, and I have found
the following procedure to be the best: In all cases of ovarian
tumor an operation should be performed at once for two
reasons : Fir>t, because it is no more dangerous to remove
the tumor during pregnancy than at any other time ; as a
rule its removal has not been followed by a miscarriage, and
the patients made excellent recoveries, none having died.
And, secondly, because every day that an ovarian tumor re¬
mains in the abdomen the woman is running the risk of losing
her life, not only by the mere growth of the tumor, but by
what is far more serious, namely, from the complications,
twisting of the pedicle, hemorrhage into the cyst and the for¬
mation of adhesions to the intestines. As a rule, ovarian
cysts grow very rapidly during pregnancy on account of the

146 SMITH : GYNECOLOGICAL NOTES.

increased blood supply, and if the tumor, which is discovered
early in pregnancy, is allowed to remain until labor is over, it
will have increased enormously in size, in addition to the
above mentioned dangers. Moreover, if the ovarian tumor
is locked in the pelvis, it would be most serious to leave it
there, as it would render natural delivery impossible.

With regard to fibroids, if they are causing no severe
symptoms, I prefer to wait until a few months after delivery,
and then, if the tumor is causing hemorrhage, to perform
hysterectomy. Sometimes, however, they cause considerable
pain. In one case to which I was called by Dr. McNamara,
the tumor was a sub-peritoneal one, and had caused very
little pain until the end of the third month, when it rose with
the uterus out of the pelvis and took a rapid growth. It
caused so much suffering that I decided to remove it, which
was easily done by making a rather long abdominal incision
and lifting the pregnant uterus and tumor out of the abdo¬
men and laying them on a sterilized towel. The pedicle,
about 3 inches wide, was clamped close to the uterus, and the
tumor, the size of a small cocoanut, was removed. The stump
was closed with interrupted silk stitches, and the clamps
were removed. The bleeding was furious for an instant until
they were put on again, and another row of medium silk
stitches were applied. On removing the clamps the second
time there was only a little oozing, which was completely
controlled by a third row of fine sutures. The uterus was
replaced, the incision closed, and the patient made an easy
recovery, and went on to full time, and had a normal labor.

In another case of fibroid during pregnancy to which I
was called by Dr. T. F. Wilson, it seemed almost impossible
that the woman could be delivered by the natural channel
on account of the size of the tumor and its location in the
lower segment of the uterus. I was loth to operate, having
been very much impressed by a similar case reported by Dr.
Weeks, of Portland, at the Washington International Con¬
gress, in which a miscarriage was induced about the fifth
month, and the patient died from uncontrollable hemorrhage.
Sir William Hingston was also called in consultation, and, as
he was strongly opposed to interfering, we decided to wait

SMITH : GYNECOLOGICAL NOTES.

147

until labor began, and then to operate if necessary. In due
time labor came on, and little by little the tumor was drawn
up out of the pelvis allowing the head to engage, and the
woman was delivered without even the use of instruments.

The Treatment of Fibroid Tumors. —As a great change
for the better has taken place in the results of operative
treatment, a few words on the subject may be df interest.
Twenty-five years ago the mortality in the hands of even the
best operators was nearly seventy-five per cent., and fifteen
years ago it was something like twenty-five per cent. No
wonder, then, that at that time Apostoli’s discovery was so
heartily welcomed that nearly all of these patients couldbe
cured of their symptoms by means of electricity and without
any death rate at all. While the abdominal surgeons, rather
than face such a risk, wisely advised their patients to do noth¬
ing, or only to take medicine as long as the tumor was not
threa‘ening their life, and even when it was threatening the
woman’s life by hemorrhage or pressure symptoms, the physi¬
cian had no other resource to offer than the always doubtful
one of ergot. The almost certain chance of being cured by
electricity was a great boon, and I lost no time in going to
Paris and learning Apostoli’s method and in being the first
to introduce it into Canada. Although I succeeded in curing
of all their symptoms sixty-three women out of ninety-seven
who were sent to me during thirteen years, I would have
been glad during all that time to have completely removed
the tumor by operation just as soon as the death rate could
be reduced to its present low rate. During all those years,
therefore, I urged electricity first, and, when it failed, I had re¬
course to Trenholme’s operation of removing the tubes and
ovaries, which, while it did not remove the tumor invariably
in my hands, at least, sooner or later, cured the symptoms and
caused the tumor to be considerably reduced in size. I say
sooner or later, for in some few cases I had to wait a year,
and in one case nearly two years before the hemorrhages en¬
tirely ceased. Another objection was that, while this opera¬
tion did not remove the tumor any more than electricity did,
it had a death rate of 7 or 8 per cent., which electricity did
not have. When Lawson Tait, Kcebreli and Joseph Price

148

SMITH: GYNECOLOGICAL NOTES.

perfected the method of removing fibroids with the serre noettd
and transfixion pins so that the death rate gradually came
down to ten per cent., I began to adopt this operation in
all cases in which electricity failed, or in which the patients
could not spare the time required for electrical treatment. A
few years later Baer and Kelly so improved the technique of
abdominal hysterectomy that the mortality fell gradually to
five per cent., and even in Kelly’s hands to tv/o per cent., he
having recently completed one hundred consecutive cases
with only two deaths. I am now employing this method in
every case that will consent to an operation, and I have now
done ten consecutive cases without a death , the tumors ranging
from one to five pounds in weight, so that my attitude has
completely changed, and I now deem it my duty to urge
every woman with a fibroid tumor to have it removed imme¬
diately. The gynecological journals, during the last few
months, record many instances in which fibroid tumors have
sloughed, suppurated, become twisted and become malignant,
so they are no longer considered the benign tumors they once
were. Malignant degeneration has occurred three times in
my experience (among those I was treating with electricity).
And last, but by no means least, the earlier the tumor is re¬
moved the safer it will be to remove it, because there will
be no adhesion to bowels, no enormous sinuses to bleed and
smaller arteries to tie, and the woman’s general health will be
better able to bear the operation, while the operation itself
will be ever so much easier to bear.

Selected Articles,

HEADACHES AND THEIR TREATMENT.

T. LAUDER BRUNTON, M. D.,

St. Bartholomew's Hospital.

Before commencing the discussion of the treatment of
headaches it will be advisable to come to an understanding
regarding the meaning which we attach to the word “ head¬
ache.” Although it is by the brain that we perceive pain,
yet the brain itself, when subjected to directirritation, give

BRUNTON : HEADACHES AND THEIR TREATMENT. 149

rise to no feeling of pain. It is only when it is excited
through the medium of peripheral nerves that the sensation
of pain is felt. This is the case with pain in the head as well
as pain in other parts of the body, and to the pains which are
confined to the head the name of headache is often given,
but not always. We find that if pain is localized in a parti¬
cular organ in the head we do not, as a rule, apply the term
“ headache ” to it. We speak of toothache, of earache, and
perhaps of eyeache, but not of headache unless the pain is of
a more diffuse character. When it is localized in a part of
the head other than the eye or ear, but is of a shooting char¬
acter and is limited to one particular spot, we often apply
the term neuralgia to it. By headache we generally mean,
then, a more or less diffused pain in some part of the head.
There are two kinds of pain, however. There may be a sharp
shooting pain in one particular part of the head or in one part¬
icular organ, and associated with this there may be a diffused
pain/so that we may have at the same time a toothache and
a headache. Not infrequently the headache depends upon
irritation in the teeth, in the eye or in the ear, but often the
cause of the headache is irritation of the nerve fibers either
in fibrous structures in vessels.

The pain which is associated with tumor in the brain is
probably due to pressure of the tumor upon some of the
fibrous structures within the cranium ; but the headache
which is associated with various nerve conditions and is
known as migraine is probab’y due almost entirely to the
stretching of the nerve fibers withing the blood vessels.
Various opinions have been advanced with regard to its
pathology. Some say it is due to cramp of the vessels and
that the vessels during the paroxysm are firmly contracted.
Others say that during the paroxysm the vessels are widely
dilated. In my own case I have found that both statements
are true and both are untrue, both being imperfect. The fact
is that I get in migraine a dilatation of the proximal parts
of the carotid artery with a contraction of the peripheral
part, and that if I take off the strain from the vessels by
pressing the carotid the pain is at once relieved.

Now, in regard to the pathology of headache, we have to
consider two things, namely, (i) a general condition and (2)
a local condition. The general condition rendeisthe patient
liable to pain, the local condition determines that the pain
should affect his head rather than his intestines or his big toe
or some other part of his body. The general conditions
which lead to headache are those either of (a) imperfect
nutrition or of (b) disordered nutrition. We find headache
very commonly in imperfect nutrition, such as anaemia, and

I 50 BRUNTON : HEADACHES AND THEIR TREATMENT.

perhaps still more commonly in disordered nutrition, such as
occurs in rheumatism, in gout, and, above all, in albuminuria.
In all those cases the tendency to headache is more or less
constant, because the disorder of nutrition is more or less
permanent. But in apparently perfectly healthy people we
find that headaches come on now and again, and they are
apt to come on with more or less regularity. Thus it would
appear that in many such people there is a tendency to
disordered nutrition occurring with more or less regularity,
and such patients are accustomed to recognize this in
themselves, and to say that they are apt to become bilious.
We find this regularity occurring most markedly in women,
because, just before, during or after the monthly period, women
are very liable to suffer from headache. But in men, where
there is no monthly period, we fiud also a tendency to regular
recurring headache, and probably in them also there is a
regular alteration in nutrition.

Now, the nature of this alteration is rather hard to de¬
termine, because our knowledge of nutrition generally is
insufficient. Yet, a common observation may allow us to
associate this altered nutrition, more especially with one
organ, namely, the liver, because men and women are accus¬
tomed to say that they are liable to bilious headaches which
recur every now and again. In order to understand this
recurrence it is necessary to consider the functions of the
liver.

The liver is a porter which stands at the gate of the
organism and prevents all the deleterious substances which
pass into the intestinal vessels from the intestine from reach¬
ing the general circulation. These substancess are caught by
the liver ; they are either destroyed or transformed by the
liver, or excreted by it unchanged into the intestine. From
the intestine they may partially pass away with fecal matters,
but many of them may be reabsorbed, and so they go on in
a continual round from the intestine to the liver, from the
liver to the intestine and back again to the liver until at last
the amount of these substances becomes so great that the
liver is no longer able to deal with it, and they pass through
the liver and get on into the general circulation. Now it
would appear as if there was a certain period required for
this accumulation. The period will vary in different in¬
dividuals, but it will also vary in the same individual under
different circumstances, and more especially we know that it
will occur in the same person in a less time when he is on a
more highly nitrogenous diet. You know that it has been
shown that during the decomposition of albuminous materials
in the intestine various poisons are formed, and these poisons

BRUNTON: HEADACHES AND THEIR TREATMENT. 1 51

probably accumulate in the liver until they get through it
into the general circulation. By putting a man, then, upon
a non-nitrogenous diet you lessen the proportion of these
substances, and so you may increase the intervals between
the headache more and more, until you may make the in¬
terval indefinite and prevent the headaches from recurring at
all. Absorption from the liver is greatly altered by emotions.
So much is this the fact that sometimes after emotions a
person may become completely jaundiced, absorption having
taken place so quickly from the liver that the bile actually
colors the conjunctiva and the face. Therefore we should
expect that anything which was circulating with the bile in
the liver would be rapidly absorbed in consequence of emo¬
tion. We find that anxiety, grief, sorrow, especially any
depressing emotion, is apt to bring on headache. We have,
therefore, very good reasons for attributing many headaches
to the presence of abnormal constituents circulating in the
blood. If this idea be true, we ought to be able to relieve
headaches by clearing out many of the morbid products from
the liver. Experience has shown this to be the case, because
one of the best methods of relieving a headache or prevent¬
ing it is to give some mercurial cholagogue, following it up
by some saline aperient. A blue pill over night and a black
draught next morning will very often prevent the headache
from occurring at the time when the person was perfectly
sure it would otherwise come on.

So far, then, for the general condition of poisoning by
toxins ; but there are other injurious substances even less
known. Many of them are classed, I believe, under the
head of uric acid, and certain substances connected with gout
and rheumatism are very apt to produce headache. The
most powerful cholagogue that is known is salicylic acid or
salicylate of soda, and one of the most powerful remedies in
preventing and relieving headache is the latter. We may
conclude, then, that a good deal of the misery caused by
headaches is due to the absorption of toxic products, and
that we may prevent headaches from coming on by the use
of cholagogues and aperients.

But why do toxins fasten upon the head and cause head¬
ache instead of causing man to suffer from pain in his intestines
or in his big toe ? The reason is that in most cases we have some
local lesion which determines the pain to the head, and the most
common lesions are either decayed teeth or something wrong
with the eyes. The abnormality in the eyes varies a good
deal. In some people it is simply a little inequality in the
visual length of the two eyes ; in others it is astigmatism, in

iS2 brunton: headaches and their treatment.

others it is want of accommodation. In others it may be
presbyopia, or it may be hypermetropia. In all cases of
headache the first thing to do is to examine the teeth and
see if any are decayed ; next the eyes, and see if there be
any abnormality in them. The most common cause of head¬
ache is certainly some abnomality in the eyes, but you will
find that a great many patients show nothing wrong with
the teeth, nothing wrong with the eyes, and then you must
look for some other cavse. You examine the ears, and see
that there is no tenderness in them ; you look at the back
of the throat and see that there is no thickening of the
mucous membrane of the posterior nares, tending to block
the Eustachian tubes, and thus indirectly affecting the ears.

A still more frequent cause of headache, however, pro¬
bably is irritation in the nose or in the cavities connected
with it. A very common cause of headache in winter is ir¬
ritation in the nasal mucous membrane spreading upwards
into the frontal sinuses and giving rise to frontal headache.
In some other cases, again, you will find that it spreads
towards the antrum of Highmore in the malar bone, and you
then get a one-sided headache. There is nothing to prevent
the irritation from spreading to the ethmoidal and sphenoidal
sinuses, and probably it does so spread, and in many cases
headache, especially when felt right in the middle of the
head, depends upon something wrong in the sphenoid or
ethmoid, but we know less about this, and we cannot deal
with them so easily. Yet it is necessary always to bear in
mind the possibility of these cavities giving rise to headache
in cases where you cannot find any other cause for it.

Headaches, and especially the headaches known as
migraine, may be accompanied by various other symptoms.
In ordinary cases migraine depends upon some spasm of
the vessels outside the head, but not infrequently there
may be spasm of the vessels inside the head, and then the func¬
tions of the brain may be effected. The function of the
cerebrum are, as you know, vision, sensation, hearing and
motor-power, to say nothing of general sensation. If
spasm of this vessel should so occur as to interfere with the
free circulation of blood through the cerebrum, symptoms
will ensue whose nature will depend upon the position of
the spasm. Supposing that spasm occurs at such a point
that the occipital lobe will be deprived of a good deal of its
blood, visual hallucinations will probably ensue, and these
are amongst the most common concomitants of sick headache.
People suffering from sick headache are very apt to get a
zigzag appearance in front of their eyes. They at the same
time frequently experience a difficulty of seeing. They look

BRUNTON : HEADACHES AND THEIR TREATMENT. I 53

at a book, but they cannot read ; the lines waver like the air
over a field on a hot summer’s day. These zigzags are
generally colored, and very often amongst other colors there
is a green color.

We do not often hear of any hallucinations of smell or
taste accompanying migraine, so that probably the contrac¬
tion of the vessel stops nearly opposite to the ascending
parietal branch. But sometimes patients may complain very
distinctly of motor symptoms, and one of the most marked is
aphasia, and in some cases of sick headache-you will find
your patient may become completely aphasic. How far this
is due to the occurrence of atheroma within the arteries I do
not know, but in one patient in whom the aphasia was well
marked during an attack of sick headache I found after
death, which resulted some years subsequently from
hemorrhage into the pons, that the cerebral arteries were
studded with atheromatous patches.

In tumor of the brain the headache is intensely severe, but
it is almost always accompanied by severe vomiting, which is
of a peculiar character, unassociated with nausea. It is sudden
and violent, and immediately after the vomiting is over
the patient feels well again and is able to eat. Associated
with those two cardinal symptoms we find optic neuritis, and,
when we find a headache without the other two symptoms,
the probability is that it is functional and not due to any
tumor whatever in the brain. Another cause of headache
seems to be associated more with some of the fibrous tissues.
There may be inflaTiination of the periosteum of the head,
just as there may be inflamation of the periosteum of any
other bone, and this inflammation may affect the periosteum
either from gouty, rheumatic or syphilitic irritation.

Treatment.—The first method of treatment in headaches
is of course to try to supply the brain with healthy blood ;
to clear away any toxins that may be present in it; and one
method of doing this I have just mentioned—namely, the
administration of a blue pill and a black draught. But more
than this, we may try to give something which may have the
power of counteracting these toxins or of producing elimina¬
tion from the liver, and I have found by personal experience
the easiest way of getting rid of the toxins or of counteracting
their effect, I do not know which, is to keep up the action of
salicylic acid or salicylate of soda. So that in persons who
are liable to headache I generally prescribe salicylate of soda,
15, 20, or 30 grains at night, with 10, 20, or 30 grains of
bromide of potassium. This mixture acts better than either
salicylate of soda or bromide of potassium alone, and it will

iS4 brunton: headaches and their treatment.

usually prevent the occurrence of a headache in the morn¬
ing.

If, however, the headache should still come on, I re¬
commend that the dose should be repeated, and in the case
of people who suffer from very violent and often recurring
headaches I give them the salicylate soda not merely morn¬
ing and night, but three times a day, in small doses, either
immediately before or after meals. The salicylate <>f soda is
apt to produce a certain feeling of depression and weakness,
and in order to counteract these I generally give it along
with half a dram of aromatic spirit of ammonia. Some of
my patients have taken salicylate of soda for several years
without any apparent harm, but we know theoretically that
all these drugs allied to salicylate of soda have a tendency to
produce anaemia ; and it may be advisable in some patients
if you are giving the salicylate of soda regularly to give also a
little iron to counteract the effect of the salicylate in produc¬
ing anaemia.

There is another large class of drugs that are used for
relieving headache. These, I should mention, ought always
to be given before the headache becomes too severe, because
when it is severe absorption from the stomach appears to be
arrested, and many patients will tell you that the first dose
they had of antipyrin acted like magic, but the next time
they took it it had no effect whatever, and you can tell them
the reason why. The first time they toox it was before the
headache had got very bad. It was, therefore, absorbed from
the stomach and acted upon their nerve centers. The second
time they waited too long, until the headache had got so bad
that absorption ceased, and so the antipyrin was no more
use to them in their stomach than in a bottle outside. Where
you have to deal with headache it is always advisable to give
your drug before the headache gets too bad. All these
belong to the class of drugs which act upon the conducting
fibers or cells in the cord and tend to disperse pain. I dare
say you know the old story of the dirty Scotch woman. A
lady came in to see her one day and found the children
walking and grubbing about, and she said to her : “ Do you
not often wash your house ?” “ No,” said the woman. “ But
when the children come in with a lot of mud on their boots
and they tramp all over the floor, what do you do ?” “ Oh, I
make them knock it about until there is none.” She distributed
the mud equally all over the floor and then she thought it
was all right. Now that is what these drugs do to the pain.

Painlul impressions do not pass to the cerebrum straight
up as a rule, because, as you know, pain is largely conducted

BRUNTON : HEADACHES AND THEIR TREATMENT. 155

up the central column of the cord, and not up through the
straight fibers which conduct tactile sensition. If you cau
distribute your sensation so much that it will get broken up
in the cord and will not reach the center for pain in the
brain, of course the patient will not feel pain, and so antipyrin,
nux vomica, strychnine, phenacetin, antifebrin, and all that
class of drugs relieve pain with one exception—namely, if
the pain be not too severe. If the irrtation of the sensory
nerve is so great that it will fill up all the channels for pain,
then phenacetin or antipyrin may sometimes make the pain
worse than belore. I did not believe this ; I thought it was
quite contrary to anything that could possibly be, but a
patient of mine told me that the antipyrin which I had
prescribed to relieve headache made him very much worse.
I thought he was mistaken, but I have no doubt he was quite
right, and that the reason was that the irritation was so
intense, for it seemed to him that the pain had been increased
tenfold by this drug.

But there is another drug that is very much used, and
which has a somewhat similar action, but it acts apparently
more upon the posterior columns than upon the central
columns—at least so far as experiment goes—and that is
caffeine. In cases where the pain is so intense that these
substances, instead of relieving it seem to make it worse, there
is perhaps no drug to which you can have recourse except
the subcutaneous injection of morphine, and that relieves the
pain and gives the patient quiet for the time being. But of
course there is always the difficult/ of the morphine habit
arising, and so you put off the use of this drug as long as
you possibly can. In some cases where there is continued
pain in the head lasting for a length of time cannabis indica
seems to help, and this may be given either in the form of
the extract or tincture. It is easier to regulate the dose of
the tincture, and you may begin with io minims three times a
day, gradually increasing the dose. You must be careful
about cannabis indica. There is no danger in it, I think,
but you may greatly alarm the patient’s friends if you run
beyond 15 or 20 minims until the patient is accustomed to it.
You may bring on a state of maniacal excitement which will
greatly alarm the patient himsell and everybody around him,
but the long-continued use of this drug will sometimes relieve
these headaches when other things seem to fail.

For the relief of headache occurring through inflamma¬
tion of the periosteum from gouty rheumatic irritation, it is
fortunate that one remedy is very useful—namely, iodide of
potassium, which should be begun in small doses, and

GILLESPIE : MEGRIM.

156

gradually increased up to 10, 20 , or 30 grains, three times a
day. Where you think that the pain is not of a pure nature,
not due simply to dilatation of the nerve fibriles in the fibrous
tissue of the periosteum, but is associated also with some
change in the vessels of a nature allied to them, which we
find in sick headache, the iodide may be combined with
bromide and salicylate, and in all those cases it is advisable
to give some aromatic spirit of ammonia along with it in
order to prevent any depressing effect of the drugs.

There is one thing more. Whenever you get a case of
intense headache which your drugs fail to relieve, always
look out for glaucoma. Even in ordinary headache you will
be very apt to find the affected eye is rather tight, that the
intra-ocular tension is higher than usual, but in glaucoma it
is very much increased, and this will be permanent, and not
temporary as in ordinary sick headache. In cases where this
increased tension exists you must either treat the glaucoma
yourself, or have the patient operated upon by some spe¬
cialist so as to prevent the loss of an eye as well as to relieve
the headache which is so intense, and which comes along
with the disease.

MEGRIM.

Fy A. LOCKHARf GILLESP’E, M D.. F.R.C.P. ED., F.R.S. ED.
Medical Registrar in the Royal Infirmary, Edinburgh ; Examiner in Materia Medica
to the Royal College of Physicians of Edinburgh. Edinburgh, Scotland.

Among the various forms of disease to which our bodies
are subject, a certain number there are which seem to be
regarded by the victims in the light of ordinary everyday
occurrences, annoying and disagreeable no doubt, but only
what is to be expected by the majority of suffering mankind,
and not of sufficient importance to call for treatment.
Megrim may be classed among them. How often do we not
hear it stated, “ Oh, So and So could not come, she has one
o( her sick headaches ; ” or to our question as to the health
of a friend get the reply : “ I am quite well, only have had
a sick headache.” Possibly the term is often employed to
cover many other conditions, notably by women ; but the
frequency of the excuse and the slight importance paid to
the announcement of the cause, serve to illustrate popular
conceptions as to the slight significance attaching to megrim
attacks.

It is an interesting fact that in Edinburgh, at least, very
few patients apply for hospital in-or-out treatment for mi¬
graine alone. Out of thirty-five thousand three hundred
and forty-six patients treated in the medical wards of the

GILLESPIE: MEGRIM.

157

Edinburgh Royal Infirmary from October, 1891, to October,
1898, only nine are recorded as having suffered from this
disease alone ; that is, only one in three thousand eight
hundred and seventeen sought or was given treatment, or
0.025 per cent. Among the medical out patients, averaging
at least nine thousand, five hundred a year, or about sixty*
six thousand, I can find very few diagnoses entered of
megrim. There can be no doubt that many of those apply¬
ing for treatment or advice for other troubles, also suffered
from sick headaches, but attached little importance to them,
imagining them to be migraine. Hemicrania, sick headache,
vertigo, megrim, are synonymous terms applied to a train of
symptoms as common as they are peculiar, as distressing
as they are common. Obviously of nervous causation, often
independent of digestive disturbances, the symptoms are so
intimately connected with those procedures common to
gastric and hepatic upheavals, that they have come to be
associated with these organs. But the sufferer from the
severest forms of gastric dyspepsia, the yellowest victim of
catarrhal jaundice, the subject of hepatic congestion or of
duodenal antiperistalsis, who vomits bilious matters, or the
obstinately constipated, do not nessarily undergo the tor¬
ments of a megrim. Per contra, the individual who expe¬
riences migranous attacks may have no dyspepsia, no liver
fault, no excessive obstipation. The first class suffer from
the effects of lccal digestive disorders ; the second from a
more or less general affection of their nervous mechanism.

All that is necessary to assume is that some conditions of
the circulating fluids of the individual organs, or of the nerv¬
ous system as a whole, able to produce the special state of
irritability and local paranoia of the nervous tissues concerned
in migranous attacks, must be present. Attacks of migraine
can be separated into one or more classes :

1. The accidental paroxysm occurring at rare intervals,
irregularly, perhaps only once in a lifetime ; an accompani¬
ment of some acute dyspeptic or hepatic condition. This is
truly a digestive sick headache.

2. The similar variety occasionally met with after severe
exertion, especially on insufficient food and in the untrained.
The acute form of metabolic migraine.

3. The common, one might almost say the family
variety of migraine, due to chronic auto-intoxication and
deficient exercise. The chronic form of metabolic migraine.

4. The functional or neurotic form, akin to epilepsy
rather than to hysteria, possibly in part and to a lesser
degree due to conditions similar to those in number three,
and aroused by slighter stimuli.

i 5 8

GILLESPIE : MEGRIM.

In men, I believe, attacks of hemicrania almost always
indicate inefficient metabolic processes, primarily in excre¬
tion, secondarily in anabolic and assimilative actions and
often appear when their manner of life alters ; for instance,
when they pass from school to office stool, or from play¬
ground to student’s class-room bench and midnight oil. I
am, perhaps, inclined to attribute greater significance to the
results of indoor employment as the casual agent in many
cases of megrim, because my own attacks arose from this,
and because I have seen complete recovery take place, after
prolonged treatment by other methods had failed, when
energetic non-medicinal measure were adopted conamore.

Latham, in his classical work upon megrim, christened
a paroxysm a “ nerve storm," a complete definition and a
comprehensive description in itself.

Before the storm a calm, befor the megrim attack comes
a period of especially bright mental weather. As the
mercury begins to dip, cirrus clouds, followed shortly by
stratus, partially veils the sky in the eye of the rising wind,
hinting at the coming stress ; so a cloud advances over a
portion of the visual field, frequently obscuring in time a full
half of it, foretelling, in more abrupt fashion than the
meteorological omens can, the onset of a “ nerve storm."
Still later the phenomena, atmospheric and ocular, may
further coincide ; the lightning of the thunder cloud, a proto¬
type of the zig zag bright lines and flashes of light, albeit
that these are more akin in color scheme to the rainbow than
the electric spark, often disposed after the manner of the
outlines of one of Vanban’s medieval fortification plans. The
nervous and atmospheric pressure still falls, the air feels op¬
pressive, and so the brain, until the crisis approaches, the
glass stops falling, begins to rise ; the atmosphere is fresh¬
ened by discharge of rain, the nervous system by some cri¬
tical evacuation or excretion, by vomiting, free perspiration,
evacuation of the bowels, or copious discharge of urine.

The recovery of normal pressure is usually more rapid
in nature than in the body, but profound sleep, as a rule,
supervenes, and after a shorter or longer period the nervous
isobars resume an anticyclonic type, and the condition is
once more “ set fair.”

In those cases beionging to the first two classes the
digestive sick headache and the acute metabolic megrim, the
cyclonic disturbance in the nervous atmosphere is like unto
the sudden cyclones of America, and tropical regions—short,
sharp, occasional. Those belonging to the other two classes
correspond more to the regular barometric depressions which
are necessarily born over the oceans, owing to the variations.

GILLESPIE ; MEGRIM. 1 59

in temperature of the ocean currents, the air above them, and
the earth’s revolutions.

That the involvement of the nervous system is by no
means a mere reflex result of local irritation of the nerve
endings in the mucous membrane of the stomach or small
bowel, is shown by the frequent absence of any sign or
symptom other than the megrim itself pointing to digestive
disturbance in these organs, and by the not uncommon oc¬
currences of symptoms of profounder nervous affections,
either during the latter stages of a paroxysm, or, and this
more often, post-paroxysmal, such symptoms as aphasia,
slight mental confusion, temporary anesthesia over various
areas of the body surface, even paresis and slight ataxia.

In dogmatizing as to the etiology of affections such as
migraine, one must needs beware of narrowness of view. The
nearest approach to truth in controversial subjects is best
made by taking a middle course, nor is it well to assume
that any one disease is always the result of one invariable
cause. Migraine is a case in point. The combinations of
symptoms undoubtedly vary, often widely, but the symptoms
themselves denote nervous disturbances of a special type, af¬
fecting a larger or smaller region in a greater or lesser
degree. The primary source of this disturbance in portions
of the nervous system cannot, however, be particularly
assigned to only one cause, or even to one class of lesions.

Now as to my personal experiences. I was first attacked
with megrim after leaving school and beginning university
work. Every three weeks or so one would occur, except
when I was on holiday and led an open-air life. Was treated
in the ordinarily approved style with cholagogues and ca¬
thartics, but though lighter in weight still suffered. But,
having read Latham’s treatise, I foreswore medicines, and
began climbing a hill of eight hundred feet in the outskirts
of Edinburgh and in a hurry, four or five times a week
throughout each session, during an off hour between classes.
No megrim has ever troubled me since then, save once when,
after a fifteen miles’ walk in the Highlands, the place at
which I had expected to be able to get some food I found
closed, and the second fifteen miles on a tightened belt
proved sufficient to bring on what was but a slight attack.
In this last case the true cause, very probably, is to be found
in an excess of the products of muscular waste, in a some¬
what starved blood stream. The physical exercise of sur¬
mounting the hill referred to, more than a mile and a quarter
from the university, with an ascent of nearly six hundred
feet from the lowest point touched, and in returning in forty-
five minutes or under, was considerable.

160 GILLESPIE: MEGRIM.

Some time back I had occasion to treat a schoolmaster,
newly come from another institution, who for two or three
years had been a victim of hemicranial attacks about every
fortnight, their first appearance coinciding with his introduc¬
tion to the duties of his office. He was of billious tempera¬
ment, whatever that may imply, in so far that his skin was
sallow, and that he had had several mild attacks of catarrhal
jaundice ; since then he has suffered from several of the
same, but the catarrhal affections of his liver did not appear
to have any relationship whatsoever with his migrainous
bouts. He had previously endured much physicking and
stimulation of his liver, with no good result on his sick head¬
aches.

As instructed, he desisted from all drug-taking ; put on
as many layers of flannels, sweaters, old clothes, as he could
place atop one another, an overcoat above these, and every
afternoon during an hour’s respite from duty, proceeded to
cover two or three miles at a smart running pace, which,
while well within his powers of endurance as to both distance
and rate, produced in him a distinct feeling of having done
some hard work, and of having caused a free secretion of
sweat.

On return he disrobed, took a cold plunge, a rub-down
with a rough towel, dressed and rested on a couch until his
time for duty arrived. This patient only experienced one
attack after commencing his daily run, and that occurred
during the first fortnight and was very slight. He has had
no further recurrence, although for a year past no special
form of exercise has been taken. Nevertheless he has, since
the megrim ceased, shown symptoms of liver disturbance, has
been bilious, jaundiced, and cholemic, without any trace of a
nerve storm initiated or brought to a point by it.

In him a sharp daily burst of active exercise, sufficient
to cause fatigue, but not enough to over-tire him, stopped
his attacks. Nor did they recur afterwards.

If this patient had been recommended to take daily
constitutionals at his own pace, in the open air, it is almost
certain that he still would be subject to megrim. Constitu¬
tionals, as a rule, are fraudulent proceedings. They savor so
much of “ needs must; ” they tend to remind the actor that he
is unhealthy, and during their monotonous performances
great opportunities are offered for introspective brooding,
and they seldom are productive of any marked muscular
exertion, for walking at the ordinary “ constitutional-by-
order ” pace requires little expenditure of energy. Energetic
exertion, short and sharp, is productive of greater benefit to
migrainous patients, and also to dyspeptics, if carried out in

GILI.ESPIE : MEGRIM.

161

a natural manner in the open air, than any sedate constitu¬
tional or indoor employment of dumbbells, Indian clubs, and
their allies.

The facts in the case illustrate very plainly some of the
points I wish to refer to, and closely reproduce the salient
features of various other cases which have come under my
observation. No clear relationship between the occurrence of
the attacks and any definite exciting factor could be traced;
but every fortnight or thereabout, his indoor life and the
mental strain imposed on him in the teaching of children,
lend to accumulation of effete metabolic products in his blood
and tissues, probably also to increased irritability of his
cerebral centers, until what time the nervous mechanism,
stimulated no doubt at first, and so causing the precedent
feeling of well-being and vigor, became over-stimulated and
was forced to find a vent for its unhealthy generated surplus
energy along the lines of least resistance.

The following case belongs to another category.
The history, briefly put, runs thus : A lady, twenty-five
years of age, unmarried, well dowered with means and living
an idle, empty life, had, since the establishment of her men¬
strual functions, suffered from severe sick headache every
month in connection with her periods. Between times
her health was as good as too little to do, sluggish bowels,
and too rich foods, would permit Of a neurotic stock, the
continued appearances of these attacks from the two causes,
inefficient use of over-rich foods and of the products of wear
and tear of her tissues, along with monthly recurrence of a
sufficiently disturbing factor to reflexly initiate an overflow
of misdirected nerve energy, her case was more serious. But
here again, sharp muscular exercise out-of-doors up to but
not beyond the limit of honest fatigue served to raise the
tone of her nervous system above the level, at which they
responded too energetically to the monthly stimuli, while
they also lacked an over-store of abnormal potential energy.

Treatmmt .—No active measures designed to relieve the
actual paroxysms are of any avail in warding off future
attacks. But given a paroxysm to treat, how best can this
be done ? By absolute rest and quiet, by allowing no food
(if food be desired, as is seldom the case) but a little milk, or
tea and toast ; by giving a dose of caffeine (the citrate is not
so good), dissolved in strong black coffee, and ordering a
purgative enema. In the early stages aperients by the mouth
are seldom indicated, for when taken they rarely pass
through the stomach, more often returning by the way they
are introduced. The peristalsis of the stomach is in abeyance
unless it be to excess in the wrong direction. Various drugs

162

GILLESPIE : MEGRIM.

have been from time to time vaunted as specifics, antipyrin,,
antipyrin with caffeine, phenacetin, cannabis indica, etc.,
among them, and frequently do good at first, generally to lose
their influence over later attacks. Where arterial spasm is
present the various nitrite compounds may give relief.

It is during the intervals that real benefit must be sought
for, and here the main factor to be considered is the nature
of the exciting cause, if it be local and general, or general
alone. Treatment must proceed along rational lines for
removal of any irritating lesion as well as towards im¬
provement of the metabolic processes of the organism.
Benefit to one of these conditions may suffice to render the
effect of the other insufficiently marked to cause attacks.

Each case has to be considered on its own merits. The
physician must endeavor to arrest the manufacture of surplus
nerve force, generated by constant, even if slight, irritation,
or conversely to get rid of the surplus by some means or
other, thus preventing its accumulation and consequent
eruption, by measures which appear best adapted for the
case. Local and remote affections must be sought for, and
when detected relieved. To advocate any one strict and
invariable mode of treatment for any simple disease on every
occasion is the essence of folly. The same effect may be
gained by different methods ; the same symptoms proceed
from dissimilar combinations of causes, and amenable, there¬
fore, to different lines of treatment.

As in epileptics who are generally benefited by hard
manual and physical labor, so those victims of migraine who
exhibit post-hemicranial mental symptoms of increasing
severity as time progresses, are usually much improved by
hard out-of-door work. Often one will be told by a patient
who has been advised to exert his muscles more, that he is
never off his feet, and gets more exercise than he likes. The
truth being that exercise of this character, indoor chiefly, or
in towns in the course of non-manual business, does little
good, and often harm. It fatigues, rather than healthily
tires.

Many sufferers from migraine will be found to avoid
butter and fats, or to partake of them sparingly, either from
personal dislike or because they disagree ; or, again, if fond
of fatty foods, they may not be able to make use of them.

Constitutional conditions may require attention ; the
gouty, syphilitic, rheumatic, and the malarial, often benefit
greatly from corresponding specific remedies, alone or along
with drugs specially indicated for the disease itself.— Med.
Brief.

Progress of Medical Science.

MEDICINE AND NEUROLOGY.

IN CHARGE OP

J. BRADFORD McCONNELL, M.D.

Associate Profewor of Medicine and Neurology and Professor of Clinical Medicine..

University of Bishop’s College; Physician Western Hospital.

ABNORMAL SELF-CONSCIOUSNESS IN
CHILDREN.

When the child’s appetite is good and his temperature
normal, most physicians are apt to think him safe in his
mother’s care and no longer dependent upon medical advice.
Yet, if we counsel correct habits of diet, exercise and sleep,
we ought not to be consideied as transgressing very fir the
legitimate bounds of medical practice if we essay occasionally
a warning word about so bad a mental habit as self-con¬
sciousness. Such advice when given to a reasonable mother,
may be in the best sense prophylactic. Few parents can be
gotten to believe, for example, that “ forwardness,” disobed¬
ience and rude conduct in a young child are sometimes a grave
sign of mental deficiency. Gowers has noted them as one of
the earliest indications of abnormal cerebral function. In¬
stead of the youngsters being prompted to rudeness and im¬
pertinence, and laughed at for his supposed precocity, such
performances should be viewed with anxiety, and should be
gently but promptly suppressed. That small children should
be “ seen and not heard ’’ is a maxim based on an enlightened
psychology. The abnormal self-consciousness that prompts
such outbreaks can easily develop into an incurable ego¬
mania; the growing brain tissue is, as Horace so well said
long ago, cereus in vitiurn Jlecti. Even where it is not con¬
genital, a morbid feeling of self can be awakened and nour¬
ished with alarming ease and speed. No child should be en¬
couraged to repeat poetry before his mother’s guests, or
praised for his “ pretty curls,” or even have his first trousers
made too much of. The less he thinks of himself the better.
He may be judiciously commended for good conduct or for
diligence in study, but never flattered for his cleverness and
good looks, or anything which he has not come by through
self-forgetting endeavor. Both boys and girls should be
taught to endure; to neglect trifling aches and pain, and seek
for a remedy rather than cry over the trouble. Self-command
and self-control are the noblest things a man can strive for.

164 PROGRESS OF MEDICAL SCIENCE.

and he will never gain them unless he began learning in
iufancy to fix his thought and will upon objects outside him¬
self. If such principles of education were more closely
followed, hysteria and the “ artistic temperament ” might
•gradually disappear, and the hosts of insane people now
walking at large, because their disorders of consciousness are
not directly menacing to society, might be much diminished.
Improper marriages are, of course, at the root of the evil.
Bad training is, however, almost as frequent a cause, and is
one which in the present state of society is much more readily
remediable. To Mac Beth’s famous question, “ Canst thou
not minister to a mind diseased ? ’’ the modern physician
should find a better and braver answer than that of the
doctor in the play, “Therein the patient must minister unto
himself.”— Pediatrics.

ANTIDOTE FOR CARBOLIC ACID.

Dr. Seneca D. Powell, of New York, has for a long time
used in his clinics at the Post-Graduate Hospital an antidote,
alcohol, that we have all come to recognize as a specific. It
is not an unusual occurrence to see Dr. Powell catch in his
open hands a quantity of pure carbolic acid, poured into
them by a nurse from a bottle. In a few moments the
doctor puts his hands into a basin of pure alcohol, and no
escharotic effect is observed whatever from the action of the
carbolic acid upon the skin. At present time we are flush¬
ing out abscess cavities with pure carbolic acid and washing
them out a few moments later with pure alcohol. In
empyema Dr. Powell, after making a large opening in the
chest wall, washes out the cavity with a ten per cent, solution
of carbolic acid, after which pure alcohol is used, and no bad
effect has thus far been observed from this treatment. The
cavity of the pleura is rendered aseptic. From personal
observations and demonstrations in the use of pare carbolic
acid, followed by the use of alcohol, Dr. Phelps states posi¬
tively that we have in alcohol an absolutely safe and sure
specific against the escharotic action of pure carbolic acid.
This fact should be given wide publication, becauses in cases
of carbolic acid poisoning with homicidal intent, if, im¬
mediately after the administration of the poison, alcohol was
thrown into the stomach of the individual, the poisonous
effect of carbolic acid would be at once neutralized. How¬
ever, as to the subsequent constitutional effect from the ab¬
sorption of the new compound formed Dr. Phelps cannot
speak, but certainly in all cases of local carbolic acid poison-

MEDICINE AND NEUROLOGY.

I6 5

ing, particularly in such a case as that mentioned by Dr.
Weiss, alcohol is an absolute, powerful and immediate specific.
— Va. Med. Semi-Monthly.

EFFECTIVENESS OF ANTI-TOXIN IN THE
TREATMENT OF DIPHTHERIA.

Dr. J. J. Kinyoun, United States Marine Hospital Ser¬
vice, in charge of the Bacteriological Laboratory at Wash¬
ington, in an article published in the Fcrum for August,
gives a lucid historical sketch of the progress and efficacy of
the anti-toxin treatment of diphtheria. The treatment
began to be used in the Berlin hospitals in 1894, and the
first full year of the anti-toxin period was 1895. The fol¬
lowing is the hospital record at Berlin for the years specified
in cases of diphtheria and membraneous croup, which latter
disease has been found to be generally due to the diphtheria
bacillus, and which consequently yields as readily to the
anti-toxic treatment as diphtheria: 1892, 3,683 cases with
1,342 deaths; 18^3, 4,315 cases with 1,637 deaths; 1894,
5,220 ca^es with 1,416 deaths; 1895,6,106 cases with 987
deaths ; 1896, 4,345 cases with 559 deaths: 1897, 3,723 cases
with 546 deaths. The anti-toxin was used for three months
only in two of the hospitals in 1894, and the death rate fell
from 37.7 per cent, in 189310 27.1 per cent. In 1897 the
death rate had fallen to 14.6 per cent.

In the Kaiserin Friedrich hospital, in 1894, the new
treatment was used from March to September, and the
mortality in all cases of diphtheria and croup was 15.6 per
cent. From September to November no further supply of
the serum could be obtained, and in that period the
mortality rose to 48.8 per cent. Then a supply of serum
came to hand, and on a resumption of the new treatment the
mortality rate at once fell to the former percentage. This
was a demonstration of its effectiveness which could not be
explained away.

The Paris statistics do not give the whole number of
cases treated, and we must judge from the number of re¬
ported deaths from the two diseases in question. From 1886
to 1893 the number of deaths averaged about 1,500 a year.
In 1895, the first year in which anti-toxin was generally
used, the number fell to 993; in the next year to 411; in
1897 to 444, and in 1898 to 274. The record of the Lon¬
don hospitals is not equal to that of Berlin and Paris, but
there, too, the death rate has been greatly reduced. In
New York during 1894 some 2,900 deaths from the two dis-

166 PROGRESS OF MEDICAL SCIENCE.

eases were reported] in 1898, under the new treatment, the
number was only 900. In Boston the death rate from these
causes averaged nearly 31 per cent, from 1880 to 1894 ;
from 1894 to 1897 it was only 12.6 per cent. In Chicago
the rate prior to 1895 had been over 30 per cent.; since
then it has fallen below 10 per cent.

Prior to the introduction of the anti-toxin treatment re¬
covery from croup was rare, unless effected by tracheotomy
or imubation. Reports upon 5,546 cases before 1892
showed a death rate of nearly 70 per cent. Another in¬
vestigator collected reports of 12,736 cases occurring prior to
1887, where the death rate was 73. Nowall this is changed,
and out of 1.074 cases reported to the American Society of
Pediatrics only 668 required surgical treatment, and the
percentage of recovery for all was nearly 79 per cent., as
contrasted with a lormer death rate of 70 per cent. Tra¬
cheotomy is now giving way to the milder operation of in¬
tubation, and even this is becoming less and less necessary,
owing to the prompt application of the new remedy. It
has been stated by Dr. Behring that if this remedy could be
applied on the first day of the disease there would be prac¬
tically no mortality from diphtheria, and Dr. Kinyoun fully
concurs in this.

The question at once arises here why anti-toxin may not
be administered to persons exposed to a diphtheria or croup
epidemic as an immunizing agent, as vaccine virus is used
against possible exposure to smallpox. While the two dis¬
eases differ materially in the nature of their origin, there is
good reason for believing that preventive treatment may be
as successlully pursued in the one case as the other. So far
as tried, it has met the most sanguine expectations. It is
mentioned in the Forum article that a Dr. Briggs has col¬
lected reports of 20000 cases of exposure to diphtheria
which have been treated with immunizing doses of anti¬
toxin, and only one fatal case was known to occur, while
only 109 cases of the disease in a very mild form developed.
It may soon be that “ anti-toxication ” will be made as pre¬
valent among children and others as vaccination.— The
Sanitarian.

COLD WATER vs. MEDICINAL TONICS.

The numerous medicinal tonics, so called, are universally
toxic in character. Whatever tonic effects they may seem
to produce are due to the fact that the system is aroused to
resist their influence and to expel them from the body; and

MEDICINE AND NEUROLOGY. 1 67

while a certain amount of benefit is perhaps derived from the
use of such agents, there is always a possibility of serious
damage ; and doubtless in all cases a considerable amount
of harm is done through the toxic influence of the drug,
which falls with especial weight upon those organs which are
most concerned in its elimination—the liver and the kidneys.

A medicinal stimulant is a mortgage placed upon the
vital capital of the body, which must be paid sooner or later.
It is a draft upon the constitution. A stimulant is simply a
means by which the nerve centers are made to give up a little
more of the energy which they have stored up, and unless
the stimulus is of such a character that the storing power as
well as the expending power of the nerve centers is increased,
there must be a loss from its employment.

A toxic agent, like strychnia, may provoke the expen¬
diture of nervous energy, but it does not replenish energy ;
while it does lessen the activity of the kidneys in eliminating
tissue poisons, and the efficiency of the liver in the destruc¬
tion of toxins and leucomains, thus encouraging the de¬
velopment and maintenance of a condition which is, in itself,
an indication for the necessity of employing tonic measures;
in other words a medicinal tonic or stimulant aggravates the
very condition it is intended to cure.

Nervous Energy .—The establishment in modern times
of laboratories for psychological and neurological research
has been the means of throwing much light upon the nature
of mental and nervcus activity. Nervous energy no longer
means, as formerly, an intangible, mysterious something, but,
as has now been clearly demonstrated, is immediately and
definitely connected with material elements found in the
interior of the nerve cell. For example, arnerve cell, when
in a state of rest, shows a large number of grayish granules,
which have been shown to be intimately connected with the
storage of energy ; so that when the granules are abundant,
the cell is like a fully charged battery, ready to discharge
under the influence of the right sort of stimulus the maximum
of energy which it is capable of exhibiting. On the other
hand, when the cell is fatigued, as after prolonged, energetic
work, the gtanules are found to be very few and small, and
the cells shrunken and pale.

With these facts in mind, it is easy to understand why
such disappointing results have followed the use of strychnia
and a very large number of medicinal agents, so-called “ nerve
tonics,” since it is evidently impossible that these drugs
should in any way increase the store of energy in the cell ;
and the most that can be expected from them is the excite-

168

PROGRESS OF MEDICAL SCIENCE.

ment of the cell to activity when it has become exhausted to
such a degree that a sense of fatigue supervenes as a warning
that the store of n« rvous energy is reduced to a point where
any further demand upon it is dangerous, and the rest is im¬
peratively d< manded.

The only way that the energy granules of a cell can be
augmented is by the assimilation of food from the blood, and
the development of energy-containing particles. Cold water
surpasses all other agents in its power to promote the normal
energy-storing processes. Cold applications also facilitate to
a very remarkable degree the discharge of nervous energy
when a sufficient store exists, though sometimes it may not
be a?ai’able because its useful application is hindered by the
influence of retained excretions of nerve-benumbing toxins
generated within the tissues or absorbed from the alimentary
canal. This effect of water is' readily apparent in the influence
of the cold bath upon muscular energy, to which attention is
called elsewhere, and also in the sensation of well being,
buoyancy and readiness for exertion which results from the
application of cold water.

The tonic effects of cold water are unquestionably to a
large degree due to the influence of cold impressions acting
through the nerves of the skin upon the sympathetic nerve
centres. The great sympathetic nerve controls the blood
vessels, glands, heart, the functions of secretion and excre¬
tion, and, in fact, all the vital functions of the body. The
awakening of the sympathetic to renewed activity, or a
balancing of its action, is what is specially needed by the
great majority of chronic invalids. The functions of the
brain and spinal cord, and through them all forms of nervous
activity, are to a remarkable extent influenced by the sym¬
pathetic. The sensation of well being which accompanies the
reaction following a general cold application is largely due to
the increased activity of the cerebral circulation, brought
abcut through the stimulation of the sympathetic. By its
powers to influence the sympathetic, hydrotherapy is capable
of controlling, restraining, reorganizing, balancing, all the
processes of organic life, and threugh them modifying the
functions of animal life to a marvelous degree.

Ccld Water a Physiological Ionic .—Cold water is a
physiological tonic, and has the advantage over medicinal
tonics of all sorts, in that it awakens nervous activity without
the imposition of any extra burdens upon any vital organs,
and without hampering the activity of any function. The
cold bath employed in such a manner as to produce tonic
effects accomplishes its results by increasing vital resistance

MEDICINE AND NEUROLOGY.

169

to the causes of pathological processes, by making the wheels
of life run more smoothly, by lifting the whole vital economy
to a higher level. The impression made upon that harp of
a million strings, the skin, with its vast network of sensory,
motor, sympathetic, vasomotor and thermic nerves, arouses
every nerve center, every sympathetic ganglion, every
sensory and motor filament in the entire body to heightened
life and activity- Every blood-vessel throbs and every cell
quivers with a new life; the whole body thrills with quickened
impulses; the whole being is translated into a new state of
existence.

A person who has never experienced the glow of exhil¬
aration, the invigoration and buoyancy of body and mirid,
which accompany the state of reaction from a short, general
cold application, can not well appreciate the value or signifi¬
cance of the cold bath as a physiological stimulant. It is
not too much to say that it is of all measures known to man
the most valuable as a means of arousing to activity the flag¬
ging energies of the body, and lifting the enervated invalid
out of the morasses and quagmires of chronic disease.—
Modern Medicine.

NAUSEA OF ANESTHESIA.

Nausea and vomiting following anesthetics is sometimes
a distressing as well as dangerous condition, and it behooves
us to avoid it as far as possible, not only for the comfort of
the patient, but for the reason that in serious surgical inter¬
ferences it may place life in peril.

Says the Therapeutic Gazette: “ Blumfield, in the Lon¬
don Lancet of September 23, 1899, observes that some of the
chief points to be attended to in the avoidance of after-sick¬
ness are: 1. Use as little of the anesthetic as possible con¬
sistent with perfect anesthesia. 2. Wash out the stomach at
the close of the operation when much mucus has been
swallowed. 3. In long operations, substitute chloroform for
ether after three-quarters of an hour. 4. Move the patient
about as little as possible during and after operation.
5. Place him on his right side in bed, with the head only
slightly raised. 6. Give nothing but hot, thin liquids in
small quantity for at least eight hours after. 7. Do not
alter the temperature of the room for some hours. With
proper attention to these points one-third of the patients
operated on will be free from after-sickness, and for short
operations the proportions will be much higher still. In fact,
after all administrations up to twenty minutes, or not much
longer, sickness will be found to be the exception.”

PROGRESS OF MEDICAL SCIENCE.

170

I have for some time given Ingluvin in liberal doses
(10 to 2o grains) just prior to the anesthetic, and have been
favorably impressed with its use, and would suggest its
thorough trial by the profession.

Two cases are reported from the Hospital College of
Medicine as follows:

Case No. 1.—Mrs. B.,age 30, operated on for co nplete
laceration of the perineum. She had twice before taken
chloroform, and after each, administration suffered from
severe vomiting. She took 3 10 grain doses of lngiuvin
six, four and two hours before the operation, and experienced
almost no sickness after coming from under the anesthetic.

Case No. 2.—J. H., age 34, amputation at the hip joint
This man said he dreaded nothing but the chloroform, as at
a previous operation he had suffered in a most distressing
manner from that anesthetic. I directed the nurse to give
him 10 grains of Ingluvin six and two hours before the
operation. He vomited only once after coming from the
table, and, though he suffered some considerable shock and
much pain, had no complaint of nausea.

Dr. E. H. Gingrich, 511 Cumberland street, Lebanon,
Pa., especially recommends Ingluvin for the vomiting so
frequently experienced by patients coming out of anesthesia.

Prof. Hobart Amory Hare, in “ Practical Therapeutics,”
writes:

1. “That chloroform or ether vomiting is probably
centric.”

2. “ Upon the mucous membranes, ether as a liquid or
in a vapor acts as an irritant, and causes, when its vapor
is first inhaled, great irritation of the fauces and respiratory
tract ”

Ingluvin is valuable on account of its mildly depressing
the sensitive nerves of the stomach, thus lessening the
irritation of that organ. The vomiting centres are subdued,
with the result that vomiting is controlled.

For vomiting succeeding anesthesia, Ingluvin should be
given,20 grains one hour before the administration of ether
or chloroform, and immediately after coming out of the
anesthesia, one 20 grain powder; to be followed every hour
by 5-grain powders, until vomiting ceases. Usually the 20-
grain powder will be found effective. Ingluvin is a bland
powder prepared from the gizzard of the chicken, and con¬
tains nothing which might contra-indicate its use in surgical
operations as specified above.

It has long been used as a remedy to allay persistent
vomiting of gestation with eminent success by many practi
tioners throughout the world. It therefore is 1 ot a nivpe

MEDICINE AND NEUROLOGY.

171

paration, but simply an old remedy in a new capacity.
Some months ago a professional suggestion was made to use
it for the nausea of ether. Subsequent tests and their results
have warranted its recommendation to the medical profes¬
sion. Samples will be sent to any physician who wishes to
test it in vomiting of anesthesia. Write W. R. Warner &
Co., Philadelphia, for a sample .—From Monthly Retrospect
of Medicine and Pharmacy .

HABITUAL CONSTIPATION.

The treatment detailed is intended for habitual consti¬
pation. For the immediate unloading of the bowel one of
the simplest and least harmful methods is the giving of one
or more enemata of warm water, containing salt in the pro¬
portion of a teaspoonful to a pint. Soapy water may be
used instead, if something stronger is needed. The amount
to be injected varies with the age. For young babies one or
two ounces is sufficient, and for those of two years, two or
three time this amount. Either the hard-rubber syringe or
the infant’s syringe may be used. A useful injection consists
of half a teaspoonful of glycerin in full strength. This is
best given from a small hard-rubber syringe holding not more
than half an ounce. The opening in the nozzle should be
larger than ordinary, as the glycerin does not flow readily.
If the mass in the bowel is large and hard, an injection of
wami sweet-oil, retained some hours if possible, is better than
anything else. It should be followed by an enema of soapy
water. In some cases it is necessary to insert the finger or
a small spoon-handle into the bowel and break up the
masses carefully.

Glycerin suppositories—glycerin and soap—of a size for
children are often excellent for opening the bowel. Gluten
suppositories are also serviceable in many instances. A
more economical plan is to employ little home-made sup¬
positories of castile soap, or, in place of these, a soap stick,
which can also be made at home, and which has the value of
lasting for lepeated usings. It consists of a smooth conical
stick of firm castile soap two or more inches long, half an
inch thick at the base, and tapering toward the other end to
the thinness of about one quarter of an inch. It should be
greased with vaselin before using, inserted part way into the
bowel and held there until a tendency to an evacuation shows
itself.

If none of the methods described is effectual, laxative
drugs must be employed. Their use, however, ought to be

172

PROGRESS OF MEDICAL SCIENCE.

deferred as long as possible, and is much better left to a
physician. Probably the best and least harmful of drugs is
cascara in some form. There is made a cascara cordial which
has a pleasant taste and is very effectual. Another very
useful preparation is the syrup of senna, which is easily
taken by children, as its taste is agreeable. Little sugar-
coated pills, each containing one-tenth grain or less of aloin,
are sometimes of service, one being given daily to a child of
two years. A small quantity of manna, about five grains,
can be given to a baby of six months once a day or oftener,
dissolved in the milk, as its taste is sweet, or ten grains of
phosphate of soda may be used in a similar manner.
Magnesia or spiced syrup of rhubarb answers very well, but
only for occasional use.— Jour A. M. A.

CARE OF THE MOUTH.

Perhaps r.o part of the body is so often neglected as the
mouth ; especially is this noticeable in the case of children.
A mother who will religiously bathe her child and keep its
body sweet and clean will often fail to cleanse its mouth. A
new-born infant should have its mouth washed after each
feeding ; a soft cloth wet in a weak solution of boracic acid
should be used for this purpose. If this were always done
we would rarely find a cause of infantile sore mouth.

After the teeth come and the mouth is large enough, a
small, soft brush should be used ; the teeth and mouth
should be thoroughly cleaned at least twice daily.

In illness where sordes and mucus accumulate rapidly,
and where the tongue and lips are parched and stiff, atten¬
tion is needed every hour ; the mouth should be kept moist,
and the same treatment carried out through the night as
during the day. Boracic acid solution, listerine, lemon
juice, glycerine and distilled water are all refreshing, and soften
the tissues; where the lips are chapped or fissures appear, a
lubricant of cold cream or sterilized vaseline should be
applied. Where the gums are spongy or soft, and bleed
readily, a few drops of tincture of myrrh added to pure water
will help to harden them. Small squares of old linen or
soft gauze should be used instead of a brush where one is ill
or weak. These should be immediately burned after use.

Every part of the mouth should be cleansed ; behind the
wisdom teeth, the roof of the mouth and under the tongue ;
lemon juice and water will remove the fur from a thickly
coated tongue. Where the teeth are sensitive the water
used should be slightly warm .—South Cal. Practitiouer.

MEDICINE AND NEUROLOGY.

173

BLACKHEADS.

'""W Blackheads are not, as is generally thought, dust or dirt
accumulated in the pores, but consist of fatty secretions of
the skin and a coloring matter. The following mixture may
beVecommended lor their removal :

R Kaolin, parts iv.

Glycerin, parts iij.

Acid acetic, parts ij.

01. odorat., ad lib.

M. Sig. Apply this mixture to the parts at night, and,
if possible, also several times during the day. The blackheads
will disappear when washed with this mixture and rubbed
freely with a towel moistened with it, or can easily be removed
after a few days.— Tri-State Medical Journal.

ALCOHOL AND CYCLISM.

MM. L. Jacquet and Regnault (Le Progres Medical ,
29th July) believe that the prevailing popular belief that
alcohol gives strength to the system is one of the causes of
the prevalence of the increasing use of alcohol throughout
the country. It is therefore the duty of physicians to com¬
bat this error, which they have heretofore contributed
largely to spread among the people. We have had, they
say, occasion to enquire of some well-known cyclists their
opinion of the effects of alcohol from a professional point of
view. Those consulted : Mr. Miller, of Chicago ; Calmettes
and Goring, of Paris; Monachon, of Geneva ; Fischer, of
Mulhouse. Their reply was invariably the same ; they are
all absolutely temperate, even when not engaged in active
exercise they avoid aperitives and absinthe. As to their
opinion of it during the race proper, it may be resumed in a
single curt and emphatic formula: Alcohol weakens the
limbs : ‘‘L’alcohol coupe ies jambes

In the spring of 1888, during the severe snowstorm
popularly known as the blizzard, the trains on the Long
Island railroads were stopped, and the passengers to New
York were obliged to endure cold and hunger, or walk
several miles through the snow drifts. A young man, tall,
slender, rather delicate, made one of the party who sought
relief. When refreshment was found he absolutely refused
alcoholic diinks in any form, and took a full cup of moderately
strong coffee instead. Having found a place in which rest
could be obtained, the most delicate of the party was the
least exhausted after the prolonged and severe journey.

174

PROGRESS OF MEDICAL SCIENCE.

Relying on his own experience he has since, much to his ad¬
vantage, avoided alcohol and tobacco.

How many of the numerous accidents that are occurring
daily are due to overstimulation ? Investigation is due to
the public.— The Sanitarian.

THE X-RAYS IN DISEASES OP THE CHEST.

In the Boston Medical and Surgical Journal for
January 18, Williams writes of the value of the X-ray ex¬
aminations in the less frequent diseases of the chest illus¬
trated by their use is those cases where aneurism is present
or suspected.

He stated that aneurisms of the thoracic aorta may be
seen by the X-rays before there are physical signs. This
method of examination may give us greater assurance of the
absence of an aneurism of the aorta in suspected cases than
any other evidence that we can have.

He reports the examination of 34 cases, 15 having
typical aneurisms, 6 had more or less dilatation of some por¬
tion of the arch, I showed an outline suggestive of aneursm,
but there was no pulsation, and on autopsy a mass of glands
was found. The remainder gave normal outlines in the
region where an aneurism had been suspected.

In 13 of the 15 cases the aortic arch was the scat of
the aneurism; in one of these there was a second
aneurism in the innominate artery also; in the fourteenth
case there were two aneurisms, one in the innominate and
another in the subclavian artery; in the fifteenth case the
aneurism was in the subclavian artery. Eleven of these
cases were males and four females; 11 were between thirty-
eight and forty-five years of age; two were thirty-three; one
was forty-nine and one fifty-nine, and one twenty nine. A
syphilitic history was obtained in four cases. Pain was pre¬
sent in 12 cases and alteration of voice in 11. Laryngoscopi-
cal examination was made in 7 of these last cases, which
showed paralysis of the vocal cord. The physical examina¬
tion of 12 out of 14 of the cases of aortic aneurism was given
in the hospital records; in five cases there were no physical
signs of aneurism; in eight cases the heart was enlarged,
and in five of these there were murmurs indicative of val¬
vular defects, four of which were aortic and one mitral.
Arteriosclerosis was found in the three cases in which an
autopsy was made. No nephritis was found in any case.—
The Charlotte Medical Journal.

SURGERY.

IN CHARGE CP

HOLLO CAMPBELL, M.D.,

Lcct irer on Surgery, University of Bishop’s College ; Assistant* Surgeon, Western Hospital;

AND

GEOROE FISK, M O.

Instructor in Surgery, University of Bishop’s College ; Assistant-Surgeon, Western Hospital

PRESERVATION OF SURGICAL NEEDLES.

At a recent meeting of the New York Surgical Society.
Dr. Dawbarn recommended the use of a saturated solution of
sodium carbonate (washing soda) in water, for the purpose
of preserving surgical needles. He stated that in his opinion
this method of keeping the needles and cutting instruments
untarnished was superior to any other which had thus far
come within his experience. He showed needles kept bright
in this way for a year and more. Most of the other methods
are open to some objection. Perhaps the most common
method is to sew the needles into an oiled cloth, but this
does not always prevent flecks of rust. As to keeping them
in carbolized oil, this to some extent dulls the edge of the
needles just as carbolic acid in watery solution does that of
scalpels; lysol being a dark solution, the needles are not
very easily seen in it; calcium chloride in a closed place to
keep the air dry, with the needles lying on a dish near it,
produces a curious tarnish, almost like rust; in Fuller’s
earth or other powders it is difficult to find the smaller
needles; in alcohol, unless it is absolute (and absolute
alcohol ceases to be absolute very soon), the needles will
finally rust. A solution of borax in water, as recommended
by M. Marshal, will also rust the needles as soon as the thin
plating, which all needles have at first, becomes worn away
from usage, exposing the steel beneath. Perhaps keeping
needles in liquid petrolatum is almost as good a way as that
under discussion; its only objection being the unpleasant
oiliness. Calcium chloride in absolute alcohol—thus keep¬
ing it absolute—is effective, but comparatively expensive*
The same is true of placing a sheet of gelatin in the absolute
alcohol, the gelatin by its affinity for water keeping the
alcohol absolute. The method now advocated—washing
soda dissolved in water to saturation—is inexpensive and
satisfactory to the author .—Gail lard’s Medical Journal.

iy6 PROGRESS OF MEDICAL SCIENCE.

DIRECTIONS FOR THE STERILIZATION OF
CATHETERS AND BOUGIES.

Nicoll gives the following directions for the sterilization
of catheters and bougies :

Bougies —Gum-elastic bougies will not bear heating to
a temperature sufficient for sterilization. Soaking for fifteen
minutes in carbolic acid solution i in 20, for half an hour in
I in 40. or for an hour in perchloride of mercury I in 1,000^
renders the surface so sticky that the towel adheres in the
process of drying, and the bougie becomes covered with fluff.
After several soakings the surface becomes permanently
dull and sticky, and unfit for use. Dr. Schimtnelbusch says
that “ a smooth bougie or catheter can mechanically be
made externally free from germs by rubbing it with a piece
of sterilized gauze and warm water." To test this a series of
six gum-elastic bougies in use from six to eighteen months,
after being employed in cases of stricture, were washed with
tepid water and soap, rinsed in cold running water, and dried
with thorough light friction with sterilized gauze. They
were then rubbed on the surface of acid and alkaline agar
tubes. In one case colonies of an unidentified coccus ap¬
peared, in another a patch of penicillium. The other ten
tubes remained steiile. Six bougies soiled with pus were
similarly treated; all the tubes remained sterile. In other
experiments, instead of the gauze, an ordinary towel fresh
from the laundry was used, and similar results were obtained.
It appears, therefore, that antiseptic solutions which rapidly
destroy instiuments are unnecessary for sterilization.

Catheters .— Red rubber catheters (Jacques) may be
sterilized by boiling or steaming, or may be soaked for
months in carbolic solution (1 in 20) or perchloride of mer¬
cury (1 in 1,000) without damage. A rubber catheter may
be used daily for six months without becoming unfit for use,
if washed every day with hot water and soap, and put to
soak in carbolic lotion for the remainder of the twenty-four
hours. But there are certain red rubber catheters which
rapidly deteriorate under repeated boiling, and all rubber
catheters ultimately do so. Prolonged and repeated soak¬
ings in antiseptics have little effect. By experiments the
writer has proved that rubber catheters, boiled, steamed,
or soaked for four hours in the lotions mentioned are rend¬
ered sterile internally and externally. But gum-elastic cathe¬
ters, like bougies, will not stand the lengthened and repeated
soaking necessary fcr sterilization. There is no entirely reli¬
able method. For practice the writer has formulated the
following rules :

SURGERY.

1 77

(i) Avoid as far as possible the employment of catheters.
In cases of stricture it can only be very exceptionally that a
catheter is called for. Bougies, which are readily sterilized,
will do all that is necessary. (2) Where a catheter must be
employed, u-e where possible a red rubber Jacques’ catheter
in preference to a gum-elastic. In retention from atony
spinal paralysis, reflex nervous effects, and other causes, and
in many cases of prostatic retention, the former answers as
well, and is as readily sterilized by boiling or immersion in
an antiseptic solution as is a metal catheter. (3) Where the
red rubber fails to pass, the use of metal catheters, epecially
by the patient, does not commend itself as free from risk of
injury. Gum-elastic catheters must therefore be used. If
the urine is very septic the writer destroys the catheters used.
If the urine is not very purulent or offensive, he washes the
catheters externally with soap and water, and then with anti¬
septic solutions, which is followed by internal steaming.
Those that survive he retains. When the regular use of a
gum-elastic catheter is necessary, the patient is supplied
with a catheter with a well-finished interior. After use he
thoroughly washes it, holds it under the tap for a few minutes,
and lays it asides in boric acid, weak perchloride, or other
weak antiseptic. This only offers a reasonable chance of
asepsis, but it is useless to expect an average patient to carry
out more elaborate plans. The writer has had glass tubes con¬
structed, which are filled with the antiseptic solution, in
which the catheter is placed after use. The solution varies
in strength according to the kind of catheter; for gum-elastic
catheters it must be weak ; red rubber catheters will stand
anything.— Gaillard's Medical Journal.

A NEW “ T •» BANDAGE.

W. O. Green, Louisville, Ky., employs a simple device
for holding dressings in place about the anal region. This
bandage is always the proper length, because it is not made
until applied. It is necessary to employ heavy, thick ma¬
terial, the heaviest unbleached cotton being the best adapted.
This is cut into strips not less than four inches wide; the
average length for each bandage is two yards. About six
inches of the bandage is unrolled, and folded upon itself
three inches from the end. In the centre of the fold a cut is
made with a pair of scissors. In consequence of the fold, the
cut should be made only one-half the desired length when
unfolded, and the limit of the cut at the centre point should
be at least an inch from the free end of the bandage. This

I?8 PROGRESS OF MEDICAL SCIENCE.

will be about half an inch or more than the diameter of the
roller. The bandage is passed around the waist, the one
end brought through the cut, which is placed in the centre
of the back. This obviates the use of pins, buttons or knots,
and at the same time the waist and perineal bands can be
made to conform to the parts. The perineal band is passed
up and under the waist band in front, where it is tied in the
form of a reinforced bow-knot, and the roller cut off after the
knot is tied. For the first dressing subsequent to rectal
operations this bandage is not employed, because sufficient
pressure cannot be brought to bear to give firm support to
the anal region, but it has been employed almost exclusively
for holding in place rectal dressings, and can be used with
equal efficiency for genito-urinary and other perineal dressings*
— N. Y. Med, Record, Medical Review.

A TREATMENT FOR ACUTE SEROUS SYNO¬
VITIS PERMITTING OF JOINT FUNCTIONS.

The method might be called the compression treatment.
It has proved far more satisfactory than the old ones of rest
and immobilization, hot or cold packs, evaporating lotion,
etc. Its application is quite simple, though considerable
care and judgment should be exercised. The principle is to
fill all depressions about the joint with cotton, and then to
apply strips of rubber adhesive plaster in such a way as to
entirely encircle the joint and several inches of the limb
above and below it, so as to make firm and equable compres¬
sion. The joint in which it has been found to be of the
greatest value, and in which the results, both immediate and
permanent, are truly remarkable, is the knee. One of these
cases treated by this method is detailed, showing exactly
the mode of procedure. The chief advantages of this dress¬
ing are its small weight, the immediate relief from pain that
it affords, and that it permits the joint functions—motion
and weight-bearing—without injury. A number of patients
were doing hard labor a day or two after the dressing was
adjusted to an acutely inflamed knee-joint. As a rule, the
patients are permitted to use the limb in any way that does
not cause pain or discomfort. We are indebted to the sprain
treatment for the suggestion of adhesive plaster as a joint
support ; but it had not been employed in the treatment of
caute serous synovitis previous to the first publication on this
method by Hoffmann in 1895.— Dr. P. Hoffmann , N. Y.
Med. Jour., Med. Review.

SURGERY. 179

CELLULOID YARN ; A NEW MATERIAL FOR
SUTURES AND LIGATURES.

J. Pagenstecher reports, in the Philadelphia Medical
Journal, the brilliant results from the use of linen thread
which has been impregnated with a solution of celluloid.
For a few years he has used this new material exclusively
for all purposes, and has found it superior to all others,
whether used only for skin sutures, internal sutures on the
bowels or the bladder, for uniting the capsule of joints, or even
to sew up the torn ligamenta cruciata. In all these cases
this material has proven to be the best that has been used.
The sterilized yarn shows its good properties when dry, but
any remnants may be kept in good condition in alcoholic
sublimate. It can be sterilized with the bandages in steam¬
ing vapor. By impregnation with celluloid the yarn acquires
great firmness and resistance : the surface is smooth and bril¬
liant, and its tendency to absorb pus and other secretions from
wounds has comparatively ceased. Therefore the thread
does not expand or unravel ; knots hold with absolute se¬
curity. As the strength of the thread is increased by the
addition of the celluloid, and is much greater than that of
silk, finer threads can be used, which will not break while
being knotted. Another advantage lies in the fact that it is
more readily handled, especially while threading the needle,
as the new thread is rigid and easy to control .—Medical
Review.

THE USE AND ABUSE OF POULTICES.

S. E. Earp, Indianapolis, believes that much harm
results from the use of a poultice because proper instructions
are not given to patients, and they remain in ignorance as to
what is to be expected from its use. As a rule, the poultice
should be non-irritating, it should be used hot and renewed
often. Its virtue depends on the heat and moisture, and hence it
is of little importance whether it consists of flaxseed meal,,
cornmeal, etc., except so far as these are capable of retaining
the heat, and the selection is a matter of convenience. The
statement of many that the antiseptic solution has superseded
the poultice in the treatment of open wounds is somewhat
misleading, and should not be a reflection on the latter from
the fact that poultices were frequently used when they
should not have been. The benefits of the poultice as such,
or as a medium, are thus summarized : 1. To relieve conges¬
tion. 2. To reduce inflammation. 3. To promote absorp¬
tion, favor resolution, or hasten suppuration. 4. To diminish

i8o

PBOGRESS OF MEDICAL SCIENCE.

tension. 5. To soften incrustations. 6. To encourage tissue
relaxation. 7. To stimulate healthy granulations. 8. To
perform the office of a deodorant and, in a sense, of an anti¬
septic.— N. Y. Med. Jour ., Med. Rev.

GERMICIDE FOR THE GONOCOCCUS.

The latest thing which is vouched for as a sure destroyer
of the gonococcus is picric acid. It is claimed by those who
have used this method that it exerts almost a specific action
in chronic urethritis. In using the remedy, a solution of
frcnx 1 to 2 per cent, is employed, and it is always used by
instillation. The soft or hard catheter is introduced into the
urethra as far as the cut-off muscle, and the injection is slowly
made until the fluid flows from the anterior urethra. It is
claimed that many cases have yielded to this treatment that
have resisted protargol, nitrate of silver, and permanganate
of potassium .—Medical Review.

LUBRICATION OF THE CATHETER.

A wholly satisfactory lubricant for catheters has not
been devised. These instruments, which should be aseptic,
are with difficulty rendered so, and it is still more difficult to
keep them so. The problem of lubricating them, and at
the same time avoiding infection, is difficult to solve.
One of the latest recommendations for this purpose
is that of Kraus, who uses a paste composed of tragacanth,
2.5 parts, glycerin, 10 parts, and a 3-per-cent, solution of
phenol (carbolic acid), 90 parts. This, he claims, is an
admirable lubricant, is easily removed by warm water, and
is aseptic .—Medical Review.

SPRAINS.

The Gibney treatment of sprained ankle is described as
follows: Ordinary adhesive plaster is cut into strips one-
half-inch wide and in two lengths—twelve and eighteen
inches. As soon as the patient is seen, one of the longer
strips is placed around the ankle parallel to the sole of the
foot. Beginning in front of the big toe, the strip is carried
around the ankle just above the contour of the sole, and the
end is brought back across the top of the foot to about the
point where the strip began. It is well to place, overlapping
this initial strip, a parallel piece. These strips should be
drawn as tightly as possible. Next, another strip should be
placed at right angles to them, which makes it run parallel

SURGERY.

131

to the back of the leg. One of the shorter strips should be
selected for this purpose. Beginning well behind and above
the ankle, this strip should be carried down around the sole
of the foot and brought up on the other side of the leg,
making, as it were, a stirrup for the foot. This strip is
closely applied. Now the strips should be applied alter¬
nately, first one around the ankle parallel to the sole, and
then one parallel to the back of the leg, each one over¬
lapping the one previously applied, running in the same
direction to some extent, until the entire foot is enclosed in
a boot of adhesive plaster, having the appearance of a shoe
in which part of the heel has been cut away. Over this
dressing is now placed an ordinary roller bandage. The
patient should be careful for a day or two, when he can
begin to move around rather freely. This dressing should
be kept on until the pain and swelling have subsided. If
the dressing becomes loose it can be reinforced by addi¬
tional strips placed over the loose ones. — J. H. Adams, in
Railway Surgeon.

REMOVAL CF EAR WAX.

I

Hardened wax in the external ear can often be removed
readily by injections of warm water and soap, soda or
ammonia. Many cases resist this, and require the softening
effects of glycerin or sweet-oil for a day or two before
syringing Do not bother with these long processes, but
use a half-strength solution of hydrogen dioxid in the ear
for about five or ten minutes. This will disintegrate the
hardest plugs, and they can be removed with very little
syringing. I have yet to see the case in which this process
has caused irritation or inflammation. Do not use too much
force with the syringe. Wipe the ear perfectly dry with
absorbent cotton and apply petrolatum. Wear a small plug
of cotton in the ear for one day after removal.— Phila. Med.
Jour.

EPISTAXIS.

Treatment .—All that is necessary in epistaxis is to
fashion with a pair of scissors a dry plug of prepared sponge,
in size and length comparable with the little finger of a
twelve year-old boy. This should be carefully soaked in
boiled water, to free it from grit, squeezed dry to free
it from unnecessary fluid, and inserted its full length,
gently, along the floor of the bleeding nostril. No

i 82

PROGRESS OF MEDICAL SCIENCE.

styptic is necessary. The expansive pressure of the soft
sponge against the bleeding side, increased by the coagula¬
tion of a few drops of blood in its interstices,'will check ihe
bleeding at once. It should be removed in twelve hours;
under no circumstances should it remain longer than
twenty-four.— Sajou's Cyclo.

BURNS AND SCALDS.

7 reatment .—According to E. T. Milligan, burns, when
under treatment, should be exposed as little as possible by
changing dressings. Morphine should be used hypo¬
dermically for pain, and tincture of musk by the mouth as a
cardiac stimulant. The latter seems to control shock, due
to injury. In burns of the first degree an ointment contain¬
ing a sedative or carron-oil can be applied with advantage.
In burns of the second or third degree picric acid in solution
(5 to 1,000) is an excellent application, but a dry dressing is
personally favored. A powder containing 2^ drachms of
pulverized camphor and I ounce each of prepared chalk and
magnesium sulphate is one of the best When powders are
used the injured parts should be covered with oiled silk to
keep the dressing from becoming entangled in the injured
parts. When prostration is great, a saline infusion is of
marked value.

Ellice M. Alger has found that the combination of picric
and citric acids, which Esbach long ago devised for the de¬
tection of albumin, is more «ffective than the picric acid
alone, in burns of the second degree.

Esbach’s solution consists of io parts of picric acid, 20
of citric acid and i,ooo of water. Without any elaborate
attempts at antisepsis the bullae and vesicles should be
opened with a clean blade and the fluid applied freely, care
being taken that the solution reaches the interior of each
one. The combination after the first smart has passed re¬
moves the pain very quickly. After the excess of fluid has
drained off the part may be covered with rubber tissue or
soft gauze, and left undisturbed for several days. After two
or three days the fluid should be reapplied to such areas as
are moist, and the part carefully recovered.

R. H. Gay has obtained good results from using the
following in burns and scalds: i pound of mutton-tallow, i
drachm of English resin and i drachm of bees-wax should
be put into a vessel, perfectly free from grease or other sub¬
stance, over a slow fire. After the ingredients are melted
and thoroughly mixed, they are to be removed from the fire

SURGERY

183

and pint of linseed-oil (linum usitatissimum) is to be
added, stirring until cool to prevent separation. A few
minims may be dropped on a smooth surface to cool, to see
whether it is of the right consistency or not. If too soft,
tallow should be added ; if too hard, oil. It is now ready
to pour off into boxes for use. The directions for using are
to spread it on old linen or cotton cloth, to a sufficient
thickness, large enough to cover the burn or scald, and to
renew daily* This preparation is cooling, detergent and
healing, and if instantly applied to burns and scalds will
almost immediately stop the pain and prevent blistering.

In the treatment of scalds and burns Edward Roelig finds
aristol of great service. After a thorough disinfection and
cleansing of the burned area, and the opening of the vesicles,
a dressing of arhtol salve smeared upon sterilized gauze in a
layer of about the thickness of a knife-blade is applied, and
this dressing changed daily. The dressing is covered with
cotton and held in place with gauze bandages. Granulation
and cicatrization occur promptly. In personal cases, at first
an aristol salve, consisting of drachms; ol. olivar., 2%
drachms; lanolin, 10 drachms, was applied, and, when the
wound surface had become smaller and granulations had
formed, aristol powder was dusted on, and covered with
gauze and cotton.

Vehmeyer has used with good results an ointment con¬
taining fluorin, and sold under the name of “ Epidermin,” in
the treatment of severe burns and scalds. It should be re¬
newed twice a day. Relief of pain, prevention of profuse
suppuration and rapid growth of any islets of undestroyed
epidermis are its great advantages.

Naftalan has been found by Richard Bloch to so fully
meet the therapeutic indications demanded in burns, whether
caused by hot fluids, steam or heated solids, etc., as to be
almost a specific.

The use of saline transfusion for burns and shock is
recommended in an editorial, which states that, even if the
toxsemic condition is not directly improved by the saline in¬
jections into the subcutaneous tissues of veins, there is still
another one in which this method of treatment may be of
great good, in that surgical shock is nearly always present as
a result of severe burns and scalds. In shock a condition
of profound relaxation of the blood-vessels exists, so that
arterial pressure is very low and the vital centres are not
properly supplied with blood.

While intravenous injection does not necessarily raise
blood-pressure, this method of treatment is capable of read „

184 PROGRESS OF MEDICAL SCIENCE.

justing the circulation to such an extent that the evil
manifestations of vasomotor paralysis are set aside. It
seems, therefore, that, in treating cases of severe burns of
scalds, this method of procedure should not be ignored, but
should be actively employed.

Patel notes the case of a child, aged zy 2 years, who had
a burn of the second degree, involving, more or less, both
arms and legs, face and trunk. The general condition was
bad, the pulse imperceptible and the child unconscious.
Caffeine, alcohol, bouillon and milk were given. On the
third day 250 cubic centimetres of saline solution were in¬
jected, and on the fourth day the child became for the first
time conscious. Between the fourth and twenty-second days
six similar injections were given. Until the twentieth day
he improved in every respect, but on the twenty-second his
general condition was not so favorable, and on the twenty-
fourth day he died. At the necropsy the lungs alone pre¬
sented appreciable lesion ; diffuse catarrhal pneumonia. The
great improvement after the first four injections and the sur¬
vival of the child for nearly a month seemed to be due to the
serum. The cause of death in extensive burns is thought to
be due to an autointoxication. Consequently, once the
period of shcck is passed, the treatment should be directed to
freeing the system of the circulating toxin, and for this saline
injections answer well. Due attention should also be paid
to the emunctories, so as to still further favor the elimination
of toxins.

Azzarello divides the theories of the cause of death
from burns into four classes: (1) death from shock or ex¬
treme pain ; (2) embolism, thrombosis and destruction of
the blood-elements; (3) pya:mic infection through the burnt
surface; (4) poisons formed by the action of heat on the
tissues or autointoxication from deficient excretion by the
skin. By experimenting upon dogs and rabbits, it is per¬
sonally claimed that the intoxication theory is the correct
one. Injection of large quantities of artificial blood-serum
subcutaneously appeared to save life in several cases.—
Monthly Cyclopedia of Practical Medicine.

Jottings

The True Value of Gargling. —By gargling in the
usual way only the upper anterior surface of the uvula and
soft palate and base of the tongue are reached. The method
of holding the nose and throwing the head well back when
gargling enables the fluid to reach every surface of the
pharynx. The value of the two methods can readily be
tested by painting the posterior wall of the pharynx with a
strong solution of methylene blue. After gargling with
water in the usual way, the latter will be perfectly clear and
unstained; then let the patient gargle again by the method
suggested, and the ejected fluid will be found stained.—
Editorial , Charlotte Medical Journal.

How to Use Eye Drops.—A suggestion as to how to
put drops in an eye may be of service. Have the patient lie
down or sit in a reclining chair, with head thrown back and
eyes closed. Drop the medicine on the closed lids, allow it
to remain until it becomes heated from contact with the
skin, then open the lids gently and allow it to flood the eyes.
In the case of children particularly will this be found to
make the work easy.— Alkaloidal Clinic.

Removing Ear Wax.—T he Western Clinical Recorder
says that cerumen may be quickly and effectually softened
by Ailing the meatus with peroxide of hydrogen and allowing
it to soak for a few moments, after which it may be easily
removed by syringing with warm water.

Poultices in Bronchitis and Broncho-Pneu¬
monia in Children.—A. W. Senior states that poulticing
of the chest in bronchitis and bronchopneumonia is un¬
scientific and prejudicial to the welfare of the patient. The
difference in the temperature of the poultice when applied
and when removed is such that one might as well be con¬
tinually removing the child from a warm room out into the
cold every few hours. The weight of the poultice must also
be taken into consideration. The disadvantages of poultices
more than counteract any beneficial influences they may
ha ve—British Med. Journal .

JOTTINGS.

186

The diagnosis of scarlet fever is not always easy, and
Lindsay (British Med. Journal) has very well summarized
the main points to be borne in mind. These are:

1. Initial vomiting, very constant in children under ten,
less so above that age, and rare in measles, German measles
and diphtheria.

2. Undue frequency of pulse—say 140 to 150—out of
proportion to the other symptoms.

3. The rash, beginning on the upper part of the chest,
over the clavicles and about the flexures of the neck; often
well marked on the back of the waist.

To discriminate between scarlatina and German
measles, Lindsay is in the habit of relying upon the follow¬
ing points: In scarlatina there is initial vomiting; a brief
but well marked prodromal stage, with vomiting, chills,
headache and sore throat, sometimes going on to ulceration;
no early enlargement of post-cervical glands. In German
measles there is no vomiting, no prodromal stage, the rash
being often the first symptom, and always appearing on the
face; little or no constitutional symptoms; no ulceration of
the throat; a very characteristic early enlargement of the
post-cervical glands.

Foreign Bodies in the Ear. —Hummel {Munch.
Med. Woch.; Am. Jour. Med. Set.) makes the following
deductions:

1. The relation of the normal ear canal to inanimate
foreign bodies is entirely without reaction ; that is, the
foreign body in the ear does not, per se, endanger the in¬
tegrity of the ear.

2. Every hasty endeavor at removal is, therefore, not
only unnecessary, but can become very injurious.

3. In all cases not previously interfered with (with few
exceptions), the foreign substance can be removed from the
ear by means of syringing.

4. The general practitioner should never employ any¬
thing but the syringe in his endeavors at removal of foreign
bodies from the external auditory canal.

5. An instrumental removal of a foreign body from the
ear should be effected only by one fully able to examine the
ear with an otoscope and acquainted with every operative
manipulation in this region.

Practical Hints Regarding Children. —Always
teach a nurse that a child cannot swallow as long as the
spoon is between the teeth; that it is advisable to de-

JOTTINGS.

187

press the tongue a brief moment and withdraw the spoon
at once, and that now and then a momentary depression of
the nose is a good adjuvant.

The taste of quinine is disguised by coffee, chocolate
and “elixir simplex.”

Powders must be thoroughly moistened ; unless they be
so the powder adhering to the fauces is apt to produce
vomiting.

Inunctions require a clean surface, and are best made
where the epidermis is thin, and the net of lymph-ducts
very extensive, as on the inner aspect of the forearm and the
thigh.

Babies, after having taken opiates for some time, demand
larger, and sometimes quite large, doses to yield a sufficient
effect.

Febrifuges and cardiac tonics, such as quinine, antipyrine,
digitalis, strophanthus, sparteine, convallaria, etc., are toler¬
ated and demanded by infants and children in larger doses
than the ages of the patients would appear to justify.

Mercurials affect the gums very much less in young than
in advanced age.

The rectum of the young is straight, the sacrum but little
concave, the sphincter ani feeble, and self-control is deve¬
loped but gradually; for these reasons rectal injection is
allowed to flow out or is vehemently expelled. Therefore,
one which is expected to be retained must not irritate. The
blandest and mildest is a solution of six or seven parts of
chloride of sodium in a thousand parts of water, which
serves as a good vehicle for medicine unless incompatible
with the latter. The injection must be made while the child
is lying on its side (preferably the left side), not on the belly
over the lap of the nurse, for in this position the space inside
the narrow infantile pelvis is reduced to nothing.

In many cases of intense intestinal catarrh, large and hot
(ioo° to 108 0 F.) enemata will relieve the irritability of the
bowels and contribute to recovery. They must be repeated
several times daily, When there are many stools, and these
complicated with tenesmus, an injection, tepid or hot, must
or may be made after every defecation, and will speedily
relieve tenesmus.— Prof. Jacobi, in Pacific Med. Jour.

THE

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price , $1.00 per annum in advance . Sing/e
Copies , io

Make all Cheques or P.O. Money Orders for subscription, or advertising, payable tp
JOILN LOVELL & SON, 28 Sc. Nicholas Street, Montreal, to whom all business oommiv
ideations should be addressed.

All communications for the Journal, books for review, and exchanges, should be
Addressed to the Editor, Box 2174, Post Office, Montreal.

Editorial.

SURGEON-CAPTAIN FISET.

The many friends of the Hon. Dr. Fiset will read with
great pleasure the following extract from the report of Lieut.-
Col. Otter, Commanding the 2nd Battalion Royal Canadian
Infantry, on the Battle, which is now nominated “Paarde-
berg”:.

“ The company stretcher-bearers exhibited great pluck,
and five of them were among the wounded. Three of them
were wounded in conveying Captain Arnold from the firing
line, the stretcher upon which he was being made a special
object of attention by the Boer marksmen. In connection
with this incident I must note the courage displayed by
Surgeon-Captain Fiset, who, when the stretcher upon which
Captain Arnold was being bro ught to the rear, was stopped
a short distance from the firing line by the wounding of one
of the bearers, went forward and attended to Captain
Arnold, and subsequently assisted as a bearer in bringing
him to the rear. Captain Fiset also attended to many
others wounded, under fire during the day.”

THE ROYAL ARMY MEDICAL CORPS.

In connection with our article in the March number of

EDITORIAL.

189

the Record on “ Medical Officers of the Canadian Militia,”
we direct the attention of our readers to the following ex¬
tract from the British Medical Journal of 17th Marcji,
headed, “The Undermanning of the Army Medical Ser¬
vice”:

Compared with the February list, the total has de¬
creased by 4, accounted for as follows in the obituary: 1
murdered on Burmah-Chinese frontier, 1 died of wounds
and 2 from disease in South Africa.

The number at home has sunk from 117 to 75, no doubt
through the mobilization of the Eighth Division, while the
number in South Africa has correspondingly increased from
35010389. The number at other foreign stations is 386,
against 385, while the unposted have declined from 6 to 4.

It must be noted that if the administrative and the
executive officers holding staff appointments, and therefore
not available for general duty, be deducted from the 75 at
home, only about 50 full-pay executive medical officers are
left for general duty. These are reinforced by about 84
retired-pay officers, called “acting” in the Estimates, and by
33 on the retired list “ temporarily employed ” (of whom 2
are in South Africa), and by a large contingent of civilian
surgeons, of which there is no complete return.

The effective total strength of full-pay army medical
officers is nominally at present 854, not including the
Director-General, but if 16 seconded officers be deducted the
real strength is 838. This number is insufficient for ordinary
peace duties, and, of course, quite unequal for the present
strain. It provides no margin whatever for current casual¬
ties and periodical reliefs; it will be still more insufficient
when the proposed addition of 27,600 men to permanent
army establishments is effected. The present number of
838 officers must indeed be reinforced by at least 200 if the
service is to be placed on an efficient footing.

DAMAGES CLAIMED FOR ANTENATAL IN-
' JURIES.

According to the New York Medical Record , the
Supreme Court of Illinois has recently adjudicated in a re¬
markable case. An infant claimed damages for a deformity
alleged to have resulted from injury to the mother before its
birth. The mother, while pregnant, was injured in an

190

EDITORIAL.

elevator accident at St. Luke’s Hospital, Chicago, her left
leg being caught and crushed. When the child was born
his left leg was deformed. The hospital anthorities settled
with the woman for her injuries, and then she brought suit
in the child’s name for 50,000 dollars damages for the de¬
formity, which it was claimed was due to the same accident.
The Court dismissed the suit on the ground that at the time
of the accident the child could not be credited as a separate
being capable of sustaining an action independent of the
mother.

The British Medical Journal of March 17 states that
Dr. William Osier, now Professor of Medicine in Johns
Hopkins University, Baltimore, has sent in an application
for vacant chair of the Practice of Physic in the University
of Edinburgh. Dr. Osier’s many friends not only in Mont¬
real, but throughout Canada, will wish him success. There
are three other candidates, all of whom are graduates of the
University of Edinburgh.

At a largely attended meeting of the profession in Ottawa
a short time ago, it was decided to hold the meeting of the
Canadian Medical Association on the 12th, 13th and 14th
of September 1900. The meeting was unanimous in the
desire to make the Century gathering of the Association the
best meeting ever held. A large sum of money was sub¬
scribed by those present for the entertainment of visiting
members, making it a certainty that those in attendance will
have, if possible, even a better time than they have ever
before had in the Capital City.

The President, Dr. R. W. Powell of Ottawa, has recently
heard from Mr. Edmund Owen of London, England, the
gratifying information that he will deliver the Address in
Surgery. This in itself should assure a large attendance.

Book Reviews.

A Pocket Medical Dictionary, giving the pronunciation
and definition of the principal words used in medicine and the
collateral sciences. By George M. Gould, A.M., M.D.
Fourth edition revised and enlarged, 30,000 words. Philadel¬
phia : P. Blakiston’s Son & Co., 1012 Walnut street, 1900.
Price,

This little book can justly claim to be a u Multum in Parvo,^
for within its very limited size is contained a vast amount of prac¬
tical information briefly put. An author who can say, as Dr.
Gould does, that the total circulation of his dictionaries has
passed the one hundred thousand mark, must feel that his efforts
have filled a long-felt want in the medical profession, and such
popularity should be very encouraging to him. Since the publica¬
tion of the last edition of this little work the author has been able
to find an unexpectedly large number of eponymic clinical terms not
previously included, and in order to insert them the table itself has
been rewritten and greatly increased in size. The Dose Table has
also been enlarged by the inclusion of the names and doses of
drugs recently introduced. To medical students this little book
will be invaluable, as it may be carried in the pocket and be avail¬
able for hurried reference, and to serve as a passing reminder of
the essential meanings of the more commonly used terms. The
binding and general “get up” of the book is excellent, and the
price ($1) brings it within the reach of all. R. C.

International Clinics. A quarterly of clinical lectures on
Medicine, Neurology, Surgery, Gynaecology, Obstetrics,
Ophthalmology, Laryngology, Pharyngology, Rhinology,
Otology and Dermatology, and specially prepared articles on
treatment and drugs by professors and lecturers in the lead¬
ing medical colleges of the United States, Germany, Austria,
France, Great Britain and Canada. Edited by Judson
Daland, M.D. (University of Pennsylvania), Philadelphia,
Instructor in Clinical Medicine in the University of Pennsyl¬
vania; Professor of Clinical Medicine in the Philadelphia
Polyclinic, etc. Volume IV., Ninth Series, 1900. J. B.
Lippincott Co., Philadelphia.

The present volume contains thirty-seven articles on different
subjects, and many of great interest. Among remedial agents dis¬
cussed are papers on Rest, a Rational Therapeutic Agent in the
Treatment of Dilatation and Dislocation of the Stomach, by C. D.
Spivak, M.D., and Hydrotherapy in the Homes of the Poor, by
Alfred C. Haven, M.D. The latter discusses the advantages of water
treatment at the homes of patients, and describes a very convenient
form of portable bath, the use of which obviates some of the
difficulties of carrying out this treatment where a trained nurse is

192

BOOK REVIEWS,

not available, and other facilities limited. Among articles on
treatment are : The Treatment of Pneumonia by Hypodermoclysis,
by Frederick P. Henry, M.D.; Albuminuria in High Altitudes and
its Treatment, by Edward C. Hill, M.S., M.D.; Treatment of the
heart in Chronic Interstitial Nephritis, by Arthur R. Elliott, M.D.
In medicine, Morbid Proc’ivities or Diathesis by Sir Dyce Duck¬
worth, M.D., LL.D.; Bronchial Asthma, by Frederick MtiUer,
M.D.; Specific Disease of Liver, by George T. Cole, M.D.; The
Necessity of Medical Attention to Abdominal Cases requiring Sur¬
gery, by A. L. Benedict, M.D.; The Time of Heart Murmurs and
the Significance of the Apex Beat, by Prof. Martius; Cerebral
Apoplexy, by Prof. Emanuel Mundel, M.D. Other interesting
papers are those by Carl Beck, M.D., H. P. Newman, A.M., M.D.,
E. Fletcher Ingals, M.D., and Prof. H. Hallopean.

J. B. McC.

PUBLISHERS DEPARTMENT,

SANMETTO IN CHRONIC ORCHITIS.

J. A. Stothart, M. D., Savannah, Ga., reports the following case : a Dur¬
ing November, 1898, a Greek fruit vender called at mv office, suffering with
chronic orchitis. The patient stated that the first attack occurred four years
pi ior to this time. During the four years there had never been more than two
and a half months between the attacks. He bad been under treatment most of
this time, and several times in the hospitals, and had been discharged as cured
by several physicians. The testicle had almost arrived at the condition of
ossification, but at no time had there been 8ny pus formation. I prescribed
Sanmetto, and directed that the treatment be continued for two or three months.
My treatment was carried out to the letter, and there has never been any
return of the trouble since beginning the use of Sanmetto. I have used Sanmetto
in other urethral troubles with very satisfactory results. ,,

LITERARY NOTES.

People who want to read Augustine BirrelPs delightful address on the
question , u Is it Possible to Tell a Good Book from a Bad One ?” will find it in
full in The Living Age for April 14. It is full of humorous and chastening re¬
flections.

l( John England’s Outgoing,” the short serial now running in The Living
Age, is a st01 y of Georgian days, told with singular delicacy and quaintness.

Lady Broome’s “ Bird Notes” in The Living Age for April 21, and the
Quarterly Review's paper on The Wild Garden, which forms the Lading article
of tl e same number, are charming and seasonable.

Peter Rosegger’s story, “ The Seal of Confession,” published in The Living
Age for April 21, in a translation by Dr. Hasket Derby, is a striking study of
the workings of conscience, and a conflict of moral duties.

The facts in that present day tragedy, the political obliteration of Finland,
are compactly but forcibly presented by Mr. J. Westlake, in an article which
7 he Living Age of April 21 reprints from The National Review.

7 he Living Age for April 28 will print the hitherto unpublished letters
between Thomas Carlyle and Robert Chambers, which first saw the light in a
recent number of Chambers's Journal . In the same number of the magazine,
A T. Quiller-Couch discourses feelingly upon The Tragedy of the Minor Post.

CANADA

MEDICAL RECORD

MAY. 1900

Original Communications.

THE REMOVAL OF THE FIBROID UTERUS BY
THE ABDOMEN, WITH REPORT OF TEN SUC¬
CESSFUL CASES.*

(. Author’s Abstract .)

By A. LAPTHORN SMITH, B..A, M.D., M.R.C.S., ENG.,

Fellow of the American and British Gynecological Societies; Professor of Clinical
Gynecology in Bishop's University ; Gynecologist to the Montreal Dispensary ;

Consulting Gynecologist to the Women’s Hospital; 8urgeon-in-Chief
of the Samaritan Free Hospital for Women; Surgeon to the
Western Hospital, Montreal, Canada.

Twenty years ago he was strongly opposed to operative
treatment of fibroids on account of the high mortality then
prevailing among the best operators. Ten years ago he
became a strong advocate of Apostoli’s method of electrical
treatment by which he had cured the hemorrhage per¬
manently in sixty-three out of a hundred and two cases in
ten years. Eight years ago Price lowered the mortality
enough to induce him to operate in certain cases with the
serre noeud. Baer farther reduced the mortality, and he
adopted his method and operated oftener. Three years ago
Pryor perfected an ideal method which has almost no
mortality, and which he (Lapthom Smith) had adopted, and
to which he gave the preference over all other treatment in
^very case of fibroid suffering enough to consult him. He
claimed that he had acted consistently throughout, being
guided by the one test question, “ What is the mortality ? ”
In his last ten successive cases, seven last year and
three this year, all had recovered. Therefore the operation

* Read before the American Gynecological Society at Washington, May 1 , 1900.

194 SMITH : REMOVAL OF THE FIBROID UTERUS.

was now almost devoid of danger, while it was absolutely
effective. Pryor’s method is by far the best, and to it the
author believed was due the absence of mortality in these
ten cases. The great advantage of Pryor’s method is that
we begin on the easy side, and, after securely tieing the
ovarian, round ligament and uterine arteries, and separating
the bladder, we cut across the cervix and roll the tumor out,
thus obtaining plenty of room to tie the arteries from below
upwards. Another great advantage of this method is that
there is much less danger of injuring the ureters. This
accident is most likely to happen on the most difficult side,
that is the side where the tumor fills all the space between
the uterus and the wall of the pelvis. But it is precisely on
this side that the tumor is dragged away from the ureter
while it is being rolled out, and, by the time that it becomes
necessary to cut anything on that side, the ureter is at least
two inches away and quite out of danger. Doyen’s method
has this advantage on both sides, because he pulls the tumor
off the bladder and ureters, and from the first cut he is get¬
ting farther and farther away from the bladder and ureters.
But Doyen’s has the grave objection of opening the vagina,
and thereby increasing the time of anesthesia, the loss of
blood and the risk of infection, besides the aesthetic one of
shortening the vagina. The author lays even greater stress
than Pryor does upon the importance of feeling for each
individual artery, and tieing it before cutting, and then put¬
ting a second ligature on it, as the first one may loosen after
the tension of the tumor has been removed. He also
strongly advises chromicised catgut prepared by each
operator himself, or else red cross cumol catgut prepared by
Johnson, of New Brunswick, N.J., which he has found re¬
liable. Besides the six principal arteries there are two small
arteries which require tieing on each side of the cervix.
There is no need of disinfecting the stump beyond wiping
away the little plug of mucus; but the cervix should be
hollowed out so as to make anterior and posterior flaps
which are securely brought together before sewing up the
peritoneum. The omentum, if long enough, should be
brought down to meet this line of suture, thereby preventing
the intestine from sticking to it or to the abdominal incision,

SMITH : REMOVAL OF THE FIBROID UTERUS. 195

The author is opposed to leaving the ovaries and tubes,
although he admits that in young women by so doing the
discomfort of the premature menopause is avoided. But in
the majority of cases the appendages are diseased, and we
run the risk of the whole success of the operation being
marred by leaving in organs which will sooner or later cause
more symptoms than did the fibroid itself. His experience
of leaving in ovaries, or portions of ovaries, has been most
unfortunate, having received no thanks for his conscientious
endeavors, but a great deal of blame for having failed to cure
the pain, which, in the patient’s estimation, was much more
important than the tumor.

He was also much opposed to myomectomy ; the opera¬
tion was quite as dangerous as hysterectomy ; there was
very seldom any reason for it, most of the women who have
fibroids being unmarried or at an age too advanced to raise
children to advantage or having passed the child-bearing
age altogether. After submitting to such serious operation
the patient had a right to be guaranteed against a second or
a third one for the same disease. So many women have
been disappointed by these incomplete or so called conserva¬
tive operations that their friends who really could be cured
by an operation hesitate to undergo it. He would make an
exception of course in case of there being apparently only
a single polypus no matter how large or a single pediculated
subperitoneal tumor.

He held the opinion that all fibroid uteri should be re¬
moved as soon as discovered, because the woman with a
fibroid is liable not only to hemorrhage, which may not be
great, but to reflex disturbances of digestion and circulation.
Besides, every day it grows, its removal is becoming more
dangerous, and the chances of its becoming malignant are
greater.

He was opposed to a preliminary curetting, because it
was unnecessary, and, second, because when done it was
seldom done effectually; having examined in a foreign city
a fibroid uterus immediately after removal which had been
curetted just before, he had found only about a twentieth
part of the uterine mucosa removed.

196

macphail: valedictory.

He was strongly opposed to vaginal morcellement which
is not to be compared with Pryor’s method. It is much
more dangerous, much more difficult, and keeps the patient
a much longer time under the anaesthetic. The operation
is carried on in the dark, and the ureters are frequently
wounded, while complications such as adhesions of the
vermiform appendix, and tears off the intestine which are
easily dealt with by the abdomen, and the patient in the
Trendelenburg posture is almost impossible to manage
when working from the vagina. Moreover, nearly all women
with fibroids are nulliparous, and the vagina is consequently
narrow; they are nearly all elderly, and the passage is con-
sequent'y inextensible. No more unsuitable class of patients
could therefore be chosen for this most difficult vaginal
work. The author strongly advises the closure of the abdo¬
men with through and through silk worm gut left in for
three, or, better still, four weeks. If not tied too tightly, and
if dressed with boracic acid in abundance, the one dressing
or at most two will suffice from the beginning to the end of
the case. Besides they can be passed very quickly, thus
saving ten minutes in the duration of the anaesthesia.

248 Bishop Street.

VALEDICTORY.

To the graduating Class delivered at the Annual Con¬
vention , held in the Synod Hall , Montreal, 2 6 th April, 1900.

By Andrew Macphail, B.A., M.D.; M R.C.S-, Engr.; L.R.C.P., London.

Professor of Pathology, University of Bishop’s College.

Mr. Chancellor, ladies and gentlemen,—But it is to you,
graduates, that I direct myself, being chosen by my col¬
leagues to address to you a word of farewell, and if I import
into the task something of what I feel, it is because this is an
occasion differing essentially from the meetings of the class¬
room or the examination hall. Our relations are changed.
There, it was our place to speak with authority, not with the
authority of office, but in virtue of possessing a little more
knowledge than you. I say a little more, because in com-

macphail: valedictory.

197

parison with the whole mass the difference between our
attainments is not so great as the incautious might suppose.
There was a time when teachers pretended to teach, ex cathe¬
dra, but that time passed away with the written lectures which
did duty from year to year. The scientific heresy of to-day
is the common sense of to-morrow, and all we have striven to
do is to set the subjects in order before you that you might
see them as they are, or at least as we conceive them to be,
remembering that the order and material is subject to instant
change, that the things which are according to our knowledge
are continually passing into uncertainty, that the things
which can be shaken are passing away to make room for
those which cannot be shaken, the things which are true.

This occasion is too serious for vaunting ourselves upon
our own facilities for teaching, or depreciating the facilities
which others possess. We are all engaged upon the same
work, and any one who casts stones at his neighbor is more
fitted for casting stortes than for the serious business of teach¬
ing. We are a small school, but it is a new doctrine that
efficiency goes with numbers, either of teachers or of students.
With us it is a labor of love. We teach because we like it,
and we only ask to be left alone to practice our harmless
amusement in our own way. Yet at home and abroad we
see our school, its future full of promise, occupying the same
official rank as others, and, best of all, our graduates main¬
taining their place in learning and in practice. You are now
sharers in this burden.

I lament that I do not see before me all of those who
were an inspiration to us in the class-room. A teacher is
more dependent upon you than you are on him. To the
missing ones, I have this to say : We did it through kindness,
we thought there was something more you could profitably
learn ; something more we would gladly teach you.

It is now too late to talk to you specifically of your work
or of your leisure. If in the last four years we have failed
to impress upon you habits of industry, you will not learn
them from anything I can say, but if you have love for your
fellow men, you will be industrious in their service. It is of
your leisure I would say one word. Do not waste your time

198

MACPHAIL : VALEDICTORY.

on that kind of reading which results in acquiring ideas
which bind instead of feed you. In the too current medical
literature, you get only the froth and scum. It would be
better for you and your patients if you were to be reading
Montaigne’s Essays for example, than all the medical journals
published on this continent the last year.

Meeting in this Synod Hall reminds me that for more
than a generation the contest has raged between those who
stood for science and those who stood for what they called
religion; the fools on one side crying, “There is no God,”
the fools on the other side crying, “There is a God, and we
know all about Him.” All this has passed away and the
small voice is prevailing over the tumult, the voice of wisdom
proclaiming that it is all an affair of the heart, a thing for
the individual, a matter of character, that after all the prin¬
cipal thing is kindness. And this practice of medicine above
all other professions affords you occasions of exercising kind¬
ness. Look at those who are kind to the outpatients ; they
are the real physicians, whose names will be held in remem¬
brance, and, if you see a man jocular or cynical or austere
with the outpatients, that is a man who is a brawler and a
stirrer up of strife in his own household. The man vain of
his attainments ; jealous for his own glory and suspicious of
his own fellows is more fitted for the street than for the
bedside.

Therefore. I adjure you to go quietly ; to walk humbly,
living your own life, striving to educate yourselves, to raise
yourselves out of the class in which we are all prone by
nature to lie ; not to be concerned about the outward things
which lead to luxury, but to kindle a flame within yourselves
and you will thereby be a light to the place in which you are,
by having light in yourselves, above all, striving to make it
prevail by its steady burning and not by blowing it with
wind. Then you will not fret yourselves over the man who
is sleek of manner and smooth of tongue, over the man who
has the latest scientific word in his mouth, the man who
alone can heal, and that only because he was called in time ;
all these are the brood of the Seventh Son ; they flourish and
have had their reward.

MACPHAIL : VALEDICTORY.

199

In addressing you I feel as if I were taking part in some
solemn rite, a ceremony by which you are being adopted into
our number, by which you are made partakers in the respon¬
sibilities and the privileges of a special caste. And this is
literally exact. In the beginning, as Spencer proves, the
priest and the physician were one ; in the highest sense this is
still true, as true as the connection between moral fault and
disease is intimate.

I would have you remember that the meaning of all this
ceremony is that you are now accredited as healers of the
sick, and any medical teaching which aspires to make any¬
thing else, to make pathologists, physiologists or chemists, is
missing the mark. If any of you have an interest in these
things apart from their bearing upon the healing of the sick,
it is as if you were dealing with any other business, like
heraldry or the counting of coins. There is a proper scientific
study of those subjects cognate to medicine, but the glamor
that has been cast over them is apt to blind you to your real
mission. Of these subjects you must know something
though you need not aspire to be handworkers in them. You
must come to them continually for direction, else you will
lose your way' in the dark and waste your effort in empty
speculation. I am not forgetful of the value of the work
that has been done by men whose amusement and interests
lie in discovering truth, but the discovery of truth is a differ¬
ent matter from the healing of the sick. After all these dis¬
coveries, we cannot do everything by their means. Read
your text book in medicine in a new light, and note how
page after page contains the melancholy words, “ uninflu¬
enced by treatment,” “ drugs are of no avail,” “ runs its
course irrespective of medication.” Yet drugs are not the
only nor even the finest weapons in our armory. The lowest
member of our class is the giver of drugs. You cannot cure
disease any more than you can cure the autumnal flush on a
hillside of Canadian maples. It is as “ natural ” to die as it is
to live, and our scientific medicine consists for the most part
in observing the phenomena which ends in death, the process
by which the dust which we are returns to the dust from
which we came. But there is the supreme thing yet you

200

PROGRESS OF MEDICAL SCIENCE.

can do; you can be the bearer of light and happiness and
calmness, a messenger of peace to those who are in pain.
The greatest healer was the greatest teacher. It was through
works of mercy He brought the truth home to men, and hav¬
ing regard to what I have called the intimacy between moral
fault and disease, what does it matter whether the mes¬
sage be, “ Thy sins be forgiven thee,” or whether it be, “ Arise
and walk.”

Progress of Medical Science.

MEDICINE AND NEUROLOGY.

XN CHARGE OF

J. BRADFORD McCONNELL, M.D.

Associate Professor of Medicine and Neurology, and Professor of Clinical Medicine
Uniyersityof Bishop's College; Physician Western Hospital.

THE HYDRIATIC TREATMENT OF HYPER-
CHLORHYDRIA.

Olsen, in Modem Medicine, for December, reports a case
of nervous hyperchlorhydria, a man aged 26, treated hy
means of the hot and cold trunk pack in conjunction with
other hydriatic measures; the patient making a rapid re¬
covery.

The following is an outline of the treatment:

Fomentations to the stomach and bowels with a hot
foot bath, spray and general faradization twice a week;
electric light bath two to five minutes, salt glow and spray
twice a week; hot and cold trunk pack, and cold friction
sponge twice a week; mechanical Swedish movements, in¬
cluding vibration, kneading, friction and percussion half an
hour daily ; specially prescribed gymnastic exercises half an
hour daily. His diet consisted of toasted breads, such as
granose, zwieback, wholewheat wafers, rolls, etc., with mild
fruits, especially stewed California prunes and steamed figs,
also especially prepared nut foods. Of the nut foods, malted
nuts and protose gave excellent results in this case. An
hour’s moderate outdoor exercise was taken daily. At the
end of two weeks the patient still complained of some
epigastric pains, although not as severe as before. The
bowels were now regular.

MEDICINE AND NEUROLOGY.

201

At this time the bathroom treatment was changed to
the following: Hot and cold trunk pack, salt glow and
' spray three times a week ; hot and cold trunk pack, hot and
cold percussion douche to the spine, talcum powder rub,
thrice a week. Within a week the gastralgia and flatulence
disappeared, and the patient made a rapid recovery. The
bowels were regular, and there was a marked gain in
strength and weight.

In cases of hyperchlorhydria the writer has found the
hot and cold trunk pack an excellent means of decreasing
the amount of hydrochloric acid secreted.— The Charlotte
Medical Journal.

THE RELATIVE INTENSITY OF THE SECOND

SOUND AT THE BASE OF THE HEART.

Creighton, in the Medical Record for January 13th,
gives the result of a study of 1,000 cases.

The pulmonic sound was the louder in 291 cases, the
aortic in 486 cases, and the two were of equal intensity in
223. The cases were from 10 to 29 years old.

She concludes that accentuation of this pulmonic second
sound is almost invariably in young children and frequent in
youth.

After the fortieth year of life, the reverse is the case,
and it is then rare to And a pulmonic second sound as loud
as the corresponding aortic sound.

Between the ages of twenty and thirty years there is no
marked accentuation of either sound.

In view of the above facts, it is obvious that when one
speaks of an accented pulmonic second sound as corrobora¬
tive of a diagnosis of heart disease, such accentuation must
mean an increase in the loudness of the sound over that
normally to be expected at the age of the patient in ques¬
tion. A comparison with the aortic second is not sufficient
to settle the question.

Further, when we speak of an aortic second sound as
accented, we must mean (in case of a patient over forty years)
more accented than it formally is. Once more, the simple
comparison with the pulmonic second sound will not settle
the question. The comparison must be with an ideal stand¬
ard carried in the mind.

In interpreting the meaning of an accentuation of the
pulmonic second in suspected mitral stenosis, one must bear
in mind the age of the patient. The presence of a pathologi¬
cal accentuation of the sound can be determined only in re-

202

PROGRESS OF MEDICAL SCIENCE.

lation to the degree of accentuation which is to be expected
at the age of the patient in question.— The Charlotte Medi¬
cal Journal.

THE FUTURE OF APPENDICITIS CASES.

E. J. Cottier {Revue Mensuelle des Maladies de lEn-
fatice), in examining the ultimate results in 86 appendicitis
cases treated by Broca, ranging in age from a few months to
fifteen years, divides them into three classes: (i) Patients
not operated on ; (2) patients operated on during an acute
attack; (3) patients operated on in the afebrile period.
Cottier’s aim is to show by analysis of Broca’s statistics that
the latter is justified in taking a position against immediate
operation in every case, and against searching for an appen¬
dix which is at the bottom of a purulent-cavity. Of these
(a) 19 went out without operation : of the 19, 5 returned
after a fresh attack, and were operated on in the afebrile
period; 13 had no pain after the operation, and remained
well; 1 had slight colicky pains, (b) 4 7 were operated on
during the acute attack; 1 for general peritonitis. The
appendix was removed from only 3. Of these 47, 28 had
no trouble afterwards and remained in perfect health ; 4 went
out with a fistula, and were subsequently operated on and
remained in perfect health, (c) 30 operated on during an
interval (8 of them had been operated on previously during
an acute attack). At the time of writing, all 30 were in per¬
fect health ; 3 showed slight separation of the muscular
walls, and a slight impulse on coughing. ( d ) 3 died of in¬
testinal obstruction, due to peritoneal bands, at intervals of
eight months, one month and seven months after operation ;
one of these was not operated on in the first place by Broca.
Two were suppurative cases, showing how adhesions were
the cause of accidents: one of these was an operation in the
acute stage for abscess; one was operated on in the afebrile
period, but in this the extent of the suppuration necessitated
drainage, and a temporary foecal fistula occurred. All the
patients were seen again from six months to five years after
they left the hospital.— 7 reatment.

TREATMENT OF NEURASTHENIA.

The close contact of physician with patient is of ex¬
treme importance in the cure of neurasthenia, according to
O. Dornbluth (Munch, med. Woch., January 16, 1900). A
thorough physical examination will awaken confidence and

MEDICINE AND NEUROLOGY.

203

prevent errors of diagnosis, and the patient should be in¬
formed of the true character of his disorder. The most im¬
portant rule is to keep the patient in bed and absolutely at
rest from one to six weeks, depending on the severity of the
case. Where this is impossible, the recumbent posture
should be assumed during all leisure moments. Strict diet¬
ing is not necessary; even coffee and tea may be allowed,
but alcohol is to be strictly interdicted. Even when ner¬
vous dyspepsia is present the regular plan of feeding five
times daily at intervals of two and a half to three hours is
admissible, but when great irritability of the stomach
dominates the clinical picture, the diet should be similar to
that for gastric ulcer, or solid and liquid food alternately
every one and a half hours may be given. To quiet the
nervous system the best results were obtained by applying
cloths wrung out in water at 59 deg. F. to the abdomen
and covering these with flannel, or by giving a bath at
81-88 deg. F. with the tub but half filled, for four minutes.
Massage is not to be resorted to, but general faradization
with weak currents is excellent. As for drugs, a depreciated
condition of the blood demands iron, preferably in organic
form, while, for the severe manifestations of the disease
codeine acts almost as specific. In selecting sanatoria,
especial care is necessary to choose such which really meet
the indications .—Mi dual News.

THE HOSPITAL TREATMENT OF MEL¬
ANCHOLIA.

Habcock, in the International Medical Magazine for
January, discusses the treatment of acute and curable forms
of melancholia.

He divides the curable forms into acute, agitated and
stuporous.

The first indication is to combat sleeplessness, and this
is done by the scientific use of massage, static electricity,
cold baths and sponges, and well regulated outdoor exercise,
leaving a very limited field for the use of hypnoti.s.

The second indication is to keep the patient well
nourished. Salines and intestinal antiseptics should be
administered with the first food given artificially. For forced
feeding give three eggs, four ounces of expressed meat juice
and one quart of milk twice daily.

Lavage, careful attention to the bowels, constant nur¬
sing, alteratives and excito-tnotors as quinine, strychnine or
nuxvomica, iron, arsenic, coca, hypophosphites and bitter
tonic are indicated.

204

PROGRESS OF MEDICAL SCIENCE.

Opium should not be used except cautiously in the
agitated form.

Melancholia with stupor should be treated as above
with special attention to the eliminative functions. Weir
Mitchell’s rest cure is applicable in this form. The cold
pack for sleeplessness.

The thyroid extract should be tried, remembering that
in many cases no mental improvement occurs until the
thyroid has been discontinued, when a mental and physical
reaction takes place which does not cease until convalescence
is well established.— The Charlotte Medical Journal.

INTRA-AURAL APPLICATION OF CHLORO¬
FORM IN TRIGEMINAL NEURALGIA.

The author describes the method of application as fol¬
lows ;

“ Taking two small pledgets of cotton wool, which I
soaked with chloroform and then wrapped up separately in
more cotton wool, I placed them just inside of the external
auditory meatus. In about 30 seconds the patient complain¬
ed of a burning sensation, and as this increased the headache
decreased, and in another 30 seconds disappeared for good.”

With the aid of his assistants, the author succeeded in-
curing over 500 cases of trigeminal neuralgia by this method-
He gives the detailed histories of 18 cases.

In conclusion, the author states that his own experience
of the effects of chlorororm teaches him :

1. That it rarely fails to give even temporary relief, and
only twice aggravated the pain.

2. That it is only a pallative in neuralgias due to fever
or dental caries, and in some cases of inflammatory origin,
but it is a curative in very many cases of inflammatory, reflex
and inexplicable origin and in cases due to anemia, insomnia,
and exposure to the sun or to cold.

3. It removes all manner of uncomfortable sensations
from the trigeminal area, and is probably the best remedy
for neuralgias in neurotic persons who cannot bear internal
medication.

4. As one application usually suffices to cure pain that
has lasted from a few hours to a few weeks in over 50 per
cent, of head and face aches, it ought, I think, to be the first
remedy to be tried in all such cases. (S. C- Bose, Indian
Med. Rec — The Post-Graduate).

MEDICINE AND NEUROLOGY. 205

TRACHEAL DIASTOLIC SHOCK IN THE DIAG¬
NOSIS OF AORTIC ANEURISM.

The author points out the value of the tracheal tug in
the differential diagnosis of intra-thoracic and aortic aneu¬
rism. It must not, he says, be confused with an up and-
down pulsation of the trachea, which normally occurs in many
healthy individuals, and accompanies other diseases. In
such, however, there is not the distinct diastolic shock (due
to the transmission of, or originating at the time of, the clo¬
sure of the aortic valves), which, traversing the aneurism, is
manifested by a distinct sharp impulse following the tracheal
tug at the same intervals as that between the apex beat and
the closure of the aortic segments. The author details four ca¬
ses in which the sign was clearly present, and in which necropsy
or after-events proved the diagnosis to be correct. The crucial
test of the value of the sign, says the author, should be in
differentiating aneurism from solid thoracic tumor in cases
not involving the chest-wall. We must conclude, however,
that if diastolic shock is of value, as it certainly is, in estab¬
lishing the diagnosis of aneurism in case the tumor is
accessible to palpation, it should be of equal value in case no
palpable tumor exist if transmitted through the vascular
tumor to the trachea. - (Dr. J. N. Hall, Am. your. Med. Sc.
— The Post Graduate).

DILATATION OF THE STOMACH.

The author’s conclusions are as follows:

1. The symptoms upon which most reliance can be
placed in determining the presence of gastric motor insuffi¬
ciency are : a. The presence of fluid and food in the stomach
fasting over night ; b. the ready entrance of fluid through
the tube and difficulty in the return flow ; c. the absence of
visible gastric peristalsis ; d. evidences of fermentation and
intoxication by the products thereof; e. thirst, and /. scanty
and concentrated urine.

2. In determining the position and size of the stomach,
by far the most certain method has been inflation by air
through the stomach-tube ; ascultatory percussion, Dehio’s
method, and determining the capacity of the stomach by the
amount of water required to produce a sense of fulness, while
signs of value may lead to error.

3. It may be inferred from the somewhat small number
of cases reported by the authors that the condition is not un
common in students. An analysis of the etiological factors
is as follows: a. Myasthenia caused by chronic gastritis from
abuse of alcohol and tobacco, four cases ; b. myasthenia from

20 6

PROGRESS OF MEDICAL SCIENCE.

deficient innervation, two cases : e. myasthenia, probably of
congenital origin, one case ; d. myasthenia occurring in the
course of acute disease, one case.—Drs. Musser & Steele,
Am. Jour. Med. Sc .— The Post Graduate.

DIET IN ACNE.

The well-to do (Dr. Jackson, in “ Manual of Diseases ”)
are prone to eat too much, and it is remarkable how rapidly
their acne will improve by reducing their diet to the simplest
elements. In many of them a milk diet—provided milk
agrees with them—will accomplish a marked benefit. On
the other hand, says the Columbus Medical Journal , many
young girls almost starve themselves under the mistaken
idea that a low diet will give them a fine complexion.
Nothing could well be less true than this. Especially is
there a prejudice against butter. The old explanation that
skin eruptions were mainly due to the use of too much butter
still remains absolutely true for most non medical people,
and even for some medical men. That butter should be
used freely, and that cod-liver oil and iron are the only drugs
required in many cases, as Dr. Jackson insists, would to
these good old conservatives seem rank heresy. It is evid¬
ent that more definite ideas as to the diathesis that underlies
the etiology of acne have been acquired, and that the dietetic
management of it, rather than any empiric use of vaunted spe¬
cifics, constitutes the most modern therapeusis of this ex¬
tremely frequent and bothersome condition.

MEDICINAL PROPERTIES OF ONIONS.

Onions are a kind of all round good medicine ( Winnipeg
Lancet ). A whole onion eaten at bedtime will, by the next
morning, break the severest cold. Onions make a good
plaster to remove inflammation and hoarseness. If an onion
is mashed so as to secure all the juice in it, it will make a
most remarkable smelling substance that will quiet the most
nervous person. The strength of it inhaled for a few mo¬
ments will dull the sense of smell and weaken the nerves,
until sleep is produced from sheer exhaustion. It all comes
from one property possessed by the onion, and that is a form
of opium.

TREATMENT OF NIGHT SWEATS OF PHTHISIS
BY FORMALDEHYDE.

The good results of treatment by this drug seen in cases
of hyperidrosis and bromidrosis caused Hirschfeld of Berlin

MEDICINE AND NEUROLOGY.

207

to try its action for phthisical sweats. He now recommends
it highly. Because of its power of penetrating the skin, he
uses an alcoholic solution, as follows :

R Formaldehyde, 40 per cent.

Spiritus abs.aa § ij.

M. .

Sig. External use. Apply on swab.

Only one part of the body is treated at one sitting ; the
shoulders and arms, for instance, on the first day ; the lower
extremities on the day following, and the trunk on the
third. From 1 to 2)4 drachms of the solution is used each
time. By following this method, toxic absorption and exces¬
sive irritation of the ocular and respiratory mucous mem¬
brane are alike avoided. If, nevertheless, a fit of coughing
should be provoked, the application should be made very
rapidly and the part covered at once. Cotton wet with
spirits of turpentine can be held in front of the nose and
mouth of a sensitive patient The treatment is not painful
only a momentary burning sensation being produced. Newly-
formed epidermis, excoriations and mucous surfaces should,
of course, be avoided. The effect of the application lasts
from five days to a month—as a rule, from one to two
weeks. The sweats cease meanwhile, and as no injury is
caused by the treatment, it can be resumed whenever neces¬
sary .—Mtd News.

SPRING COUGHS.

Dr. George Brown, Eye, Ear,Nose and Throat Specialist,
of Atlanta, Ga., in a timely article in Moody's Ma&azint of
Medicine said —“Nothing is more annoying to a patient than
a perpetual tickling cough. Whether the immediate cause
be marked or mild, if allowed to continue the results are
almost sure to be more or less serious. The paroxysms
initiate untoward reflex impressions, augment the local dis¬
turbances ; and by interfering with the patient’s rest depress
the vis vitae, making the sufferer readily susceptible to the
inroads of other attacks. As practitioners are aware, tickling
coughs are particularly numerous and stubborn during the
spring and fall. It is well, therefore, at such times to pre¬
scribe that which will be sure to relieve without unpleasant
after-effects. In nine cases out of ten Antikamnia and
Codeine Tablets will be found almost a specific. The well-
known analgesic properties of Antikamnia act excellently
and synergetically with the physiological effects of Codeine,
which has a marked salutary selective influence on the pneu-
mogastric nerve, making this combination one of the most
valuable in medicine."

2o8

PROGRESS OF MEDICAL SCIENCE.

RHEUMATIC GOUT.

In addition to dietetic, hygienic and hydrotherapeutic
measures, Dr. B. C. Loveland {New York Medical Journal ,
March 3), has found sodium salicylate and potassium iodide
most useful. Five grains each of sodium salicylate and sodium
benzoate, given in a glass of hot water three times a day, has
a very good effect and is well tolerated. Potassium iodide is
of great service in some cases; in others sodium bicarbonate
will do as well as anything if given jn repeated doses well
diluted. When the alkali most suitable for the individual
patient is found, it should be continued for three months
steadily, then three weeks out of four for another three or six
months.

TREATMENT OF WHOOPING BY PHENOCOLL.

fll. Uargus, of Barcelona, first tried phenocoll in 1895,
and derived from it very good results. I have used it, too,
in seven children who were attacked with whooping cough
during measles. In all there was marked and rapid improve¬
ment. The remedy diminished the frequency of the attacks
and their intensity; the nocturnal attacks especially were less
frequent, and the total duration of the disease notably less¬
ened. The dose administered was from one to two grammes
daily. M. Fabistocherski has had like success in forty cases
at the Hospital “St. Olga.” Without being a specific remedy,
phenocoll offers real advantages in whooping cough, and
should always be resorted to when other remedies, particu¬
larly morphine, are contraindicated, especially in some chil¬
dren, in whom the disease is often dangerous. There are no
inconveniences attending its use.— Med. Rev. of Reviews.

NITRIC ACID.

As an internal medicament nitric acid has its own
peculiar place, and we use it quite often. The marked redness
of and slick mucous membranes, indicating the use of an
acid, are not only present, but there is besides a very marked
purple or violet tinge. The late Prof. Scudder laid great
stress upon the colbr when writing of nitric acid and of
baptisia. It may be used in any disease when these indica¬
tions prevail. It is said that a too long use of nitric acid
causes hypersecretion of saliva.

Nitric acid has frequently a very pleasant effect in malig¬
nant typhoid fever, diphtheria, scarlet fever, etc. It brings
about changes that directly or indirectly favorably influences

MEDICINE AND NEUROLOGY.

209

the temperature. It is an excellent remedy in many cases
■of chronic ague, and in gastro-intestinal dyspepsia. One of
the most prominent writers upon materia medica and thera¬
peutics recommends the administration of nitric acid in the
“ green stool ” diarrhea and in chronic diarrhea of children.
We have had no experience with it in these troubles. We
believe it should not be given simply because the stools are
green.

Nitric acid, according to our experience, is very often
the indicated remedy in whooping cough, and is very efficient.
We have thought that in this disease we could more often
see in nitric acid Prof. Scudder’s “ epidemic remedy,” than
in any other. The dose of nitric acid is from ten to fifteen
drops in four ounces of water, a teaspoonful of the mixture
every one to four hours —Cincinnati Med. Jour.

TO REMOVE THE ODOR OF IODOFORM.

Dr. Edwin Ricketts states, Cincinnati Lancet-Clinic, a
teaspoonful of vinegar rubbed on the hands after thorough
cleansing with soap and water, “ does away promptly with
the very disagreeable odor ” of iodoform.— Penn. Med. Jour.

BELLADONNA IN THE BRONCHO PNEUMONIA
OF CHILDREN.

Hodghead (. Pediatrics , September 1, 1899) reports a
case in a child eighteen months old, where, on the treatment
ordinarily used in pneumonia, the child gradually failed,
when he determined to use the following: The child was
wrapped in soft, loose clothing; water was given instead of
milk ; the atmosphere of the room was made moist and kept
at an even temperature. One-twelfth of a grain of calomel
was given every hour until the bowels were moved, and two
drops of tincture of belladonna given every hour. In twelve
hours a marked improvement was evident, and in twenty-
four hours, all the symptoms were so much improved that
the belladonna was gradually decreased, and the child made
a rapid recovery. Based upon this case, a series of experi¬
ments was begun, with the result that in twenty-five cases of
his own, and five in practice of other physicians, there were
twenty-eight recoveries. He concludes (1) that calomel
should be used in small doses until a cathartic effect is
secured; that the belladonna in small doses is mildly nar¬
cotic, and brings about a condition less uncomfortable to the

210

PROGRESS OF MEDICAL SCIENCE.

child ; that it is a heart-tonic; that it is a respiratory stimu¬
lant, and that it produces dilatation of the superficial capil¬
laries, and relieves the congested lungs. The most important
influence, however, is that it diminishes the secretion in the
bronchial tubes and the pulmonary tissues. To be effective
it has to be used every hour or two, until the desired effect is
obtained. The drug has not been found effective in the
beginning of the disease, but becomes especially applicable
when the bronchial secretion is abundant.

HAY FEVER.

Douglass {New York Medical Journal , September 2,
1898), after speaking of the local remedies which he always
uses, says, “ The most important remedy to use internally is
dried suprarenal gland.” In his experience, it is almost a
specific for the symptoms of hay fever, and a remedy to
safely and surely restore the over distended condition of the
nasal erectile tissue. It may be used either as a spray to
the mucous membrane of the nose or internally. The tablets
are given every two hours day and night until some prostra¬
tion is produced. They are then discontinued.

ANTIPYRIN IN DYSENTERY.

The Maryland Medical Journal, September 2, 1899,
quotes from the Therapeutic Gazette the following : Seventy-
five grains of antipyrin are dissolved in eight ounces of
water and used as a rectal injection, given three times a day,
and retained fifteen minutes. It is claimed that the relief
from pain and tenesmus is immediate and the number of
stools is decreased, and that convalescence is speedily esta¬
blished.

WATER TREATMENT OF GASTRO-INTESTINALr
DISTURBANCES.

Marfan advocates an exclusive diet of water for infants
with diarrhoea or other gastro-intestinal disturbances, the
amount corresponding to the usual amount of milk ingested.
A number of our Southern and European confreres have
found this treatment extremely effective, and a communica¬
tion in El Progresso Medico for August describes cases of
diarrhoea during the war in Cuba cured in three to five days
with nothing but water taken freely, boiled and cooled to
the temperature of the room.— Journal of the American
Medical Association.

MEDICINE AND NEUROLOGY. 211

TREATMENT OF RENAL CONCRETIONS OF
URIC ACID WITH GLYCERIN.

T>r. Hermann {Med. Chron ., Jan. 1900; Ref. Brit. Med.
your.. No. 2040, Epit. p. 28) has obtained favorable results
in nephrolithiasis by the administration of glycerin by the
mouth. He gave it in the first instance on theoretical grounds,
based on the facts that glycerin is a solvent of uric acid, and
when given per orem it is excreted in large part with the urine.
The good effects he has observed he does not now attribute
to any solvent action of the glycerin on the uric acid, but to
physical changes produced in the urine. When given in the
large doses he employs, it causes the urine to become some¬
what oily in consistence, and to its lubricating action he be¬
lieves the good results are to be ascribed. Rosenfeld, who has
also praised the method, believes it to give relief by raising
the specific gravity of the urine and thereby producing a
change in the position of the calculi in the pelvis of the
kidney. It is given in quantities of from one to four ounces,
dissolved in an equal quantity of water, and taken as one
dose, between two meals and repeated two or three times in
a period of several days. He has used it in 115 cases of
nephrolithiasis, and in 60 per cent, of these it proved effica¬
cious either by removing concretions or by relieving the pain
associated with the disease. Ortner and Kugler have con¬
firmed the stone expelling power of glycerin, while Casper
and Rosenfeld speak of its anodyne effect as simply astound¬
ing. Given in the doses named, the only unpleasant effects
observed were headache in twelve nervous patients, and
diarrhoea in three cases where the digestive organs were not
healthy. In all the fifteen cases these effects ceased in the
course of a few hours. In such patients, and indeed in others,
it is recommended that the initial dose should be smaller
than the minimum dose named, and that it should be gra¬
dually increased. The presence ofalbuminuria does not con¬
traindicate the employment of glycerin ; the amount of
albumin was never increased, and in one case, after three
doses of the agent, the previous albuminuria completely
disappeared. In six cases of the 115, hematuria occurred,
and this the author ascribes to the concretions changing
their position either spontaneously or owing to the glycerin.
—Post Graduate, April, 1900.

TANNOPINE FOR INFANTILE DIARRHCEA.

Dr. D. E. Smith, of Minneapolis (.Northwestern Lancet
November 13, 1899), states that in cases of diarrhoea charac-

212

PROGRESS OF MEDICAL SCIENCE.

terized by copious serous discharges it is necessary to resort
to some astringent which would be antiseptic and not
absorbent to any extent. Tannic acid was the drug par excel¬
lence, but it has been dismissed by the profession on account
of its unpalatability, its bulk, its taste, its rapid absorption
in the upper intestinal tract, and its rapid decomposition.
Recently a chemical combination of 87 per cent, tannic acid
and hexamethylen-tetramine has been introduced under
the name of tannopine, which the author considers an ideal
remedy in this class of cases. It is given in small doses from
three to ten grains every three hours. 11 does not break up
until it comes in contact with the alkaline medium of the
lower intestine, when the tannic acid is freed and the hexa¬
methylen-tetramine liberates the most desirable of anti¬
septics, formalin. Children take tannopine readily as it is
tasteless and small in bulk. It may be given either on the
tongue or in any kind of nourishment The formalin des¬
troys the germs already attenuated by previous treatment.
As soon as the serous discharge is stopped there is an im¬
mediate improvement in the patient’s condition.

EXPERIMENTAL INVESTIGATION OF THE

FUNCTIONS OF THE HUMAN SALIVA.

The investigations of Shule concerning the diastatic
energy of the mixed saliva resulted as follows: The secre¬
tion increased from morning until noon, while the maximum
would be reached between 11 a.m. and 3 p. m. alter which
time it would gradually decrease.

Further experiments confirm the reports of Biernacki,
according to which the secretion of pepsin and HCI, pro¬
gress much better in the stomach when the food has passed
the mouth and has been thoroughly incorporated with saliva
than if it had been introduced through the stomach tube.
This shows that the secretion of HCI, is reflexly excited by
suitable food in the buccal cavity* and by the act of mastica¬
tion.

(This would be a good criterion for taking the principal
meal at this time of day.) Schiile, Archiv, fur Verd. Krank.
— St. Paul Med. Jour.

DILATATION OF THE STOMACH.

This paper presents the histories of eight cases of atonic
dilatations of the stomach ; occurring in patients of about the
same age (19-28) the same sex (male) pursuing the same
vocations (students) and, in a measure possessed of similar
habits—(sedentary).

MEDICINE AND NEUROLOGY.

213

The author considers it sufficient to place dia tation un¬
der two heads as suggested by Pepper and Stengel, viz : Dila¬
tation from atonic and Dilatation from pyloric obstruc¬
tion.

In only one of reported cases was there an associated
gastroptosis.

Etiology ;—Some of the etiological factors present in the
cases were the following:

Sedentary occupation and inherited tendency.

Poor fare, excessive application and sedentary habits.

Privation incident to a course of study with insufficient
means. Congenital weakness of tissues and over use of
alcohol and tobacco. Typhoid fever was believed to be a
factor in one case.

Dignosis :—The following points are mentioned as of
especial significance and value :

Presence of fluid in the fasting stomach—(Early morning
lavage). Characteristic freedom of inflow through stomach
tube of the water used in lavage, contrasting strongly with
difficulty experienced in emptying the stomach. Inspection
was found to be of little use in this class of cases. No peris-
talic waves were seen. The urine was almost always scant
and of high color and specific gravity.

General symptoms. —Insomnia, lack of mental concen¬
tration and initiation, muscular weakness, pain and twitching,
eructation of gas and bitter fluid, appetite usually good, thirst
moderate.

Differential diagnosis :—From cicatricial stenosis follow¬
ing ulcer—it is differentiated by absence of a history of
haematemesis and other symptoms of ulcer. From cancer
by the age and absence of tumor and the presence of hydro¬
chloric acid. Pyloric obstruction in general is excluded by
the lack of visible peristalsis and the slow return of fluid
introduced by tube. From duodenal stenosisby the absence
of bile from the stomach contents. J. H. Musser and J. D.
Sceele, Am. Jour, of Med. Science.— St. Paul Med. Jour.

SURGERY.

IN CHARGB OP

ROLLO CAMPBELL, M.D.,

Lecturer on Surgery, University of Bishop's College ; Assistant-Surgeon, Western Hospital »

AND

GEORGE FISK, M.D.

Instructor in Surgery, University of Bishop's College ; Assistant-Surgeon, Western Hospital

A NEW INVAGINATION METHOD OF INTES¬
TINAL ANASTOMOSIS.

The author describes a new method of anastomosis which
he has employed with success in a number of cases, and has
proved by experimentation on animals to be technically
efficient in all cases. A strip of mucous lining is removed
from the inner surface of the distal end of the intestine, so
that it permits the proximal end to be invaginated into it.
When this has been accomplished it is held in place by
fixation sutures, while a continuous suture unites the cut end
of the gut, with its raw muscular layer, to the serous surface
of the proximal or invaginated portion. The process of in¬
vagination protects the stitches and the line of union in a
degree from contamination by the intestinal contents while
strengthening it against pressure from within. The denud¬
ing of the muscular coat where it is brought in contact with
the serous surface of the proximal portion, in the line of
union hastens the reparative process, and^frees the wound
from the contamination of the intestinal contents.

The histological examination made on the experimental
cases shows that firm adhesion is present in twenty-four
hours, and that there is no contraction of the lumen of the
gut. The method is free from the objections made where
foreign bodies are employed, while the suture line is pro¬
tected from infection from within the bowel.—Dr. Morisani.
Centbl. f. Chir. ( The Post-Graduate).

SUTURE OF FRACTURED PATELLA BY AN
IMPROVED METHOD.

The author employs silver wire as suture, and a single
drilling of each fragment only. The suture is a D-shaped
wire, No. 16 gauge, made of the softest silver, which, being
flat on one surface and very broad, is free from the tendency
to cut through the drill hole, and strong enough to admit of

SURGERY.

215

only a single suture being inserted. It was found that this
wire was sufficiently strong for one suture to hold together,
under considerable strain, the sawn ends of a patella, and
also that, on account of its shape and strength, a single loop
of each end, interlocked, was quite sufficient to secure the
suture, and the ends could be readily flattened down without
forming any appreciable foreign body which could irritate
the surrounding tissues.

The author cites a case of transverse fracture of the
patella in the lower third, with an inch separation, in a male
aged 24. Four days after the accident the joint was opened
by a large U-shaped flap, having its convexity downwards,
just below the ligamentum patellae and extending laterally
well away from the margins of the fractured bone. On open¬
ing the joint, a large number of firm and partly decolorized
clots were freed and washed out with sterilized water. After
drilling the two fragments, the D-wire was passed, accurate
approximation of the fragments secured, the wire looped,
and the aponeurosis and periosteum closely sutured with fine
silk over the overlying wire. In this way the fractured sur¬
faces were completely protected. The author regards this
as one of the most important steps in the operation. The
skin flap was then closed with salmon-gut sutures, and when
put in position no trace of the wire loop could be detected
with the fingers. Aseptic dressings and light posterior splint
were applied, and the limb kept elevated. On the eighth day
the sutures were removed, the skin incision being soundly
healed, On the 14th day the splint was removed to admit
passive motion. A skiagraph taken three weeks after the
operation showed such accurate approximation that the line
of fracture could only be faintly recognized. Four weeks
after the operation the patient could walk without aid of a
stick, and eight weeks after operation he was able to walk
two miles on a level, the only remaining evidence of injury
being a slight feeling of weakness ongoing up stairs.

In conclusion, the author offers the following :

In young and healthy subjects the ideal operation is pri¬
mary suture ; and with care and strictly asceptic precautions
it offers no more grave risks than many of the forms of so-
called subcutaneous suture, while in relative accuracy and
efficiency no reasonable comparison can be established.
Among the important points connected with the operation
the author specially emphasizes the following ;

1. The advisability of delaying operation for a few days
after the injury until the subsidence of the more acute symp¬
toms in the joints.

2. The thorough clearing out of the joint; all the recesses

216

PROGRESS OF MEDICAL SCIENCE.

of the synovial membrane being completely freed from clots,
and the broken surfaces of the bone thoroughly cleaned. This
can only be secured by the open operation. •' •’’i

3. The use of an easily sterilizable suture, strong enough
to secure apposition by a single drilling, and so shaped as to
render splitting of the bone an impossibility, and to prevent
in fastening it the formation of a large and irritating loop.

4. The elevation, and not the resection, of the fibrous
curtain, and its subsequent accurate suturing over the imbed¬
ded wire, forming an additional barrier underneath the skin
flap against infection or irritation.

5. The early commencement of passive movement, which
is thus rendered feasible, and undoubtedly shortens the
period of disability following the fracture-—a point of para¬
mount importance to the class of persons most subject to the
injury.—Dr. R. G. Patterson— Brit. Med. Jour .— The Post
Graduate.

TREATMENT OF ANEURISM BY SUBCUTA¬
NEOUS GELATIN INJECTIONS.

The author draws the following conclusions from his
experience with the gelatin treatment in nine cases, at the
Johns-Hopkins Hospital:

1. In not a single instance has the aneurism been cured,
although in one case the abdominal aneurism has diminished
considerably in size, and the case is still under treatment.

2. In seven of the nine cases there was an appreciable
diminution in the subjective symptoms referable to the pres¬
sure of the aneurism.

3. It seems quite certain that the subcutaneous injection
of gelatin solution does materially increase the coagulability
of the blood.

4. Contrary to the statement of Lancereaux, we have
found that the gelatin injections are frequently very painful
to the patient, the pain lasting and being most intense often
as late as six hours after the injection.

5. Athough Lancereaux states, that with strict antiseptic
precautions there should be no elevation of temperature, we
have found the contrary. In several instances, the injections
were followed, two to four hours later, by a distinct chill,
with an elevation of temperature reaching at times as high
as 103° F. In no case did we have any local suppuration,
and in only one case was there even any local reaction.

6. Notwithstanding the fact that we have not yet a case
which can b$ reported as cured, we are convinced that there

SURGERY.

217

is some merit in the treatment, and that it deserves a further
trial.—Dr. T. B. Futcher— Jour. Ant. Med. Assoc. — Post-

FORMALIN IN SURGICAL TUBERCULOSIS.

Hahn {Centralblatt fur Chirurgie, No. 24, 1899) states
that he has obtained excellent results from a mixture
of formalin and glycerin, 1 to 5 per cent., in the treatment
of surgical tuberculosis. As an injection into abscesses con¬
nected with diseased joints, the author believes that this
mixture is superior to an emulsion of iodoform.— University
Medical Magazine.

DEAFNESS IN CHILDREN.

The following is an original abstract of a paper read by
Edward F. Parker, M. D., Charleston, S. C., at the annual
meeting at the Tri-State Medical Association of the Caro-
linas and Virginia, held February 20, 21, 22, 1900, in Char¬
leston, S. C.:

Deafness in young children is so often allowed to go
unnoticed because the child is uncomplaining or the parents
careless, and is so often mistaken for dullness and inatten¬
tion that the disability is apt to become fixed and beyond
repair before expert skill is solicited.

The most common of the numerous causes of deafness
in children is adenoid hypertrophy in the naso pharynx.
Recurrent earache and deafness are symptoms which im¬
peratively demand a thorough exploration of that cavitjv
Faulty ventilation and drainage will invariably produce
catarrhal inflammation of the middle ear. The importance
of such early examination and ^treatment cannot be over
estimated.

The treatment consists in the administration of appro¬
priate constitutional remedies and in the surgical removal of
the exciting cause.

Incurable deafness in adults can often be referred to
adenoid hypertrophy in childhood. Particular attention is
called to recurrent earache and slight deafness as danger
signals never to be disregarded when noticed either by
parents or practitioner.

A REMARKABLE CASE.

By Dr. C. B. JOHNSTON, Monroe, Louisiana

During the Civil War, at the siege of Vicksburg, on the
10th of June, 1863, Capt. Alex. Myatt, of the Confederate
forces, received what was supposed to be a fatal wound,

2l8

PROGRESS OF MEDICAL SCIENCE.

having been shot in the right eye; the missile afterwards
proved to be a Springfield rifle-ball of about 55 caliber.
Death did not ensue, but for more than a third of a century
the leaden missile was a continued source of torture to its
victim. The wounded soldier remained in the hospital
until the fall of Vicksburg, the fourth of July. General
Grant, who was in command of the Federal forces, visited the
Confederate hospital after the surrender, and had his atten¬
tion called to the nature of the wound, and became so in¬
terested in the case that he ordered his staff surgeon to visit
the patient and examine the wound. After careful examina¬
tion. this eminent surgeon agreed fully with the diagnosis
made by the Confederate surgeons: that the bullet, after
penetrating the eye, had taken a backward course, lodging
in the back part of the head, its location making its removal
impossible, except at the risk of the patient’s life. On the
17th of July the patient was paroled and sent home, a physi¬
cal and, alas, a financial wreck. Notwithstanding his con¬
dition, however, he has accumulated a competency for his
declining years and made ample provision for his family.

During these thirty-five years he suffered more or less
constantly from the pressure of the bullet, and from time to
time visited the most eminent surgeons in hope of obtaining
Telief, among others the noted Dr. Stone, of New Orleans,
but always to no avail.

His sufferings were finally brought to an end, by the
services of a dentist, and in a most remarkable manner.

In the fall of 1898, Capt. Myatt called on Dr. Johnston,
for the removal of a broken tooth. To the surprise of the
operator, a foreign substance, evidently lead, was found to
be occupying the depths of the socket, after the removal of
the tooth. This seemed so incredible that, at the request of
the patient, his family physician was called in to make an
examination. A brother dental surgeon, Dr. J. F. Johnston,
was called in. After careful examination, the foreign sub¬
stance was pronounced to be the bullet which had entered
the eye of the patient thirty-five years previous.

The operation of removal was tedious and difficult, as it
was necessary, with saws and drills, to divide the bullet into
sections, and several days were consumed in the operation,
as the patient objected to the use of any anesthetic. It was
successfully accomplished, however, and the old veteran en¬
joys life once more, and has gained twenty pounds in weight
since the operation.

After removing the several pieces into which the bullet
had been divided, the gaping v/ound was well washed out
with peroxide of hydrogen, and then packed with dry cotton

SURGERY

219

thoroughly impregnated with iodoform, the dressing being
changed about once a week. Some little necrosed bone was
thrown off and there is still a little more, but as the patient
will not permit the use of any anesthetic, Dr. Johnston pro¬
poses simply to assist the powers of nature in completing
healing. One small piece of necrosed bone came away
through the nostril. The patient is doing well, and has
better health and enjoys life more than at any time since re¬
ceiving the wound in 1863 .—Ohio Den. your.

A NEW LOCAL ANESTHETIC SOLUTION.

Frank G. Lydston has used as a substitute for cocaine
in urethrotomy a fresh 10 per cent, solution of antipyrin in
a r per cent, carbolic add solution. The advantages of this
combination over cocaine are safety, freedom from constitu¬
tional effects, and the inhibition of hemorrhage. The solu¬
tion should be allowed to remain in the urethra ten minutes,
as a rule, before beginning to cut .—Med Record.

SILVER CATGUT AND HOW TO TIE IT.

E. Boeckman, St. Paul, Minn. Catgut, in order to give
ideal results, must be selected with reference to tensile
strength, cleanliness and sterility. It must be rendered
aseptic and then antiseptic, yet non poisonous and non¬
irritating. It should be able to withstand dry sterilization.
It must be absorbable, but, at the same time, its life in the
tissues should be such as to enable a ligature to hold from
one to several weeks. Although he has not as yet attained
the ideal in the preparation of catgut, the author seems to
have approached it in his so-called silver catgut. This is
prepared through soaking well-selected, clean, formalized
catgut in a 1 to 5 per cent, nitrate of silver solution. The
gut is then exposed to the light, thus reducing the silver silt
to black metallic silver. It is then cut up in desirable
lengths and wrapped in paraffin paper. It can then be sub¬
jected to dry heat for further sterilization betore using.
Silver catgut prepared carefully seems to meet with most of
the requirements demanded of an ideal catgut.

EARLY AND METHODICAL MOBILIZATION IN

THE TREATMENT OF INJURIES AND DIS¬
EASES OF THE JOINTS.

M. J. Lucas Championniere, of Paris, in a most interest¬
ing address, says that all the old authors and nearly all the

220

PROGRESS OF MEDICAL SCIENCE.

more recent writers advised rest for cases of every sort. For
the joints, which are a part of the motive apparatus, a cer¬
tain amount of motion is essential to nutrition and conserva¬
tion of function. In inflammatory joint affections im¬
mobilization has no specific effect; it simply allows of more de¬
cided action being taken to combat the disease. In contusions
it is pain alone which indicates rest treatment; but this must
be as short as possible. Sprains are to be treated with mas¬
sage and early passive motion. In fractures into a joint
immediate mobilization is the only proper measure. In dis¬
locations the author has never remarked the well known
tendency to recurrence; this he ascribes to immediate mas¬
sage and passive motion. Open wounds extending into joint
cavities must have antiseptic treatment, but not necessarily im¬
mobilization ; a stiff joint will result unless passive movement
be made here. After surgical invasion of a joint cavity the same
rule holds good. When not contraindicated by the presence of
pain, the author has seen no ill effect of motion in a joint from
which pus has been evacuated ; in fact, function can be re¬
tained by this method alone. After resection, the best play
of muscles and the greatest range of movements can be
obtained by passive motion instituted as soon as possible
after operation. The same applies to arthrectomy. A good'
result has also followed movement in the tuberculous tumor
albus.

AN EASY METHOD OF REDUCING DISLOCA¬
TIONS OF SHOULDER AND HIP.

L. A. Stimson, New York, describes a method of reduc¬
ing anterior dislocations of the shoulder, which has not failed
in ten successive recent cases, and has never required more
than six minutes to effect reduction. The principle is that
of moderate traction upon the arm in abduction, and the pro¬
cedure is as follows: A round hole about six inches in
diameter is made in the middle of the canvas of a cot, about
eighteen inches from one end. The patient is placed upon
the cot, with the injured arm hanging down through the
hole. The cot is raised upon blocks so that it is at a
sufficient height from the floor, and a ten-pound sand-bag is
fastened to the wrist of the dependent arm. After a wait of
a few minutes reduction is found to have taken place. The
procedure is not painful, and is an effectual, easy, expedi¬
tious and apparently safe method. Instead of a cot two
tables might be used, placed end to end, the head resting on
one, the body on the other, with the arm hanging down
between them. In dorsal dislocations of the hip the method

SURGERY.

221

is applied as follows: The patient is placed prone upon a
table in such a way that his thighs extend beyond its end.
The uninjured thigh is held horizontal by an assistant, to
prevent tilting of the pelvis, and the injured one is allowed
to hang vertically, while the surgeon, grasping the ankle,
holds the leg horizontal (right-angle flexion at the knee), and
gently moves it from side to side. If relaxation of the
muscles is slow to appear, a sand-bag of five or ten pound
weight is placed on the leg close behind the knee, or pres¬
sure is made there with the hand. This has succeeded in
four-fifths of the cases, and often without the aid of anes¬
thesia. In two cases in which it failed reduction was accom-
plished by traction in a line midway between right-angle
flexion and full extension .—New York Med. Record; Med.
Review.

SPINAL FRACTURE PARAPLEGIA.

Robert Abbe, New York, in order to show the relations
between the damage in broken-neck cases and the group of
symptoms following, cites three cases in which the injury
was due to diving into shallow water; a fourth case is re¬
ported, the patient having been shot by a Mauser bullet
over the second left sacral vertebra, with immediate paralysis
below the hips. He summarizes his observations as fol¬
lows : The immediate signs and symptoms of fracture
paraplegia give fairly accurate data for prognosis. If loss of
sensation and motion below the injured part is complete
and instantaneous, and the patella reflex is lost, the outlook
for recovery is almost hopeless. Yet knee-jerk, sensation or
motion may be absent, and recovery take place. Partial loss
of sensation or motion gives hope that a large degree of
recovery may be looked for, the cause in such cases being
hemorrhage within the central canal or in the cord sub¬
stance, or in the meninges. Distribution and absorption of
blood-clot take place usually within ten days or a fortnight,
and returning sensation follows. Return of motion in com¬
plete paraplegia cases does not always go on to perfect re¬
storation. Wrist-drop of one hand, or dragging of one foot,
may still remain two or three years after. In cervical frac¬
ture paraplegia the fifth vertebral body is most often injured ;
hence the phrenic nerve derived from the third and fourth
branches of the cervical plexus gives the only supply to a
respiratory muscle—the diaphragm. The labored respira¬
tion by diaphragm only usually results in pulmonary edema
and hypostatic pneumonia a few days after the accident.
This may be overcome by nitroglycerin internally and

222

PROGRESS OF MEDICAL SCIENCE.

frequent change of posture. Intestinal fermentation with
temperature disturbance easily occurs in high paraplegias,
and is speedily relieved by calomel. Regeneration of a
pulpified cord is impossible. Restored function is probably
always due to absorption of blood, or of the secondary in¬
flammatory deposits, which prolong the pressure symptoms.
The persistence of bone pressure at the site of the injury
justifies operation as much as in depressed fracture of the
skull, because through pressure an injured cord must be
further degenerated. Laminectomy should be done as
promptly as possible. If the subject be favorable it may be
done by expert use of cocain. It will be less painful if done
before local meningitis sets in. An X-ray view of the frac¬
ture can readily be taken by from ten to fifteen minutes’ ex¬
posure, and greatly aid the surgeon— New York Medical
Record; Medical Record.

CHLORETONE AS AN ANTISEPTIC AND LOCAL

ANESTHETIC.

T. D. Dewar reports two cases of severe lacerated
wounds, three of amputation of a finger and one of urethral
stricture, in which chloretone was employed for irrigation, as
a dressing, and for injection prior to introducing a sound.
The results indicate that this new drug possesses decided
local anesthetic and apparently also antiseptic properties.—
Therapeutic Gazette; Medical Record.

BURNS AND SCALDS.

Treatment. —According to E. T. Milligan, burns, when
under treatment, should be exposed as little as possible by
changing dressings. Morphine should be used hypoder¬
mically for pain, and tincture of musk by the mouth as a -
cardiac stimulant. The latter seems to control shock, due to
injury. In burns of the first degree an ointment containing
a sedative or carron-oil can be applied with advantage. In
burns of the second or third degree picric acid in solution
(5 to l,ooo) is an excellent application, but a dry dressing
js personally favored. A powder containing 2^4 drachms
of pulverized camphor and I ounce each of prepared chalk
and magnesium sulphate is one of the best. When powders-
are used the injured parts should be covered with oiled silk
to keep the dressing from becoming entangled in the injured
parts. When prostration is great, a saline infusion is of
marked value.

SURGERY.

223

Ellice M. Alger has found that the combination of
picric and citric acids, which Esbach long ago devised for the
detection of albumin, is more effective than the picric acid
alone, in burns of the second degree.

Esbach's solution consists of 10 parts of picric acid, 20
of citric acid and 1,000 of water. Without any elaborate
attempts at antisepsis the bullse and vesicles should be
opened with a clean blade and the fluid applied freely, care
being taken that the solution reaches the interior of each
one. The combination after the first smart has passed re¬
moves the pain very quickly. After the excess of fluid has
drained off the part may be covered with rubber tissue or
soft gauze, and left undisturbed for several days. After two
or three days the fluid should be reapplied to such areas as
are moist, and the part carefully recovered.

R. H. Gay has obtained good results from using the
following in burns and scalds: 1 one pound of mutton-tallow,
1 drachm of English resin, and 1 drachm of bees-wax should
be put into a vessel, perfectly free from grease or other sub¬
stance, over a slow fire. After the ingredients are melted
and thoroughly mixed, they are to be removed from the fire
and Yi pint of linseed-oil (linum usitatissimum) is to be
added, stirring until cool to prevent separation. A few
minims may be dropped on a smooth surface to cool, to see
whether it is of the right consistency or not. If too soft,
tallow should be added ; if too hard, oil. It is now ready
to pour off into boxes for use. The directions for using are
to spread it on old linen, or cotton cloth, to a sufficient
thickness, large enough to cover the burn or scald, and to re¬
new daily. This preparation is cooling, detergent and heal¬
ing, and if instantly applied to burns and scalds will almost
immediately stop the pain and prevent blistering.

In the treatment of scalds and burns Edward Roelig
finds aristol of great service. After a thorough disinfection
and cleansing of the burned area, and the opening of the
vesicles, a dressing of aristol salve smeared upon sterilized
gauze in a layer of about the thickness of a knife-blade is
applied, and this dressing changed daily. The dressing is
covered with cotton and held in place with gauze bandages.
Granulation and cicatrization occur promptly. In personal
cases, at first an aristol salve, consisting of drachms; ol.
olivar., 2^ drachms; lanolin, 10 drachms, was applied, and,
when the wound surface had become smaller and granula¬
tions had formed, aristol powder was dusted on, and covered
with gauze and cotton.

Vehmeyer has used with good results an ointment con¬
taining fluorin, and sold under the name of “Epidermin,” in

224

PROGRESS OF SCIENCE.

the treatment of severe burns and scalds. It should be re¬
newed twice a day. Relief of pain, prevention of profuse
suppuration and rapid growth of any islets of undestroyed
epidermis are its great advantages.

Naftalan has been found by Richard Bloch to so fully
meet the therapeutic indications demanded in burns, whether
caused by hot fluids, steam or heated solids, etc., as to be
almost a specific.

The use of saline transfusion for burns and shock is re¬
commended in an editorial, which states that, even if the
toxaemic condition is not directly improved by the saline
injections into the subcutaneous tissues of veins, there is still
another one in which this method of treatment may be of
great good, in that surgical shock is nearly always present
as a result of severe burns and scalds. In shock a condition
of profound relaxation of the blood-vessels exists, so that
arterial pressure is very low and the vital centres are not
properly supplied with blood.

While intravenous injection does not necessarily raise
blood-pressure, this method of treatment is capable of read¬
justing the circulation to such an extent that the evil mani¬
festations of vasomotor paralysis are set aside. It seems>
therefore, that, in treating cases of severe burns or scalds,
thi$ method of procedure should not be ignored, but should
be actively employed.

Patel notes the case of a child, aged 2}£ years, who had
a burn of the second degree, involving, more or less, both
arms and legs, face and trunk. The general condition was
bad, the pulse imperceptible and the child unconscious.
Caffeine, alcohol, bouillon and milk were given. On the
third day 250 cubic centimetres of saline solution were in¬
jected, and on the fourth day the child became for the first
time conscious. Between the fourth and twenty-second days
six similar injections were given. Until the twentieth day
he improved in every respect, but on the twenty-second his
general condition was not so favorable, and on the twenty-
fourth day he died. At the necropsy the lungs alone pre¬
sented appreciable lesion; diffuse and catarrhal pneumonia.
The great improvement after the first four injections and the
survival of the child for nearly a month seemed to be due to
the serum. The cause of death in extensive burns is thought
to be due to an autointoxication. Consequently, once the
period of shock is passed, the treatment should be directed
to freeing the system of the circulating toxin, and for this
saline injections answer well. Due attention should also be
paid to the emunctories, so as to still further favor the
elimination of toxins.

SURGERY.

225

Azzarello divides the theories of the causes of death
from burns into four classes: (1) death from shock or ex¬
treme pain ; (2) embolism, thrombosis and destruction of the
blood-elements; (3) pyaemic infection through the burnt sur¬
face; (4) poisons formed by the action of heat on the tissues
or autointoxication from deficient excretion by the skin.
By experimenting upon dogs and rabbits, it is personally
claimed that the intoxication theory is the correct one. In.
jection of large quantities of artificial blood-serum sub¬
cutaneously appeared to save life in several cases .—Monthly
Cyclopedia of Practical Medicine.

THE TREATMENT OF PARAPHYMOSIS.

In treating paraphymosis most practitioners endea¬
vor to produce retraction of the foreskin, and failing in
this maneuvre, incise the stricture. A writer in the Gazette
des Hopitaux recommends a simple measure, which is well
worthy of practice before the severer one is adopted. He
advises that two to five punctures be made with a bistoury
in the swollen edematous prepuce, which should then be
-gently kneaded during three or four minutes. An abundant
flow of serum, containing some or little blood, escapes, and
immediately the integuments which were swollen and ready
to burst become soft and slack. A slight taxis is then suc¬
cessful in restoring the parts to their natural position.

THERAPEUTIC NOTES.

, Pruritus Ani and Vulv^e.

In pruritus ani and vulvse the following formula will
afford relief from the itching and irritation, to be applied

locally :

R Sodii hyposulphis. I drachm.

Acid, carbol. % drachm.

Glycerins. 1 ounce.

Listerine. 3 ounces.

Mix.

Uric-Acid Diathesis.

R Sodii bicarbonatis. gr. xlv.

Acidi benzoici. gr. xv.

Sodii phosphatis. gr. lxxx.

Aq. bullient. 5 iss.

M. Solve et adde :

Aq. cinnamomi. 3 iij.

S. Two teaspoonfuls three times daily.

—Golding Bird.

Jottings

HOW TO STOP COUGHING.

The Virginia Medical Semi-Monthly correctly states
that coughing is precisely like scratching a wound ; so long
as it is continued, the wound will not heal. Let a person,
when tempted to cough, draw a long breath and hold it until
it warms and soothes every air cell. The benefit will soon be
apparent.

Orchitis.

Hyrarg. oleat...3 iss.

Morphine sulph .gr. iv.

01. gaultheria. .3 j-

01. olivae, q.s. ad.3 vi.

M. Ft. lin. Sig. Apply after bathing with hot water
night and morning, and wrap testicles in absorbent cotton
or flannel and have them suspended.

This prescription is also one of the finest in the world
for sprains and rheumatism.— Vail, Med. Sum .

To Overcome Whiskey or Morphine Habit.— Dr.
L. V. Weathers, Bracken, Texas, says (Texas Med. Jour.,
April, 1900,) that a few drops of tincture of cinchona dropped
far back on the tongue will at once overcome the craving
for whiskey in a drinker.

He has used successfully the following for both whiskey

and morphine craving:

R Ammon, bromid. gr. v.

Fid, ext. belladon
“ “ nuc vomic.

“ “ cannabis Ind. ad min. ij.

Water. q. s. gij.

M. S.—Repeat same four times daily.

THE)

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price , $(.oo per annum in advance . Sing/e
Copies , io

Make all Cheques or P.O. Money Orders for subscription, or advertising, payable to
JOHN LOVELL &SON, 23 St. Nicholas Street, Montreal, to whom all business co mm a*
ni cations should be addressed.

All communications for the Journal, books for review, and exchangee, should b#
addressed to the Editor, Box 2174, Post (Juice, Montreal,

Editorial.

WESTERN OPHTHALMOLOGIC AND OTO-LA-
RYNGOLOGIC ASSOCIATION.

The Western Opthalmologic and Oto-Laryngologic As¬
sociation held its fifth annual meeting at St. Louis, on the
5th, 6th and 7th of April. The President, Dr. W. Schep-
pergrell, of New Orleans, opened the meeting with a paper
on “ The Rise of Specialism,” in which he disproved the oft-
repeated charge that specialism in medicine are modern in¬
novations. He cited historical data dating several centuries
before Christ, in which distinct reference was made to
specialists of the eyes, stomach and the head. The essayist
commended specialists in medicine, as they promote more
detailed study, and therefore lead to higher medical attain¬
ments.

J. W. Bullard, M.D., of Pawnee City, Neb., read a paper
on “Two Classes of Eye Cases that Give Me a Great Deal of
Trouble." Chief among them was those in which irritation
and dryness of the conjunctiva persisted in spite of every
attempt at refraction which had been made.

Edwin Pynchon, M.D., of Chicago, “ Slight Irregularities
of the Nasal Septum.” The author advocated the removal
or correction of slight irregularities of the septum when there
were disturbances of the nasal functions on account of their
presence. If later and larger development justified their

228

EDITORIAL. .

removal, the author thought their early removal was justified
on the grounds of “ A stitch in time saves nine.”

C. R. Holmes, M.D., Cincinnati, “ Foreign Bodies of the
Orbit, with Report of Cases.” About seventy cases were
compiled from the literature by the author, and three addi¬
tional ones reported by him. The most interesting and
unique case was one reported by the author. It consisted of
a knife blade about I % inches long which had been in the
orbit 32 years without causing much inconvenience. It was
imbedded in a fibrous capsule and was but slightly rusted.

B. E. Freyer, M.D., Kansas City, “ Report of a Case of
Railway Trauma of the Eye, with the Report of a Case and
Its Legal Aspect”

M. A. Goldstein. M.D., St. Louis, “Presentation of
Cases; (a) Primary Tuberculosis of the Ear ; (b) Primary
Tuberculosis of the Larynx.” ( a ) The case had been
operated on some years previously and had a recurrence
some months ago, at which time Dr. Goldstein did the
Schwartz operation. Bad symptoms developed a few weeks
ago and he did the radical operation, since which time the
patient is doing well, (b) The second case was one of pro¬
bable primary tuberculosis of the larnyx, which came under
the observation of the author about one year ago. At that
time he was in a very serious condition ; death seemed but
a matter of a few weeks or months. The patient was greatly
emaciated, and in response to the treatment administered
had gained a fair degree of health, being able to attend to
business. The diagnosis in the case is somewhat doubtful,
but the author having excluded luies and malignant growth,
has made the diagnosis of primary laryngeal tuberculosis.
Tubercle bacilli are absent, and the tissue has not been ex¬
amined m croscopically.

Dr. Wm. L, Ballenger, of Chicago, “The Physiologic
Tests of the Organs of Hearing as Aids in the Differential
Diagnosis of Lesions of thq Ear.” The author advocated the
physiologic tests of the ear, including the range of hearing,
as tested with the tuning fork, Galton whistle, the Webber
experiment, the Rinne experiment, the Schwaback and Bing
tests, as important aids in the differential diagnosis of the

EDITORIAL.

229

lesions of the ear. They are of special importance in deter¬
mining the location of the lesion. He suggested that in a
general way the deeper the structure involved, the more pro¬
nounced the disturbance of hearing and the less probability
of a cure. The tests were, therefore, recommended more for
the purpose of aiding the surgeon in giving a correct diag¬
nosis than for the purpose of aiding him in the treatment,
which is often unsuccessful. Six cases were cited illustrating
lesions of different kinds in the middle ear and labyrinth in
which the tests were used for the purpose of differentiating
them. He recommended that the tests be made in all cases
of ear disease in which there was marked deafness and
tinnitus, both before and after inflation of the tympanum. If
this point is neglected the diagnosis may not be properly
made. While the physiologic tests are not absolute guides
to a correct diagnosis, they are, together with all the other
means of diagnosis, the most correct at the command of the
aural surgeon, and, therefore, should be invariably used.

O. J. Stein, M.D., Chicago, “ Symetrical Osteoma of the
Nose; Report of a Case.” The author reported a very rare
case ofsymetrical or double osteoma of the nose, occluding the
nasal chambers and extending to either side for a consider¬
able distance, whereby the patient was given the typical frog-
face appearance. Osteoma upon one side is rather common.
This case was presented on account of its unique type, and
was reported with a number of other cases collected from the
literature. No attempt was made to correct the deformity,
as the patient is well advanced with tuberculosis, several other
members of the family having died with the same disease.

Jno. J. Kyle, M.D., Indianapolis, “ The Sympathetic
Inflammation and Sympathetic Irritation of the Eye.” The
author made an interesting review of the subject presented,
in which he advocated the usual classical treatment.

Adolph Alt, M.D., St. Louis, “Studies Concerning the
Anatomy of the Eye Lids, Especially Their Glands (with
lantern slides).” The purpose of the author was to report
the result of* an extensive examination made of the tissues of
the eye lids, in which he had found mucous glands located in
positions where they were not usually found. He also stated

230

EDITORIAL.

that in all his examinations, with one exception, the torsal
cartilages of the eye lids were not true cartilaginous tissue.

W. H. Loeb, M.D., St. Louis, “ Presentation of Specimen
of 107 Polypi Removed at One Sitting.” This case was unique,
not so much on account of the great number of polypi removed
from the nose, as from the fact that they were removed at a
single sitting. They were uniformly pedunculated and
varied greatly in size.

THE INTERNAL USE OF WATER.

To quench thirst there is no fluid comparable to clear#
filtered water. As a keeper of health and a restorer to health,
in many minor diseases, we believe it is not used as freely as
it should be. The sewers of towns and cities are not flushed,
except by heavy rain storms, as freely as common sense tells
us they ought. Often they are choked, and are the source
from which disease attacks a community. The sewers of the
human body are the bowels, the kidneys and the lungs-
These are the organs by which the waste material is got rid
of. Water very materially assists them in carrying out their
functions, for it holds much of the debris material in solution.
It keeps up to its full proportion the amount required for the
blood to perform its function, and it stimulates glandular
action. Many hepatic diseases can be benefited by copious
drinking of water. Now that we are entering upon the hot
season, the body will call loudly for water, and it should be
freely allowed. The medical profession will shortly be send¬
ing their rheumatic patients to the numerous springs, cele¬
brated as resorts for this class of diseases. They will be
instructed to drink of the “ water ” freely, and the advice will
be followed, sometimes we think, too freely. A patient who
cannot be induced to drink daily half a dozen glasses of
water at home will willingly drink twenty at the springs.
The result is beneficial, not so much because of the various
salts found in the “ spring’s ” water, but on account of the
flushing which the sewers of the body undergo. The sur¬
roundings at these resorts are also beneficial, the eye is rested,
and through it the entire system is benefited. Copious
drinking of water prevents overfeeding, and thus important

EDITORIAL.

231

or g an gets a much needed rest. There are, however, a large
army of sufferers who cannot afford the luxury of visiting
these health resorts. Such, however, can receive benefit at
home by drinking freely of water. Human nature is, how¬
ever, distrustful of such a simple remedy. He must get
specific directions to take so many glasses daily, and the
chances of his carrying out such treatment will be largely in¬
creased by giving him a small alkaline powder to be dissolved
in each glass. He will then believe that he is taking medicine,
for that is what man craves for. If you wont give it to him
someone else will.

DR OSLER AND THE UNIVERSITY OF
EDINBURGH.

It is announced by the British Medical Journal, on
authority, that Dr. Osier, of the Johns Hopkins University,
Baltimore, is not an applicant for the Chair of Medicine in
the University of Edinburgh.

ANNUAL CONVOCATION OF THE MEDICAL
AND DENTAL FACULTIES, UNIVERSITY OF
BISHOP’S COLLEGE.

The twenty-ninth Annual Convocation of the Medical
Faculty of the University of Bishop’s College, and that
of the Dental Department, was held in the Synod Hall, Mont-
real.on the 26th of April. The day was beautiful and there
was a large turn out of the friends of the Faculty, the large hall
being crowded in every part. The chair was taken shortly
after three o’clock by Chancellor Heneker, who was supported
on the platform by Acting Principal Allnatt and the various
members of the Medical and Dental Faculties. The Dean,
Dr. F. W. Campbell, made the usual announcements, and the
candidates for the degree of C.M., M.D., and that of D.D.S.
were presented by the Deans. The following ladies and
gentlemen received the degrees of C.M., M.D.:

Francis Oscar Anderson, Montreal; Albert Cuff Lopez,
Manderville, Jamaica, W.I.; Miss Mary Adelaide Runnels.
Milton, P.Q.; Alexander Macdonald, Scotstown, P.Q.; Miss

232

EDITORIAL.

Margaret Jane Currie, Montreal; Christopher Healy Christie,
Montreal; John Albin Hamilton, Montreal; Frederick
Wilmot Mann, Maine, U.S.; Joseph William Davis, Windsor,
Ont.

To those students who had distinguished themselves by
winning prizes and medals, hearty applause was accorded as
they stepped forward to receive awards, viz.:—Histology, W.
H. Still ; first year practical anatomy, Jas. McGregor;
second year practical anatomy, E- H. Brown ; David silver
medal, Miss Florence Evans; Chancellor’s prize, A- C.
Lopez; Wood gold medal, F. O. Anderson.

The following gentlemen received the degree of D.D.S.,
being presented to the Chancellor by Dean Kerr, of the
Dental Faculty:

G. H. A. Stevenson, F. W. McKenna, F. E. Skinner,
J. B. Morrison, William Watson.

The Chancellor then addressed the audience, after which
the convocation was declared closed.

HYDROPHOBIA.

The Chicago Pasteur Institute has published a brief
report of its work since its organization, July 2, 1890. Num¬
ber of patients treated, 780. 709 persons were bitten by

dogs, 29 by cats, 26 by horses, 7 by skunks, 5 by wolves, 2
by cows, 1 by calf, 1 by rat, 1 by mule, 1 by pig and 3 by
hydrophobic individuals. 268 were persons who had been
bitten by animals known positively to have been rabid, 358
were bitten by animals recognized as rabid by their symp¬
toms, and 161 were bitten by animals strongly suspected as
infected with rabies- Three deaths are reported, a mortality
of 0.38 per cent. Before the Pasteur treatment the mortality
was 88 per cent, for bites of the face, 67 per cent, for bites of
the hands, and 30 per cent, for bites in other portions of the
body. Of the number treated 377 persons suffered from
severe and multiple bites on hands and wrists, 92 on head
and face, no on arms, 173 on legs and thighs and 28 on
trunk. The report is certainly a very gratifying one for the
Institute and an excellent testimonial to the eminent scientist
who established this mode of treatment

PERSONAL.

233

PERSONAL,

Dr. Walker, M.D., Bishop's, 1895, ofMenomee, Mich., has re¬
cently married—a sign that hs is meeting with good success—which
we are informed is the fact. We also hear that he proposes in the
near future to devote himself to the eye, ear, nose and throat.

Dr. Addison, M.D., Bishop’s, 1896, has ever since his gradual
tion been practising in Marinette, Wisconsin. He has met with
almost phenomenal success, and proposes in the near future to pay
a visit to his old home in Tasmania.

Dr. Fairfield, M.D., Bishop’s, 1887, is still at Green Bay,
Wisconsin, where his success has been marked. He found his in¬
struction at the Women's hospital of immense advantage to him
when he began to practice.

Dr. H. B. Chandler, M.D., Bishop's, 1880, has just been
appointed Professor of Ophthalmology at Tafts Medical school,
Boston. This medical school has a very large Eastern patronage,
and occupies a high position among the medical colleges of the
United States. The Faculty have recently paid $180,000 for a lot
on the Back Bay, on which it is proposed to erect the finest and
best equipped medical building in America.

Dr. Webb, M.D., Bishop's, 1897, has settled in Cambridge,
Mass., and has met with success sufficient to determine it as his
permanent home.

We had the pleasure recently of having luncheon with Dr.
Wolfrid Nelson, C.M., M.D., Bishop's, 1872, at the Astor hpuse.
New York, where he has his office and resides. Dr. Nelson is
surely drawing around him a good clientele, and is employed by a
number of life insurance companies as special medical examiner.
Dr. Nelson is one of the leading Canadians in New York, and
occupies the position of vice-president of the Canadian society.

Dr, Ford, M.D., Bishop's, 1898, is surgeon of the Elder-
Dempster royal mail steamship “ Lake Superior/' sailing between
Montreal and Liverpool.

Book Reviews

Progressive Medicine. A quarterly Digest of Advances, Dis*
coveries and Improvements in the Medical and Surgical
Sciences, edited by Hobart Amory Hare, M.D., Professor of
Therapeutics and Materia Medica in the Jefferson Medical
College, Philadelphia, assisted by Charles Adams Holder,
M.D., Assistant Demonstrator of Therapeutics in the Jefferson
Medical College. Vol. i, March, 1900. Lea Bros, & Co.,
Philadelphia and New York.

This volume reaches us promptly on time, and continues to
be filled with well made selections on the principal subjects which
have received the attention of professional workers during the pre¬
ceding quarter. A somewhat close scrutiny reveals the fact that
the profession is still being deluged with a mass of theoretical
pabulum, which, while destroying much that has been considered
sound and orthodox, does not replace it with material of a similar
kind. The present volume embraces the Surgery of the Head,
Neck and Chest, which has been collated by such a well known
man as Dr. J. C. Da Costa; Infectious Diseases, including Acute
Rheumatism, Croupous Pneumonia and Influenza, by Dr. Packard.
The Diseases of Children have shown up well under the direction
of Dr. Blackader, of Montreal; Pathology, by Dr. Hektven;
Laryngology, by Dr. A. Logan Turner, and Otology, by Dr.
Randolph.

The style in which this work is being produced is deserving
of special acknowledgment. The type is of good size, causing no
straining of the eye, and the paper is beautifully White and clear,
and entire absence of gloss. It is handsomely bound, and makes
an elegant addition to any library. F. W. C.

Injuries to the Eye in their Medico Legal Aspect.

By S. Baudry, M.D. Professor in the Faculty of Medicine,
University of Lille, France, etc. Translated from the original
by Alfred James Ostheimer, Jr., M.D., of Philadelphia, Pa.
Revised and edited by Charles A. Oliver, A.M., M.D., Attend¬
ing Surgeon to the Wills Eye Hospital; Ophthalmic Surgeon
to the Philadelphia Hospital; Member of the American and
French Ophthalmological Societies, etc. With an adaptation
of the Medico-Legal Chapter to the Courts of the United
States of America, by Charles Sinkler, Esq., Member of the
Philadelphia Bar. 5^4 x inches. Pages, x-161. Extra
cloth, $1, net. The F. A. Davis Co., publishers, 1914-16
Cherry street, Philadelphia, Pa.

This book comes to us most opportunely in these days when
Mutual Benefit Societies are so numerous and insurance against
accidental injury either in such societies or in the regular insurance
companies is the rule among that part of the population engaged
in industrial pursuits. Cases of persons so insured claiming in-

BOOK REVIEWS.

235

•demnity for accidental injuries to the eye are constantly being
brought to the oculist for a decision as to the duration of the re¬
sulting disability, the gravity of the injury, its effect on the wage-
earning power of the insured, etc., etc. Dr. Baudry’s book gives
us in a clear and compact form what is known with regard to diag¬
nosis and prognosis of such injuries, with an excellent chapter on
the best means of detecting simulation.

A full bibliography, and numerous illustrative cases taken
from the author’s practice, add to the value and interest of the book.

The general principles laid down in the chapter devoted to
medico-legal evidence apply everywhere, although legal procedure
in this province differs largely from that of other countries.

G. W. M.

Essentials of Surgery, arranged in the form of Questions
and Answers, by Edward Martin, A.M., M.D., Clinical Pro¬
fessor of Genito-urinary Diseases in the University of Pennsyl¬
vania. Seventh edition, revised and enlarged. Publishers,
W. B. Saunders, Philadelphia. Price, cloth, $1.

This little book is very cleverly prepared, and is most concise
and to the point. While it is too brief for the student, who is in
the habit of making a thorough study of his subject, yet as a rapid
reference for some half-forgotten point or a hurried review of a sub¬
ject it is certainly excellent. It is very complete on all the
branches of surgery, and the chapter on bandaging is nicely illus¬
trated. The other illustrations throughout the book are appro¬
priate. An appendix of receipts and antiseptic methods of prepar¬
ing ligatures, dressings, etc., is very well arranged, and contains
many useful hints. G. F.

Diseases of the Throat and Nose. By J. Price Brown,
M.B., etc., of Toronto. F. A. Davis Co., publishers, Philadelphia.
This important book has been prepared particularly for the
assistance and guidance of practitioners who cannot send all their
patients to the specialist of acknowledged skill. There are many,
in fact the great majority of patients with ailments in the region of
throat and nose who are too poor to pay more than a small fee, hence
the author aims at aiding the practitioner to better understand
and treat such special work. There is omitted such subjects as are
treated fully in the more classical specialists’ text-book, as the
descriptive anatomy of the parts, and this is only touched upon se
far as it relates to the practical treatment of diseases of these
organs.

The book is restricted within certain lines because of the de¬
sire to enter—as fully as space would permit—into the many ques¬
tions within its range, and to do so in accordance with the most
recent scientific investigations, bringing the record down to the
immediate present. The metrical system, which we must all adopt
sooner or later, has been adopted.

The book is very freely illustrated with clear plates, the colored
and Indian ink illustrations deserving special mention. Altogether
we regard the production as a worthy addition to the many
volumes already presented to the medical public on this subject.

G. T. R.

236 BOOK REVIEWS.

The Anatomy of the Brain. A text-book for medical
students, by Richard H. Whitehead, M.D., Professor of
Anatomy in the University of N. Carolina. Illustrated with
41 engravings ; 96 pages. Cloth, $1.00. Publishers, The F.
A. Davis Co., Philadelphia.

This work is suitable for students of Brain Anatomy, being
clear, concise and untrammeled with those subjects which are still
matters of controversy. The first chapter considers the embryo¬
logy of the nervous system, thus explaining the origin of the five
parts of the encephalon. The text is very brief in describing the
various anatomal structures throughout, and does not supplement
the bare anatomical facts by comparative descriptions or physiolo¬
gical functions so valuable in aiding the student to assimilate this
difficult subject.

We are pleased to note that the Latin terms adopted by the
German Anatomical Society have been inserted parenthetically
after the name commonly used in this country.

G. F.

A Dictionary of Terms Used in Medicine and the
Ooilateral Sciences. By Richard D. Hoblyn, M.A.,
Oxon. Thirteenth edition, revised thoroughly, with numer¬
ous additions by John A. Price, B.A.,M.D., Oxon, late Physi¬
cian to the Royal Hospital for Children and Women. Lea
Brothers, & Co., Philadelphia and New York, 1900.

This is a volume of almost nine hundred pages, printed in
easily-read type, and is fully up to date, embracing practically all,
or nearly all, the terms relating to Bacteriology. This last has
been materially added to since the publication of the last edition.
It is got up in very convenient size, and the fact that it has gone
through twelve editions is an evidence that the medical profession
has found it meets their wants. F. W. C.

WANTED

Position to write advertising
matter for Medicinal Prepara¬
tions. Signature not required. Address
X, P. O. Box 636.

CANADA

MEDICAL RECORD

JUNE. 1900

Original Communications.

PROGRESS OF GYNECOLOGY.

By A. LAPTHORN SMITH. B.A., M.D., M.B.C.S., Eng.

Fellow of the British and American Gynecological Societies; Professor of Clinical
Gynecology in Bishop's University; Gynecologist to the Montreal Dispensary
and to the Samaritan Hospital; Surgeon to the Western Hospital and
Consulting Gynecologist to the Women's Hospital.

Appendicitis as a complication of pelvic disease. A
number of papers have recently been read on this subject,
among the most important being one by Dr. McLaren, of
St. Paul, at the meeting of the American Gynecological
Society at Washington in May. It has been pointed out
that dysmenorrhcea, which is a common disease in young
girls, is frequently due to disease of the tubes; secondly,
that disease of the tubes is often due to infection from the
vermiform appendix; and thirdly, that disease of the vermi¬
form appendix or appendicitis is always due to infection by
the color bacillus, and that the color bacillus increases in
numbers in proportion to the length of time the bowels re¬
main unmoved. My own experience in over a hundred
operations for pus tubes quite bear out this theory; for in
about fifteen cases the vermiform appendix was adherent to
the right tube and in one case to the left tube, and in nearly
all there was severe dysmenorrhcea. Although gonorrhoea
was the principal cause of the pus tubes, yet in some of the
cases there was no possibility of this being the case as they
were young girls of irreproachable character. Many of these
cases occurred in the practice of confreres who called me in
consultation; in some of them appendicitis had been.

238 SMITH: PROGRESS OF GYNECOLOGY.

diagnosed and in others salpingitis, but at the operation
both conditions were- found to be present, so that there was
no mistake in the diagnosis. The lesson to be learned is
that the first thing to do in treating dysmenorrhoea and in¬
flammation of the right side of the pelvis is to have the
bowels thoroughly moved. No reliance must be placed on
enemas for this purpose as they only empty the rectum.
Ten grains of calomel followed in five hours by a saline.
Several cases, have recently been reported where all arrange¬
ments had been made for removing the appendix, but as
soon as the calomel and saline had moved the bowels the
patient rapidly got well. However, when a patient has had
more than one attack, however slight, she should have the
appendix removed soon after recovering from the second
attack, while in severe attacks incision and drainage should
be done within twenty-four hours.

Several cases have been reported in the journals where
immediate recovery followed this method without breaking
up the wall of adhesions which nature almost always throws
up to save the general peritoneal cavity from infection.
Many other cases are recorded where these adhesions were
broken up in the endeavor to be very thorough in the effort
to remove the remains of the appendix, and in all of them
the patient died.

Vaginal hysterectomy for procidentia. Although it is
hot very certain for how many thousands of years the womb
has been falling out of the body, it is probable that it was
the first gynecological disease to receive treatment. Of
course until within the last ten or twenty years the relief
obtained by pessaries was only partial, because, as a rule, the
perineum was torn, and the outlet of the vagina at the vulva
was as large as any other part of it, so that it was difficult
to keep any support in. Large ring pessaries, and stem and
cup pessaries held in by a perineal bandage were the most
effective, but were very inconvenient, while sometimes quite
dangerous owing to the cutting of the pessary through the
vagina into the peritoneal cavity. The present methods are
much more satisfactory, and have the merit of effecting a

smith: progress of gvnEcology. 239

complete cure. We have two operations tb choose front*-
according to the degree of prolapse and the size of the
uterus. If the uterus is small and not far enough out of the
body to have become ulcerated, the safest operation is to
make a small incision in the abdomen, and catching the
fundus with bullet forceps draw it up to the meatus and
scarify the whole anterior surface of the fundus, and then
sew it to the abdominal wall with buried chromicized catgut.
Then- to close up the vaginal outlet by a large posterior
colporhaphy. If, however, the uterus is very long (some¬
times it is seven or eight inches deep), and especially if it is
ulcerated, it is better to perform vaginal hysterectomy, and
after bringing the stumps of the broad ligaments together to
sew up the roof of the vagina and then to close up the
perineum. The objection is often raised that the woman is
too old to undergo such operations, but I hatfe found by ex¬
perience in many cases that there is no foundation for the
objection. The two last cases of this kind I operated at the
Western Hospital a week ago and two weeks ago respec¬
tively on women sixty-five years and seventy-five years of
age. In the first one I had already done ventrofixation
three months ago followed by colporhaphy at the same sit¬
ting ; but the uterus was so long that when the fundus was
attached high up on the abdominal wall, half way to the
umbilicus* the cervical end with the vagina was at the vulva
In this case I removed the lower four inches of the uterus,
and sewed the vagina to the cervical canal remaining. The
result seems to be good. In the second case, age seventy-
five, there was a large malignant-looking ulcer on the cervix,
due to the cervix sticking to the clothing when sTie sat
down, and I therefore removed the whole uterus, which was
about five inches long, and closed the perineum. Although
the arteries were very hard and there was an arcux senilis,
she bore the operations remarkably well; she was only on
the table half an hour for the two operations, and did not
lose more than three ounces of blood, most of which was
dpring the perineoraphy, She is quite convalescent with a
pulse of eighty. The result promises to bevery .satisfactory.

240 CAMPBELL: FORMATION OF THE MEDICAL FACULTY

HISTORY OF THE FORMATION OF THE MEDI¬
CAL FACULTY OF THE UNIVERSITY
OF BISHOP'S COLLEGE.

By FRANCIS W. CAMPBELL, M.A., M.D , L.B.O.P., London,

D. c. L., Dean, Faculty of Medlolne, University of Bishop's College.

Those who in the early part of the present century
established in Montreal the first Medical School in Canada,,
now the Faculty of Medicine of McGill University, were far-
seeing men. The future of Montreal, as a centre for Medical
education was evidently not beyond the horiscope of their-
vision. Events have thoroughly proved the wisdom of the
action which they took and persevered in, often, no doubt,,
amidst much discouragement. A few years later, in 1845,
the Montreal School of Medicine was incorporated, and its
lectures were delivered in .both the French and English lan¬
guages. This system of double lectures was found not to
work satisfactorily and was discontinued. It then became
what it is to-day, the medical educational institution for our-
French speaking confreres. During its history it has in turn
been simply a teaching body or School, a Faculty of Victoria.
University, Cobourg, and now is a Faculty of Laval Uni¬
versity.

Such was the position of Medical teaching in Montreal
in 1851—This was before my day, but I can imagine existing
lines to have been then, as I know them to have been
twenty years later. It was this condition which induced the
formation of the St. Lawrence School of Medicine, a copy of
whose first and only announcement was as follows:—

ST. LAWRENCE SCHOOL of MEDICINE of
MONTREAL.

Midwifery and Diseases
of Women and Children.

Institutes of Medicine,
Physiology, Pathology
and. Therapeutics.

F. C. T. ARNOLDI, M.D., late Lecturer on Mid¬
wifery, School of Medicine, and on Medical Juris¬
prudence McGill College. Surgeon Montreal General
Hospital, and member of the Board of Examiner*
College of Physicians and Surgeons, L. C.

GEORGE D. GIBB, M.D., L.R.C.S.I., Physician
to the Montreal Dispensary.

OF THE UNIVERSITY OF BISHOP’S COLLEGE. 241

"Theory and Practice of
Surgery.

Anatomy, Descriptive
and Surgical.

Theory and Practice of
Medicine.

Materia Medica and
Pharmacy.

Ophthalmic and Aural
Surgery.

Chemistry.

Botany.

“Clinical Medicine*
Clinical Surgery.

Comparative Anatomy
and Zoology.

R. L. MacDonnell, M.D., L.K., Q.C*P. and R.C.

S. I., late lecturer on Institutes of Medicine, and on
Clinical Medicine, McGill College, late Surgeon to
the Montreal General Hospital.

THOMAS WALTER JONES, M.D., L.R.C.S.E*

A. H. DAVID, M.D., L.R.C.S.E., Physician to
the Montreal General Hospital, Member of the
Board of Examiners College of Physicians and
Surgeons, L. C.

GEORGE E. FENWICK, M.D., Physician to the
Montreal Dispensary, late Curator to the Museum,
McGill College.

HENRY HOWARD, M.R.C.S.I., Surgeon to the
Montreal Eye and Ear Institution.

ROBERT PALMER HOWARD, M.D., L.R.C.
S.E., Physician the Montreal Dispensary.

* * * * * *

At the Montreal General Hospital by
Dr. DAVID.

At the Montreal General Hospital by
Dr. ARNOLDI.

Dr. GIBB.

Anatomy being the basis of Medicine and Surgery
special care will be devoted to its cultivation, and every
■facility will be afforded the pupil by dissections and demon¬
strations ; and in order to enable him to prosecute his studies
,tn this department more profitably, the dissecting rooms will
jbe lighted with gas and will be kept open from 6 A.M. to
(I P.M. daily, during which time competent demonstrators
will attend to superintend the pupils.

The business of this School will be carried on in a com¬
modious building, situate in the immediate vicinity of the
.Montreal General Hospital, containing a large theatre,
•spacious and well ventilated dissecting rooms, and a Museum
Human and Comparative Anatomy and Pathology.

.1 «Five lectures will be delivered weekly throughout “the

• 242 CAMPBELL : FORMATION OF THE MEDICAL FACULTY

. session, on each branch (excepting Forensic Medicine,
Clinical Medicine, Clinical Surgery, Ophthalmic and Aural
Surgery, Botany and Comparative Anatomy and Zoology,
each of which will be a three months Course) from 1st
•November to end of April, in conformity with the rules of
the College of Physicians and Surgeons of Lower Canada*
They will be illustrated by numerous preparations, a large
collection of plates, drawings, models and casts; and the
recent discoveries in Physiology and Pathology will be prac¬
tically taught by means of Achromatic Microscopes by the
Lecturers on these branches.

Ample opportunities for Midwifery practice will be
afforded to the Senior students in that branch, under the
immediate superintendence of the Lecturer.

Students attending the lectures on Ophthalmic and
Aural Surgery will have the privilege of witnessing the prac¬
tice at the Montreal Eye and Ear Institution, during the
session.

Board and lodging can be obtained at moderate rates in>
the vicinity of the School.

The fees for the lectures will be the same as at the Uni¬
versity of McGill College.

_ For further particulars apply to ___

A. H. DAVID, M.D.

Secretary.

N. B—The certificates of this School being recognized
by all the principal Colleges in Great Britain and the United
States, it will be to the advantage of students intending to.
complete their professional education in either of these coun¬
tries, to attend the courses of lectures of this school.

The St. Lawrence School of Medicine only existed for
. cvne session. The cause which, it is said, terminated its exis¬
tence should have prevented its birth. This was the fact that
it could not compete on equal terms with McGill University*
—The graduates from McGill; received their license from
the College of Physicians and Surgeons of Lower Canada,
without further examination as to their knowledge and skilly

' OF THE UNIVERSITY OF BISHOP’S COLLEGE. 243

Those whose Medical course would have been completed at
the St. Lawrence School, had it lived and requiring the
Provincial License, would have had to present themselves
before the College of Physicians and Surgeons of Lower
Canada for examination on all the branches of Medital
Science. The examiners of this Board were, many of them,
Professors in McGill. I have been told by several who were
Lecturers in the St. Lawrence School, that it was not considr
ered either wise or fair to submit the chance of their Students
getting fair play from a Board largely composed of rival Pro¬
fessors. With the termination of its first session—the St.
Lawrence School of Medicine therefore closed its doors.

The spirit, however, which had brought to life this
School did not die. On the contrary it continued to grow,
and gain force, and when I entered upon my professional
life in 1862 in the city of Montreal, I found among many a
feeling of the necessity for a new, or if you like the word
better, an opposition School of Medicine in this city. Various
reasons may be assigned for this feeling, and they may briefly
be epitomised as follows :■—(1) A desire to have an up-to-date
School, for the only existing English School had been for
years running in the groove, which it had long followed,
some subjects taught in England and the United States or
more elaborately taught, not yet having been added to its
curriculum. (2) A feeling that the members of the profes¬
sion, outside of this school, had no chance to secure Hospital
and other appointments—for when vacancies for these occur¬
red, candidates from the outside profession were met with
the united opposition of this School. (3) This same opposi r
tion was evident in private practice, and gave rise to nu¬
merous heart burnings. It was felt that the formation of 4
new Medical School would afford an opportunity of at least
attempting to rectify some of these grievances, and if successful
place the profession generally in a more satisfactory condi¬
tion.’ It was very generally expressed that a new School would
b^ beneficial in many ways, and that McGill had not pre¬
occupied every avenue to science. How keen thte feeling
was, even at the foundation of the “ School of Medicine

744 CAMPBELL: FORMATION OF THE MEDICAL FACULTY

and Surgery,” will be understood by the following lines
taken from the lecture delivered at its opening by Dr. Su-
therland : “ What exclusive right is possessed by this Faculty ?
What species of idolatry is it which ought to enforce us to
blindly worship the memory of its departed founders, in
permitting their representatives to hold within an iron grasp
all the reputation derivable from such a source. What has
rendered this place a shrine at which they alone are to receive
homage.” I found this feeling strong in 1862,1 saw it grow
year by year until in 1871 it culminated in the formation of
the Medical Faculty of Bishop’s College. This new teaching
body was free from the central point of weakness which had
wrecked the St. Lawrence School of Medicine. It was, like
the Medical School of McGill, the Faculty of a University.
The early history of this Faculty of Medicine, and of its crea*
tion may not as yet possess the interest which attaches to
older institutions. It is however advisable that its history
should be written while some of those who participated in its
formation are still alive. When time shall have given anti*
quity to an institution still in its youth—but a youth of
vigour, energy, and promise, it doubtless will be surrounded
by hosts of friends. These will realise and we believe ap¬
preciate the untiring, unpaid energy and determination of its
founders, who brushed aside all obstacles, till success rewarded
their efforts. In January 1871, Dr. Charles Smallwood, Dr.
Hingston, Dr. A. H. David, and Dr. E. H. Trenholme,
met and discussed the formation of a School of Medicine in
Montreal, in connection with the University of Bishop’s
College, Lennoxville. The decision being in the affirmative,
it was decided to ask me to assist them in the work. Having
accepted the proposal, I attended a meeting at Dr. David’s
house in Beaver Hall Terrace, on the evening of 1st February,
1871, when the four gentlemen named above were present;
The following telegram was read :

St. Hilaikk, February j, 1871.

To Dr. Hingston s

More particulars of Medical Corporation requited, give them in person, k
•rill tstfen matters,

Signed, T. E. CAMPBELL.

OF THE UNIVERSITY OF BISHOP’S COLLEGE. 245

Major Campbell, 'C.B, who signed this telegram was
Seignior at St. Hilaire, and a warm friend of Bishop’s College
up to his death in August, 1872. He was a lineal descendant
of the Campbells of Inverawe, and served in several Imperial
Regiments, his last I believe being the 7th Hussars. The
Faculty of Medicine of Bishop’s College owe to him a debt
of gratitude for the active interest he took in its formation.

It was decided to send Dr. David to Lennoxville, and
he accordingly left that night, to lay before the Board of
Trustees a proposition for the establishment of a Medical
School in Montreal, in connection with the University of
Bishop’s College. On the 3rd of February, Dr. David re¬
ported to the above five named gentlemen that his interview
with the Board of Trustees of Bishop’s College had been
very satisfactory—the following resolution having been
passed by them :

“That it is the unanimous opinion of the gentlemen
present at this meeting .... that the proposal to affiliate
to the University the Medical School about to be formed
in Montreal, consisting of ... . and others, is one of the
highest importance to the University, and with this view
the gentlemen now present will request the President of the
Corporation at the earliest possible period to call a meeting
of the Corporation to consider this proposal.”

On the 9th of March, 1871, a special meeting of the
Corporation of Bishop’s College was held in the Cathedral
school-house (now Synod Hall), the Hon. Edward Hale,
Chancellor of the University, being in the chair. A motion
accepting the offer of the proposed Medical School, and that
it go into operation not later than the following October,
was unanimously passed.

The following gentlemen were then appointed Pro¬
cessors in the Medical Faculty of Bishop’s College: Charles
Smallwood, M.D., LL.D., D.C.L., Professor of Midwifery;
•A. H. David, M.D., Edin., L.R.C.S., Edin., Professor of the
Theory and Practice of Medicine; William H. Hingston,

246 CAMPBELL: FORMATION OF THE MEDICAL FACULTY

M.D., L.R.C.S., Edin., Professor of Surgery; Francis
Wayland Campbell, M.D., L.R.C.P., London, Professor of
Institutes of Medicine; Edward H. Trenholme, M.D.,
B.C.L., Professor of Materia Medica. Dr. Smallwood was
named Dean and Dr. F. W. Campbell, Registrar, at a meet¬
ing of the new Faculty held on the 14th of March at Dr.
Hingston’s house.

On the 18th of March at a Faculty meeting, a code of
rules for its government was adopted. The only rule
worthy of special mention was the following : “ Should the
resignation of any professor be deemed advantageous to the
interest of the School, he shall, upon the written request to do
so of any six of his colleagues, resign forthwith his appoint¬
ment.” From this date till the 7th of June, the Faculty was
engaged in the work of completing its formation. On this
day it struck its first shoal, by Dr. Smallwood severing his
connection with it, on account of having “ received an
appointment from the Signal Office of the United States
War Department, and also from the Hon. Minister of
Marine and Fisheries,” which would occupy all his spare time.
The resignation was accepted and Dr. Hingston elected
Dean in his place. At the annual Convocation of the Uni¬
versity held at Lennoxville, in the latter part of June, the
Faculty attended, each member receiving the degree of
M.A. honoris causa. The end of July the Faculty issued its
first annual announcements, which created no small excite¬
ment, as it had been hoped by many that the efforts which
had been put forth to strangle its birth would have been
successful.

The Faculty at the time stood as follows:

Wm. H. Hingston, M. D., L. R. C. S. E., D. C. L., Prof. Principles and
Pratice of Surgery, Dean of the Faculty.

Aaron H. David, M. D., Edin. L. R. C. S. E., D. C. L., Prof. Theory and
Pratice of Medicine.

Robert T. Godfrey, M. A., M. D., Prof, of Midwifery and Diseases of Women
and Children.

Jean Lukin Leprobon, M. A., M. D., Prof, of Hygiene.

Francis W. Campbell, M. A., M, D., L. R. C. P., Lond. Prof, of Institutes oi
Medicine, Registrar of Faculty.

OF THE UNIVjERSITY OF BISHOP’S COLLEGE. 247

Edward H. Trenholme, M. A., M. D., B. C. L., Prof, of Materia Medica and
Therapeutics.

J. Baker Edwards, M. A,, Ph. D., D. C. L., Prof, of Chemistry, Practical Chem«
istry, and Microscopy.

Richard A. Kennedy, M. A., M. D.. Prof, of Anatomy.

William Gardner, M. A., M. D., Prof, of Medical Jurisprudence.

George Wilkins, M A. # M. D., Prof, of Pathology.

Silas E. Tabb, M. A., M. D., Prof, of Botany.

James Perrigo, M. A., M. D., M. R. C. S. Eng., Demonstrator of Anatomy and
Curator of Museum.

The second vicissitude of the Faculty came about soon
after its first announcement was issued, and was the with¬
drawal of Dr. Hingston (now Sir William Hingston) from
the Deanship and Professorship of Surgery, this action on
his part having become necessary in order to retain his con¬
nection with his Hospital (the Hotel Dieu). It appears that
many years previously the medical control of this hospital
was, by notarial deed, placed in the hands of the Montreal
School of Medicine (at this time affiliated with Victoria
College, Cobourg, Ont.). On the announcement of the
Medical Faculty of Bishop’s College being placed in the
hands of the public, Dr. Hingston was notified by the
Montreal School through its Secretary, the late Dr. Pelletier,
that he must sever his connection with Bishop’s College, or
his connection with the Hotel Dieu would cease on a date
named. The future of the new School was, of course, uncer¬
tain, and after weighing well the pour et contre , he deter¬
mined, with deep regret, to withdraw. I need hardly say
that the Faculty felt that Dr. Hingston’s retirement was a
severe blow. Several meetings were held, and the situation
thoroughly and thoughtfully discussed. The decision was
to proceed and prepare for the opening of the School in
October. Dr. David was elected Dean and Dr. Godfrey
was transferred to the chair of Surgery, Dr. Trenholme to
that of Midwifery, and Dr. Kollnlyer was taken into the
School and elected Professor of Materia Medica. The future
being now clear, the Faculty began to look around for a
building in which to carry on its work. In this search great
difficulty was experienced, as several buildings, which were

248 CAMPBELL : FORMATION OF THE MEDICAL FACULTY

deemed suitable, were refused by their proprietors to be
rented for such a purpose. At last a top fiat was secured in
' a building on the northeast corner of McGill and Notre
Dame streets, it being sub-leased from the Chemists’ Asso¬
ciation. The date for opening the school was fixed for the
4th of October, 1871, and the opening lecture to be de¬
livered by the Dean, Dr. David. This fact was duly ad¬
vertised, also that the Registration book was open. The
first name entered upon it was Wolfred Nelson, a son of the
late Dr. Horace Nelson, and a grandson of the late Dr.
Wolfred Nelson, an ex-Mayor of Montreal and well known
in Canadian political life. The opening lecture was de¬
livered on the date named. The audience was not large,
but among those present was the late Dr. William Suther¬
land, Professor of Chemistry in McGill University. Work
was then commenced and the lectures regularly delivered,
and the dissecting-room : opened. Many interesting anec¬
dotes of this first session might be given, but they would
occupy too much space; one will suffice. My class for
the first two weeks consisted of two students, viz., Mr.
Richmond Spencer, and Mr. Robert Costigan. About the
end of the second week, on arriving to deliver my lecture,
1 found that my class had diminished by one-half. Mr.
Robert Costigan was absent. I was told he had been in¬
duced to leave and go to McGill College. Depressed by this
desertion, but not discouraged, I lectured for a whole week
to the remaining member of the class, when Mr. Costigan
returned to his first love. He attended the College for three
years, and graduated M.D. from Bishop’s, April, 1874. The
means used to detach Mr. Costigan were not fair. I will not
say more, though the details are as clear in my mind to-day
as if they had occurred but yesterday.

By the time the registration book closed in December,
twenty-five students had registered their names. On the
4th of April, 1872, the first Convocation of the Faculty took
place at LennoxviUe, the Chancellor of the University, the
late Hon. Edward Hale, conferring degrees. The entire

OF THE UNIVERSITY OF BISHOP’S COLLEGE.

249

Faculty were present The following are the names of the
first graduating class:—

Wolfred D. E. Nelson,
Henry S. Cunningham,
Philippe Desilets,

Joseph F. A. Lanouette,
Andre Latour,

Richard Webber,

Montreal, Que.
St. Catharines, Ont
Three Rivers, Que.
Champlain, Que.

Lachine, Que.
Richmond, Que.

The first session was considered as being more than
satisfactory. As a result of this success, the idea of erecting
a building for occupation by the School was mooted and
seriously discussed. There were difficulties in the way—
financial difficulties, of course. These were soon relieved by
a generous offer on the part of Dr. Godfrey, our Professor of
Surgery, to erect such a building as the School required, on the
Faculty agreeing to pay interest on the cost. I need hardly
say that this offer was accepted. Plans were prepared and
discussed and finally adopted. That such an idea had very
early in the history of the Faculty taken root, is proved by the
fact that Dr. Hingston had secured for this purpose a lot of
ground on the corner of Mance and Ontario St*. This land
was purchased by Dr. Godfrey, and work was commenced
on the building. Although not completed, yet it was in such
a forward state, that the second session opened on time
within its walls, the introductory lecture being delivered by
me. The session showed a registered class of thirty students
being an increase of five over the previous year. This was
considered a satisfactory showing, seeing that this faculty was
competing for students on an advanced schedule. By this I
mean that we were teaching subjects which up to that time
had not been included, as distinct branches, in any Medical
School in the Dominion. These were. Pathology by Dr.
Wilkins, Hygiene, by Dr. Leprohon, and Practical Che¬
mistry by Dr. J. Baker Edwards. Subsequently—within a
year or two—Dr. Wilkins took up Practical Physiology and
Histology. In 1877, Dr. O. C. Wood of Ottawa, through
his son, Dr. C. A. Wood, a graduate of the College, offered a

250 CAMPBELL : FORMATION OF THE MEDICAL FACULTY

Gold Medal, to be known as the “ Wood Medal,” to be com¬
peted for annually on the following terms:—1st, Competitors
must attend at least two sessions at Bishop’s College ; 2nd,
75 per cent of the whole number of marks must be taken—
including all subjects ; 3rd, If the graduating dass, at any
time be less than four, the Medal may be withheld, unless
the Faculty thought that the best man had shown such ex¬
cellence, that he was deserving of it. Dr. O. C. Wood
having died, Dr. C. A. Wood has donated the sum of $1000,
which is invested to produce the Medal yearly.

In 1880, Dr. C. E. Nelson of New York founded the
“ Robert Nelson ” Gold Medal- For this purpose he donated
the sum of one thousand dollars. The Medal was in com¬
memoration of his father, Dr. Robert Nelson, who began his
medical career in Montreal, where he obtained special emi¬
nence in surgery. He subsequently removed to New York,
where he died. This Medal, was donated as a special prize
in Surgery, and for it there was to be a special examination,
which must be written, oral, and the performance of opera¬
tions on the Cadaver. To compete for this Medal, students
must have attended two sessions at Bishop’s, and have
obtained 75 p*r cent of the allotted marks on all subjects.
With the exception of one or two years, this medal has been
awarded since its endowment, and at times the competition
has been very keen and close. I believe the Faculty secured
this magnificent Medal, which is of the value of $60.00,
through the influence of Dr. Wolfred Nelson, who, as I have
already mentioned, was our first registered student, and a
member of our first graduating class. In 1882, Dr. David, who
had been Dean of the Faculty since the active work of the
School began, died, after a lingering illness. The loss which
the Faculty sustained by his death was very great, for from
its inception he had been its most zealous friend and faithful
adviser. To show its appreciation of his work, the Faculty
founded the “ David ” Scholarship, which some years later
was changed to the“ David ” Silver Medal. This is awarded
to the student obtaining the highest'number of marks in the
Primary-Examination.- The other Prizes-in the Faculty are

OF THE. UNIVERSITY OF BISHOP’S COLLEGE. 2.51

‘‘The Chancellor’s Prize’’ (books), to the student who passes
tjie best examination on the Final branches j Prize for the
best examination in Histology ; Prize to the best Dissector,
and best examination in the practical Anatomy course (first
year) and a similar Prize for the same (second year).- A
scholarship, consisting of a reduction of one half the fees, in
all theoretical subjects of the Medical course, to the applicant
showing the highest aggregate of marks, taken in the Provin¬
cial Matriculation examination. A similar scholarship to the
graduate in Arts of Bishop’s College who shows the highest
aggregate number of marks in the Arts course. The vacant
position of Dean, and the Professorship of the Theory and
Practice of Medicine, was filled in 1882, by my election
thereto, and which positions I still occupy. In another year
the Faculty will be in the thirtieth year of its existence, and
until recently the work has been performed by all as a
labour of love, the various members not receiving any money
reward for their labour. A surplus there has been over ex¬
penses—but this has been used in the purchase of equip¬
ment—so that the amount so expended now stands at many
thousands of dollars. Within the last few years, however, it
has been found advisable to obtain special workers, and we
now possess two who devote their entire time to College
work. These naturally are paid. At this moment the
College is as fully equipped for its work as is any College in
the Dominion. Our endeavour, and in this I know we are
successful, is to give a thoroughly practical training. In one
department, Midwifery, whose successful practice has such an
important bearing on the success of a general practitioner,
we possess advantages certainly not surpassed, if equalled,
by any Medical College in Canada—we possess a Women’s
Hospital which is under the charge of our Professor of Mid¬
wifery, where the practice is so extensive as to give our gradu¬
ates practical charge of as many cases as fall, as a rule, into the
hands of the young practitioner during the first four or five
years of his professional life. The University has graduated
M. D. 222 students. Of these thirty have passed to their rest.
Those who survive are in the full pursuit of their life work

252 CAMPBELL: FORMATION OF THE MEDICAL FACULTY

in almost every quarter of the globe. More than the usual
success has been obtained by many, due beyond doubt to
the eminently practical training they received.

Some have risen to distinction—carving for themselves
a name and a professional reputation extending far beyond
the cities in which they reside, and reflecting honour on the
University which'fc their Alma Mater. In the special field
of Ophthalmology—Dr. Wood, of Chicago, stands pre-eminent
among the practitioners in the United States who follow
this specialty. This gentleman graduated in 1877, and
practiced for at least ten years in Montreal as a general
practitioner, filling during that time in Bishop’s the chairs of
Chemistry and Pathology. Another graduate who occupies
a distinguished position in this same field is Dr. H. B.
Chandler, of Boston—one of the Surgeons of the Boston Eye
and Ear Hospital. I every now and then see evidence of
the very excellent work he is doing. In the field of general
Medicine I find Dr. Tetreault, of Orange, New Jersey, oc¬
cupying the position of Medical Health Officer, and a re¬
cognized authority on Sanitary matters. In the City of
New York I find Dr. Wolfred Nelson holding an enviable
position as a Life Insurance Specialist. In Kingston, Jam¬
aica, West Indies, Dr. Bronstorph, who graduated in 1884,
I am informed, has risen to the position of one of the lead¬
ing Surgeons, and has a reputation for Surgical knowledge,
and skilful operator, which extends all over the Island. Dr.
A. J. Richer, one of our graduates, and on the Faculty Staff,
is rapidly coming into notice as an authority on Tuberculous
diseases, and is the head of the Sanatorium at St. Agathe.
In the far West, at Belt, Montana, I hear of Dr. Vidal, who
graduated in 1890, being so pressed with work as to need for
several years past, two assistants. Dr. Blackmeer, who gra¬
duated in 1884, is Professor of Medical Jurisprudence in the
Barnes Medical College, (St. Louis), with a class of over four
hundred students. In Montreal I find Dr. Maude Abbott
one of our first lady graduates doing excellent work in the
Pathological Laboratory of the Royal Victoria Hospital—
also Drs. Jack and Foley—who graduated from Bishop’s in

OF THE UNIVERSITY OF BISHOP’S COLLEGE. 253

1889 and 1890—forging rapidly to the front as Skin Special
lists. Dr. C. R. Wood (M. D. Bishop’s. 1891)—is in Ujjain^.
India, doing excellent work as a. Medical Missionary. Ii»
Literature, my fellow Professor and Bishop’s College graduate*
Dr. W. H. Drummond, has won a place of great eminence.
His book of poems, “ The Habitant,” is read and admired all
over this Continent. These are but a few samples to show
that our teaching has not been in vain.

Ever since the Faculty was organized, its members felt ‘
that a Dental Department would prove a valuable addition
to the University. It was, however, not till about 1895 that
the matter took shape and it was then in a measure forced
upon it by the action of the Dental Board of this Province.
That body had established the Dental College of the Pro¬
vince of Quebec, and sought affiliation with another Univer¬
sity. As we had for years given the Medical portion of the
Dental Curriculum to many students, we were forced in self
defence to seek a change in the Dental Act. In this we
failed before the Quebec Legislature, that is we succeeded
before the Legislative Assembly—but failed before the Le¬
gislative Council. A year later the attempt was made again,
and resulted in a compromise.

The Dental College became affiliated to the University
of Bishop’s College. The result has been excellent to both
of the contracting parties. The Dental College has prospered
beyond the hope of its most sanguine friends, and the
Medical and Dental students fraternize in a way that is cal¬
culated to add to the prestige of the two Faculties and the
University. Lectures in the Dental Department are
delivered in both the English and French languages.

During the twenty-nine years of its existence the Medi¬
cal Faculty has had many vicissitudes. It has had its periods
of despondency and of exultation, but it has, in spite of
bitter opposition, never wavered in its determination to
continue the struggle till complete success rests upon its Ban¬
ner. A large measure of this success has already been
obtained. To the present members, and those who
succeed them, remains the duty of pressing forward oa

*54 SHERIDAN : DIABETES MELLITUS.

the line of their predecessors, Of the original members of
the Faculty only Dr. Perrigo and myself remain—before very
long we also will be gone. The hope of the school lies in
its own graduates, of whom I am proud to say ten are to¬
day on its teaching staff. It requires Hospital facilities for
its clinical teaching. Will not some man or number of men,
possessed of the means, come forward in answer to the appeal
which is being made for this object ? The Faculty has done,
and is doing good work, and deserves recognition.

The establishment of this Faculty of Medicine and
Dentistry has exerted a most beneficial effect upon the entire
University. The name of Bishop’s College is known to-day
in every quarter of the Globe, and this is very largely due
to its Medical Faculty. If the friends of the University
would remember that its Faculty of Medicine is as integral
a part of it as the Faculties of Arts and Divinity, it would
inspire additional enthusiasm among its workers. I hope
the future—the near future, will show evidence of it.

Selected Article,

FOUR CASES OF DIABETES MELLITUS OF

APPARENT BACTERIAL ORIGIN, AND
THEIR SUCCESSFUL TREATMENT.

By J. P. SHERIDAN, M. D., of New York City.

In the latter part of 1898 a writer in the Medical
Record related his experience with bichloride of mercury in
the treatment of diabetes mellitus, and advanced the novel
theory of the bacterial origin of this affection.

At the time of publication of the article in question I
had some diabetics under treatment. As a moderately rigid
antidiabetic diet and the time-honored remedies did not
check the glycosuria in my patients, I adopted the newly
proffered theory and eagerly prescribed the advocated
chemical.

To-day, after a year’s trial of germicidal remedies in
diabetes, I have become a firm believer in the -bacterial
origin of diabetes. It is true, the bichloride of mercury did

SHERIDAN: DIABETES MELLITUS.

255

not prove a success in my bands, but this only tends to
demonstrate the existence of a peculiar diabetic toxine,
which has to combated by other means. This toxine, in my
opinion, is particulary apt to attack the nervous matter, which
in turn gives rise to the well-known disturbance of metabolism
in diabetes—namely, preventing the deposition of glycogen
in the liver and muscles and causing its discharge by the
kidneys in the form of grape sugar. The irritation of the
vaso-motor centers, to which may be attributed all the
symptoms of diabetes, seems to be caused by this toxine.
It is plainly the physcian’y duty to eliminate the toxic in¬
fluences, for he thereby relieves the irritation of the nervous
centers. However, he must be most careful in the
selection of the proper remedy and in the administration of
its indicated dose. The failures in diabetic therapy have to
be ascribed either to a wrong medicine or its improper
administration, or to both. The ideal autidiabetic drug
should not only exert distinct germicidal and antiseptic
powers, but should be a powerful alterative. At the same
time, the system should not become weakened and emaciated
by its prolonged administration. On the contrary, the ideal
diabetic remedy should afford great tonic properties.

Bichloride of mercury and auri et sodii chloridum,
which latter is so much lauded of late by a Chicago physi¬
cian, possess some of these desiderata, bur neither proved of
any success in my hands in the treatment of diabetes mellitus.
This non-success is due to three factors :

(a) The specific toxine of diabetes is affected only by a
specific antiseptic.

( b ) Bichloride of mercury or auri et sodii chloridum,
when pushed to their physiological tolerance, do not effect
the decline of the glycosuria.

(t) Bichloride of mercury, as well as chloride of gold
and sodium, when administered for any length of time and
in larger doses, reduce the oxidizing power of the red blood
cells, thereby weakening the system and producing rapid
emaciation.

The remedy answering all the demands for an ideal
antidiabetic I find in a combination of bromide of gold
with bromide of arsenic, called by its makers “ arsenauro.”
This preparation undoubtedly exerts a specific influence
upon the bacteria and the toxine of diabetes mellitus, which
is elucidated by the following four cases :

Case I.—Mr. C. L., aged fifty, American, clerk, consult¬
ed me on June 8, 1898. Family history was negative.

SHERIDAN: DIABETES MELLITUS.

256

Patient complained of polyuria, the existence of which dated •
back about three months. The frequency in urination he
thought to be due to a stricture, the possible result of a
neglected gonorrhoea. Patient had a moderate appetite, .
felt quite thirsty at times, and had lost some weight. The
urine (which was voided to the amount of about seven pints
daily), on June 10, 1898, showed a specific gravity of 1038,
and contained 7.1 per cent, of sugar, as ascertained by means
of Stern’s urinoglucosometer. A restricted diet and the
administration of codeine caused only a moderate improve¬
ment of the symptoms. Bichloride of murcury. which was
given for the last three weeks of December, 1898, in the
doses recommended, not only produced no beneficial in¬
fluence whatsoever upon the diabetic condition, but actually
aggravated the condition of the patient. Early in July,
1898, my attention was drawn to the chloride of gold and
sodium which was handed to the patient in tablet form and
administered first in doses of a fiftieth of a grain. The dose
was gradually increased to a twentieth of a grain. After
five weeks’ trial of this drug it had to be abandoned, as the
condition of the patient had become alarming in the mean¬
time.

At about this period I ran across an article in the New
York Medical Journal regarding the use of arsenauro in
diabetes, and determined to test this product, having pie-
viously used it with satisfactory results in malarial toxaemia.

On February 7, 1899, eight drops of arsenauro were
given in half a glass of water three times daily. The res¬
tricted diet was ordered to be continued. Patient reported
to me in one week. The glycosuria and polyuria were
greatly diminished. The feeling of thirst was not expe¬
rienced any longer, and he expressed himself as feeling per¬
fectly well. The dose of arsenauro was gradually increased
until he reached his full limit of toleration, which supervened
at fifty drops. The quantity was lessened to forty-five
drops, and continued in this dose for sixteen weeks. After
this period I examined the urine, which revealed a specific
gravity of 1.020 and was absolutely free of sugar. Patient
was discharged as cured, with the instruction to continue the
arsenauro for at least six months.

Case 2.—M. H., a woman, aged thirty-four, American,
unmarried, came to consult me September 11, 1898. In
July previous, during the hot spell, she perspired greatly and
suffered from excessive thirst. Her weight, which normally
was a hundred and sixty-five pounds, had diminished to a

SHERIDAN: DIABETES MELLITUS. 257

hundred and thirty-five pounds. Frequent micturition was
•distressing her greatly. Appetite was voracious for some
time,and her strength graduelly declined. When first seen
by me the daily quantity of her urine amounted to eight
pints. Specific gravity, 1.046 ; sugar, 7,538 grains a day.
She complained of incessant thirst, inordinate appetite, pain
in back, and extreme feebleness. She was put on a re¬
stricted diet on September 20th, but no medication given
her. Patient improved somewhat, but not sufficiently. In
December, 1893, bichloride of mercury was given and the
same diet continued, without effecting any noticeable change
in the patient’s condition. In February, 1899. she was put
on arsenauro, and the same diet still continued. The medicine
was started in eieht drop doses three times daily, to be taken
in a glassful of Vichy water. Ten days after, great improve¬
ment had taken place. The urine became reduced to forty-
nine ounces, specific gravity 1.028, and the sugar output to
two hundred and ten grains for the twenty-four hours.
After this the dose of arsenauro was gradually increased until
the patient reached her full physiological limit ; this took
place at forty-drop doses—that is, after the administration of
two drachms a day. Patient was instructed to occasionally
discontinue the administration of the remedy for twenty-four
hours, and then to start again on thirty-five drops.

This latter dose was taken for some months, with the
Tesult of rendering the urine entirely free of sugar, She
was advised to continue with the medicine for at least six
months longer. I examined her urine of late and found it
absolutely normal and free of sugar.

Case 3.—H. E. B., a man, aged thirty-seven, American,
railroad conductor, consulted me in March, 1899, on account
of an irritable bladder. Patient was compelled to urinate
-quite frequently during the day as well as during the night.
His other symptoms left no doubt as to his real affection—
diabetes mellitus. The disease, so far as I could ascertain,
dated back for about a year, and seemed to be devoid of
further complications. The quantity of urine voided varied
from twelve to fifteen pints a day, with an average specific
-gravity of 1.0.12. Sugar average four thousand grains for
the twenty-four hours. The treatment consisted in restric¬
tion of diet and the administration of arsenauro, ten drops
of which were ordered to be taken in half a goblet of water
three times a day. This dose was gradually increased until
patient took sixty drops three times daily. When this
quantity, three drachms, was taken every day, the patient’s
lids began to puff and his bowels became loose and caused

25 8 SHERIDAN; DIABETES MELLITUS.

griping. The medicine was discontinued for twenty-four
hours, but again ordered to be taken in fifty-five drop doses.
Patient had taken the fifty-five-drop doses for eight weeks,
when I again examined his urine, which contained only a.
trace of sugar. One month later he was perfectly well, and
all vesical irritation had disappeared—in fact, I pronounced
him well. I advised patient to report to me from time to
time, but to continue tke arsenauro for at last six months.

Case 4.— B. R., aged forty-seven, a woman, unmarried,
American, milliner, thin and emaciated, able to attend to
her business, consulted me April 22, 1899. Patient com¬
plained of great weakness, which had gradually increased
for several months. She had excessive thirst and had voided
a greatly increased quantity of urine, but her appetite was
moderate. Her skin was dry, and she complained of intense
pains in the calves of her legs, especially in the morning.
There was distressing pruritus vulvae present. The specimen
of urine sent to me for examination presented a specific
gravity of 1.045, and contained 8.1 per cent, of sugar I
restricted the patient’s diet as to starches and sugar, and
placed her at once on ten-drop doses of arsenauro, to be
taken in a half tumblerful of water three times daily. After
one week the dose of arsenauro was increased three
drops every day until she reached its toleration. Physiolo¬
gical saturation was obtained when forty-five drops were
taken three times a day. The administration of the remedy
was then stopped (as I am in the habit of doing) for twenty-
four hours, after the lapse of which it was again ordered to
be taken in forty-drop doses. This dose was kept up for six
weeks. On July 3d she had gained seven pounds in weight;,
urinallysis demonstrated entire absence of sugar ; the pruri¬
tus had entirely disappeared, and there were no evidences
whatsoever of symptoms pertaining to diabetes mellitus. Pa¬
tient was advised to continue the medication for at least
another six months.

The four cases which so readily yielded to this antioxic
treatment were apparently of bacterial origin. Arsenauro,
by saturating the system arrested bacterial activity, or killd
the germs, or neutralized their toxines. However, only by
saturation with the proper' medicine—and, by the way,
arsenauro is the only powerful alterative neutralizer which
which can be pushed to an almost incredible dose without
doing bodily harm—can such results as are recorded in the
foregoing be obtained .—Interstate Medical Journal.

Progress of Medical Science.

MEDICINE AND NEUROLOGY.

IN CHARGE OF

J. BRADFORD MCCONNELL, M.D.

Associate Professor of Medicine and Neurology, and Professor of Clinical Medicine
University of Bishop's College; Physician Western Hospital.

RICKETS—THE TREATMENT OF.

For patients in the first few years of life, from i }4 to 5
years, my plan of campaign is practically the same for all.
For those with heavy bodies and heads, protuberant bellies,
head sweats, and commencing or acquired bow-legs or knock-
knees, the food supply is carefully attended to, the digestive
functions restored as soon as possible, starchy food being
limited, fats being recommended, especially bacon fat and
dripping, which I believe has for these cases a high nutritive
value. For very young children especially the addition of
some cream to the dietary is most valuable. Condensed
milk, if. it be taken, should be replaced by cow’s milk boiled,
and a weak gravy soup or broth will often help to stop the
rickety tendency. For marasmic patients nothing acts so
well as a daily rubbing under each axilla of cod liver oil.
For all these rachitic patients, then, varying the dose slightly
according to age, I prescribed cod liver oil and syrup of the
phosphates of iron. In very hot weather I let the children
leave off the oil, but the mixture generally is very well taken,
and the results are most satisfactory. In cases with any
tuberculous or syphilitic history, the syrup of the iodide of
iron should be substituted for that of the phosphates. Next
as to the treatment of the rickety deformities, especially
of the leg bones. In the case of patients under the age of
4 years, even with very marked bowed and bent tibiae, and
some degree of knock-knee, I can assure the parents with
great confidence that after nine months’ to fifteen months’
treatment these deformities will be very greatly improved
or altogether remedied. I am prepared to leave any ques¬
tion of operation to a later age—say that of 5 or 6 years.
By that time we can see whether ordinary treatment has
;been able to effect anything, the bones.have got harder, and
there is less risk of producing the calamitous condition of
pseudarthrosis. These children's legs should be put up in

260

PROGRESS OF MEDICAL SCIENCE.

splints, preferably outside ones, which may purposely be
made three or four inches too long. The splints should be
taken off once every month or three weeks in the winter and
•once a fortnight in the summer. I do not deny that a
rjckety child’s legs occasionally becomes much straighter
with ho treatment whatever. Still I feel sure that the great
mass of these rickety children are far better when off their
feet—for this reason, that the deformity of the pelvis is so
much less apt to ’occur, as little or no pressure is acting
upwards through the acetabula while the child is lying
down or. even sitting up.—From Dr. E. Mansel Sympson’s
article in Pediatrics, October 15, 1899.

TYPHOID FEVER, DIET IN.

Dr. E. J. Abbott (Northwestern Lancet , August 15, 1899)
says that it has been his practice for years to allow his
typhoid patients what is termed “soft diet” instead of milk
diet, namely, a diet consisting of milk if it is agreeable,
buttermilk, all kinds of soups and broths, eggs, raw or soft,
or the yolk, if they like, of hard-boiled eggs. By hard-
boiled eggs he does not mean an egg that is boiled four or
five minutes, just sufficient to coagulate the albumen, but an
egg that is cooked from one-half to three-quarters of an
hour. The yolk of an egg in this condition is easily digested
and is nutritious. He also permits custards, rice, farina,
junket, tea, coffee, chocolate, cocoa, ice cream, and parti¬
cularly milk and cream-toast and all foods of that class.
The writer says he has never yet had cause to regret feeding
his patients in this way, and is convinced that this diet leaves
less waste of indigestible material as a possible irritant to the
ulcerated surface than does an exclusive milk diet The
writer also advises the lengthening out of the intervals of
feeding from two to three or four hours, perhaps even longer,
and thinks that by doing this his patients relish their food
more than before, and that they will digest it better and will
recover from the fever stronger and in better condition than
they would otherwise .-—Medical Age, October 10, 1899.

CONVULSIONS IN CHILDREN.

Drs. Gossage and Coutts make the following remarks
in their paper: All th*t is necessary during an actual attack
of convulsions in most cases is to loosen the clothing about
the neck, chest and abdomen, and to lay the child on its

. MEDICINE AND NEUROLOGY.

26l

back with the head slightly raised until it recovers con¬
sciousness from the fit and the subsequent drowsiness. The
placing of the child in a hot bath, as is such a common prac¬
tice, probably does no harm, and if the child be in feeble health
it may be advantageous to use a mustard bath, which has
decided stimulating properties. Cases, however, where the
unconsciousness is unduly profound and prolonged, and
especially if with this further fits are associated, require
more active measures. Chloroform inhalation is the most
efficacious of these, and profound unconsciousness is no bar
to its employment, recovery from the anaesthetic being
usually accompanied by regain of consciousness. The in¬
halation of chloroform may be replaced, or in severe cases
followed by the rectal injection of chloral in doses of 3 gr.
to an infant of six months, to which 2 to 3 gr. of potassium
bromide can be added if desired. Some authorities have
recommended the inhalation of nitrite of amyl in i-minim
doses, and Eustace Smith praises the hypodermic injection
of morphine in doses of gr. to an infant of six months, and
says that it can be repeated, if necessary, in the course of
half an hour. Any local irritation which may be regarded
as an exciting cause of the fit calls for appropriate treat¬
ment.— British Medical Journal, August 19, 1899.

EPILEPSY—BROMIDE OF CAMPHOR IN.

Hasle ( 7 hhe de Paris , 1899), after carefully selecting a
number of cases of epilepsy from the abundant material at
Bicetre, obtained the following very constant results : (1) As
regards epilepsy proper ( haul mal), the action of bromide of
camphor was doubtful, and was less effectual than the mixed
bromides of potassium and sodium and ammonium. (2) In
attacks of petit mal, and in all cases of epileptic vertigo,
however, its effect was incontestable ; it at first diminished
the frequency of the vertiginous attack, and finally made
them disappear altogether. The condition to be observed in
prescribing was to begin with moderate doses, made
gradually progressive, and lasting for a sufficient time.
Owing to its disagreeable odour it is best taken in capsules
■of 20 centigrammes, or dragees of 10 centigrammes, beginning
with two capsules per diem, and augmenting by two cap¬
sules the second week, etc., till eight capsules per diem are
taken, then as gradually diminishing the dose till two capsules
per diem are reached and maintained for some time.—From
abstract in Epitome, British Medical Journal, August, 5,

262 PROGRESS OF MEDICAL SCIENCE.

DIARRHCEA, CHRONIC INFANTILE.

Irrigation of the large bowel, carefully aud thoroughly
carried out each day with a fountain syringe and No-12
catheter (not too flexible) is of decided benefit. A gallon of
fluid should be employed for each irrigation, the liquid being
at 98° to ioo° F. Saline solution, boric acid solution, or
nitrate of silver, 7 grains to the gallon, have all in my
hands been most useful. The child lies with the hips
elevated ; the catheter, well oiled, is allowed to gently pass
six or eight inches up the bowel, the liquid being allowed to
flow gently during its introduction, and the reservoir not
raised more than three feet above the child’s body.—From
Dr. A. Jacobi’s paper in The Iherapeutic Gazette , August

IS, 1899-

THE TREATMENT OF SCARLET FEVER.

This subject was discussed at some length in the section
of Diseases of Children at the annual meeting of the Ameri¬
can Medical Association (reported in the Philadelphia
Medical Journal , July 1), and Dr. R. A. Birdwood, Medical
Superintendent of the Park Hospital, Lewisham, has stated
his experience in the Hospital , April 15, 1899. In an
ordinary mild uncomplicated attack of scarlet-fever Bird-
wood keeps the child in bed for three weeks on a low diet
with stewed fruit till three days after the temperature has
fallen to normal. The bowels are opened daily, and the
urine tested for albumin on alternate days. The reason for
so long a stay in bed is that if nephritis supervenes it usually
does so about the end of the third week, and the mainten¬
ance of the regular action of the bowels seems to have a
marked and beneficial effect in preventing oedematous swell¬
ings of the legs. They are also detained in bed whilst
albuminuria or dilated heart persists, and when in bed are
blanket-bathed daily. It is not prudent to use the bath dur¬
ing this time, as faintness or a bad colour comes on occa¬
sionally. During convalescence, if all goes well, a warm soap
and water bath is given three times weekly. As a rule, this
is sufficient treatment for desquamation. A. Gilbert recom¬
mends anointing the skin with lard, vaseline or lanolin. If
desquamation continues, a weak acid solution, such as an
ounce of dilute acetic acid to half a pint of water, applied to
the soles or palms on lint for a quarter of an hour, or else
rubbing with glycerine and borax, does much to'remove ad¬
herent epithelium. Desquamation may go on for three of

MEDICINE AND NEUROLOGY. 263

four months, or even longer, and it is quite common for it to
come on twice and sometimes three times.

High Temperature. —B. Gilbert objects to the use of
coal-tar antipyretics, and to the full bath unless the fever is
very high and there is very active delirium. The nervous
excitement can best be allayed by chloral hydrate. Slagle
and Ewing agree in objecting to antipyretic drugs, but
advocate the free use of cold water for drinks, enemas and
packs. By drinking water freely they contend that the
toxins are eliminated. Quayle prescribes lithia water and
Ewing prescribes potassium acetate in addition. Garrison
has used acetanilid for eight years, and finds it useful; it
promotes a feeling of well-being, and if combined with soda
bicarbonate does not diminish the renal secretion. Garrison
does not hesitate to employ antipyrin if the pulse denotes
high arterial tension, and has given it to young infants in
doses of a quarter of a grain. Birdwood finds that the high
temperature of scarlet fever is well controlled by sponging
with tepid water, and the patient generally feels better after
it is done. It is good practice to sponge whenever the four-
hourly temperature exceeds 39 0 C. Hyperpyrexia of scarlet
fever is not controlled by baths or drugs ; the former may
be frequeutly repeated, but the temperature rises again, and
the patient becomes rapidly worse. Now and again a
patient recovers after a temperature of 41 0 C., and this en¬
courages one to keep on with tepid sponging. An un¬
doubtedly good effect is sometimes observed in the reduction
of temperature on removal of blankets, and leaving the
patient covered with a sheet only. If either sponging or re¬
moval of blankets induces shivering or a feeling of coldness,
or actual coldness of the extremities, it should be discon¬
tinued, and warm water bottles should be used. A thirsty
fever patient should be given plenty of drink, and it is well
to remember that there is sometimes a repugnance to milk.
Water relieves thirst best, and should be given. Grape or
orange juice is generally liked, and does good. Barley
water is a suitable drink.

Sore Throat .—A chlorine gargle is used at the Park
Hospital (chlorate of potash, giss.; hydrochloric acid, 3yj.,
with five pints of water added after the evolution of the gas)
when an acid preparation is desired, or Liq. sodae chlorinatae
I in 15 of water when an alkaline. Equal parts of either of
these chlorine solutions and warm water are mixed just
before use. If the patient is not old enough to gargle, a
ball syringe with a long nozzle attached is used for flushing

264 PROGRESS OF MEDICAL SCIENCE.

out the fauces. Two 4 oz. syringefuls are enough. Should
the patient resist the attempt to pass the nozzle between
the teeth, there is no occasion to use force to do so. The
fauces can be well washed by passing the nozzle between
the cheek and the teeth, so that its point goes just beyond
the last molar tooth. This should be done first on one side,
then on the other. The patient should be held with the
face downwards. The practice of gargling the throat is far
better than swabbing, for the tissues are often soft enough to
be damaged by the latter proceeding.

Nose and Ear Discharges .—A solution of boric acid
•(Sii. to 5 pints) is used by Birdwood; before use it is mixed
with an equal quantity of warm water.

Nephritis .—Bird wood usually orders loin poultices or
fomentations. In some instances the drawing of a few
ounces of blood has been followed by a flow of urine; in
others, no such result has ensued. Seidlitz powders or com¬
pound liquorice powder should be given, not calomel.
Solomon prescribes cascara and sodium phosphate, and also
a decoction of scoparius (?i. to Oi) to relieve the kidney con¬
gestion.

Joint and Muscle Pains .—Solomon has found acetan/lid
useful in relieving the severe headache and pains in joints,
but where muscular pain was complained of he gave phena-
cetin instead. Birdwood employs salicylate of soda.—Dr.
Francis J. Allan’s abstract in Treatment, September 14, 1899

HABITUAL CONSTIPATION.

The treatment detailed is intended for habitual constipa¬
tion. For the immediate unloading of the bowel one of the
simplest and least harmful methods is the giving of one or
more enemata of warm water, containing salt in the propor¬
tion of a teaspoonful to a pint. Soapy water may be used
instead, if something stronger is needed. The amount to be
injected varies with the age. For youug babies, one or two
ounces in sufficient, and for those of two years, two or three
times this amount. Either the hard rubber syringe or the
infant’s syringe may be used. A useful injection consists of
half a teaspoonful of glycerin in full strength. This is best
given from a small hard-rubber syringe holding not more than
half an ounce. The opening in the nozzle should be larger
than ordinary, as the glycerin does not flow readily. If the
mass in the bowel is large and hard, an injection of warm
sweet-oil, retained some hours if possible, is better than any-

MEDICINE AND NEUROLOGY. '

265

thing else. It should be followed by an enema of soapy
water. In some cases it is necessary to insert the finger or a
small spoon-handle into the bowel and break up the masses
carefully.

Glycerin suppositories—glycerin and soap—of a size for
children are often exceilent for opening the bowel. Gluten
suppositories are also serviceable in many instances. A more
economical plan is to employ little home made suppositories
of castile soap, or, in place of these, a soap stick which can
also be made at home, and which has the value of lasting for
repeated usings. It consits of a smooth conical stick of firm
castile soap two or more inches long, half an inch thick at the
base, and tapering toward the other end to the thinness of
about one-quarter of an inch. It should be greased with
vaselin before using, inserted part way into the bowel and
held there until a tendency to an evacuation shows itself.

If none of the methods described is effectual, laxative
drugs must be employed. Their use, however, ought to be
deferred as long as possible, and is much better left to a
physician. Probably the best and least harmful of drugs is
cascara in some form. There is made a cascara cordial which
has a pleasant taste and is very effectual. Another very
useful preparation is the syrup of senna, which is easily taken
by children, as its taste is agreeable. Little sugar coated
pills, each containing one-tenth grain or less of aloin are
sometimes of service, one being given daily to a child of two
years. A small quantity of manna, about five grains, can be
given to a baby of six months once a day or oftener, dissolved
in the milk, as its taste is sweet, or ten grains of phosphate
of soda may be used in a similar manner, Magnesia or
spiced syrup of rhubarb answers very well, but only for occa¬
sional use.— Jour. A. M. A.

CARE OF THE MOUTH.

Perhaps no part of the body is so often neglected as the
mouth ; especially is this noticeable in the case of children.
A mother who will religiously bathe her ehild and keep its
body sweet and clean will often fail to cleans its mouth. A
new-born infant should have its mouth washed after each
feeding; a'soft cloth wet in a weak solution of boracic acid
should be used for this purpose. If this were always done
we would rarely find a case of infantile sore mouth.

After the teeth come and the mouth is large enough, a
small, soft brush should be used ; the teeth and mouth should
be thoroughly cleaned at least twice daily.

266

PROGRESS OF MEDICAL SCIENCE.

In illness where sordes and mucus accumulate rapidly,
and where the tongue and lips are parched and stiff, atten¬
tion is needed every hour; the mouth should be kept moist
and the same treatment carried out through the night as
during the day. Boracic acid solution, listerme, lemon juice,
glycerine and distilled water are all refreshing, and soften
the tissues; where the lips are chapped or fissures appear, a
lubricant of cold cream or sterilized vaseline should he applied.
Where the gums are spongy or soft; and bleed readily, a few
drops of tincture of myrrh added to pure water will help to
harden them. Small squares of old linen or soft gauze
should be used instead of a brush where one is ill or week.
These should be immediately burned after use.

Every part of the mouth should be cleansed; behind
the wisdom teeth, the roof of the mouth and under the
tongue; lemon juce and water will remove the fur from a
thickly coated tongue. Where the teeth are sensitive the
water used should be slightly warm.— South Cal. Practi¬
tioner.

ATROPINE IN DELIRIUM TREMENS.

Touvine ( Archives Medicates Belgiqties ) administers
atropine to his alcoholic patients in one sixtieth grain doses
hypodermatically. The result is to quiet them, and to put
them to sleep in a few minutes. It is believed that the
prompt action of the atropine is due to its stimulating effects
on certain centers of the brain, thus inducing the quiet and
sleep.— American Practitioner and News.

THE TREATMENT OF HICCOUGH.

M. J. Noir records the case of a girl, six years and a
half of age, who suffered from persistent attacks of hiccough.
M. Noir, on seeing her in one access, which had continued
for six hours and a half, drew out the tongue and held it
protruded for the space of a minute and a half, which calmed
the spasms as if by enchantment. They did not reappear.
This procedure is not altogether new, but is not, we think,
sufficiently appreciated.— Progres Medical.

SURGERY

IN CHARGE OP

HOLLO CAMPBELL, M.D.,

Lecturer ou Surgery, University of Bishop’s College ; Assistant-Surgeon, Western Hospital;

AND

QEOBGB FISK, M.D.

InstructorJn Surgery, University of Bishop’s College; Assistant-Surgeon, WesternJHospital,

AN IMPROVED METHOD OF ABDOMINAL
INCISION.

George R. Fowler, in the Medical News of March 3,
1900, says that two cardinal points must be borne in mind
in making the incision through the abdominal wall. It should
be so madethatall parts involved in the intended operation are
readily within reach. Weakening of the wall of the abdomen
should be avoided by carrying the incision, whenever prac¬
ticable, in the direction of the fibers so as to avoid cross-
sectioning the muscular and fibrous structures. The incision
in all cases of appendicitis should be so planned as to admit
of removal of the appendix. In his experience access to the
base of this organ is secured in the largest number of cases
through an incision so planned that its center strikes a point
corresponding to the intersection of a line extending from
one anterior superior spinous process of the ilium to the
other, with a vertical line drawn half-way between the median
line and the right anterior superior spine. This differs from
Clado’s point

The skin incision commences at the upper rounded pro¬
minence of the anterior superior spinous process of the ilium,
is carried almost horizontally to the outer edge of the rectus
abdominis muscle, from which point it is curved downward
and extended parallel with the edge of the rectus for a dis¬
tance of two and a half inches, or more, as required by the
exigencies of the case. The skin, fat and fascia are divided,
and the triangular-shaped flap with rounded corner dissected
and reflected downward and outward, exposing the aponeu¬
rosis of the external oblique.

A retractor is applied at the lower angle of the wound
and another at the middle of the horizontal incision. Trac¬
tion upon these in the direction of the course taken by the

268

PROGRESS OF MEDICAL SCIENCE.

external oblique exposes the latter for a distance of three or
more inches, if necessary. This structure is divided in the
direction of its fibers to the extent of its exposed portion,
two more retractors applied, and the sheath of the rectus
exposed and likewise opened. The rectus muscle and the
underlying deep epigastric artery and veins are now retracted
toward the median line, the outer edge' of the incised apo¬
neurosis being retracted in the opposite direction. A space
of four inches in its transverse diameter is thus exposed.

With the rectus well displaced toward the median line,
care being taken to retract the deep epigastric artery and
veins as well, and the outer edge of the incised external
oblique aponeurosis retracted in an outward direction, the
following parts are exposed : In the outer two-thirds of the
space between the retractors is to be seen the muscular por¬
tion of the internal oblique, this terminating in the aponeu¬
rotic portion of this muscle at the point where the aponeuro-'
sis divides to enclose the rectus (the linea semilunaris). The
inner third includes that portion of the exposed space left
by the inward displacement of the rectus muscle, and is occu¬
pied by the posterior lamella of the sheath of the latter. In
this space the transverse incision is to be made. For this
operation the remaining structures of the abdominal wall may
be considered as one layer, and the transverse incision carried
directly through these in the direction of the fibers of the
internal oblique and transversalis into the peritoneal cavity.
The incision is commenced at the inner end of the space
beneath the rectus muscle and access gained to the cavity of
the peritoneum at this point first; after which, with the finger
as a guide, the section is completed. Retraction of the
edges of the transverse incision will be found to give ready
access to the region of the caecum.

At the completion of the operation the parts are to be
replaced and sutured. The transverse incision is closed by
running a catgut suture including all of its layers. In clos¬
ing the incision in the external oblique aponeurosis, care
must be taken to include in the suture the incised edge of the
sheath of the rectus muscle. The muscular structure itself
should not be included in the suture, since the interposition of
this between the incised edges of the sheath which may fol¬
low the attempts to include the muscle will prevent the
prompt union of the aponeurosis.

In view of the supreme importance of securing imme¬
diate firm and permanent union of the aponeurosis of the ex¬
ternal oblique, It is best to employ kangaroo tendon for the'

SURGERY.

> 269 ,

suture material in the case of this structure at least Finally,,
the skin wound is to be close. This may be done by the
ordinary interrupted suture, although this, as all skin inci¬
sions, is best closed by the subcuticular suture.— Medicine.

A NEW METHOD OF DILATING A STRICTURE
OF THE ESOPHAGUS.

J. S. Pyle, in the Philadelphia Medical Journal of Feb.
3, 1900, describes a rare case of stricture of the esophagus
following typhoid fever. In Keen’s work on the surgical
complications of typhoid two cases are mentioned, and Osier
has described a case. While this complication is rare, the
real interest of Pyle’s communication relates to his novel
method of treating the stricture. The difficulty of swallow¬
ing precluded the taking of solid food, and as time progres¬
sed the ingestion of liquids was attended with great difficulty.
The stricture was situated at the esophageal opening of the
diaphragm, and it could not be enlarged by the use of pro¬
bangs or dilators. He was able to pass a small bougie, and
later devised a small instrument somewhat after the plan of
a Barnes dilator. Between two layers of fine rubber tissue
a silk bag is placed, the whole being, when dilated to the full
extent of the silk, about the size of the little finger. This was
mounted upon a small rubber tube and carried with the aid of
a small wire through the stricture. With a suitable pump
the apparatus was filled with water and the stricture success¬
fully dilated. This was accomplished with very little discom¬
fort to the patient and the complete relief of the stricture.—
Medicine.

THE TREATMENT OF EPIDIDYMITIS.

H. M. Christian, in the Therapeutic Gazette of March 15*
1900, says that for the last few months applications of
guaiacol have been adopted as a routine practice at the
University and Polyclinic Hospital of Philadelphia. Since
this form of treatment was instituted, about sixty cases of
epididymitis have been treated. These were all acute walking
cases. In all but six great relief from pain followed during
the course of the first twenty-four hours after application.
All were able to keep on their feet through the whole of the
attack, with little discomfort. The application of the drug
was followed in all cases by a smarting and tingling sensa¬
tion in the skin, lasting for about an hour.

In all cases the testicle was first gently massaged with

270

PROGRESS OF MEDICAL SCIENCE.

a 20-per cent guaiacol ointment made up with lanolin.
Some of the ointment was then spread upon lint and applied
to the part, the whole being enveloped in a layer of absorb*
ent cotton, over which was applied a snugly fitting laced
suspensory bandage. The dressing was reapplied every
second day. At the end of about six days after the in.
flammation and pain had ceased, the guaiacol was substi¬
tuted by an ointment composed of

R Unguentum hydrarg.

Unguentum belladonnse.

Ichthyol.

Lanolin.aa 3 ij.

It was found that this application produced a prompt les¬
sening of the inflammation and a rapid return to the normal
size.— Medicine.

TREATMENT OF AORTIC ANEURISM.

Moritz Schmidt, in the Medical Chronicle for March, 1900,
discusses the early diagnosis and treatment of aortic aneurism.
During the past eleven years he has seen fifty-four cases. Of
these thirty-eight had paralysis of the left recurrent laryngeal
nerve. Tracheal tugging was present in nineteen of thirty-
one cases. He regards this as one of the most decisive
symptoms in the early stage of the disease. A less definite
indication is a murmur. This may be due to tumors of the
mediastinum and is frequently absent in aneurism. He pre¬
fers iodide of potassium and strict rest in the treatment of
aneurism. In addition Tufnell’s limited diet is employed,
which includes a marked reduction in the amount of fluid
allowed the patient. A lessening of the fluid to 1200
grammes is not difficult, but a further reduction is often fol¬
lowed by distress and must be gradually employed. In one
of his cured cases the amount of fluid was reduced to 340
grammes ; this was followed by a nervous condition which
compelled the raising of the amount of fluid to between 500
and 600 grammes. His paper is illustrated with radiographs.
He comes to the conclusion that the treatment of aortic
aneurism should be undertaken early, and the condition
should be regarded as a curable one, and a rigid system of
dietetics and medicinal measures instituted. If these are
undertaken with confidence, he thinks that the results in the
treatmen of this . ondition will be greatly improved.—
Medicine .

SURGERY. 271

SUPRARENAL EXTRACT IN THE URETHRA.

In % discussion before the New York County Medical
Society (.Medical News , March 24, 1900), J. A. Moore stated*
that he had used suprarenal extract more than two hundred
times in the urethra. He has found instrumentation possi¬
ble without bleeding, and with the production of very little
irritation if the extract has been previously used. This should
consist of a io-per-cent infiltrate solution, which may be
injected without causing the slightest irritation, and is fol¬
lowed by a decrease in the irritability in the pathogenic
structures. When a structure is to be stretched, it lessens
the congestion, increases the caliber of the urethra, and pre¬
vents bleeding. The effect of suprarenal extract is evan¬
escent, and if two or more sounds are to be passed it is
necessary to employ a second injection. There is no danger
of constitutional symptoms, nor has the extract any action
on the urethra. In six meatotomies he used a 12-per-cent
solution injection hypodermically and had very‘little bleed¬
ing after the operation. In gonorrhea the injection of supra¬
renal extract in two cases gave complete relief from the
smarting, and there was no pain in urination during the
acute stage.— Medicine.

To avoid the harmful effects of the X-ray from either a
static machine or a coil as an exciter one should never have
the tube near the patient ; it should be two or three feet
feet away when using the fluorescent screen, and should be
three feet or more from the plate when taking x-ray photo¬
graphs. Between the patient and the Crookes tube there
should always be placed a thin screen of aluminum, which
should be grounded by connecting it to the gas-pipe with a
proper wire.—F. H. Williams. — N. Y. Med Rec.

SEQUEL AS TO HERNIOTOMY.

(1) The wound may not unite by first intention, and if
the sac has been very adherent the disturbance of the cellular
tissue may cause some sloughing. In such cases the wound
should be reopened and stuffed with iodoform gauze. (2)
Diffuse general peritonitis may set in ; this is known by the
persistence of the vomiting, the continuance of the pain,
distention, and tenderness of the abdomen, with elevation of
temperature This may be due to leakage from a perforation,
to a gangrenous condition of the gut, or to the introduction
of septic matter from without at the time of operation, as in

PROGRESS OP MEDICAL SCIENCE.

27 ?

any other abdominal section. Immediate laparotomy should*
be done. . (3) The reduced gut, which has been returned as
uspicious, may become gangrenous and obstruction of the
bowel may still continue. If this condition be suspected,,
the abdomen should be opened and the gangrenous bowel
sought for, and either resected or incised, and kept outside
the abdomen with the object of forming an artificial anus.
(4) The bowel may not be gangrenous, yet be so injured
that it may not be able to resume its proper functions, and
the patient may die in consequence if not relieved by a
laparotomy. (5) The bowel may be temporarily paralyzed
by local inflammation so as not to be able immediately to
resume its functions, though after some days it may recover
completely its normal condition. In such cases there is
obstinate constipation, without vomiting or other signs of
peritonitis. (6) Cases of acute mania have followed the
operation for strangulated hernia, some of which have proved
fatal.— Shepherd, “ American Text-Book of Surgery."—
N. Y. Med. Rec.

SURGICAL HINTS.

Never use morphine before anesthesia in patient*
who are in a state of stupor or traumatic shock. In these
the drug has a distinct tendency to increase these con¬
ditions.— Never have any more assistants at an
operation than are absolutely necessary. They are apt to
get into each other’s way, and the more people help you,
the greater the difficulty of securing asepsis.— Excepting
IN EMERGENCY CASES, every patient about to be operated
on is entitled to as careful an examination as if he were
applying for life insurance, and to treatment before the
operation for any complicating condition.— There are
CERTAIN PATIENTS in whom it is very desirable that they
shall make no violent movements while they are being
anaesthetized, as for instance in certain fractures. In these
cases a full dose of morphine an hour before the anaesthesia
will contribute a great deal to secure a quiet etherization.—
When using cocaine hypodermically, it is seldom necessary
to use a solution stronger than one per cent., and then
always have the patient in a recumbent position. The danger
of cocaine lies in the possibility of syncope from failure of
the heart’s action, and lying down is the best preventive.—
WHEN operating, never put too many instruments in one
tray, as it becomes more difficult to find just what you want.
It is best to have several small trays, and to put the cutting

SURGERY.

273

instruments in one, the artery forceps in another, and the
special instruments required in the particular operation you
are doing in a thir l .— DURING the removal OF TUMORS
having many attachments, it is a good principle to free first
all the points that are easily detached, and to pediculate the
tumor, as it were, where it is most difficult to free it. This
will usually result in the largest vessels being included in the
pedicle, so that with your ligature or clamp you may safely
secure the most dangerous region, and cut above it without
danger.— In old ovarian lesions, it is often a fact that
the patients show a decided insufficiency in the secretion of
urea. It is well to subject such patients to preliminary
treatment for this condition, for two reasons : The first is
that if the proper treatment increases the excretion of urea
the patient will have a better chance of recovering from the
•operation, and the second is that if the patient’s urine shows
no improvement, the prognosis is rendered more serious, and
forewarned is forearmed .—International Journal of Surgery,
N. Y. Med . Record.

CURLED HORSEHAIR IN PLACE OF A SCRUB.

BING-BRUSH.

W. S. Forbes, in the Penn. Med. Jour., says that
■ordinary curled hair forms one of the best mechanical devices
for cleansing the skin that has yet been discovered. In its
preparation about three drachms of curled hair is employed,
and this is easily shaped by the hands into a loose pad
about the size of the hand. When desired, the flattened
mass may be held together by stitching with sterilized silk,
catgut or other aseptic material, but this is opitional. When
once fashioned, it will hold its shape without change. It can
not cut or tear the skin, and it is easily cleansed with boiling
water before and after each surgical operation. A solution
of bichloride of mercury, one to one hundred, and steam to
ioo° do not act upon it. It may be kept in alcohol after
being sterilized, and is thus always ready for use. It is
cheap and efficient, and is far superior to the scrubbing-
brush of tainted memory.

OBSTETRICS.

IN CHANGE OP

H. L. REDDY, H.D., L. R. C. P., London,

Pnfoioc of Obstetrics, University of Bishop's College; Physician Accoucheur Womeoft
Hospital; Physician to the Western Hospital*

TREATMENT OF ACUTE PUERPERAL SEPSIS.

H. N. Vineberg brings out the following points in a
paper on puerperal sepsis.

I. Puerperal sepsis is wound fever or wound infection,
and wound infection in the female genital canal, as else¬
where, calls for surgical measures, such as free drainage,
irrigation, and the removal with a sharp instrument of any
debris or exudate that may form on the surface of the wound.
These means failing to accomplish the desired result, perform
ablation of the diseased organ.

2. In a given case of puerperal sepsis a thorough search
is to be made of the whole of the genital canal, in order to
determine the site of the original infection.

3. If this is situated in the uterus, curettage, drainage,
and irrigation are to be employed. In 95 per cent, of the
cases of puerperal sepsis nowadays met with, this plan of pro¬
cedure will be all that is necessary to bring about a cure.

4. In the remaining 5 per cent, roughly speaking, these
measures fail to arrest the infection. An exploratory laparat-
omy is then indicated, the further course to be guided by the
pathological lesions found. In most cases total hysterec¬
tomy will be required.

5. When large collections of pus form and are so situ¬
ated that they can be readily reached either with a vaginal
incision, or with one above either of Poupart’s ligaments, no
time should be lost in resorting to surgical relief. When,
however, they are not so favorably situated, judicious delay
is advisable, with the hope that ultimately the pus may be
evacuated without the risk of soiling the general peritoneum^
— Jour. Obstet.

ANTISTREPTOCOCCUS SERUM IN PUER¬
PERAL SEPTICEMIA.

H. W. Webber reports a case in which a favourable
result was obtained from one injection of antistreptococcus
serum. The injection consisted of 10 cubic centimetres Qf

OBSTETRICS.

27s

serum. This injection was given in the afternoon, and by
the next morning the temperature had fallen two degrees,
the pulse become slower by thirty beats. The aspect of the
patient was much better. The vaginal discharge had de¬
creased in amount, had lost its foul smell, and was much
cleaner.

Alex. J. Anderson cities a case of puerperal septicemia
which had run for one week, and, the patient being in a very
low condition, they gave injections of antistreptococcus serum^
The first injection was given on a falling temperature. In
one hour and a half it was down to 99.49 but three hours
later went up to 102o. The second injection was given the
next morning, and the temperature, which was 101.80, went
up to 103.80, but got down below normal by 10 next morn¬
ing. The next day another injection was given when the
temperature was going up, and had the effect of keeping it
down to 101.40. The following day the temperature was
99.40. An injection was given and the temperature fell
below normal and remained there three days. He used ten
cubic centimetres of the serum at a time.

S. J. Barker reports a case successfully treated by
serum.

Sergueu reports a case of acute sepsis in which injections
of Marmorek’s serum were apparently followed by success.
The patient was a primipara, 21 years old, who at the end of
gestation suddenly became septic. No discoverable cause.
The emptying of the uterus brought no relief,and subcutane¬
ous saline infusions produced no improvement. As a last re¬
sort 20 cubic centimetres of Marmorek’s antistreptococcic
serum were injected, and, whether post hoc or propter hoc,
from that time improvement began .—Journal Obstet.

AIR EMBOLISM IN PLACENTA PREVIA.

Hubl publishes two cases from Braun’s clinic. The first
was a woman 40 years old with a rachitic pelvis. The
patient collapsed while version was performed. Postmortem
showed the right side of the heart filled with air. The
upper margin of the placenta was detached, and a blood
vessel the size of a crow’s quill was wide open and probably
formed the entrance gate of the air. In the second case
death occurred about nine hours post partum, also after
version. Death was preceded by several attacks of collapse.
No postmortem in this case. The author discusses the
differential diagnosis of chloroform collapse and air era-

* 76 . PROGRESS OF MEDICAL SCIENCE.

•holism. In the latter there is usually a sudden escape of
liquor amnii and a consequent rush of air into the cavity of
the uterus.

APPARENT DEATH OF THE NEW BORN.

Keiffer believes that attempts to resuscitate apparently
still-born children are frequently given up too soon. He
cites a case in which breathing did not begin until thirty-five
minutes after commencing artificial respiration, and another in
which fifty minutes elapsed before this result was obtained.—
Journ. Obstet.

HEART DISEASE FROM AN OBSTETRICAL

POINT.

A. H. Wright believes that a woman having a heart
lesion which is compensated should not be prevented from
marrying. Abortion should not be induced on a woman
with heart disease, unless very serious symptoms are present.
Premature labor should be seldom or never induced. Mitral
stenosis is the most serious heart lesion during pregnancy
and labor; aortic stenosis comes next, then probably aortic
incompetency. Mitral insufficiency is the least serious lesion.

Treatment during Pregnancy .—Administer the follow¬
ing according to indications: strychnine, digitalis, or stroph-
anthus, cathartics, nitrite of amyl, nitroglycerin ; and regu¬
late the diet.

Treatment during Labor .—Keep up the action of digi¬
talis, especially during first stage. Give strychnine and
stimulants, if required, and chloroform. As soon as the first
stage is completed deliver with forceps. The patient must
be watched very carefully during the third stage, as this is
the most serious period.— Jour. Obstet.

OBSERVATION ABOUT SORE NIPPLES.

According to Platzer, sore nipples are caused through
biting and pulling during the process of nursing. The best
treatment of fissures are applications of carbolic acid solution.
Ulcerations should be washed with corrosive sublimate solu¬
tion and dusted with dermatol. In mastitis nursing must be
interrupted, the breasts compressed, and ice bags applied.
Among i,ooo nursing puerperse in Kezmarsky’s clinic sore
nipples were observed in, 51.5 per ;cent 4 — Jour. Obstet.

THE

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price % $c.oo per annum in advance . Single
Copies, io cents.

Hake all Cheques or P.O. Money Orders for subscription, or advertising, payable to
JOHN LOVELL <s SON, 28 Sc. Nicholas Street, Montreal, to whom all business oommtw
ideations should be addressed.

All communications for the Journal, books for review, and exchanges, should Oe
addressed to the Editor, Box 2174, Post Office, Montreal.

Editorial.

THE TRAIN.

We copy the following from the Stylus , a medical jour¬
nal published in St. Louis, Mo., and most heartily endorse
every word that it contains. The train has arrived in Mon¬
treal, and the dust that it creates as it sweeps along our
streets almost chokes one. More than once, when follow¬
ing in its wake, we have been obliged to lessen our gait so
as to be able to breathe air not composed of about half dust.
We have heard ladies complain of the dust raised by
carriages on our unwatered streets, while their trains raised
almost as much on our unwatered sidewalks. Of a truth,
if these disgusting trains are not abolished, we will be
compelled to ask that our sidewalks be watered as well as
our streets. We very much doubt whether, if this were done,
it would induce the ladies to wear sensible skirts. It at all
events would render life pleasant to those whom necessity
compelled to walk behind them, and they could collect on
these streets, without annoyance to others, all the filth they
desire—no, not desire, yet nevertheless get.

“ There are many kinds of trains, but the dirtiest, the
most vulgar, the most .to be avoided, the most horribly sug¬
gestive, is the long dress train on the dirty street It is not a

EDITORIAL.

278

matter of fashion, it may not be a matter of health, although
our hygienists, with good reason, think so; it is mainly a
matter of dirt —of vile, disreputable, unmitigated, dirty dirt.
We saw a beautifully-dressed young lady on Broadway yes¬
terday. Her little hands were daintily gloved, her dress
was the latest and the best, her face was pure and sweet and
gentle, but then—

“ She was walking on a pavement that had not been swept
—except by others of her exclusive class'—since morning-
Some of the things on that pavement are not to be described
or even named, for chewers and oonsumptives and coach dogs
had been there and left their mark. Miss Vere de Vere
swept on while a cloud of dust and other things around and
underneath arose to do her homage—Bah.

“ Is the picture too strong ? It is at least true.”

JEAN LUKIN LEPROHON, M.D.

The death of this well-known Montreal medical man
took place on the 23rd of May from pneumonia, at the age of
78 years and two months. He filled at one time a pro¬
minent place among the profession in Montreal by whom
he was highly esteemed. Of late years advancing age
obliged him to reduce his work, so that among the younger
members he was hardly if at all known. Dr. Leprohon
belonged to a very old French-Canadian family, his great¬
grandfather coming to Canada in 1758 as an officer in a
French regiment, and, after the conquest, he settled in the
country. He graduated from McGill University in 1843,
so that he was among the oldest, if not the oldest, of its
living medical graduates. On the formation of the Medical
Faculty of Bishop’s College, he accepted the Professorship
of Hygiene, which position he filled for several years with
much ability. He was one of the three original founders of
the Women’s Hospital of this city—the sole survivor being
Sir William Hingston. He also for years took a very
active interest in the Montreal Dispensary, of which at his
death he was a consulting physician. He had also filled
the office of Vice-President of the College of Physicians
and Surgeons of the Province of Quebec. Among the

»»ITQRIAL.

879

older members of the profession in Montreal he was held in
high esteem. He was a typical specimen of that politesse
which is so characteristic of our French-Canadian brethren.

FERROL.

Since our attention was drawn to this preparation,
which is advertised in the Record, we have used it some-
what extensively in both private and hospital practice. The
results on the whole have been very satisfactory, practically
bearing out all that is claimed for it. In one or two instances
it was not well borne, but in the great majority it was readily
taken and easily assimilated. This preparation is not pre¬
sented for sale to the general public, and is not advertised in
ordinary newspapers. On the contrary it is only advertised
in medical journals and presented to the medical profession
for prescription. Among the profession in Toronto it is
largely used, and what is most unusual, nearly every physi¬
cian of any note in that city has above his signature certified
to its efficacy and to his faith in it. Any preparation certi¬
fied to by such men as Drs. Geikie, Temple and Ryerson
must at least be worth investigation. It was these and other
names which induced us to use Ferrol, and we have no regret
that we did so.

THE LACTOPEPTINE MEDICAL ANNUAL
FOR 1900.

The New York Pharmacal Association, whose headquarters
are at Yonkers, N. Y., have sent us a copy of their Medical
Annual. It is beautifully printed and covered. It also con¬
tains some copifes of unique medical engravings, which cannot
help being viewed with much interest. The reading matter
is useful and some of it very amusing. The Association will
be glad tp send a copy to any physician who may ask for it

28 o

BOOK reviews.

PERSONAL.

Dr. Wyllie has been appointed Professor of the Prac¬
tice of Physic in Edinburgh University, rendered vacant by
the death of Sir Thomas Grainger Stewart. He took his
M.D. from Edinburgh University in 1865. He had been
connected for many years as a Lecturer on Medicine with
the Extra-Academical School.

Dr. E. R. Brown (M.D., Toronto University), of Mont¬
real, was in the accident which took place on the 28th of
May on the Canadian Pacific Railway, near Labelle, P.Q.
He was much shaken up and received a number of bruises,
but fortunately escaped serious injury.

Book Reviews.

Gynecology —A manual for students and practitioners, by
Montgomery A. Crockett, M.D., adjunct professor of Obstetrics
and Clinical Gynecology, Medical Department, University of
Baffalo; attending Gynecologist to the Buffalo General and
Erie County Hospitals. Series edited by Bern B. Gallaudet,
M.D., Demonstrator of Anatomy and Instructor in Surgery, Col¬
lege of Physicians and Surgeons Columbia University, New
York; Visiting Surgeon Bellevue Hospital, New York. Illustrated
with one hundred and seven engravings. Lea Brothers & Co.,
Philadelphia and New York.

In the author’s own words “ a book can be too condensed or
too expanded. In the aim to avoid either extreme, the present
volume endeavors to give an intelligent idea of the present status of
gynecology. To be valuable, such a work must be representative.
The writer has therefore endeavored to reflect the accepted views of
the foremost authors and practical gynecologists as expressed in the
rich standard literature of the subject. His own experience in
practice and teaching has been embodied, and has at least served
to make his presentation more uniform and clear.” We think that
Dr. Crockett has succeeded admirably in his endeavor to write a
text book for students; everything is briefly and clearly stated.
The busy practitioner will also find it very handy for consulting,
and for refreshing his memory while driving from case to case. The
author only claims that it is a pocket text book, but we think it is all
that he has claimed for it, and even more. It is thoroughly up to
date and should have a large sale.

A. L, S«

BOOK REVIEWS.

2 8 t

Saunders’ American Tear-Book of Medicine and
Surgery- —Being a yearly digest of scientific progress and
authoritative opinion in all branches of medicine and surge¬
ry, drawn from journals, monographs and text-books, of the
leading American and foreign authors and investigation: under
the general editorial charge of George M. Gould, M.D. In
two volumes of about 600 pages each, on Medicine and Surgery,
respectively, each volume complete in itself and for sale separ¬
ately, cloth $3 net, half morocco, $3.75 net. Published by W.
B. Saunders, Philadelphia, 1900.

Volume II, of Saunders' American Year-Book of Medicine and
Surgery is devoted to Surgery, and is not quite so large as volume
I, which treats of the medical subjects. The diligent editors, ta
meet the great demand for this work, have gathered together an
abundant supply of materia', and this has led the publishers to issue
it, for the first time this year, in two volumes, each complete in
itself.

This arrangement has a double advantage. To the physician
who uses the entire book, it offers an increased amount of matter
in the most convenient form for easy consultation, and without any
increase in price; while the man who wants either the medical or
surgical section alone secures the complete consideration of his
branch without the necessity of purchasing matter for which he
has no use. This work is deservedly popular, and ranks as one of
the best yearly compendiums now published. Volume H. treats of
the following subjects : General Surgery, Obstetrics, Gynecology,
Orthopedic Surgery, Ophthalmology, Otology, diseases of the Nose
and Laiynx and Anatomy. The subjects are dealt with by men
well known by their constant contributions to medical and surgical
literature and scientific progress ; e.g. Keen, Dabosta, Hirst, Dar-
landand Baldy. All the features of the work that have in the
past proved so valuable will be retained.

The publisher has done his work up in the usual attractive
and serviceable finish, and the type is of such size and character as
to prove attractive to the eye, so that the latest and best is here
given in a very convenient form.

R. C.

Saunders’ American Tear-Book of Medicine and
Surgery—Medicine. —As intimated above, the Year Book is
now published in two volumes—one devoted to Surgery, the
other to Medicine. That this is an advantage is without ques¬
tion. I find it quite impossible to criticise the contents of the
Medical volume, for it is simply a collection of the current medical
literature of the past year. This clearly shows that our leading
scientific workers have, during that time, not been idle; on the
contrary the amount of material collected proves that in spite of
much to discourage, some advance of a practical character has
been made. It, however, is but slight, and it must be admitted
that pure Medicine still lags behind Surgery in its advance¬
ment, Indeed at times I am inclined to think that we have

BOOK' REVIEWS.

28 *

been unfortunate id casting aside the old to tafcte hold oFthe iieWX
Still as things go we must follow the crowd, being- conservative
enough to judge how far we must go before being obliged to cry
“ halt.” The contributors to this volume are all men eminent m
their special departments, and they have done their work Well.

F. W. C.

The International Medical Annual and Practitioners’
Index. —A work of reference for Medical Practitioners, 1900.
' Eighteenth year. New York, E. B. Treat & Co., 241-243 West
23rd street; Chicago, 199 Clark street. Price $3.00
This annual is an established favorite with Canadian Medical
men on account of the editors of a great many sections being
practitioners attached to British Hospitals either in the British
Isles or India. The same condition prevails in the present volume,
as thirty-three out of the forty-two editors or collectors are prac¬
titioners residing in Great Britain. Their work, however, is fully
equalled by the American Editors, among whom are Dwight
Chapin, Samuel Gant, G. M. Hammond and H. P. Loomis of New
York. Its contents do not show that during the past year there
has been any special extension of our Therapeutic knowledge.
They prove, however, that disease has been studied closely, and
that a more exact diagnosis is as a consequence now possible.
Treatment, however, still lags behind. The field is fully covered
in this volume, and the selections have been made with care, and
in some cases are more fully copied than we have found in some
other similar volumes. It is well worth its cost.

F. W. C.

The International Text Book of Surgery, by British
and American Authors. Edited by J. Collins Warren, M.D.,
and A. Pearce Gould, M.S., F.R.C.S. In 2 Volumes. Price,
cloth $5.00 ; sheep or M. $6.00 Pub. W. B. Saunders,
Philadelphia.

The second Volume of this work takes up regional surgery, and
is illustrated with many excellent cuts from original photographs
and several colored plates. The division into regions is very good,
and each author deals most thoroughly with his division. It is
hardly just to single out one or two authors for special praise, as
the entire work is so creditable, but Dr. H. Holbrook Curtis in his
chapter on Surgery of the Nose shows clearly the recent advances
in the surgical treatment of the accessory cavities of the nose. His
llustrations of before and after operations in the case of nasal
deformities is most interesting. In the chapter on Surgery of the
Neck A. Pearce Gould discusses many interesting points. In
dealing with Parotid Bubo he speaks of intraperitoneal operations
and peritonitis as causes, adding, that “ no explanation can at
present be given of the association of this secondary suppuration
with operations within the peritoneal cavity.” Possibly this condi*

BOOK REVIEWS. 283

lion can be considered a reversion of the phenomenon of occhitis,
ovaritis or metritis following mumps.

Surgery of the Breast by J. Collins Warren is splendidly
illustrated and concisely written. A careful perusal will aid in form¬
ing a diagnosis in cases of suspected maliguancy.

Taken together, these two volumes cannot but be heartily
recommended as a thoroughly comprehensive and up-to-date pro¬
duction. G. F.

Martin and Rockwell’s Chemistry and Physics— A.
Pocket Text-Book of Chemistry and Physics. By Walton
Martin, M. D., and William H. Rockwell, Jr., A.B., M.D., of
the College of Physicians and Surgeons, New York. In one
r 2mo. volume of 336 pages, with 137 illustrations. Just Ready .
Cloth, $r.5o, net. Flexible red leather, $2.00, net. Lea
Brothers & Co., Philadelphia and New York.

An acquaintance with the general principles of Chemistry and
Physics is absolutely necessary for the student who would intelli¬
gently follow such important subjects of a medical curriculum, as
Physiology, Materia Medica, Hygiene, etc.

But the subjects are so very wide that every lecturer on Chem¬
istry in a Medical College finds himself again and again confronted
with the question : “ How much and what portions of Physics and
Chemistry shall I lay before my students ? ” This book is an
attempt to answer this question, and is a very creditable attempt.

In the first 182 pages we find brief but terse and vigorous state¬
ments, as to mode of occurrence, preparation and properties of
the more important elements and compounds. In Organic Chem¬
istry, only the Methane and Benzene series of hydrocarbons and
their derivatives are taken up. Special attention is given to the
compounds “ which are of medical interest not only medicinally,
but in physiological chemistry ”.

The second part of the book, 187 pages, is devoted to Physics,
and is a very satisfactory treatise on elementary physics, and takes
note of the latest developments, as witness the brief reference to
wireless telegraphy. In the writer’s opinion, the book would be
improved by reducing the portion devoted to Physics, and enlarg¬
ing that allotted to Chemistry. The work seems disproportioned,
when we find the part devoted to Physics discussing the construc¬
tion of the telephone and wireless telegraphy ; but look in vain
in the chemical portion for any reference to such important sub¬
stances as Calcium Carbide and Acetylene, for example.

We find also a few statements throughout the text that are
scarcely correct, and which we expect will be altered in another
edition. Among them we may mention the statement on page 72
“ seventy elements now known,” whilst symbols are given for
more than that number on page 22. Then again on page 76 the
statement is made that ‘‘ potassium Iodide occurs in sea water and
is takeh up by sea weeds;" whilst this may not be absolutely in-

284

PUBLISHERS’ DEPARTMENT.

correct, it would be more accurate to write thus of Sodium Iodide.
On the whole, however, we are favorably impressed with the volume,
and can recommend it as a text book for medical students if used
in connection with a course of lectures and demonstrations• in
Chemistry and Physics.

J. T. D.

The Essentials of Hematology.—A practical guide to the
clinical examination of the blood for diagnostic purposes.
Illustrated. Published by the Palisade Manufacturing Com¬
pany, Yonkers, N.Y.

This little work on the clinical examination of the blood is
published by The Palisade Manufacturing Co., makers of “ Hema-
boloids.” Starting with a careful description of the instruments
needed, and their methods of use, the author passes on to the
simple methods of staining best suited for blood work.

The brochure is cart fully compiled, and the information it
gives is accurate and up to present day requirements. It is well
illustrated.

A.B.

PUBLISHERS DEPARTMENT.

SANME 1 TO ENDORSED AFTER WATCHING ITS EFFECTS IN
SEVERAL HUNDRED CASES OF GENITO URINARY
DISEASES.

It gives me great pleasure to add my testimony to that of the many emin¬
ent physicians in this city and elsewhere, attesting the wonderful curative value
of Sanmttto. In nearly all genito-urinary ailments, especially of a chronic
nature, it is simply invaluable. I consider Sanmetto almost a specific for chro¬
nic prostatitis, especially in old men, where more or less hypertrophy exists ;
also in weakness of the generative system, it has wonderful power in restoring
waning sexual strength. This is my first testimonial for any medicine, but
having prescribed Sanmetto ever since its introduction to the profession, and
watched its effects in several hundred cases, I feel that I need not hesitate to
endorse it.

Chicago, Ill. L. E. MILEY, M.D.

Grad. 1881, Michigan University; Member American Med. Assn.,
Member Illinois State Med. Assn., Member Chicago Med. Soc.

SANMETTO IN ENURESIS NOCTURNA.

Dr. L. L. Gray, St. John, Mo., reports the outline of a case of enuresis-
nocturna, treated with Sanmetto, several years ago. The case was that of a
maid thirteen years of age, who had suffered with enuresis from infancy. She
was old enough to realize her condition, and keenly felt its effects—acted as
though she thought every one she met knew her troubles, and consequently she
was shy, unsociable, ashamed to be seen in company, and strangers would ask if
she was entirely sane. He gave her a bottle of Sanmetto, told her mother to give
her all assurance that it would cure her, if properly taken. A second four
ounce prescription verified the truth of his statement He says it did cure her
for all time, and to-day she is a perfectly formed young lady, intelligent and
sociable, the downcast countenance gone,and life is again worth living.

CANADA

MEDICAL RECORD

JULY. 1900

Original Communications.

FOR “THAT NOSE.”

By GIFFAKD KNOX, M.D., Westflel 1, New Jersey, U.S.

He “ would give anything ” to be rid of it.

What? “That nose,” red, bulbous, deformed.

Not the nose itself, but the deformity, the high color,
the manifest deformity. “ That nose,” indeed ! It is by no
means a rare condition, and because of this fact it would
seem as though a successful treatment should have been de¬
fined long ago. Instead—the records do not seem to justify
any such conclusion. The practitioner’s disposition is either
to make light of the disorder or to ignore it altogether.”

“ It is no disease. Stop drinking, and it will disappear.”

That is your opinion whether you say it or not. But
you are not honest with yourself in saying this. It is a
disease.

Dignified as “ acne rosacea ? ” Not necessarily ; neither
is it necessarily the fotts et origo of rhinophyma. But, be¬
yond question, it is a disorder of the most stubborn character,
and characterized by a chronicity that is disheartening to
patient and physician alike. Both know that the aggravation
is due to a complicated condition of affairs produced by in¬
dulgence in alcoholics. The disorder is nothing if not of a
marked character—of such a marked character as to attract
attention. Pfundnase is the expressive name that the Ger¬
mans bestow on it. The patient, despairing of ever getting
well, or, as he says, of “ ever getting over that nose,” offers
his “ anything ” for the good riddance.

2 86 KNOX : FOR “THAT NOSE.”

He asks bread, and the physician gives a stone. The
“ anything ” crystalizes into a “ You must stop your alcoholic
habits.” Job’s comforter! You know as well as he does,,
perhaps better, that if he becomes as temperate as a Woolley
or a Gough, the malady remains to mock and menace.

The tendency to the peculiar hypertrophy of the tissues
of the nose is never uniform. In some it ceases after an un¬
certain length of time, in others, however chaste the habits
may be, it continues. In others still, where there is but a
minimum of exasperating irritation, it goes on to a degen¬
eration of tissues. In still others a deformity supervenes
which is something appalling in its dimensions,—a pendulous
nose with rugous, shining, red surface.

It is not necessary to describe the disorder pathologi¬
cally ; it would be a work of supererogation. There are,
however, certain points to be corrected as mistakes. On
ocular examination it would seem as if the formation was
one of dense fibrous tissue only, and occurrent in the
cutaneous tissue. But, as we study such cases, we find, first
of all, that the skin covering the hypertrophied mass is thin
instead of being at all hypertrophied. In point of fact it
might better be described as atrophied. It is healthy in
every sense. It is not fibrous. In some cases the rete
mucosum is thickened, but this is not uniform.

The openings of the sebaceous glands are large and
patulous, and the glands themselves are encysted. Invariably
these glands are numerous and distended with fatty material.
These form the prominent element in the disease, as this
condition of abnormal enlargement of the sebaceous glands
becomes secondary to a connective tissue hypertrophy,
which by its development occludes a portion of the
sebaceous glands, which then go on secreting, and thus
producing a retention of sebum, which in turn acts as an
irritant, and thus stimulates to further hypertrophy.
There also ensues upon this an enlargement of the blood
vessels, together with some new formation of blood vessels.
These blood vessels consist of arteries with hypertrophied
coats and of dilated veins, with their coats unchanged.

If now we photograph the microscopal condition, we find

KNOX : FOR “ THAT NOSE.”

287

(1) that the epidermis is unchanged, (2) that the corium may
or may not be hypertrophied. (3) that the number as well as
size of the sebaceous glands appears increased, (4) that the
blood vessels are also enlarged and more numerous, (5) that
the appearance is strongly suggestive of a derivation from
the subcutaneous adipose tissue, and (6) that the compen¬
sating hypertrophy is adipose rather than fibrous. Auxiliary
pathological facts are (a) seborrhcea, ( 6 ) stasis of the blood
in the vessels, and (r) a disagreeable itching. There is no
tendency to suppuration, although under the influence of
irritation the glands may become suppurating sacs. (In
operations for rhinophyma, it is stated to me that the sutures
are “ always apt to ulcerate out.” This is quite probable.)

“That nose ” then represents an organ with the cellulo-
adipose structures over-distended, and with the morbid accu¬
mulation mechanically interferent with nutrition.

While it is true that “ that nose” condition may some¬
times have nothing to do with abuse of alcoholics, still it is a
condition manifesting mal-assimilation or mal-nutrition from
some other cause of allied kind. If we will but receive it,
“ that nose ” is a form of obesity. We have cases of unsightly-
abdominal fat, chin, facial, bust and hip fat. And we have
also nose fat.

Now as to earning that “anything to get rid of it ” fee.
The indication is to inhibit or control the disproportionate
activity of fat-cell nutrition by placing less fatty pabulum at
the service of the absorbents and thus preventing further in¬
filtration or super-storage of the adipose matter.

The primary indication points to a rational dietary, and
I scarcely need to say that there is a wide choice for a system
to limit the supply of fat-forming elements. The Bantingism
that interdicts all fats, sugar and starches is perhaps unex¬
celled. As for medicinal treatment:—I am agnostic. The
permanganate of potash and bromide of ammonium are both
excellent in diminishing deposition and hastening the retro¬
grade metamorphosis of fat; but both tend to cause gastric
catarrh. The Cathell treatment for obesity is equally as good
for nasal as for abdominal corpulence. I heartily favor it.

I would, however, suggest a modification, and it is one that

288

DOYLE THE WAR IN SOUTH AFRICA.

has commended itself by large experience. Instead of giving
the Vichy one day and the Kissingen the next, I order the
Vichy for two successive days, a glass after each meal, then
the Kissingen for one day, the Vichy for the fourth, the
Kissingen for the fifth and sixth, the Vichy for the seventh,
the Kissingen for the eighth and ninth, and so on. This
plan of treatment leaves nothing to be desired. It is well
nigh specific. The rationale is apparent. The water may be
taken at the fountain, or the granular or effervescing salt post-
prandially.

It is also indispensable that during the course of mineral
water the patient should take before each meal ten drops of
eucalyptol, preferably the Australian or Sander eucalyptol.
We are, perhaps, too over-confident in this year of grace, but
if the patient is in earnest in getting rid of “ that nose,” the
eucalyptol will accomplish it, he meanwhile taking the waters
in lieu of his alcoholic beverage. The eucalyptol acts on the
abused tissues, and the waters correct the depravity in
appetite.

Selected Articles.

THE WAR IN SOUTH AFRICA.

THE EPIDEMIC OF ENTF.R 1 C FEVER AT BLOEMFONTEIN.

By A. CONAN DOYLE, M.D.

{To the Editor of the British Medical Journal.)

The Langman Hospital, South African Field Force,

Bloemfontein, June 5, 1900.

Dear Sir, —You were good enough to suggest when I
left England that I should send you some notes upon any
points which might strike me. The pressure of work has
prevented me from complying with your request, and even
now I feel that you will find these comments of a very
scrappy character.

When the nation sums up its debt of gratitude to the
men who have spent themselves in this war I fear that they
will almost certainly ignore those who have done the hardest
and the most essential work. There are three classes, as it

DOYLE: THE WAR IN SOUTH AFRICA.

289

seems to me, who have put in more solid and unremitting
toil than any others. They are the commissariat, the rail¬
way men and the medical orderlies. Of the three, the first
two are the most essential, since the war cannot proceed
without food and without railways. But the third is the
most laborious, and infinitely the most dangerous.

THE OUTBREAK OF ENTERIC*FEVER.

The outbreak of enteric among the troops in South
Africa was a calamity the magnitude of which had not been
foreseen, and which even now is imperfectly appreciated.
We naturally did not dwell too much upon it while the war
was in progress. But it was appalling in its severity, both
in quantity and quality. I know of no instance of such an
epidemic in modern warfare. I have not had access to any
official figures, but I believe that in one month there were
from 10,000 to I2,ooo men down with this, the most de¬
bilitating and lingering of continued fevers. I know that in
one month 600 meh were laid in the Bloemfontein Ceme¬
tery. A single day in this one town saw 40 deaths.
These facts would have stiffened the resistance at Pretoria if
they'had been generally known. It is only now, when the
worst is past, that they can be talked of.

THE HOSPITAL ORDERLY.

How was this unforeseen and unprecedented crisis
grappled with ? Entirely by the efforts of the medical men
and by the devotion of the orderlies. When a department
is confronted by a task which demands four times more men
than it has, the only way of meeting it is for each man to
work four times as hard. This is exactly what occurred,
and the crisis was met. In some of the general hospitals
orderlies were on djty for thirty-six hours in forty-eight,
and what their duties were—how sordid and obscene—let
those who have been through such an epidemic tell.

He is not a picturesque figure, the orderly, as we know
him. We have not the trim, well-nourished army man, but
we have recruited from the St. John Ambulance men, who
are drawn, in this particular instance, from the mill hands of
a northern town. They were not very strong to start with,
and the poor fellows are ghastly now. There is none of the
dash and glory of war about the sallow tired men in the
dingy khaki suits—which, for the sake of the public health,
we will hope may never see England again. And yet they
are patriots, these men ; for many of them have accepted a
smaller wage in order to take on these arduous duties, and
they are facing danger for twelve hours of the twenty-four,

290

BOYLE: THE WAR IN SOUTH AFRICA.

ju>t as real and much more repulsive than the scout who
rides up to the strange kopje or the gunner who stands to
his gun with a pom-pom quacking at him from the hill.

Let our statistics speak for themselves, and we make no
claim to be more long-suffering than our neighbours. We
have 3 on the staff (Mr. Gibbs, Mr. Scharlieb and myself).
Four started, but one left us early in the proceedings. We
have had 6 nurses, 5 dressers, i wardmaster, I washerman
and 18 orderlies, or 32 in all, who actually came in contact
with the sick. Out of the 6 nurses, 1 has died and 3 others
have had enteric. Of the 5 dressers, 2 have had severe en¬
teric. The wardmaster has spent a fortnight in bed with
veld sores. The washerman has enteric. Of the 18 order¬
lies, 1 is dead and 8 others are down with enteric. So
that out of a total of 34 we have 17 severe casual ies—50
per cent.—in nine weeks. Two are dead and the rest in¬
capacitated for the campaign, since a man whose heart has
been cooked by a temperature over 103* is not likely to do
hard work for another three months. If the war lasts nine
more weeks, it will be interesting to see how many are left
of the original personnel. When the scouts and the Lancers
and the other picturesque people ride in procession through
London, have a thought for the sallow orderly, who has also
given of his best for his country. He is not a fancy man—
you do not find them in enteric wards—but for solid work
and quiet courage you will not beat him in all that gallant

army.

antityphoid inoculation.

There is one mistake which we have made, and it is one
which will not, I think, be repeated in any subsequent cam¬
paign. Inoculation for enteric was not made compulsory.
If it had been so I believe that we should (and, what is more
important, the army would) have escaped from most of its
troubles. No doubt the matter will be fully threshed out in
statistics, but our strong impression, from our own experi¬
ence, is that, although it is by no means an absolute preven¬
tive, it certainly modifies the course of the disease very
materially. We have had no death yet (absit omen) from
among the inoculated, and more than once we have diagnosed
the inoculation from the temperature chart before being in¬
formed of it. Of our own personnel only one inoculated man
has had it, and his case was certainly modified very favour¬
ably by the inoculation.

THE SOLDIER IN HOSPITAL.

Of the courage and patience of the soldiers in hospital it

DOYLE: THE WAR IN SOUTH AFRICA.

291

is impossible to speak too highly. We have had 500 cases
pass through our hands, and can speak now from a fairly
large experience. I had always imagined that in every large
army there must be a minority of skulkers and shirkers, but
they are singularly absent in the South African Field Force.
I have not had more than two or three cases in my wards
which bore a suspicion of malingering, and my colleagues
say the same. They are uniformly patient, docile and cheer¬
ful, with an inextinguishable hope of "getting to Pretoria.”
There is a gallantry even about their delirium, for their de¬
lusion continually is that they have won the Victoria Cross.
One patient, whom I found the other day rummaging under
his pillow, informed me that he was looking for “his two
Victoria Crosses.” Very touching also is their care of each
other. The bond which unites two soldier pals is one of the
most sacred kind. One man shot in three places was being
carried into Mr. Gibb's ward. I lent an arm to his friend,
shot through the leg, who limped behind him. “ I want to
be next Jim,’cos I’m lookin’after him,” said he. That he
needed looking after himself seemed never to have occurred
to him.

THE SPECIAL HOSPITALS.

I do not think that any men have ever expended money
better than those who fitted out the private hospitals. The
officers of the Army Medical Department freely admit that
they do not know what they would have done without their
aid. They arrived out here at the very moment when the
sickness was becoming alarming, and they took their share
of the strain when the epidemic was at its height. The
large general hospitals found it difficult to get to work on
account of the pressure on the line which prevented them
from getting up their bulky equipment, but the private
hospitals, more compact and mobile, got to work almost at
once after their arrival. The pressure was severe. Our own
hospital, with equipment and persotttiel for 100 cases, had 150
cases, mest of them virulent Paardeburg enterics, shot upon
them, and had to cope with them as best they might. But
the men had come out to work, and the orderlies, though
untrained, never once grumbled at the great exertions which
were called for. Without the Yeomanry, the Portland, the
Irish, the Scotch, the Welsh and the other hospitals fitted
up by private effort, and manned by volunteers, it is difficult
to see how the epidemic could have been met.

THE WORK OF THE R.A.M.C.

There is sure to be some adverse criticism of the Army

292

CANBY : A CASE OF PNEUMONIA

Medical Department after the war, because they have had
to meet so difficult a situation with such inadequate re¬
sources that it is impossible that there should not be parti¬
cular instances where the machinery has broken down. A
captious critic could quote cases of an overfilled, underman¬
ned hospital without medical necessities in one place, or of
hardships endured by the sick and wounded in another.
How can it be otherwise when a Department which is
sufficient for the needs of two army corps has to provide for
the wants of 200,000 men with typhoid raging among them ?
Taking it on the whole, the Department has been well
organized and well worked, and has met an unforeseen and
exceptional state of things with remarkable success.

A CASE OF PNEUMONIA TREATED WITH
ANTIPNEUMOTOXIN.

By CHARLBS B. CANBY, M.D.

CLINICAL HISTORY.

I was called on December 20 to see E. T., twenty years
of age, who worked in the moulding-room of a large stove
factory. He had an attack of pneumonia five years ago.
His present illness began on the 18th, and may have been in
a measure due to his having worked all day (on the 16th)
in wet clothing.

The attack began with a chill on the 18th of December.
When seen at noon on the 20th he was in bed, with cough
and pain in the left side. He expectorated, a large amount
of rusty sputum, and had a temperature of 104°, pulse 120,
and respiration 24. The physical signs were, increased vocal
fremitus, bronchial breathing and dullness on percussion over
the lower lobe of the left lung. The crisis apparently oc¬
curred on the 24th. Up to this time the patient had been
treated with alcohol and digitalis, with one or two doses of
morphia to quiet pain. On Christmas day, feeling very
much better, the patient most imprudently left his bed, dress¬
ed and went into the yard.

On the 26th I found him in bed delirious, with a tempera¬
ture of 104°,respiration 56, and a pulse that could not be count¬
ed. The pain was severe on the right side, and the physicaL
signs were those of consolidation of the right lower lobe.
At 6 o’clock in the evening his temperature had risen to
105°, his pulse was still uncountable, and his respirations
were 56 to the minute. At this visit I injected 12 c. c. of
antipneumotoxin. In three hours his temperature fell two

TREATED WITH ANTIPNEUMOTOXIN. 293

and one-half degrees, he was sweating freely, and his respir¬
ation came down to 40, but his pulse remained uncountable.

At 10 o’clock on the morning of the 27th his temper¬
ature was 99 0 , respiration 24 and pulse 96. Notwithstand¬
ing his apparent improvement I gave him again 12 c. c. of
the antitoxic serum.

His improvement was not interrupted, and on the 8th
of January, 1900, he was able to return to his work.

This clinical history, showing a left pneumonia having
crisis on the eight day under ordinary treatment, followed
by a much severer right pneumonia which came to apparent
crisis in two days, suggests that the antitoxin might have
produced a much earlier crisis than the first attack would
have led one to expect. Indeed, the second attack seemed
to be of extraordinary severity and likely to result fatally.
One must not draw conclusions from a single case, but the
record of this case seems worth publishing, because it seems,
in effect, to have been two attacks of pneumonia in the same
subject, treated upon widely different lines, and with strik¬
ingly different results.

Through the courtesy of my friend, Dr. Geo. H. Ever¬
hart, I am able to append the following brief notes of two
cases of pneumonia in which he used antipneumotoxin.

Eli P. J. was seized with a chill on January 13. When
first seen on the night of January 14, he had a temperature
of 103°, pulse no, rapid respiration, cough, rusty sputa, and
the physical signs of consolidation of the lower lobe of the
right lung. On the following morning, the 15th, the man
was in substantially the same condition, and in the evening
of that day he received a hypodermic injection of 10 c. c. of
antipneumotoxin. On the morning of the 16th (fourth day
in bed) he was in a profuse sweat, having a temperature of
99 0 , and with pulse and respiration much improved. On the
20th his temperature was normal, and on the 24th was up
and apparently well.

On Tuesday evening, February 1, Kate C., aged twenty
years, was found ill with pneumonia, the signs of consolida¬
tion being apparent everywhere over the right lung ; tem¬
perature 103'', pulse 108, respiration 40. On the morning of
February 2, her temperature being at the time 103° and pulse
HO, she received by hypodermic injection 10 c. c. of anti¬
toxic serum. At the evening visit her temperature was 102 0 ,
pulse 108, respiration 33. On the morning of February 3,
her temperature was normal, pulse 80 and respiration 20.
She was in all respects comfortable, and remained so until
the 5th, when she sat up in bed. In the evening she had a
chill and a rise of temperature to 105°, with a respiration rate

294 canby: a case of pneumonia

-of 32. Next morning she was again injected with 10 c. c.
of antipneumotoxin, her temperature then being 104.2°,
pulse 113, respiration 32.

As happened after the first injection, very little change
in her condition was apparent at the evening visit, when her
temperature was 104°, pulse 108, respiration 32. On Feb,
7, twenty-four hours after the second injection, her temper¬
ature was normal, pulse 70, respiration 18. From this time
on, her convalescence was uninterrupted, and on the 12th of
February she was discharged.

I am indebted to Dr.‘Louis F. Frey for the following notes
of a case in his practice, together with Dr. Stokes’ report
upon the sputum:

W. S., driver of an express wagon, had a chill on the
-afternoon of January 30, followed by fever, headache and pain
in the chest and abdomen, I saw him for the first time
-at 9 o’clock in the evening of January 3t. He had a temper¬
ature of 103°, pulse 120, respiration 38, cough and rusty ex¬
pectoration. The physical signs were moderate percussion
dullness, increased vocal fremitus, and fine crepitant and
bronchial rales on the left side.

“ He was put on five-grain doses of carbonate of am¬
monia. On the following morning he was no better, his tem¬
perature having risen to 103.6°, pulse 138, respiration 40; at
4 p.m. his temperature was 103.8°, pulse 140, respiration 42.
At this visit I gave him 20 c.c. of antipneumococcic serum.
At 10 p.m. temperature 103.6°, pulse 102, respiration 28,
headache and pain better, but percussion dullness much
increased. A second dose of serum, 20 c.c. was injected.
At 9 a.m. on the following day (February 2), temperature
99 , pulse 76, respiration 28; next morning his temperature
was 98.4°, pulse 70, respiration 23, and he had slept well
during the night.

“ Up to this date (February 14) his temperature has
remained normal, and he seems well, but I have not yet per¬
mitted him to go out.

“ Two specimens of his sputum, submitted to Dr. Wm.
R. Stokes, were reported on as follows :

“ February 1, 1900.-—The sputum shows a dusty light-
brown color, and is streaked with blood. Fresh examiuation
shows areas where the red-blood corpuscles are in excess
when compared with the pus cells, and other areas where
the pus cells are greatly in excess. Specimens stained with
Stirling’s gentian violet show a few typical pneumococci, with
unstained capsules, but no organisms are seen inside the pus
cells. There are also present numerous large cocci and a
few bacilli.

TREATED WITH ANTIPNEUMOTOXIN.

295

“February 2,1900.—The gross appearance of the sputum
is the same as on yesterday, and the examination of a fresh
specimen shows no change. Specimens stained with gentian
violet show a greater number of pneumococci, and at times
these organisms are included within the protoplasm of the
pus cells, showing a phagocytosis. There are very few other
organisms present." — Abbreviated from Maryland Medical
Journal, March, 1900.

ALCOHOLISM.

By CHARLES J. DOUGLAS, M.D., Bcs'on.

There are few chronic diseases that will more surely
yield to proper medical treatment than alcoholism. Proper
treatment can be given, however, only when the patient has
been removed from his home and customary surroundings.
Any practitioner who has attempted to treat alcoholics at
their homes will admit that it is practically impossible to
more than temporarily relieve such patients. Still, a removal
may be made that will be to the patient’s disadvantage.
Confinement in a jail is worse than no treatment at all, and
an insane asylum is almost as objectionable. The so-called
“homes” for inebriates are another class of worse than use¬
less institutions, in which an intoxicated man is thrown into
a cell and allowed to rave without stimulants till sober, or till
death relieves his suffering. A humane man would not treat
a dog with such barbarity. The sudden withdrawal of
alcoholic liquors in this way not only causes the patient in¬
tense suffering, but, after a protracted spree, is the prin¬
cipal cause of delirium tremens and death. The with¬
drawal of alcohol should be gradual, its place being tem¬
porarily taken by such remedies as hydrastis or capsicum,
or other indicated remedies. I have followed this course for
years in the treatment of many hundreds of alcoholics, and
my cases of delirium tremens never go beyond the first
symptoms, and I have never had a death. To successfully
treat alcoholism the patient should be removed to a sani¬
tarium where the treatment of such ailments is made a
specialty. Here he can be under the constant care and ob¬
servation, day and night, of physicians and attendants whose
special training and experience enable them to adopt the
best methods in the management of the changing conditions
of this peculiar disease. Fortunately, there are now sani¬
tariums of this kind in many parts of the United States. I,
-of course, do not here have reference to the quack “ cures ”

2^6

DOUGLAS: ALCOHOLISM.

in which secret nostrums are dispensed in a routine way by
a physician who knows nothing of their composition. No
self-respecting practitioner can take his patients to such an
institution. But I refer to sanitaria that are ethically con¬
ducted, to which a physician can take his alcoholic cases and
receive any information he desires regarding the remedies
employed in the treatment of his patients, and where he will
be cordially welcomed as a consultant by the house phy¬
sician.

In treating of the pathology of this disease it is cus¬
tomary to enumerate the abnormities found in the stomach,
liver, bowels, kidneys, etc. But the disease of alcoholism
stands quite apart from these ailments. The patient may or
may npt have gastritis or enteritis or nephritis, but in all
cases he will have an abnormal condition of the nervous
system that produces either a perpetual or a periodic de¬
mand for the drug action of alcohol. Hence alcoholism
per se is a disease of the nervous system. He who can drink
moderately without ever becoming intoxicated may have the
drinking habit, but he has not acquired the disease. This,
however, does not prove that he possesses superior in¬
telligence or will power. It only indicates that his nervous
system is less susceptible than others to the poisonous action
of alcohol. It is purely a physical difference that dis¬
tinguishes the moderate drinker from the helpless drunkard.
Professor Atwater’s dictum that two ounces of alcohol a day
is a food, and more than that a poison, may be true in some
individuals, but as a statement of universal law it is absurdly
false. I have a patient now under treatment to whom two
ounces of alcohol is such an active poison as to transform
him from a clear-headed business man into an irresponsible
automaton.

The aetiology, symptoms and diagnosis of alcoholism
are well known, but its treatment deserves far more atten¬
tion than it has ever received. The advice given in some
text-books appears to be of a purely theoretical character,
unsupported by sufficient practical experience. Much of it
is certainly very erroneous. In the acute stages, sleep and
nourishment are of the first importance, especially if the
patient hits been on a protracted spree, or is showing signs
of delirium tremens. If the stomach is too weak to retain
more substantial food, an excellent aliment is hot malted
milk. But the best food in this stage of the disease is
eggnog, if the stomach will retain it, and it usually will.
Beat up one egg in a tumbler, nearly fill the glass with milk,
and add one or two ounces of whisky. Sugar may be a lded
if desired, but sweets are usually distasteful to a patient in

DOUGLAS : ALCOHOLISM.

297

this condition. I believe this combination to be the tte plus
ultra of foods in acute alcoholism. In many cases, however,
the patient refuses all nutriment till atter he has been made
to sleep.

A very satisfactory hypnotic in this disease is a mixture
of bromide of potassium and chloral in equal parts. This
should be given in several small doses, the effect of each dose
being carefully noted. Of the coal-tar products trional is
the best hypnotic, but it must be given in large doses.
Suggestion, as practised by the school of Nancy, is occa¬
sionally useful in promoting sleep. I never use morphine
unless there is some unusual complication.

There is, however, one harmless remedy that will pro¬
duce sleep in a few minntes, even when the patient is suffer¬
ing with the wildest delirium. That remedy is apomorphine.

I inject subcutaneously just enough to produce slight nausea,
but not enough to cause vomiting. One-thirtieth of a grain
is the average quantity required, but individual susceptibility
to this drug greatly varies. In a few minutes after adminis¬
tering the remedy perspiration appears and the patient
voluntarily lies down, when a sound and restful sleep imme¬
diately follows. This sleep lasts at least an hour or two.
and, if other sedatives are previously given, it will usually
last six or eight hours. The use of apo norphine in this
manner and for this purpose is ; I believe, original with me.
While its value has remained so long unrecognized by the
profession, yet in point of fact there is no hypnotic in our
materia medica that is at once so prompt, so safe, and so
sure. It is of special value in all forms of mania, regardless
of the cause. It may also be given in full emetic doses in
many cases of alcoholism with marked benefit. I have
frequently had such patients express gratitude for the great
relief afforded by this emetic- It seems to frequently act
as almost a specific in relieving the alcoholic craving.

After the patient has recovered from the acute symp¬
toms, he should have a course of tonic treatment covering
a period of several weeks. The limits of this article will not
permit a discussion of all the remedies that should be em¬
ployed in the varying states of this erratic disease. An
excellent one, if properly and judiciously used in connection
with other remedies, is the nitrate of strychnine. It may
be given, however, in much smaller doses than the text¬
books usually recommend. Potter, in his Materia Medica ,
advises the hypodermic use of this remedy. He says: ‘It
removes the craving for stimulants, counteracting the vaso¬
motor paralysis, to which most of the injurious effects of
alcohol are due, and is probably in other respects a true

298

DOUGLAS : ALCOHOLISM.

antagonist to the action of that narcotic poison on the hu¬
man system.”

Dr. Portugaloff, of Russia, under date of September 2,
1891, writes as follows: “ I have first and foremost to state
that the use of strychnine in the treatment of alcoholism is
no discovery of mine. In all the articles I have ever written
upon the subject I have always pointed out that the credit
of the discovery belongs to the English and French doctors
Luton and Dujardin Beaumetz. Convinced that all forms
of drunkenness are but forms of disease, with perhaps a basis
of vice, I have during the period of five years treated about
five hundred patients suffering from different forms of alco¬
holism by hypodermic injections of strychnine ... I do
not order the patient at once to discontinue drinking. I
prefer that he should voluntarily leave it off, and that alcohol
should become distasteful to him. . . . Then I have

cases of relapse—patients who once a year return to their
old bad habits, but who, on such occasions, always come to
me for a repetition of the treatment, which invariably sets
them right again for another year. ... I have always
felt sure that if in obstinate cases the patient could be iso¬
lated, and all possibility of obtaining alcohol removed—
which would be easy in a ‘ sanitarium for inebriates ’—cure
would certainiy follow.”

There are several reasons why the hypodermic method
here recommended by Dr. Portugaloff and Dr. Potter is pre¬
ferable to the administration of remedies exclusively by the
mouth. The stomach is less burdened by drugs. The
remedy goes directly into the circulation without being
subjected to the action of the digestive fluids. The dosage
can be regulated with great accuracy. The remedial action
is more prompt. It brings the patient face to face with the
physician several times a day.

It is remarkable how few physicians know how to properly
give a hypodermic injection. It should not hurt nor scarcely
be felt by the patient. It should never produce an abscess.
It should not produce a temporary subcutaneous swilling.
The operation should be performed so quickly that five can
not be counted between the insertion and withdrawal of the
needle. The physician who fails in any of these respects
has not yet learned the art of administering a hypodermic
injection.

As early as the sixteenth century gold was recommended
as a remedy for alcoholism, and recently extraordinary virtue
has been alleged for it. I have not, however, found that it
possesses the marvellous properties attributed to it by the
public, although it is probably not devoid of merit.

DOUGLAS: ALCOHOLISM.

299.

One or more of the bitter tonics should be employed
during the entire period of convalescence. With good appe¬
tite and digestion and restful sleep the patient will rapidly
improve. The aim of the entire treatment should be to
build up his general health, so that when he returns to his
home he will be in the best possible condition.

Cheerful and hopeful surroundings, in the company of
others who are under similar treatment, are conditions of
great value. It is desirable that an earnest and purposeful
spirit should be cultivated. It has been our custom for
several years at our sanitarium here, in Boston, to begin each
day with a simple service of songs and reading, lasting about
ten minutes. I consider the esprit de corps of a properly re¬
gulated sanitarium is of great importance in the treatment
of this disease.

The rescue of humanity from the physical, mental and
moral ruin resulting from alcoholism and other drug addic¬
tions devolves not upon the moralist but upon the physician.
This is the medical man’s burden, and the enlightenment of
the future will hold him responsible if he does not earnestly
take it up .—New York Medical Journal.

THE TREATMENT OF ACUTE ARTICULAR
RHEUMATISM AT THE MT. SINAI HOS¬
PITAL, NEW YORK CITY*

By L. A. 8. BODINE, M. D., of New York City.

House Physician, Mt. Sinai Hospital.

In the following brief summiry of the treatment em¬
ployed for rheumatic cases in the Mt. Sinai Hospital, I have
tried to adhere as closely as possible to rheumatism itself,
and no make no mention of treatment used in any of the
numerous rheumatic complications. In acute articular rheu¬
matism, after a thorough clearing out of the alimentary canal
with calomel and salts, our patients are at first put on sodium
salicylate, from fifteen to twenty grains every four hours,
with very frequently the addition of bicarbonate of sodium,
the latter drug being given to render the urine alkaline and
to maintain its alkalinity during the course of progress of the
disease. Fluid diet, rest in bed, with sponge baths for hyper¬
pyrexia at a temperature of from 95 0 to 75 0 F., depending
upon the patient’s condition, constitute the initial treatment

* Read before the Section on Practice of Medicine, New* York Academy of Medicine,
March 20,1900.

300 BODINE : THE TREATMENT OF ACUTE ARTICULAR

of these cases. If, for any reason, the salicylates are not well
borne, owing to tinnitus aurium, eruptions or gastric dis¬
turbances, either the oil of wintergreen or the citrate or
acetate of potassium is used as a substitute. In nephritic
subjects neither the oil of wintergreen nor the salicylates are
given. The bowels are kept open by cathartics, preferably
salines and enemata. Hyperidrosis is controlled by doses of
belladonna or its alkaloid. To control or relieve pain, phe-
nacetin, acetanilid, antipyrin, and codein are used sometimes,
but rarely morphine. To induce sleep, trional, in combina¬
tion with the bromide of sodium, is a frequent remedy.
Sometimes chloral, chloralose, cannabis indica, or even mor¬
phine itself is given. The diet during the acute stage
consists of fluids only. Milk, strained soups, clam-broth, cocoa,
egg-nogg, milk-shakes, ice-cream, lemon and orangeades
satisfy the patient much better than does a pure milk diet,
ane hence he takes his nourishment more willingly and fre¬
quently. Coffee in small quantities is also given, but if often
taken is apt to cause insomnia. Nitrogenous food is avoided
as much as possible, and large quantities of water are taken
daily. The salicylates are always given well diluted, and
never, if it can be avoided, on an empty stomach.

Local applications of oleum gaultheriae, salicylate of
menthol, or guaiacol painted over the inflamed joints, and
rubber protective bandaged firmly over them, seem to afford
great relief to the majority of patients, and also to exert a
favorable influence on the inflammation. When a joint in¬
volvement passes the ordinary inflammatory stage and there is
a commencing effusion, local applications of tincture of iodine,
uuiform pressure by bandaging, cold in the form of ice-bags,
immobilization, and elevation of the joint, if possible, are suc¬
cessfully used to abort and inhibit the exudation. In spite of
treatment the effusion may persist, and with it some eleva¬
tion of temperature. In these cases the joint itself is
aspirated in order to determine the character of the exudate.
If pus or purulent serum is found, the case becomes a surgical
one, and is treated accordingly. In those cases in which the
effused fluid is absorbed and there is a disappearance of all of
the constitutional symptoms, there may still remain pain on
motion, some periarticular thickening, and more or less
anchylosis. In these cases local treatment seems to give th^
best results, and is the only treatment used, except the in¬
ternal administration of the iodidle of potassium. For local
treatment we use daily baths of hot air at a temperature of
2 oo° F. 4 oo q F. for.from twenty minutes to a half hour
duration, hot salt packs, hot sand-bags, local applications of
iodine, galvanism, cataphoresis, passive motion, and massage.

RHEUMATISM AT THE MT. SINAI HOSPITAL, N.Y. 301

In the majority of instances iodide of potassium internally,,
combined with passive motion, massage and the hot-air bath
have given the best results. What gives good results in one
case does not always do so in another ; so we may have to
try a number of remedies before finding one suited to the case
in question.

Before the convalescent stage, particularly if the attack
has lasted for any length of time, tonic treatment is instituted,
most frequently in the form of iron, strychnine, and quinine.
The salicylate of iron is another remedy often employed.
After the temperature has remained at the normal point for
from forty-eight to seventy-two hours the diet consists of eggs,
bread, potatoes, toast, and fresh vegetables, but no meats.
In some cases in which the fever persists and the patient
seems to be suffering from malnutrition, it may not only be
advisable, but necessary, to enforce such a diet at an early
date. Meats are withheld until convalescence is well esta¬
blished, and are first given in the form of chicken or turkey.
Absolute rest for all cases of pyrexia is required, and all
patients are kept in bed for from two to five days after their
temperatures have reached the normal point.

„Out of thirty-eight cases of acute articular rheumatism
treated in this hospital during the past year, twenty-nine left
the hospital cured, and nine were discharged improved. Of
these thirty-eight patients all but three had had salicylic acid
in some form or other .—Interstate Medical journal.

Progress of Medical Science.

MEDICINE AND NEUROLOGY.

IN CHARGE OF

j. Bradford McConnell, m.d.

AsBOciate Professor of Medicine and Neurology, and Professor of Clinical Medicine
University of Bishop’s College; Physician Western Hospital.

THE USE OF COLD IN THE TREATMENT OF

PNEUMONIA.

[Editorial Note. —The following question was ad¬
dressed to a selected list of representative clinicians in various
parts of the United States :—“ Has the application of cold
given you satisfaction in the treatment of pneumonia ? ” The
replies came in very speedily, and the assembled opinions not
only form a mass of strong testimony, but have also, as the
Journal desired, much of the force and freshness of speech.]

302

PROGRESS OF MEDICAL SCIENCE.

A partial analysis of the testimony, made, as nearly
as possible in accordance with the language of the writers’
gives the following results :

The therapeutic use of cold in lobar pneumonia is—

Very valuable , according to seven observers : Baruch, Folsom,
Fowler, Mays, Musser, Stucky, Wilson ;

Valuable, according to nine observers : Atkinson, Bowditch,
JjJjJ^Cutler, Forcheimer, Johnston, Lange, Rochester, Stock-
ton, Tyson ;

Useful, according to four observers: Fitz, Hare, Janeway,
Smith;

Unsatisfactory, and abandoned, one observer : Eichberg.
MODE OF EMPLOYMENT.

Ice bags, by thirteen observers. Those who do not recom¬
mend ice bags are Baruch, Bowditch, Fitz, Folsom,
Fowler, Janeway, Johnston ;

Cold wet compresses are approved by seven observers : Baruch,
Cutler, Folsom, Fowler, Johnston, Musser, Stockton ;
Cold sponging, five observers: Atkinson, Bowditch, Fitz,
Musser, Stockton ;

Cold plunge or tub, six observers: Atkinson, Folsom, Musser,
Rochester, Stockton, Wilson;

The cold sheet is applied to the front of the body by Janeway.

INDICATIONS.

Hyperpyrexia is the only symptom relieved by cold, accord¬
ing to Janeway, Smith and Tyson ;

Pain and delirium are also relieved, according to Atkinson,
Baruch, Bowditch, Cutler, Fitz, Folsom, Forcheimer,
Fowler, Johnston, Mays, Musser, Rochester, Stockton ;
The heart and lungs obtain relief from mechanical embarrass¬
ment, in the opinions of Baruch, Cutler, Fowler, Hare,
Lange, Mays, musser;

The toxemia is lessened, according to Baruch and Musser.
CONTRAINDICATIONS.

As to contraindications, Musser says that they are pre¬
cisely such as are recognized in typhoid fever. Atkinson,
Bowditch, Cutler, Folsom, Smith and Tyson admit practically
the same contraindications. Forcheimer warns against the
use of ice bags in children. Janeway says that furunculosis
may follow the application of cold to the posterior chest.
Lange considers marked toxemia a contraindication.

Broncho-ptieumonia is mentioned by Forcheimer, Hare,
Lange, Rochester, as unlikely to be benefited by cold. Mays
employs ice bags in catarrhal pneumonia. The good effects

\

MEDICINE AND NEUROLOGY.

303

of warm moist applications in this class of cases, especially in
children, are spoken of by Forcheimer, Rochester and Smith.

PERIODS OF EMPLOYMENT.

On this point Stucky advises cold applications from the
moment of diagnosis until “ resolution is well established.”
Cutler says that the indications for the use of cold “do not
extend beyond a few days, perhaps only over a few hours.”
Baruch, Bowditch, Folssom, Fowler, Mays, Musser, Rochester
and Tyson use cold through the period of pyrexia. Fowler
mentions 104 0 and over as the thermometric indication for
cold applications. Tyson applies ice as often as the tempera¬
ture goes above 104°.

Eichberg alone of the twenty clinicians has abandoned
cold applications, having found them unsatisfactory. He
uses hot baths in all but anemic or very prostrated patients.

The collected testimony seems to assign to hydrotherapy
a very important place in the treatment of lobar pneumonia,
and these short utterances, coming as they do from authori¬
tative sources, form a substantial contribution to practical
therapeutics .—Maryland Medical Journal.

Dr. Andrew H. Smith, in the Medical News of Decem¬
ber 16, advocates the use of creasote in the treatment of
pneumonia. He believes that pneumonia could be prevented
if persons known to be susceptible would always begin at
once to take full doses of creasote on the appearance of those
symptoms which are popularly described in the phrase “taking
cold ”.

His use of this remedy is based upon his very interesting
views upon the pathology of pneumonia. He lays especial
stress upon the double circulation in the lung, that from the
left heart, borne in the nutrient vessels, and maintaining its
integrity during the whole course of pneumonia, and that
from the right heart which becomes thrombotic throughout
the affected area.

This arrangement of closely adjacent double circulating
channels removes pneumonia, he says, “ out of the category of
diseases for which analogous conditions can be found in
other parts of the body.” The pneumococcus is the essential
pathologic factor, but it does not excite inflammation, the
elements of perverted nutrition, necrosis, interstitial deposits,
obliteration of vessels and new formations being absent. The
process, he says, is a germ culture going on in each air-cell,
as in a tiny test tube, on a special medium supplied by the
functional blood-vessels. This bacterial growth is the essence

304 PROGRESS OF MEDICAL SCIENCE.

of the pathology of pneumonia, and the mechanical and
chemical results are but more or less serious epiphenomena.
The extent of the bacterial growth is limited, partly by
exhaustion of the medium, partly by the formation of pneumic
acid, inhibiting growth, and partly by the development of an
antitoxin. Crisis occurs promptly upon the arrest of growth
of the pneumococcus, because the nutrient vessels permeating
the consolidated area, but not participating in or suffering
from the disease process, are ready at once to assist in remov¬
ing the exudate and restoring the functional blood channels.

From this central idea that “ the beginning of pneumonia
is the lodgment of the pneumococcus in the air-cell'’ he
reasons that the symptoms and signs upon which we
ordinarily base the diagnosis of pneumonia really indicate a
very advanced stage of the disorder. Antimicrobic treatment
is nevertheless valuable, since it is possible to charge the
blood with a substance which, being borne to the margins
of the consolidated area, will prevent the further growth of
the bacillus. Besides its accessible situation in the lung, he
considers the known cultural peculiarities of the pneumo¬
coccus, its brief existence under laboratory methods, and its
sensitiveness to acids. He cites the successes in the treat¬
ment of pneumonia claimed by various authors for calomel,
chloroform, the salicylates, and creasote.

Of these. Smith strongly prefers creasote in the form of
the.carbonate creasotal. He takes occasion to condemn the
use of digitalis in those cases marked by cyanosis and dilated
veins, where life is threatened chiefly by the mechanical ob¬
struction. He says that in his experience “ blueness and
digitalis go hand in hand.”

His remarks upon accessory treatment are very brief,
comprising, first, stimulation of the emunctories ; second,
sustaining the heart by stimulation and hydrotherapy ; third,
relieving the pulmonary condition by vaso-dilators or venesec¬
tion ; fourth, compensating loss of respiratory surface by
inhalations of oxygen ; fifth, reduction of excessive tem¬
perature by cold applications .—Maryland Medical Journal.

TREATMENT OF INSOMNIA.

In the treatment of habitual sleeplessness there are two
main factors: The removal of the cause and breaking up the
the habit. When acid or gouty dyspepsia is the cause, says.
J. B. Bradbury (quoted in Monthly Cyclopedia of Practical'
Medicine ), it is essential to avoid tea, fruit and vegetable
acids. An alkaline bitter before meals and an occasional
mercurial at bedtime, followed by a saline aperient the next

MEDICINE AND NEUROLOGY.

305

•morning,*are of service, and in the gouty, colchicum and
magnesia or sodium salcylate should be prescribed. Nux
vomica and strychnine are good remedies for the insomnia
of age and fatigue and cardiac and vascular disease. Digi¬
talis and other cardiac tonics are indicated at times in cardiac
disease and neurasthenia with low arterial tension. For
anemia, iron, nux vomica and sometimes digitalis are re¬
quired. Sleeplessness from overwork and worry demands
mental rest and change of air and scene. Capsules contain¬
ing 30 minims of turpentine, taken at bedtime, are occasion¬
ally beneficial in these cases. No beverages containing caffeine
should be drunk after breakfast. The cool air bath or wet
pack or bath is often decidedly sedative, as is a glass of
whiskey and water, to those unaccustomed to alcohol. The
bromides are very useful in nervous and hysterical women,
and a mixture of a bromide with tincture of sumbul and
tincture of hops in camphor water is serviceable at the cli¬
macteric.

Concerning the habit of sleeplessness, it is here that
hypnotics are of great value, tie bromides being the least
harmful (30 or 40 grains dose), though sulphonal (20 grains)
and paraldehyde are in the front rank for effectiveness. If
-possible the bedroom ought to be in a quiet part of the
house, well ventilated, of moderate temperature, scantily
furnished and darkened. For young and middle-age adults
a firm mattress is the best bed, but the old may require
something softer. The covering should be light and warm.
The pillows may be arranged according to individual choice.
As a rule, a light supper is best, and for many, especially
those who awake in the middle of the night, a little hot
milk or meat juice with a small amount of alcohol is helpful.
If the feet are cold, rub them vigorously or use the hot bottle
or the foot-bath with mustard. Massage is sometimes ad¬
vantageous, and may be aided by a hot compress to the
abdomen. Walking about naked or taking a cold or tepid
bath is also often of service.

PAINTING WITH FORMALIN IN THE SWEAT¬
ING OF PHTHISIS.

m

Dr. H. Hirschfield (.Medical Press and Circular , April
11, 1900) covers the patient with a coat of formalin, protect¬
ing the nostrils with plugs of lint soaked in turpentine. In
this way no harm is done to the respiratory organs. In the
100 cases treated by Dr. Hirchfield there were no failures,
although one-half of the cases were such as had derived no
benefit from antihydrotics. In some cases a single painting

30 6

PROGRESS OF MEDICAL SCIENCE.

■was sufficient to prevent a return of the sweating for some
weeks. Others required two applications, and in three the
painting had to be done three times before a lasting success
was effected. No physical effect was produced on the skin
except a slight scaliness, and in one case a mild urticaria and
slight erosions.

INFANTILE COLIC.

It is one of the commonest ailments in infancy, and fre¬
quently appears in those perfectly well in other respects.
It may occur either only occasionally or many times every
day. The symptoms consist of sudden and violent crying—
which may continue until the child is bluish in the face and
often exhausted and cold—a swollen and hard abdomen, and
doubling up and straightening of the legs, arms and trunk.
These symptoms last a variable time and then suddenly
cease, perhaps preceded by the passage of wind by the
mouth or bowel. Chilling of the skin and indigestion are the
commonest causes, the latter usually depending on too fre¬
quent or too abundant feeding. To prevent repeated attacks
the stomach should be allowed to rest by diminishing the
amount of nourishment and increasing the length of time
between feedings. If the baby is bottle fed, it may be neces¬
sary to change the character of the food in some way, but
this should be the duty of the physician. The child must be
warmly clothed, since any chilling of the surface may cause
pain, no matter how good the digestion may be. The feet
and legs especially should be kept warm by thick loose
stockings and by daily friction with a mixture of I part
of turpentine and 3 parts of sweet oil. An abdominal binder
may be worn if one is not already in use.

During an attack the baby must never be fed. The
warm milk, it is true, often stops the crying for the moment,
but it is sure to increase the indigestion and to bring the
pain back as bad as or worse than ever. Rubbing the ab¬
domen for several minutes, or the mere change of the child’s
position, as by lifting it over the shoulder, will sometimes
cause the gas to escape and the colic to cease. A spice
plaster is often very useful. It is prepared as follows: Take
1 part each of ground ginger, cloves, cinnamon, and allspice,
with or without y part of cayenne pepper, according as the
plaster is to be strong or weak. Put the dry and well-mixed
powder into a flannel bag. spread it evenly and quilt the bag
to prevent the spices from getting into lumps. Before
applying, wet it with hot alcohol or hot whiskey. The same

MEDICINE AND NEUROLOGY. 3«>7

spice bag may be used repeatedly until it begins to lose its
strength too greatly.

Sometimes an injection of two or more ounces of warm
water will relieve the attack. Generally some medicine
given internally is necessary. Peppermint-water or cinna¬
mon-water, diluted and sweetened and given after each
nursing, may keep the pain from coming on; while during
an attack one of the simplest and most effectual reme¬
dies in soda-mint mixed with an equal quantity of hot
water and given every half hour or hour for a time. It is
prepared as follows:

Bicarbonate of soda, drachm.

Aromatic spirits of ammonia, fluid drachm.

Spearmint-water or peppermint-water, enough to make
two fluid ounces.

A teaspoonful in hot water at one year of age.

If the baby seems exhauted and cold as a result of the
pain, it should be given a few drops of brandy in a tea¬
spoonful of hot sweentened water and be placed at once in
a hot bath, and after that should be kept very warm and
have a mustard plaster app’ied over the abdomen. A
mustard plaster for this purpose should be made as follows :
One part of mustard should be mixed with 3 or 4, or, in
the case of infants, 5 parts of flour or flaxseed meal. Boiling
water is added and the mixture stirred until it is of the
proper .softness. It is then spread on a cloth and applied
directly to the skin. If it burns too much a layer of linen or
some other thin material can be placed between. It should
be kept on until the skin is well reddened, but not long
enough to blister.— Doctors' Magazine.

ERYSIPELAS AND ICHTHYOL.

The Medical Press and Circular of November 8, 1899,
states that a medical confrere has recently published a series
of 250 cases of erysipelas treated exclusively with ichthyol ;
the patients belonged to all grades of society, and their ages
varied from 6 months to 87 years. Afcer having cleaned the
surface with a plug of cotton wool wet with alcohol, he applies
with the fingers an ointment of vaselin and ichthyol (13 to
30 per cent). The treatment is renewed every four or six
hours. Recovery was rapid in every case.

THE FIRST PRODUCT OF THE GASTRIC DIGES¬
TION OF CASEIN.

Ernst Salkowski (Zeit Physiol. Chern ., 1899; J.
Chem. Soc„ 1895). Under favorable circumstances casein is

308 PROGRESS OF MEDICAL SCIENCE.

wholly digested by gastric juice ; under unfavorable circum¬
stances (too low a temperature, or too little digestive fluid)
there is a residue of paranudein. Before this, however,
there is primary stage in which the casein is converted into
a protose which contains all the phosphorus of the original
proteid. Casein and caseinogen are in this respect alike.—
jBuffalo Medical Journal ,

DETECTION OF ALBUMIN IN URINE.

Gabriel Gu£rm {J. Pharrn., 1899: j- Client. Soc.,
1899). A 10 per cent, aqueous solution of di-iodopara-
phenol sulphonic acid (sozoiodo) is a very delicate reagent
for the detection of albumin in urine. 10-15 drops of the
reagent when added to 8 or 10 c.c. of the filtered urine pro¬
duce a whiteish, flocculent precipitate or a miky turbidity if
albumin is present. Albumoses, peptones and some alkaloids
are also precipitated by it, but their precipitates readily dis¬
solve on heating, whereas that produced by albumin is com¬
pletely insoluble. Alkaline urates and uric acid are pre-
dpitated by this reagent — Buffalo Med. Jour.

THE TREATMENT OF HICCOUGH.

Noir (Progres Medicate) reviews the various methods
of treating obstinate hiccough. He alludes to galvanization
of the phrenic nerve ; to the application of a faradic current
to the epigastrium (Erb’s method) ; to compression of the
left phreric nerve (I.eloir’s method); to the forcible elevation
of the hyoid bone by the fingers (Nothnagel’s method); and
finally to vigourous traction of the tongue (Laborde’s method).
He prefers the latter on account of its simplicity and effi¬
ciency. It has given excellent results in his hands. In a
nervous girl, aged six years, who was completely exhausted
by hiccough of over six hours' duration, traction of the
tongue for a minute gave immediate and permanent relief.
In a second case, a patient with advanced diabetes com¬
plicated with tuberculosis, hiccough which had already lasted
several days, and which had resisted all other remedial
measures, promptly yielded to Laborde’s treatment conti¬
nued for about two minutes.— Philadelphia Med. Jour.

SURGERY

ZN CHARGE OP

HOLLO CAMPBELL,*M.D.,

Lecturer on Surgery, University of Bishop's College ; Assistant-Surgeon, Western Hospital;

AND

GEORGE FISK, M.D.

Instructor in Surgery, University of Bishop's College ; Assistant-Surgeon, Western Hospital?

TO IRRIGATE OR NOT TO IRRIGATE IN IN-

FLAMMATION OF THE PERITONEUM AND

AFTER ABDOMINAL OPERATIONS.

There is still a wide diversity of opinion among surgeons
as to the value of irrigation after surgical operations and in
inflammation of the peritoneum. Many operators believe
that intra-abdominal work should follow the sime rules that
are applied to surgery on external surfaces. The peritoneum
is surgically regarded in the same light as the skin, they both
having epithelial coverings. Incisions into the peritoneum
are to follow the same rule as incisions into the skin, and
after the removal of organs or plastic work within the
abdomen the incisions are covered in by this membrane,
which is to be carefully sutured. With an aseptic technique
and field, such a conception of abdominal surgery is an ideal
one. An operation which leaves carefully approximated
peritoneal surfaces and the abdomen perfectly dry at the
time of the closure of the external wound, leaves nothing to
be desired in the aid of the healing process.

The conditions that confront a surgeon in a septic case,
or one in which the inflammation has extended to the peri¬
toneal surfaces, are quite different. Here the question of
irrigation is still sub judice. Many operators are of the
opinion that, if the infection is of sufficient severity to have
extensively involved the peritoneum, irrigation will be of no
value, and, on the contrary, may do harm by diluting and
spreading the infection to previously uninvolved portions of
the peritoneum, and may actually aid in the absorption of
toxins from the peritoneal cavity. Other equally good
operators are of the opinion that irrigation does get rid
to a certain extent of the infecting agent and ptomaines, and
the products of bacterial growth are washed out of the
abdomen.

Unfortunately, the question is one to be decided largely

3io

PROGRESS OF MEDICAL SCIENCE.

by the experience and opinions of individual operators, as it
seems almost impossible to study it from an experimental
basis, and the examination of statistics presents so many ex¬
traneous and accidental conditions that figures based upon
these alone are exceedingly fallacious. So far as conclusions
may be drawn from the published cases, we leel safe in
asserting that aseptic operations should be conducted with¬
out flushing and without drainage. In those in which there
is a general infection of the peritoneum from a suppurating
focus, or in which the operation is made for the purpose of
relieving septic peritonitis, it is probable that flushing and
drainage is a material aid in the recovery of the patient.
The flushing, if done at all, should be thorough ; that is, in a
widespread septic peritonitis, if it is to be of any value, it
must not consist of the pouring of a few quarts of water into
the abdominal cavity and allowing it to drain away, but it
should be done with many gallons of aseptic normal salt
solution. There are now a number of cases on record in
which some form of continuous irrigation has been employed
with success. There is great need of further studies along
these lines, as the treatment of septic peritonitis from the
operative standpoint does not form a brilliant chapter in the
mortality records.— Medicine.

DRAINAGE.

Paul Morf, in the Bulletin of the Northwestern University
Medical School , of January 31, 1900, says that wounds may
be divided with reference to drainage into two classes : First,
those which are aseptic; secondly, those which have been
infected, or are made to relieve suppurative conditions. In
the vast majority of cases drainage is unnecessary in aseptic
wounds. The danger of drainage is due to the fact that the
skin contains normally germs which cannot be wholly re¬
moved. The drain, whether capillary or tubular, moistened
by secretions, is a ready pathway for the entrance of such
infection from the surface to the deeper structures. Aseptic
wounds in which no antiseptics have been used have, as a
rule, little oozing. Healthy tissue can take care of a large
amount of extravasated blood and lymph. Drainage in
aseptic cases is limited to those cases where there has been
much traumatism, and where large areas of lymphatic vessels
have been opened. Examples of this class of wounds are
furnished by amputations of the breast with their attendant
dissection of the axilla, amputations of the thigh and hip,
and extirpations of tubercular lymphatic glands. Another
class of cases is where there remain “ dead spaces ” which.

SURGERY.

3 11

cannot be obliterated by deep sutures or other means. Ex¬
amples of these are furnished by unilateral thyroidectomy
and operation for carcinoma of the rectum. In most of these
cases twenty-four hours is a sufficient time to leave the drain
in position. At the end of that time the tissues have
accommodated themselves and the dead spaces are oblit¬
erated.

In infected wounds and those made for the relief of
septic foci, drainage is demanded almost without exception.
Drainage of abscess empyemas and suppurating joints should
be made in the location which gives the best possible escape
to the secretions. A good-sized fenestrated rubber tube is
to be preferred, which, if possible, is to be carried through the
cavity and out at a counter-opening. As the suppuration
lessens, this is to be replaced by a drain of iodoform gauze.

In the relation of drainage to the abdominal cavity it is
difficult to make a general statement, but drainage is useful
when pus is found free in the peritoneal cavity, as in cases of
acute suppurative peritonitis; where there is localized pus
formation, the suppuration being walled off by adhesions—
this class of cases includes appendicular abscess, pelvic dis¬
ease and pus tubes. Drainage must also be employed in the
removal of pus from a hollow viscus.— Medicine.

LOOK TO THE TEETH.

Dr. Howard B. Hills, of Youngstown, gave the follow¬
ing hint anent eye diseases:

Mrs. B. W. called at my office for relief from an ex¬
ceedingly troublesome eye. The e was pain, lachrymation,
photophobia and congestion. After the examination I
directed her to her dentist, who extracted a wisdom tooth in
the right side of her jaw. Within a week she returned to
tell me her eye had not troubled her after the tooth was
out.

Mr. D. J. was directed to my office by one of our local
physicians, because of an intense photophobia and lachryma¬
tion of both eyes. I sent him, in turn, to his dentist, who
extracted all his imperfect teeth, and within ten days his eyes
were free from pain, and as clear and bright as they had ever
been. These cases will, I think, answer the purpose I had
in writing this brief paper. I have in my case book the his¬
tory of a case where the filling of a molar tooth promptly
stopped an earache. In conclusion I will add that, while we
know all these things, our business and interests demand that
we should not forget them.

312

PROGRESS OF MEDICAL SCIENCE.

TREATMENT OF ORCHITIS.

Dr. Pigot highly recommends the following treatment
for orchitis due to gonorrhea: The patient is first given an
ounce of salts as a purgative and then salicylate of soda,
fifteen grains, four times a day. Improvement shows itself
after twenty-four hours, and at the end of eight or ten days
the cure is complete. Mercurial ointment need only be em¬
ployed where there is effusion into the vaginal sac. During
the treatment the patient remains in bed, and maintains con¬
stantly in situ a suspensory bandage lined with cotton wad¬
ding.— Paris Cor. Med. Press and Circular.

CHRONIC ECZEMA.

A confrere asserts that he obtains the radical cure of
■eczema where it occurs in isolated patches on the upper ex¬
tremities and so rebellious to the ordinary method of treat¬
ment, as follows : After having washed thoroughly with
soap and water the part and dried it, he rubs in vigorously
a fifty per cent, solution of caustic potash by means of a plug
-of cotton tied to a rod ; he then washes the spot freely with
water, and, finally, paints it over with a fifty per cent, solu¬
tion of nitrate of silver, and envelops the whole in aseptic
cotton. This pressing is left in place until the cicatrix is
formed beneath the slough, or from one to two weeks. The
itching ceases immmedialy after the application of the caus¬
tics. Out of thirty cases thus treated, only one required the
operation a second time.— Med. Press and Circular.

BOILS.

Not long ago I was afflicted with a developing boil on
the back of my neck. I was kept painfully conscious of its
presence and tenderness by the constant rubbing of my col¬
lar. I chanced into a neighboring doctor’s office and inci¬
dentally referred to the annoyance of the aforesaid boil, and
wished he could stepped its progress. The good doctor
examined it and said aqua calcis will do it. I questioned
the taking of lime water for such a complaint, but he ad¬
vised taking a teaspoonful three or four times a day. Three
or four doses settled the boil.

The conversation regarding the boil brought forth an¬
other statement from the same good doctor, and that was that
the suppuration in tonsilitis need never occur if treated with
aconite tincture and phytolacca tincture in fractional drop
doses in alternation every hour or two. The same may be
said of inflammation of the mammary glands.— Med. Arena.

OBSTETRICS.

IN CHANGE OF

H. L. REDDY, M.D., L. R. O. P., London,

Piofcssor of Obstetrics, University of Bishop's College; Physician Accoucheur WooaeaV
Hospital ; Physician to the Western Hospital.

INFLUENCE OF PREGNANCY UPON THE

TEETH.

Terrier states that caries is more rapid in its advanc
that the sensibility and friability of the teeth are increase
that their chemical composition is altered during pregnancv.
These changes are caused by gingivitis of pregnancy, altera-
tion of saliva, acid regurgitations from the stomach, general
modifications in the digestive and in the urinary apparatus
and increased excitability of the nervous system due to
pregnancy. He urges careful cleansing of the teeth and
treatment of caries and gingivitis early in pregnancy, while
the daily care of the teeth should be continued through
pregnancy and lactation.— Jour, Obstet.

HYPEREMESIS GRAVIDARUM.

Dirmoser believes that auto-infection from the intestinal
tract is the usual cause of hyperemesis, and that the etio¬
logical importance of hysteria is largely overestimated. He
refers to the similarity of postmortem changes in hypere¬
mesis and acute infection. Urinary analysis shows an in¬
crease of indol, skatol and other products of retrograde
metabolism, also albumin, acetone and peptone. Organic
structural elements are found in the urine, indicating a neph¬
ritis. There exists an individual predisposition, probably
owing to the abnormal condition of the intestinal canal. The
best treatment for this obstinate and often serious complica¬
tion of the pregnant state would be intestinal antisepsis, and
the author states that the results obtained from such treat¬
ment will be published at a later date.— Jour. Obst't,

INDUCTION OF LABOR FOR NEPHRITIS.

I. W. Lwoff writes that cases of so-called kidney of
pregnancy may sometimes be carried to term by milk diet,
baths and pilocarpine, but when the albumin increases and
urine diminishes induction of premature labor is indicated.
These accidents usually begin about the sixth month and
pregnancy may be carried to the second half of the eighth
month before inducing labor. In cases of acute nephritis-

314

THERAPEUTIC NOTES.

gestation should be interrupted at once whatever its duration
may have been.

In chronic nephritis interference with pregnancy is de¬
manded whenever the general condition becomes worse.

PUERPERAL INFECTION.

H. W. Longyear states that the early diagnosis and
treatment of pseudo-membrane by topical applications is of
great importance.

The intra-uterine douche frequently applied is of the
most value in the forms of infection unattended by the forma¬
tion of a pseudo-membrane. The vaginal use of peroxide
of hydrogen is helpful in all forms of infection. Frequent
packing of the vagina previously dried with iodoform gauze
is especially useful in cases with pseudo-membrane. In
the general treatment he gives quinine twice daily, whiskey
and strychnine to support the heart, nuclein and protonuclein
in all cases, mercurial and saline cathartics at first in all cases,
then as indicated. Serum therapy to be applied where the
Klebs-Loffler bacillus or the streptococcus can be demon¬
strated by the bacteriologic examination. Stretococcus
antitoxin serum is to be used persistently to prevent pus
formation and symptoms of systemetic infction.

Therapeutic Notes.

Muscular Rheumatism.

R Sodii salicylatis.

Potass, acetatis aa. dr. 4

Glycerini. . oz. 2

Acquseq. s.ad. oz. 4

M. Sig. One teaspoonful in one-half glass of water or
milk every two hours.— Ex.

Children’s Emetic.

R Pulv. ipecacuan. gr. viiss

Antimonii et potassi tartratis..... gr. ) 4 >

Oxymel scillse... jiiss

Aq. distill, q. s. ad. 3i

M. S. One teaspoonful every ten minutes .—Baginsky

THERAPEUTIC NOTES.

3*5

Inhalation in Tuberculous Laryngitis.

R Menthol.

Ether, sulphuric.

01. pini sylvestris.

Tinct. iodi aa. z'\)

Tinct. benzoin, co. ad. 51'j

M. S. Ten drops on an oro-nasal inhaler which is
worn as much of the time as possible.— IV. Fowler.

Treatment of Baldness.

Dr. Whitla gives this as one of the best combinations in

the treatment of baldness:

R Pilocarp. hydrochloratis. gr. 5

Otto rosje. m. 8

Ol. rosmarini. dr. 4

Linimenti cantharidis. dr. 4

Glycerini puri. oz. 1

01. amygdalae dulcis. oz. 3

Spts. Camphorae. oz. 3

M. Sig. To be rubbed well into the scalf night and
morning.— Ex.

Pneumonia.

Bowen, in his late work on materia niedica, prescribes for

pneumonia:

R Ammonii iodidi.. 2 drachms

Spir. ammon. aromatic, fl . 2 drachms

Elixir, simplicis, fl. 1 ounce

Aquae q. s. ad., fl. 8 ounces

M. Sig. Two tablespoonfuls three times a day.— Pre¬
scription.

A Goitre Remedy.

Dr. Chavette, who will be remembered by the older
Chicago physicians, claimed to cure every case of goitre he
treated by the use of the following remedy :

R Zinc sulphate. 2 drachms

Salicylic acid. 2 drachms

Iodoform.*. 2 drachms

Boric acid. 3 drachms

Oleic acid. 8 ounces

Mix and keep at a boiling heat for several hours, then
pour off the liquid, and when cold, bottle. Sig. Apply to
the enlarged gland, with slight friction, twice daily, until a
slight desquamation occurs, after which apply once daily
until the enlargement is entirely reduced. In no instance
did the disease return .—Medical Council.

316 JOTTINGS.

Fissure of Nipples.

R Tinct. benzoini composite.... 2 drachms

Listerinae.. 4 drachms

Aquae camphorae q. s. ad. 3 ounces

M. Sig. Shake. Bathe nipple, and apply freely after
each nursing.

A Cure for Ringworm.

R Salicylic acid. gr. viij

Vaselin. dr. j

Mix and apply twice daily. Sometimes a little stronger
salve is necessary.

Treatment of Hemorrhoids.

Dr. J. P. Tuttle, in a recent lecture at the New York
Polyclinic, said: In cases of internal hemorrhoids that are
thought suited to cure by the injection method, I use the

following formula:

R Carbolic acid. l}£ drachms

Salicylic acid. drachms

Soda biborate-. I drachm

Glycerine(sterilized),q.s. ad. I ounce

M. ft. liquor. Sig. Inject for hemorrhoids.

Of this fluid from two to four minims are injected into
the base of the hemorrhoid If other injections are to be
made, they are made in from three to five days— Polyclinic.

children’s sore mouth.

Borax. 2 drachms.

Tinct. Benzoin. I drachm.

Honey.. 10 drachms.

Aq. Dest.q. s.ad. 2 ounces.

Dip a camel’s hair brush into this solution, and touch
patches in mouth four or five times a day .—N . V . Med. Jour

Jottings.

HEART DISEASE IN CHILDREN.

Dr. Weill (Therapeutic Gazette ) states that in the treat¬
ment of heart diseases, in children if marked insomnia exists,,
it should be combated with Trional or S ill fortul.—/I rc/iives
of Pediatrics , January, 1900.

JOTTINGS.

3*7

TO REMOVE WRINKLES.

Oil of sweet almond, two drachms ; cacao butter, four
drachms ; lanolin, two ounces ; glycerine, two drachms ; otto
of rose, two drops. Me|t the three first ingredients, then
add the other two, according to “Practitioner.” It is ap¬
plied at night. Another useful application is Glycerole of
tannin, rosewater, of each one drachm. Mix. To be ap¬
plied to the wrinkled surface with a camel's hair brush.

ACUTE BRONCHITIS.

According to the Indian Med. Rec., the mor.t painful
period in acute or subacute bronchitis is at the onset, when
the expectoration is absent and the cough very severe.
According to Dr. F. Edgeworth, of Bristol, caffeine, especi¬
ally when associated with an alkali, facilitates the expul¬
sion of the sputum and shortens the stage. He employs
every three or four hours a dose of from fifteen to twenty-five
grains of citrate or acetate of potassium, and in addition at
bedtime five grains of caffeine. Administered in this way
he finds that caffeine quickly overcomes the spasm of the
bronchial muscles, which checks the expulsion of the sputum
and thus relieves the patient.

HOW TO GIVE A HYPODERMIC INJECTION.

This is a simple procedure which, however, may be
the making or unmaking of the doctor. It is so common
to give it the wrong way, the most painful way, as much
so, nearly, as it is not to feel the stab of the needle if one is
not receiving it. The wrong way is to pinch up a fold of
skin in the tenderest part of the upper limb, the anterior
fore-arm, and then slowly push the needle through, shoul-
derwards, with as much deliberation as if it was intended
to make it steal to its destination without cognition by the
involved nerves. We never see it done this way without
imagining part of the unnecessary pain it causes, and hav¬
ing rather hard feelings against the introducer of the needle.

The right way to do this is to pick up the entire fleshy
mass between the skin and the bone in the less tender
part of the upper limb, the back upper arm or shoulder,
and push the needle directly through at right angles to
the skin. It should be done with a quick stab, and made
to enter the muscle mass. The fluid is then gradually pushed
home, after which the needle is withdrawn quicker than
it went in, the puncture site being massaged for a mo¬
ment for ihe double purpose of obliterating the needle
track and promoting absorption of the injected liquid.

318

JOTTINGS.

Try this method once and you will never want to go
back to the other. The patient does not mind it. We have
never had an abscess in twenty years’ work. It is the only
right and least painful way of giving a hypodermic injection.
— Med. Council.

GOITRE OINTMENT.

An ointment made by incorporating ten grains red
iodide of mercury and one-half grain atropine with one ounce
of some unguent is a useful external application in goitre;
a piece the size of a pea, or slightly larger, to be well rubbed
into the skin over the tumor two or three mornings in suc¬
cession, and repeated once a week. This, with iodides of
mercury and arsenic internally, was the treatment used by
an old Scotch physician, who made a reputation and a for¬
tune with it .—Alkaloidal Clinic.

GOLDEN RULES OF OBSTETRIC PRACTICE.

Do not be unduly hopeful if a tubercular patient seems
to improve during pregnancy. She will probably lose ground
rapidly when gestation is ended.

Improvement in the later manifestations of syphilis is
often observed during pregnancy. But it does not indicate
that treatment may be neglected.

If albumen appears in the urine for the first time during
pregnancy, be prepared for eclampsia. Where chronic renal
disease is known to exist there need be less fear of this com¬
plication, though the disease is aggravated by pregnancy.—
Fothergill.

THE HOT DRY-AIR TREATMENT OF
RHEUMATISM.

An editorial in the International Medical Annual criticises
this revival of a method as being generally useless and harm¬
ful in regard to permanent effects. The excessive or long-
continued application of dry heat, he says, tends to destroy
the functional activity of the skin, and impairs the nervous
mechanism of the joints. A more simple, convenient, com¬
fortable and efficient application of local heat than can be
made by any of the patented appliances is as follows: Six
thicknesses of flannel of convenient size are sewn together;
these are wrung out of water at 120° F., and wrapped around
the joint over this is placed a hot-water bottle filled with
water, and the whole secured with a flannel wrapper.

THE

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price , $c.oo per annum in advance . Single
Copies , io

Make all Cheques or P.O. Money Orders for subscription, or advertising, payable to
JOHN LOVELL St SON, 28 Sc. Nicholas Street, Montreal, to whom all business commit
ideations should be addressed.

All communications for the Journal, books for review, and exchanges, should be
addressed to the Editor, Box 2174, Post Office- Montreal.

Editorial.

The surgical history of the present war in South Africa
has been a series of surprises, and the unexpected has been
constantly occurring. In this connection it is a matter of
very great interest to look back to the introduction of the
rifle now in use as the weapon of the British Army. At that
time there was much speculation as to the terrible execution
it would make. There was also a distinct recognition by
more than one observer of the special conditions in which the
wounded would be placed, because of the great distance the
bullet is tarried. Professor Bilroth, in 1891, writing of the
new rifle adopted by the Austrian Army, said : “ Every new
gun carries further and wounds at greater distance than its
predecessors .... and this means that the shelters for
the wounded have to be set up at greater distances from the
line of battle .... Thus all ambulance duty to be
effective should be proportionately increased.” About the
same time Surgeon Captain Perry Marsh, of our own Army»
lectured before the United Service Institute on the new
“ Magazine Rifle in War.” In his lecture he said: “From
the increased range, lower trajectory and more rapid firing
power of the new rifle, the number of wounded will doubtless,
in every conflict where these weapons are used, be very large,
and much exceed the average of what was obtained in battles
up to the present date.” Commenting on this extract the

320

EDITORIAL

British Medical Journal of Jan. 16, 1892, says: “These
speculations, based on no doubtful data, suggest the practical
question, Are the numbers and equipment of our bearer
companies and field hospitals keeping pace with the demands
which the new warfare will make on them. Alluding to the
nature and treatment which the new gun shot wounds will
demand, Marshf says : “ The treatment of the wounded should
begin in the field at the earliest possible time after the in¬
juries have been received.” Again, “ What is most likely to
be felt in future campaigns will be the want of moving hos¬
pitals, where the entire treatment of a large proportion of th e
wounded may be carried out.” Again, “ For future cam¬
paigns the number of bearer companies allowed to each
Army Corps, and the strength of each individual company,
will require considerable augmentation if we wish to provide
for the increased requirements which may reasonably be ex¬
pected in future campaigns.” This same writer proves, not
only theoretically, but from practical experience from acci¬
dents, that the fear of the deadliest results from this rifle, as
prognosed by Bilroth, was not correct. He found that the
direct injury and concomitant shock was much less than from
the bullets of the older Snider and Martini-Henry rifles.
This he believed was due to three factors : the material com¬
prising the projectile, its lessened diameter and,increased
velocity. The British Medical Journal , reviewing the
theories as advanced by Marsh, uses these words, which may
truly be said to have been prophetic, when one considers the
experience of the present South African War, “The outlook
for injuries by these new weapons is not, therefore, so terrible
after all. The assumption is warranted that many men in
future wounded by small arms will only be temporarily dis¬
abled, and if promptly and properly treated would soon be
in the ranks again.”

These are very striking statements written some years
before any experience on a large scale had occurred. One
point, however, which will demand the strictest investigation
by the committee appointed, as a result of the charges made
by Mr. Burdett-Coutts, is this: Whether in view of the state¬
ments made by Marsh there has been since his lecture any

EDITORIAL.

3 21

marked increase in the number of bearer companies or in
their strength. If there has not, the War Department will
certainly come in for considerable blame. If we are to judge
from the statements which have from time to time appeared
in British Medical Journals, there is no doubt that the Royal
Army Medical Corps has been numerically absolutely unable
to cope with the army Britain sent to South Africa. This is
proved by the fact that fully four hundred civilian surgeons
are employed at the seat of war, and that the numerous
private field hospitals, which private munificence organized,
have had more than an abundance of work to perform.
Military men say that civilian surgeons are the curse of any
army. Utterly unacquainted with the details of military life,
which are so essential to make things run smoothly, they get
them so tangled as to make their straightening out well nigh
an impossibility. This has occurred again and again in South
Africa. Dr. Conan Doyle, writing from the seat of w«ir, says
that the authorities have been vainly trying to meet the
necessities of over 200,000 men from the regular medical es¬
tablishment sufficient only for two Army Corps or less than
80,000 men. It is as much the duty of the War Office to
provide sufficient medical establishments for peace and war as
to organize sufficient transport or artillery. While we con¬
demn, as a rule, the employment of untrained civilian doctors
in a military capacity, it is but right to'admit that, had it not
been for them, the medical arrangements of the present cam¬
paign would have collapsed long ago.

COLLEGE OF PHYSICIANS AND SURGEONS,
PROVINCE OF QUEBEC.

The half-yearly meeting of this College held in the early
part of this month was perhaps the most remarkable of which
the history of the College has any record. The work of the
Credential Committee doubtless hid this fact from the knowl¬
edge of the governors, and thus certainly saved a great deal
of useless discussion. This Committee for a day of three
sessions and a day of one session held a reception, when,
figuratively speaking, the blind, the lame and the distressed,
came before them and pleaded that either the Pinault

322

EDITORIAL.

amendment of 1898 or the Roy amendment of 1900 applied
to their particular case. As a general rule, it was very often
hard to say that they did not, and as a consequence the
Committee felt that a general amnesty all round was in order,
and acted accordingly. Any one with a ghost of a show
was not turned away empty handed. Those who did not
have this show were honest enough not to complain. They
admitted that they were the most irregular of the irregulars,
and left determined to improve matters before the meeting
at Quebec in September.

It has already been a mystery to us how many irregu¬
lars—that is irregular in their manner of entering the pro¬
fession—have for years appeared before this Licensing Board.
It can only be accounted for by the fact that the Creden¬
tial Committee has almost every year—certainly every three
years—altered its decision in previously similar cases. As a
consequence, no officer of the College felt justified in saying
what action this Committee would take in any case present¬
ed to it. This fact becoming known, possibly justified
students in hoping that when their turn came the action of
the Credential Committee might be in their favor. The plea
so often set up in the past and even to-day that such and
such rules were unknown to them, is absurd. If unknown it
is because they do not take the trouble to learn what it was
their duty to know.

The present Credential Committee is suffering to a large
extent from the faults of its predecessors, whose decisions
we have no hesitation in saying were often absurd and irk¬
some. The consequence is that, in the Legislature of the
Province, the College has lost many friends, and the students
found not a few. The situation is in our opinion somewhat
critical. If care is not taken, the College may be deprived
of many of the safeguards which it is necessary it should
possess, and which have largely elevated the profession. But
there is no need to be oppressive. We think the preliminary
examination of the Board is perhaps too apt to be consi¬
dered as a means of keeping men out of the profession than
of permitting them to enter it. If not, then but one conclu-

EDITORIAL.

323

sion can be arrived at, viz : that it is not on a line with the
ordinary education given at the numerous educational insti¬
tutions of the province. In this way only can the really
enormous proportion of rejections be accounted for.

As a matter of fact, the large proportion of rejections
at this preliminary examination attracted the attention of
the writer some fifteen years ago, when he was one of the
secretaries of the College. They seemed to him to be beyond
all reason and common sense. As a result of this convic"
tion he succeeded in getting a meeting in Montreal of the
heads of nearly all the Roman Catholic and large Protestant
teaching institutions of the province. It was held in the
rooms of the Medico-Chirurgical Society of Montreal. The
attendance was large, the situation was freely discussed, and
the conclusion come to was, that not a single institution in the
province gave an education which fitted for presentation for
this examination.

If such a conclusion was correct, it was the legitimate
outcome of that meeting, that either the education should be
altered or the examination brought on a line with that given.
But neither has been done, and the result is that the whole¬
sale rejections go on. This is not fair; it is not just, and we
appeal once more through this journal for a re examination
of this matter by the present Board, which we believe is com¬
posed of men who desire to act in the best interests of the
profession.

At the request of the editors of the Journal of Laryn¬
gology, Rhinology and Otology, published in London, we
reproduce the following extract from their April issue :

“ An Appendix to the ‘ International Directory of
Laryngologists and Otologists,’ compiled by Mr. Richard
Lake, is in course of preparation. In it will be found cor¬
rections of names and addresses already given, an additional
list of names and addresses received since publication and
an obituary list.

“. . . . Considerable additions have been obtained

for the foreign list, which will materially add to its value and
completeness. The decision of the Editors of the Journal of
La'yngology, Rhinology aud Otology, under whose auspices

324

EDITORIAL.

the Directory is published, to allow no name to be inserted
in the British list for wh : ch sanction has not been given in
writing, at once explains some omissions and criticisms. The
editors, whilst desirous of making the Directory as complete
as possible, consider it best to adhere to this course. It is
therefore hoped that all engaged in the practice of Laryn¬
gology, Rhinology and Otology will assist as far as possible
in making this useful work complete," by sending in their
names and addresses to the Editor, “ International Directory
of Laryngologists and Otologists,’ 129 Shaftesbury Avenue,
VV. C.

UNIVERSITY OF BISHOP’S COLLEGE.

FACULTY OF MEDICINE.

We have received the calendar for 1900 1901 of the
above College. It is growing with age, and in bulk is very
voluminous compared with the modest pamphlet which an¬
nounced the birth of this Faculty thirty years ago. A glance
through its contents proves that Bishop’s College is well
equipped in every way for its work, and that all who select
it for their Alma Mater will not regret their choice. In Mid¬
wifery and Gynecology this school is especially strong, and
these two branches have much to do with success in the
profession. Its graduates are to be -found in every quarter
of the world, and occupying a leading position wherever
placed. The Annual Calendar can be had by applying to
either Dr. Ross, Registrar; Dr. Fish, A-st. Registrar.

PAN AMERICAN EXPOSITION 1901
AT BUFFALO, N. Y.

Dr. A. L. Benedict, of Buffa'o, who has been appointed
superintendent of the Ethnological and Archaeological de¬
partments of this exposition, writes us as follows :

“ Many members of the medical profession are interest¬
ed in the study of Amer can ethnology and archaeology, and
not a few have valuable collections of Indian relics and
skeletons from Indian graves. Those not directly interested
in this study are so circumstanced as to be aware of the
hobbies of their neighbors and could doubtless furnish the
address of collectors. I should be greatly obliged for in-

EDITORIAL.

/

325

formation and for the loan of collections for the use of this
department of the exposition. Exhibits which represent
study in some special line of American Ethnology and
Archaeology will be particularly suitable.”

CANADIAN MEDICAL ASSOCIATION.

The attention of the Profession in the various Pro¬
vinces is called to the Annual Meeting of the Canadian
Medical Asseciation at Ottawa, September 12th, 13th and
14th, 19:0.' The pre’iminary programme is now being

arraged for. Members intending to present papers are re¬
quested to send in their names and the titles of the papers.
Mr. Edwin Owens, of London, England, will deliver the
address in Surgery. The attendance, it is believed, will
be large. Ottawa is a very central point, and the secretary
promises a very interesting meeting. Within the last few
years the attendance at the meetings of this association
has been steadily increasing; we hope this year will not
show any change in this respect.

The undersigned will be glad to give information regard¬
ing the meeting : A. R. Marsolais, M.D., 159 St. Denis st.,
Montreal (Vice-President) ; J. Alex. Hutchison, M.D., 70
Mackay st., Montreal (Secretary); F. N. C. Starr, M.D.,
471 College st., Toronto (General Secretary).

The Journal of Surgical Technology is the title of
a new periodical, to be published monthly, beginning July I,
1900. It will be devoted to the consideration of the tech¬
nic of surgical procedures, at a subscription price of $1.00 a
year. Valuable premiums are offered with the first subscrip¬
tions. Address the Technique Publishing Co., 404 East
14th St , New York City, N. Y., for sample copy.

326

PERSONAL.

PERSONAL.

Dr. F. J. Shepherd, of Montreal, has been elected President of
the American Dermatological Association, which will hold its next
meeting at Chicago (p June, 1901.

The following Montreal medical men left for Europe the eirly
part of July: Sir William Hingston, Dr. T. G.. Roddick and Dr
E. P. Lachapelle.

Dr. Birkett has been appointed Major of the Bearer Company,
just raised in Montreal. His two Lieutenants are Dr. Kenneth
Cameron and Dr. Wylde.

Dr. Harry Bell has temporarily assumed the position of Sur¬
geon on the well-known Allan liner “ Parisian.”

Dr. Weir Mitchell, of Philadelphia, was in Montreal for a day
early in June, on his way to his silmm fishing ground 01 the “ Cas-
capedia.”

Dr. Fraser (M. D., McGill, 1897) has assumed the duties of
resident physician at the Laurentian Sanatorium, St. Agathe, Que.

Dr. Otis, of New York, died recently at New Orleans. He
gave up practice some years ago, on account of failing health.
Among the medical men of New York he occupied a prominent
position as a specialist on Genito-Urinary Surgery. He was one of
the early members of the Restigouche Salmon Club at Metapedia,
Que., and was an enthusiastic angler.

Dr. Lopez (M.D. Bishop’s College, 1900) sailed in June for
Edinburgh, where he proposes to take out the triple qualification.

Dr. N. C. Smillie (VI. D. Bishop’s, 1882) left early this
month, for British Columbia to look after some mines in which lie
is interested.

Book Reviews.

Normal Histology. By Edward K. Dunham, Ph.B., M. D.,
Professor of General Pathology, Bacteriology, and Hygiene, in
the University and Bellevue Hospital Medical College, New
York. Second Edition. Illustrated with 244 engravings.
Lea Bros. & Co., New York and Philadelphia, 1900.

There being many excellent text books of Histology which
already meet the requirements of students of the subject, a new
work on Histology, in order to be successful, must recommend
itself by its thoroughly practical tone, its clearness of language and
its modern treatment of the science. Now, the chief merit of Dr.
Dunham’s work lies in the brevity and clearness of its descriptive
text, enriched by a wealth of carefully selected drawings, and in the

BOOK REVIEWS. 327

simplicity of the methods for preparing specimens for microscopical
study.

The work consists of two parts. Part I. is devoted tn an
account of the structure of the cell, the elementary tissues, and the
organs of the body. Part II. deals with histological methods.

Dental students will be disappointed with the author’s too
brief description of the structure of the teeth, but they must remem¬
ber that a detailed account of every tissue and organ does not fall
within the scope of an elementary text-book. The account of the
structure of the nervous system is well abreast of the teachings of
Golgi, Cajal and others, who by their investigations have effected
an entire reconstruction of our conceptions of the minute structure
of the central nervous system. We take pleasure in recommending
this work to the student as a serviceable guide, designed to supple¬
ment the knowledge acquired from his laboratory experience.

A. B.

Surgical Pathology and Therapeutics. By John Col¬
lins Warren, M.D., LL.D., Professor of Surgery in Harvard
University; Surgeon to the Massachusetts General Hospital.
Illustrated. Second edition, with appendix, containing an
enumeration of the scientific aids to surgical diagnosis, together
with a series of sections on regional bacteriology. Philadel¬
phia; W. B. Saundeis, 925 Walnut St. 1900. Price, cloth,
$5.00 net; sheep or half Morocco, $6.00 net. Canadian
Agents, J. A. Carveth & Co., Toronto, Ont.

This volume on Surgical Pathology is assuredly a most valu¬
able contribution to medical and surgical literature. It is the second
edition (the first edition appeared about five years ago) of this im¬
portant work, containing in addition an appendix of sixty five
pages. The work is a decided improvement on the first edition.
The scientific portion of a surgical education was formerly regard¬
ed as something apart and ornamental, but it has now become an
eminently practical feature of the students’ curriculum. No young
practitioner can be regarded as thoroughly equipped for surgical
work who is not both a good pathologist and an expert bacteriolo¬
gist. An attempt is therefore made in this book to associate patho¬
logical conditions as closely as possible with the symptoms and treat¬
ment of surgical diseases, and to impress upon the student the value
of these lines of study as a firm foundation for good clinical work.
In the second edition the author states that the attempt has been
made to embody all the important changes in a new appendix,
which replaces the old one and the chapter on Antiseptic Surgery.
In this new chapter the author has aimed to present in as practical a
manner as possible the resources of surgical pathology. In addition
to an enumeration of the scientific aids to surgical diagnosis, there is
given a series of sections on what may be termed regional bacteri¬
ology, in which are given a description of not only the flera of the
part affected, but also the general principles of treating the affec¬
tions which they produce, based upon the latest views of the best
authorities. The work is written in an easy and yet masterful man¬
ner, and as it deals with a subject of the greatest interest and im-
p ortance to the rising surgeon (who should endeavor to keep
abreast of the times) few medical or surgical men can afford to be

3^8

BOOK REVIEWS.

without this valuable work. The chapter on bacteriology, which
is n- w so important, is deeply interesting, also that dealing with
tuberculosis. In fact, the book from the beginning to the end is so
written that one’s interest never slackens, nor is its perusal at all
wearisome, considering the highly scientific character of the work.
One has only to read to fully appreciate the high merit of the book.
The general get*up of the volume is up to the usual high standard
of the publishers. R. C.

Post Mortem Examinations, Methods and Tech¬
nique. By John Caven, B.A., M.D., Toronto; L.R.C.P.,
London. Illustrated. J A. Carveth & Co., Toronto, Ont.

This work is a small handbook for the use of students, dealing
with the usual method of making post-mortem examinations,
whether for scientific investigation or for medico-legal purposes.
Such instructions are found in most works on legal medicine, more
ofien detailed and valuable. This volume, in addit on. has a chapter
on the preservation of tissues, and in the early part of the book a list
of an ouifii for bacteriological use. With regard to the letter press,
the instructions are given with clearness and show a practical
knowledge of the subject. We would, however, criticize the method
of opening the right side of the heart. In order to expose a’l the
valves of the pulmonary artery in their entirety, a section close to the
interventricular septum, and not “ half an inch *' to the right, is the
one usually adopted, this section to be continued round the apex of
the heart to a point midway between the orifices of the venae cavae.
This will show the tricuspid valves also entire.

The illustrations of the work are semi-diagrammatic, and not
very accurate, a fault easily rectified in a future edition by c >pies
of the excelkntcutsin Quain’sor Morris* Anatomy. Illustrations for
Students to be useful must be accurate even if semi diagrammatic,
and these pictures of the brain and heart are crude and misleading.
The one of the convolutions of the brain is exceptionally poor.
When students see such imperfections issued by their teachers,
they are inclined to quote “Quis custodiet ipsos custodes.’*

As before stated, instructions as givjn in the book under review
are found in all the most important works on legal medicine, ani
we very much doubt the utility of a special work of this kind un¬
less accompanied by a series of illustrative cases, comprehending
most of the forms of natural death, and selected for other specific
lessons. These would show how the procedure necessarily differs
in each case submitted to the expert pathologist or medical jurist.

The details of pathology, as of anatomy, students must learn,
but the application of a knowledge of the one as of the other is
best taught by instruction on selected individual conditions; to
recognize the abnormal from the normal, and howto proceed in
each case under observation.

It is only, as we hold, by a careful description and record of
illustrative cases that works of this kind can be made complete and
acceptable.

It would be well to study th? procedure indicated, by the dis¬
tinguished pathologist Virchow, in his admirable manual on post¬
mortem examinations. C. H.

BOOK REVIEWS.

329

Diseases Of the Eye. By Edward Nettleship, F. R. C. S.;
Ophthalmic Surgeon at St. Thomas Hospital, London ; Sur¬
geon to the Royal London (Moorfields) Ophthalmic Hospital.
Revised and edited by Wm. Campbell Posey, A. B., M D.,
Ophthalmic Surgeon to the Howard and Epileptic Hospitals,
Philadelphia ; Assistant-Surgeon Hills* Eye Hospital; Fellow
of the College of Physicians of Philadelphia ; Associate Mem¬
ber of the American Ophthalmological Society, etc. Sixth
American frcm the Sixth English Edition. With a supplement
on Examinations for Color-Blindness and Acuity of Vision and
Hearing, by William Thomson, M. D., Emeritus Professor of
Ophthalmology in the Jefferson Medical College of Philadel¬
phia. With 5 colored plates and 19a engravings. Lea Bros.-
& Co., Philadelphia and New York. 1900.

Mr. Nettleship’s book has been so frequently reviewed that
further comment on it is unnecessary. The fact that a sixth Ameri¬
can edition is called for shows that Nettlcship's “ Diseases of the
Eye ” is a standard text-book in America as well as in Great Britain.
The editor has done his work well, and has added much useful
information, especially in the way of treatment.

G. W. M.

Progressive Medicine, Vol. II, 1900 . A Quarterly Digest
of Advances, Discoveries and Improvements in the Medical
and Surgical Sciences. Edited by Hobart Amory Hare, M.D.,
Professor of Therapeutics and Materia-Medica in Jefferson
Medical College of Philadelphia, Octavo, handsomely bound
in cloth, 401 pages, with 8t engravings. Lea Brothers & Co.,
Philadelphia and New York. Issued quarterly. Price, $10 00
per year.

An examination of this, the second volume of the 1900 series
of Progressive Midicine , reveals the very practical lines which have
been folk wed ty its contributors.

Dr. Coley, in his article on •• Surgery of the Abdomen, Includ¬
ing Hernia,” treats of one of the newest and most interesting phases
of modern surgical practice, namely, operations upon the stomach.
With admirable detail, this able authority describes the diagnostic
symptoms, the methods of operating, treatment and the manage¬
ment of convalescence.

1 he ever-important subject of appendicitis is next considered
from a practical standpoint, the merits of a newer method of operat¬
ing being carefully investigated. Bassini’s operation in Hernia is
described in practical detail, and operations upon the intestines,
colon and liver are exhaustively considered in the aspects of opera¬
tion and results. Abdominal tumors and the methods for their
diagnosis, come next, and this is followed by a most interesting
comideration of the use of the X-ray in detecting abdominal calculi.
The illustrations given in this section, as in fact is the case through¬
out the volume, are most helpful.

Dr. John G. Claik gives an admirable r£sum6 of the progress
made in Gynecology during the past year. The various topics

330

BOOK REVIEWS.

discussed are too numerous for spechl mention, but the sections on
“ The Treatment of Pelvic Peritonitis,” “The Treatment of In¬
flammatory Pelvic Exudates,” “ Ultimate Results in Treatment of
Retroversions,” etc., are especially interesting.

Dr. Stengel covers a list of diseases, from which arise a large
proportion of human ills, following the preliminary pages in which
the diagnostic value of the varying conditions of the blood is dealt
with. Such pathological conditions as anemia, chlorosis, leukemia,
etc., are practically considered. The diseases due to metabolism
logically follow, and as the subject matter is treated in great detail.
Dr. Stengel's section must prove of great practical value to the
physician.

In treating of his specialty, Dr. Jackson has aimed to supply
the requirements of the general practitioner rather than those of the
specialist in Ophthalmology. He has endeavored to so equip the
practitioner with the most recent knowledge in this branch of medi¬
cine as to enable him to successfully treat the majority of cases
which may come before him. In fact, this entire volume is full of
practical information to an extent which has rarely been equalled in
a single book. The aim of the editors and contributors to produce
in narrative form the record of the year's events has been ably car¬
ried out. Each succeeding volume of this series emphasizes the
degree to which this original and ingenious plan has been perfected,
and the necessity for increasing the large editions with each succeed¬
ing volume attests the growing popularity of the work. F. W. C.

A Dictionary of Medicine and the Allied Sciences,
comprising the pronunciation, derivation and full explanation
of Medical, Pharmaceutical, Dental and Veterinary terms,
together with much collateral descriptive matter, numerous
tables, etc., by Alexander Duane, Assistant Surgeon to the
New York Ophthalmic and Aural Institute ; Review of Medi¬
cal Terms, for Webster’s International Dictionary. Third
edition. Enlarged and thoroughly revised, with eight full page
colored plates. Lea Brothers & Co., Philadelphia and New
York. 1900.

Within the last few years a complete dictionary of medical
terms has become an absolute necessity in the library of every read¬
ing physician. Such a work to be of value must be an up-to-date
one, so numerous has been the additions to our medical vocabulary.
It has evidently been the aim of the author to give sufficient infor¬
mation concerning every word that is likely to be met with in the
course: of professional realing. So numerous, however, is our
vocabulary to-day that space for the insertion of all useful terms
has only been secured by the omission of words that have practi¬
cally become obsolete. Practical utility rather than historical tradi¬
tion has controlled the selection of matter ; hence, words are
omitted which to-day are only found in dictionaries. The space
thus gained has been used for the insertion of much descriptive and
explanatory matter, which would be very inadequately represented
by mere definition, no matter however full. Thus under the prin¬
cipal diseases a sketch is given of their causation, symptom, and

BOOK REVIEWS.

331

treatment; under the more important organs, an outline of their
structure and functions ; under each drug, an account of its action
and therapeutic uses, and of all the preparations of it offi:ia! in the
latest editions of the pharmacopoeias of the United S.ates, Great
Britain (1898) and Germany. The important physiological func¬
tions and generic biological and chemical terras receive similar
extended explanation. This being the third edition of this work, it
contains a vastamount of new material representing the great advances
made in all branches of medicine since th» previous edition was issu¬
ed. It has also been revised in every part, and beyond all question is
the very latest and b:st of its kin I. Tne d ratal and veterinary
term; have-been supplied by experts in these departments of medi¬
cal science. To fasten in the memory a vivid and enduring recol¬
lection of the meaning of words, no aid is equal to that furnished
by derivation. Special care has therefore been taken to state and
defi le the original words from which medical terms are derived, To
render this feature of the work available for those unfamiliar with
Greek, all such derivations are given in ordinary type. Vowels
long by nature have been appropriately marked, owing to the im
portant influence of natural quantity in determining the pronuncia¬
tion of a word and the form of its derivatives. As the essence of a
dictionary lies in its definitions, no pains hive been spired to make
the explanation of each word clear and sufficent. Where words
have several distinct meanings, clearness his been promoted by the
use of numerals to emphasize the distinction.

The colored plates appear for the first time in this edition, and
have been selected with a view to their practical utility, as illustrat¬
ing subjects which are of importance and general interest, but
which are not portrayed in the ordinary text-book.

The publisher his done his part more than well. The typo¬
graphy is compact, but pleasing. It is truly marvellous what an
amount of matter each page is made to contain.

F. W. C.

A Handbook for Nurses —By J. H. Watson, M.D., Edin.
Late House Surgeon, Essex and Colchester Hospital; As¬
sistant House Surgeon, Sheffield Royal Infirmary and
Sheffield Royal Hospital. American Edition under the Super¬
vision of A. A. Stevens, A.M., M.D., Professor of Pathology
in the Women’s Medical College of Pennsylvania; Lecturer
on Physical Diagnosis in the University of Pennsylvania;
Physician to St Agnes’ Hospital, Philadelphia. Published
by W. B. Saunders, 925 Walnut Street, Philadelphia, 1900.
Can be obtained in Canada from J. A. Carveth & Co., 413
Parliament street, Toronto.

Although there are many works on nursing, the majority fail
either to contain sufficient information or contain too much tech¬
nical knowledge for the average nurse. In this work the author
has, we think, written a most valuable work for nurses. Th^re is
a great deal of information on almost everything that a nurse
shou’d know. A little knowledge is a dangerous thing, and never

332

BOOK REVIEWS.

more so than in a nurse. A well trained, well educated nurse will
never attempt to usurp the role of a medical man, but will be as
his right hand, whereas an ill-educated one is apt to do so and
so bring discredit on her nursing sister and sore trouble to the
doctor. We can most heartily recommend this work, and would
like to see a copy of it in the possession of every one engaged in
nursing in this country.

PUBLISHERS DEPARTMENT,

LITERARY NOTES.

Two of the freshest and most important of recent articles on China, namely,
Mr. Gundry’s acocunt of i€ The Last Palace Intrigue at Peking,” and Mr. Dou¬
glas’s hopeful view of 44 The Intellectual Awakening of China 99 will be found in
The Living Age. Mr. Gundry’s article in the number for July 7 and Mr. Dou¬
glas’s in the number for July 21.

One of the most delightful of recent contributions to natural history, popu¬
larly treated, is Mr. Mathias Dunn’s study of “Mimicry and Other Habits of
Crabs” in 1 he Living Age for July 7. It is marked by close and sympathetic
observation and contains curious facts which will be new to most readers.

One crisis at a time is all that most people have leisure to consider, and the
very grave crisis in China may distract aittntion from “ The Coming Afghan
Crisis” which Mr. Demetiius C. Boulger considers in an article reprinted from
The Fortnightly Review in 7 he Living Age for July 14 Nevertheless, the facts
which Mr. Boulger presents are interesting, and, to the English reader, must be
somewhat startling.

The last number of The Quarterly Review contained an innovation in the
shape of an article writttn in French by Mr. Ferdinand Bruneti&re, and not
translated. Mr. Bruneti&re undertook to g ve his English friends and readers
some idea of the present French feeling toward England and the reasons for it.
The Living Age presents the article in an admirable translation, and makes it
its leading article in the number for June 30.

u Imperialism ” is so much under discussion in the United States at the pre¬
sent time that the Scottish Review’s article on “The Literary Inspiration of Im¬
perialism,” which The Living Age prints in its number for June 30, is particu¬
larly timely.

CANADA

MEDICAL RECORD

AUGUST . 1900

Original Communications.

SHALL WE TELL WOMEN WITH UTERINE
CANCER THE NATURE OF THEIR DISEASE?

By A. LAPTHOBN SMITH, B.A., M.D., M.RC.S., England.

Professor Clinical Gynecology in Blahop's College, Montreal.

No more unpleasant task perhaps ever falls to the lot of
the tender-hearted physician, and I think the majority of
physicians are tender-hearted, than to have to tell a patient
that she is suffering from malignant disease. Some deliber¬
ately shirk this unpleasant duty on principle, believing that
we are not called upon to tell her the truth in these circum¬
stances ; while others avoid it from expediency because they
dislike to cause pain, or because they think that it pays better
to say something pleasant which will cheer up the discon¬
solate one for the time and leave a temporary agreeable im¬
pression on her mind. In the course of a newspaper inter¬
view with a great London surgeon, whose name is known all
over the world, while speaking of tact as an element of
success, he says that the successful physician will not tell a
woman that she is suffering from cancer; and one of our
greatest Canadian physicians evidently holds the same views,
as in consultation over their cases he invariably tells the
patient that they will be better soon. As some of these
patients were dead two or three weeks later his prognosis
was correct in a sense, but not in the one in which the
patient would be supposed to take it. The view taken by
these two great men, and by many others in the profession,
is equally held by a great many of the laity, as seems certain
by the number of people who have asked me to tell them

334

SMITH : SHALL WE TELL WOMEN WITH

truly what was the matter with their sick friend, but on no
account to let the sick one herself know the nature of her
malady. Not only do the friends almost invariably take this
course, but, strange to say, I have known the patient herself
beg that I would not tell her the truth.

Notwithstanding all this, I venture to differ from these
doctors, from the patients and their friends, and I wish to enter
a firm protest against any other course being adopted than to
tell the truth every time; and I think I can show that this is
our duty for many reasons. For those (and I hope they
are few) who require any other argument than duty, I think
that I can prove that it does not pay to deceive a patient
even under the mistaken idea that good may come of it.

I am not saying anything about telling the friends what
is the matter; for when they have brought me a patient and
mysteriously called me to one side to whisper that I could
tell them, but not to tell the patient, I have often said
to them, “ the patient is the only one who has any right to
know; what is the matter with her and what she tells me are
alike profound secrets; I will tell her and she can tell you if
she likes ; but I will not tell any one else."

Is it right to tell the truth ? At first sight I will admit
that it appears more humane not to tell a woman that she
has cancer of the womb, but in reality this course is most
cruel; for, in each of the three stages into which I will
divide the progress of the disease, the woman has an
immense stake at risk ; she has everything to lose and
nothing to gain by being kept in ignorance of her actual con¬
dition, and she has a right to know it whether she wants to
or not, from the moment the physician knows it himself. In
the first stage of cancer of the womb the disease is absolutely
local; that is to say it occupies a small spot on the angle of
a laceration or is limited to the endometrium. During this
stage the disease is positively and entirely curable by the re¬
moval of the womb. Vaginal hysterectomy for cancer in this
stage by a good operator has at the present time a death rate
of two or three per cent, at the very most. Alas, it is bad
enough to think that so few cases are even diagnosed at this
stage, without wishing that the few which are diagnosed

CANCER THE NATURE OF THEIR DISEASE ?

335

should be deceived into a fool’s paradise, while their physi¬
cian, whom they trust to save them when they could be saved,
quietly stands by and with the friends becomes a conspirator
to hide their danger from them, until it is too late to escape
it. How can she hold out her hand for help if she does not
know that she is in danger. I for one decline to place such
a responsibility upon my conscience or to become a plotter
against her life, as I would be if I knowingly and willfully
concealed from her the one fact that she had cancer of the
womb, and the other that vaginal hysterectomy would save
her. I shall never forget the remorse of a medical friend who
brought me a patient with a large cancer of the uterus with
the broad ligaments infiltrated with the disease which he had
been treating with caustics for six months, and which was
then too far advanced to permit of hysterectomy ; looking me
straight in the eyes he asked me whether, if he had brought
her when he first discovered it, I could have saved her, and I
was obliged to answer that I believed I could have done so.
He only replied, “I will never forgive myself,” and from the
tone in which he said it I believed him. And yet he only
lost her life through unintentional ignorance of her true con¬
dition and not through willful deceit, and he was not therefore
anything like so much to blame.

In what I call the second stage the cervix is invaded, the
broad ligaments are full of cancerous tissue and the lymphatics
are infiltrated with it. The patient is alternately being drained
of her life blood by irregular hemorrhages, which she attii-
butes to the change of life, and poisoned by the absorption
of decomposing and gangrenous material, which keep her in a
burning fever. Her presence, moreover, is made loathsome
to her friends by reason of the foul smelling discharge. And
yet she does not know that she is a hopeless case of cancer of
the womb. Why tell her ? Because we can prolong her life,
diminish her suffering, and not only thus make her life en¬
durable to herself but render her unoffensive to her family by
a thorough use of the curette and cautery. Under an
anesthetic we can do all this without any danger or causing
any pain, and in a few days she will feel so well that she
almost doubts the accuracy of the diagnosis which she has to

33 6 SMITH : SHALL WE TELL WOMEN WlTH

thank for her improved condition. I have had, unfortunately,
too many of these cases and too few of those in the first
stage, but I have had the pleasure of seeing apparently dying
woman almost at once become comparatively Well. In a few
cases I have curetted them a second time at the end of three
months more, but as a rule the one curetting has sufficed >
and they have died peacefully and painlessly from cancer of
the liver from six to nine months later, surrounded by their
friends to whom they were no longer an object of disgust.
Now, how can they avail themselves of this merciful treat¬
ment unless they know the necessity for it ? It is more than
we can expect, and certainly more than we often find, a
women willing to submit to an operation without knowing
the nature of the operation and why it is to be done. If their
condition is made known to them they readily consent to
have it performed.

In the third stage, where the whole pelvis is filled with
a cancerous mass and the bladder and rectum involved, and
nothing is to be done except to make death painless, whaj
should be our answer to the woman who asks us what is the
nature of her disease, and whether we can cure her. I have
had such patients ask me if they could be quite cured in a
month, when as events turned out they were fated to be dead
and buried in less than that time. Shall we follow the golden
rule and do to this poor woman as we would be done by if
our positions were reversed ? And would we not wish to
know the truth so that we might prepare for death ?

At the beginning of this article I said that duty should
be our first consideration, and I hope I have shown thit it is
our duty in this case, as in all cases, to tell the honest
truth. But even from the infinitely lower standpoint of ex¬
pediency, I hope to show that it pays to tell the truth.

When we hear a friend lying from kindness or ex¬
pediency, does our opinion of that friend go up or down ?
When we have heard him telling a woman with cancer that
she will be all right soon, and telling us five minutes later
outside the house that he believes she will be dead in a week,
and when we have heard him saying the same two opposite
things in twenty other case®, will our faith in his word be as

CANCER THE NATURE OF THEIR DISEASE?

337

implicit as it would be if we had heard him on every occasion
telling the truth, the whole truth, and nothing but the truth ?
If we weakly comply with the request of the friends and lie
to a patient, what will these same friends think of our truth¬
fulness when it is their turn to consult us ? Even if we told
them the truth, would they believe us ? Certainly not, if they
knew that we had lied to others in the same circumstances.

We see the effect of this mistaken policy almost every
day in patients who have been under several doctors. When
we go to examine them they ask us if we will hurt them ; if
we say “ no,” they exclaim, “ I know you will.” If we are going
to hurt them it is better to tell them so before hand, and they
will bear it quite bravely. It is only after the second or third
visit that we will succeed in winning their confidence by tell¬
ing them the truth every time ; and then when we pick up the
speculum they no longer jump up saying, “ Is that a knife you
have in your hand ? ” By showing them each instrument and
explaining what we are going to do, they will no longer fea
or doubt us. And this is how it pays to tell the truth ;
little by little you will build up a circle of friends who will
tell their friends that they can depend upon what Dr. so-and-
so tells them, and the staunchest friend of all will be the poor
dyinr woman whom you have given a chance to prepare for
death. Next to her will be the woman who has been
curetted and made comfortable and endurable to her friends ;
and last but not least the woman will thank you for the
truthfulness to which she owes her life, and by which she
has been saved from a painful and loathsome death.

Not only does the reputation of, and faith in, the indi¬
vidual physician increase in proportion as his word can be
trusted implicitly, but the faith of the public in the profession
as a whole would be still greater if even in these distressing
cases, no matter how good and kind the motive may be, our
invariable rule with every one of us would be to leave noth¬
ing undone to make an early and accurate diagnosis, and
once that has been done, not to lose a single hour in hav¬
ing the proper treatment carried out.

248 Bishop Street.

33«

ROSS : QUARTERLY RETROSPECT.

QUARTERLY RETROSPECT.

(Department kor Diseases ok Throat and Nose.)

UNDE ft THE CHARGE OF

GEO. T. ROSS, M.D., Laryngologist to the Wee tern Hospital,

Professor of Laryngology and Rhinology, Faculty of Medicine,

University of Bishop’s College, Montreal.

Atrophic Rhinitis .—This almost incurable disease was the
subject of a very exhaustive discussion at N. Y. Academy of
Medicine in March last, when a symposium was given by
various American physicians. The etiology of the disease is
not yet satisfactorily solved, as is evident when various
authors endeavor to support as many theories as were brought
forward on the occasion referred to. Bosworth has for the
past twenty years maintained that the disease is a develop¬
ment from the purulent rhinitis of childhood, and as far as
my own experience goes I have found in many cases, upon
strict enquiry, that this theory is well supported by evidence.

The declaration of Jonathan Hutchison, that inherited
syphilis was an etiological factor in every case of atrophic
rhinitis, was shown by Wright to be ill founded, while it
was admitted that, although many cases have a syphilitic
basis, yet all of them have not. Gerber*s cases were quoted
to show that both syphilis and rachitis were frequently im¬
portant factors.

The importance of recognising functional collapse of the
nasal tissues from atrophic rhinitis was shown by Clarence
Rice. Some of the points of difference are as follows:—
Functional collapse is not often seen before young adult life,
when the effects of combined malnutrition begin to be notice-.
able, while atrophic rhinitis may often be seen in children at
the age of ten. Collapse without atrophy is seen in the
poorer classes, or at least with people living in bad hygienic
state, and true atrophy in people of any class. Anemia and
debility seen in collapse is not necessarily seen in atrophic
rhinitis. In the simple dry nose of anemia we find a mucous
membrane all shades of palor such as we would expect, but
smooth, pressed down tightly on the turbinals which retain
their contour, while in atrophic rhinitis, if the patient is well

ROSS: QUARTERLY RETROSPECT.

339

nourished, any color from that of acute coryza to a dirty gray
is found. The surface is granular and the turbinals are more
or less destroyed by atrophy. There is also abundant muco-
pus and crusts in atrophic rhinitis, while in functional col¬
lapse almost no secretion is present. Authors generally think
that vascular collapse very rarely ends in atrophic rhinitis.
The diagnosis is important because the collapse is curable by
proper means, it being only of temporary character, while the
treatment of the atrophic disease is discouraging.

As to treatment of atrophic rhinitis, the two main indica¬
tions are local cleansing and stimulation. In children little
can be done because they will not as a rule submit to treat¬
ment. Alkaline solutions are best to use, and they should be
used both before and after a spray of peroxide of hydrogen.
Oils should be used sparingly. Menthol improves the quality
of secretion and lessens the quantity. The solution should
be as strong as the patient can endure, beginning with weak¬
er solutions. Formaldehyde is an ideal remedy for this
disease—one part to 5000, and weaker or stronger may be
sprayed after the saline spray. Borolyptol is a good form of
this drug, and can be diluted 10 to 15 times. Ichthyol in
the form of Keroline-Ichthyol 2 and 5 per cent, solutions is
advocated, and I can testify to its benefit. The antitoxine
treatment formerly advocated has been abandoned. As one-
fifth of the subjects of this disease are in ill health, some con¬
stitutional treatment is essential. Any existing dyscrasia
has to be specially regarded. Change of climate to suit any
defect in constitution is called for where it can be done. Iron,
arsenic, iodine, cod liver oil, is often needed, and even
inunction of oils has given good results. Mechanical means,
such as tampons, plugs and bougies, are often useful to stimu¬
late the shrunken glands to secretion. Curetting the diseased
membrane has been advocated and the various forms of elec¬
tricity often are useful. Vibratory massage is thought by
some to deserve a leading place amongst remedies, but this
demands prolonged applications, and most patients cannot
devote as much time as is required for good results. In this
connection prevention is dwelt upon as being worth every¬
thing, and the care of nasal diseases promptly when they

34 ° COLEY: TREATMENT OF INOPERABLE CANCER.

assert themselves, either in childhood or later, is the best
means of avoiding this disease.

Hypertrophied Turbinals. —Submucous linear cauteriz •
ation is advocated by Pierce as superseding all other methods
of reducing hypertrophied turbinals. The technique is simple
and the advantages claimed are—cheapness of outfit, re*
liability, simplicity, not terrifying to nervous people, painless
under cocaine, does not destroy mucous membrane, reaction
slight, and much less than follow electrical cautery.

Death after removing adenoids, due to hoemophilia —This
case, related by Dr. R. Sachs (Hamburg) died four days
after operation, all meanshaving failed to arrest the bleeding.
The operation was done before the family failing was ascer¬
tained, the bleeding tendency being easily traceable. The
importance of invariably asking before operation if any evi¬
dence of haemophilia has been at any time noticed is em¬
phasized.

Selected Articles.

TREATMENT OF INOPERABLE CANCER.

By WILLIAM B. COLEY, M. D., New York.

It is unnecessary to state here that however great were
differences of opinion as to the value of operations upon
cancerous tumors a quarter of a century ago, to-day we are
practically all agreed that early and complete removal by the
knife, while far from ideal in results, still furnishes the best
hope of permanent cure of all the methods with which we
are acquainted. This, it is needless to say, applies only to
opet able tumors, and here at once arises a difficulty in what
shall we regard as operable and what as inoperable. Certain
general rules may be laid down, but the classification of
doubtful cases will have to be left to the personal judgment
of the surgeon.

I believe that in recent years much harm has been done
by surgeons attempting impossible operations, or performing
operations upon patients in cases in which it was clearly
impossible to remove the entire tumor. Not infrequently

COLEY: TREATMENT OF INOPERABLE CANCER. 34 1

such operative interference greatly increases the rapidity of
the growth of the tumor, and moreover the high mortality
which often attends these operations has the unfortunate
effect of deterring others suffering from cancer from submit¬
ting to operation at a time when the chances for permanent
cure are great We have no right to perform an operation
that is attended with the gravest risk unless there is some
prospect of being able to save the patient or at least prolong
or render more comfortable his life. The fact that the pa¬
tient himself desires the operation and is willing to assume
the risk should have no influence in causing us to break
sound surgical principles.

In the brief limits of this paper it will be impossible
to speak in detail of all the various methods of treatment
employed in inoptrable cancer. When we consider the well-
established fact that cancer is rapidly increasing throughout
the world, and that in spite of the vast improvements in
results of operative treatment, three-fourths of all cases be¬
come inoperable, we see at once the importance of the
subject. If we cannot find any means to cure these pa¬
tients it behooves us to do all in our power to discover the
best methods of rendering the remainder of their lives en¬
durable.

Personally I have long believed the solution of this
problem of treatment to be so intimately connected with
that of the etiology of cancer that there is little hope of
accomplishing much with the former until the latter has
been determined.

Eight years ago, in a paper before the Academy of
Medicine, I expressed my firm belief that cancer was due to an
infection from some extraneous micro-organism. It seemed
to me then that the clinical and experimental evidence in
favor of this theory was even then sufficiently strong to justify
one in hoping that scientific proof would soon be forthcoming.

Th^se of us who had the privilege of listening to the
admirable and convincing papers of Drs. Park and Gaylord
at the last meeting of the Academy describing the recent ex¬
perimental researches of San Felice and Plimmer, as well as
their own, cannot but feel hopeful that the problem is near¬
ing a solution.

The present paper will permit only of a brief discussion
of the treatment of inoperable sarcoma.

THE TREATMENT OF INOPERABLE SARCOMA WITH THE
MIXED TOXINS OF ERYSIPELAS AND BACILLUS
PRODIGIOSUS.

The results of this methol during the past year have

342 COLEY: TREATMENT OF INOPERABLE CANCER.

given me no reason to change the conclusions already ex¬
pressed in earlier papers.

I still find that round-celled sarcoma is much less sus¬
ceptible to the inhibitory action of the toxins than spindle-
celled, and the melanotic is even less affected.

In regard to the method of preparing the toxins and the
technique of administration I have nothing new to add.
The preparation which I believe to be the best is the mixed
unfiltered toxins of erysipelas and bacillus prodigiosus
made from cultures grown together in the same bouillon
and sterilized by heating to 58° C. In children and persons
much reduced in strength it is safer to use the filtered toxins.
The preparation is much weaker; the relative strength of
the two being about I to IO. Toxins to be of value must be
made from very virulent cultures, the virulence being kept up
by frequently passing the cultures through rabbits. The pre¬
paration being bacteriologically sterile, it can be used with
perfect safety in a general hospital ward.

Dosage :—The dose depends largely upon the vascula¬
rity of the tumor and upon the condition of the patient,
and injections when possible should be made directly into the
tumor. The initial dose should seldom be more than one half
a minim diluted with boiled water, which should be gradually
increased until the reaction temperature reaches 102° or
103° F. After the dose has been increased to one minim
dilution is unnecessary. When the injections are given sub¬
cutaneously remote from the tumor, much larger doses may
be borne. Sometimes 12 or 15 minims may be given before
the chill is produced.

Aseptic precautions :—Inasmuch as the administration
of these as well as other toxins unquestionably increases the
liability to infection, if pathogenic germs are present in the
vicinity, great caution should be exercised in sterilizing the
hypodermic needle as well as the skin. If the tumor be ulcer¬
ated or broken down, great care should be taken to keep
the parts aseptic. Lack of such precautions has been the
cause of death in two fatal cases. In regard to the duration
of the treatment, fortunately we are able in most cases to
tell within three or four weeks whether or not the toxins are
likely to be beneficial. If no improvement is apparent at
the end of this time, it is seldom worth while to continue the
injections. In most of the successful cases marked improve¬
ment has occurred within a week after the first injections.
The growth may disappear in one of two ways. If very vas¬
cular there may be rapid breaking down and sloughing of the

COLEY: TREATMENT OF INOPERABLE .CANCER. 343

tumor, while fibrous elements predominate. Absorption
without breaking down is the more likely to occur.

If improvement occurs the toxins should be continued
until either the tumor has entirely disappeared or until it has
become evident that the injections have lost their controlling
influence, as evidenced by the further increase in size.

The question of harm resulting from long continued in¬
jections is a very important one. That the toxins may be
given for very long periods without injury to the patient has
already been proved. In one patient with a three times
recurrent rapidly growing carcinoma of the breast and axilla
the toxins were administered for two and a half years. The
doses were moderate and averaged two a week. The tumor
disappeared, the patient gained ten pounds in weight and her
general health remained good, until at the end of this time
there was both a local recurrence and abdominal metastasis,
the disease running a very rapid course and causing death in
six months.

In another patient with eight times recurrent spindle
celled sarcoma of the chest wall, the toxins were administered
with occasional intervals for nearly four years. The disease
was held in check by small doses. The patient, who was a
well known physician, is at present in perfect health, nearly
six years from the beginning of the treatment.

In order to properly explain the curative action of
streptococcus of erysipelas and its toxins upon sarcoma, I am
convinced more than ever that this action can be explained
only on the theory that sarcoma is of a micro-parasitic and
infectious or gin. I will even go further and say that I
believe this action of the toxins furnishes additional evidence
in support of the infectious origin of sarcoma and carcinoma.
In view of the steady accumulation of successful cases, the
early attempts to explain the disappeat 1 ice of these tumors,
upon the theory of mistaken diagnosis 01 spontaneous disap¬
pearance, no longer requires serious con-'deration. It would
be clearly unfair to rule out the cases cuied withtoxins on
the ground of error in diagnosis witho if including in the
same manner the cases cured by operation. Both classes of
cases have been submitted to the same standards of diag¬
nosis with one important exception, viz. that the cases
treated with toxins have been submitted to far more severe
tests. In the majority of these cases the clinical and micros¬
copical diagnosis was confirmed by a number of the best
surgeons and pathologists, instead of by a single individual.

After an experience of upwards of eight years with this
method of treatment, the question Jmay be fairly asked,

344 COLEY : TREATMENT OF INOPERABLE CANCER.

“ Has the method any permanent value, and if so, what are
its limitations and dangers?” The question can only be
answered by giving a careful resume of the final results in
the cases thus far-treated.

This I shall attempt to do as in as few words as possible.
Before doing this I sh mid like to briefly report a few unpub¬
lished cases.

RECENT UNREPORTED CASES OF SARCOMA TREATED WITH

TOXINES.

Case I. Recurrent Sarcoma of the Tibia ; Anputation
Advised. —F. W. F., male, age 27 ; unmarried ; was referred to
me on February 12, 1899, by Dr. J. M. Stewart, of Chesley,
Ontario. His family history was good and there was no
tuberculous or specific history. In July, 1898, a swelling
over the tibia of the left leg was noticed. It slowly increased
in size, and on November 25, 1898. it was operated upon by
Dr. Stewart, who made an incision down to the bone and
scraped out as much of the diseased tissue as possible. The
portion that was removed was sent to Dr. John Caven, Pro¬
fessor of Pathology at the University of Toronto, who, after
a careful examination, pronounced the growth a spindle-cell
sarcoma. The wound healed slowly, and a short time after¬
ward the disease returned locally.

Physical examination showed a tumor over the middle
and anterior portion of the left tibia about three by four
inches in size, projecting above the surrounding tissues to a
distance of y 2 to ^ of an inch. Over the central portion
there were two small ulcerated areas.

The patient was sent to the New York Cancer Hospital
and was put upon the mixed toxins of erysipelas and ba¬
cillus prodigiosus. Within two weeks there was decided
evidence of improvement, which continued slowly but steadily
until the end of three months, when the growth had entirely
disappeared. About a week after the injections had been
suspended, the patient became suddenly infected with erysi¬
pelas in the unhealed portion of the ulcerated area where the
tumor had sloughed out. The patient had a very severe
attack of erysipelas, and on his recovery returned to his
home in Canada. I personally examined him on the first
of September in Toronto, and there was absolutely no trace
of any return of the disease. I again heard from him in
April, 1900, and he stated that he was in perfect health and
engaged in his regular occupation as a farmer.

Case 2. Round-cell sarcoma of the nose and antrum—partial
success. —J. M., age 42, colored ; was referred to me by Dr.

COLEY: TREATMENT OF INOPERABLE CANCER.. 345

Win. T. Bull, December 29, 1898, with the following history :
One year before he noticed a filling up of the right nostril*
and was treated for some time by a throat and nose special¬
ist at one of the clinics, for a polypus. September 28th,
1898, he was operated upon at the New York Hospital, and
as much of the tumor as possible removed. It grew again
very rapidly after the operation, and when I first saw him it
had reached the size of half an egg. The cavity of the right
nostril was filled, there was marked bulging of the nose and
some bulging of the antrum. He had frequent and severe
hemorrhages. He was admitted to my service at the New
York Cancer Hospital, January 9, 1899, and the toxins were
given daily. Injections were made into the tumor and the
doses increased to the point of causing three or four severe
reactions a week followed by a temperature of 103° to 105°.
The tumor diminished very markedly in size, the hemorr¬
hages stopped, and portions of the tumor filling the nasal
cavity sloughed out. With a view of increasing chances of
success, a few weeks after the beginning of the treatment, 1
tied the right external carotid artery. The improvement con¬
tinued until the middle of March, when there was almo.t no
trace of the tumor remaining. The patient was sent home
for two weeks ; but during this interval the tumor began to
increase in size. Although he was readmitted to the hospital
and the treatment was resumed, we were never able to en¬
tirely control the disease. There was steadily although slow
increase in size, until the fall of 1899, when the tumor grew
with great rapidity, and the injections were stopped, fhe
increase of growth was far more rapid after the cessation of
the treatment, and he died not long afterward in another
hospital, from shock and hemorrhage following operation of
excision of the carotid aiteries.

Case 3. Recurrent sarcoma of the cheek, following trau¬
ma. —Mrs. L., aged 40 years, was referred to me by Dr. C. M.
Thomas of Spokane Falls, March 8th, 1:98, with the follow¬
ing history. The patient was in good health until June, 1897,
when she received a dIow from a fist upon her left cheek. A
swelling appeared at once at the site of the injury and never
entirely, disappeared. After a few weeks it began to grow
slowly, and seemed to be situated between the skin and the
mucous membrane. On February 4th, 1898, it had reached
the size of half a hen's egg, when it was removed by Dr.
Thomas.

The patient thinks it did not again recur until about
November, 1898 When I first saw her, March 8th, 1898,
physical examination showed a cicatrix extending from the
angle of the mouth on left side backward 2J^ inches.

3 |0 COLEV : TREATMENT OF INOPERABLE CANCER.

There was a hard tumor ^ an inch in thickness and
about 2x3 inches in area. The tumor was firm in con¬
sistence, and was situated between the skin and the mucous
membrane. The mouth could be opened only ^ of an inch,
and she had not been able to wear her false teeth for several
months.

Mixed toxins were begun at once at the New York
Cancer Hospital and continued for six weeks, at the end of
which time there was entire disappearance of the tumor. On
March 3rd, 1899, I performed a plastic operation to improve
the appearance of the mouth, because of the previous opera¬
tions. I removed most of the old scar. Careful micros¬
copic examination, made by Dr. Buxton, showed no evi¬
dence of sarcoma remaining. A few weeks later the patient
complained of stinging pains oft the site of the cicatrix, very
similar to those she had noticed previously when the disease
began to return, and there seemd to be a thickening in the
scar. Injections were begun for a time and the pain disap¬
peared. Shortly after this the patient returned to her home
in British Columbia, and I am unable to give the later his¬
tory.

There are other recent cases of interest that I could men¬
tion did the time permit It is true that sufficient time has
not elapsed in these particular cases to justily one in claiming
them as permanent cures, and they are not mentioned for
this purpose, but merely to furnish additional proof that the
mixed toxins have a specific action upon sarcoma. That this
action is permanent and curative in a large number of cases
is proved by a brief reference to my earlier cases already
reported. The later history of these cases is as follows ;

Case 1. Spindle-celled sarcoma of the neck and tonsil .—
Tumor entirely disappeared under injections of the living
bouillon cultures of erysipelas, producing an attack of erysi¬
pelas. Patient well six years later when last heard from.

Case 3. Spindle-celled sarcoma <f the abdomial walls and
pelvis. —M-xed toxins administered Jan. 3, 1*93. Tumor
entirely disappeared. Patient alive and well at present,
seven years later. This p; tient was exhibited before the
Academy of Medicine, Mr rch 1, 1900.

Case 4. Spindle-celled sarcoma of the abdominal walls .—
Pronounced inoperable by Dr. M. II. Richardson of Boston.
Microscopical examination by Dr Whitney, Pathologist to
the Mass. General Hospital. Turn r entirely disappeared
and the patient is now well, six years later.

Case 5. Recurrent spindlt-celled sarcoma of the popliteal
space and leg, —Tu r disappeared. Recurred one and a

COLEY : TREATMENT OF INOPERABLE CANCER. 347

half years later. Amputation of the thigh. Recurrence in
the gluteal region again treated with toxins; patient now
well, six years after.

Case 6. Inoperable epithelioma of ihe chin, lower jaw and
floor of ihe mouth. —Mixed toxins for three months. Growth
disappeared. The patient was well when last heard from
five years later. This patient was pronounced inoperable by
Dr. George R. Fowler of Brooklyn, and the microscopical
diagnosis made by Dr. Belcher, the pathologist of the
Methodist-Episcopal Hospital.

Case 24. Very large recurrent inoperable sarcoma of glu -
teal region treated 1894.—Tumor slowly decreased in size and
5 years later there remained only a mass of pure fibrous tissue.
Removed and examined microscopically. Patient in good
condition 6 years later.

As to the risk attending the treatment, I believe that with
the observance of proper precautions, it is nil or exceedingly
slight. Including the early experiments in cases of carci¬
noma I have used the toxins in upward of 200 cases with
but two deaths ; both of which occurred more than four
years ago. In estimating the percentage of cures it is well to
remember that the treatment is advised only in cases of sar¬
coma in which there is no hope of cure from operation. In
other words, in entirely hopeless cases. Of my series of cases,
in a very large number treatment was begun after the
disease had reached such an advanced stage that there was
practically no hope of more than temporary improvement.
To have saved even one case of inoperable cancer would
seem quite sufficient to offset the disappointment of a hun¬
dred failures. If instead of one per cent there is a proba¬
bility of being able to save upwards of 10 p. c. of these
otherwise hopeless cases we certainly have sufficient encour¬
agement to continue the method. I believe that the most pro¬
mising field lies in the use of the toxins in small and safe doses
directly alter the primary operation, instead of waiting for a
recurrence to appear. If the toxins can in a considerable
number of cases destroy and permanently cure large inoper¬
able sarcoma, it is reasonable to suppose that their adminis¬
tration after operation will destroy the invisible portions left
behind, and thus in a much larger number of cases prevent
subsequent recurrence.— St. Paul Medical Journal, June,
1900.

34«

DALY: A CLINICAL STUDY OF HEROIN,

A CLINICAL STUDY OF HEROIN.

By JAMBS R. L. DALY, M.D-
Resident Physician, Seton Hospital, Spuyten Duyril, N. Y.

A new agent in the treatment of cough, at present in wide
use and attracting considerable attention in the medical
world, is Heroin. It is a derivative of morphine—the dia-
cetic acid ester—and is a white crystalline powder, almost
insoluble in water, but readily soluble rn water to which a few
drops of acetic or hydrochloric acid have been added. It
possesses many advantages over morphine as a respiratory
sedative, among which the following may be mentioned : (t)
It prolongs respiration, and at the same time increases the
volume of each inspiration, making it a remedy much to be
desired in the treatment of cough ; (2) it is not an hypnotic ;
(3) absence of danger of acquiring the habit; (4) it does not
weaken the respiratory apparatus; (5) it does not cause
unpleasant disturbance ot the stomach or intestines ; (6) it
can be prescribed in cases in which heart complications occur
without risk of any deleterious effect upon that organ ; (7)
the ratio of the therapeutic dose to the toxic dose is con¬
siderably smaller than that of morphine.

The following cases taken at random from a clinical field
of over 100 cases of pulmonary tuberculosis in all stages < f
the disease in this hospital will best serve to illustrate the
efficacy of the drug :

Case i. —A. B., male, age thirty-two, clerk, entered
hospital with history of pain in leftside, which began about
four months before admission; night sweats hacking cough,
most troublesome at night, with markedly diminished secretion
and slight dyspnoea at varying intervals during day and night.
Physical examination revealed consolidation of upper lobe
on left side, and of apex on right side. Mist, codeia, one
drachm, three times daily and at midnight was administered
and continued for two weeks, but with little result. At the
end of this period the codeine was stopped and Heroin
substituted in doses of one-twelfth grain three times daily
and at midnight. In four days the cough began to lose its
hacking character, and the secretion became more abun¬
dant; in about one week the c> ugh could only be observed
in the morning and evening, and remained sufficiently loose
to render the patient very comfortable. No dyspnoea was
observed a week after the Heroin was begun, and breathing
still remained free. Mean respiration during first twenty
days in hospital, a.m., 29; p.m., 29 3-20. Mean respiration
for twenty days following the first administration of Heroin,
a. m., 24 6 20; p. m., 25 1-20. For the night sweats the

DALY: A CLINICAL STUDY OF HEROIN.

349

patient was given a pill of zinc oxide, two grains, with
extract belladonna, three-tenths grain, for three nights without
result. On the third night Heroin was substituted for codeine,
and on the second night following the sweats ceased.

Case 2. —On admission the patient complained of severe
and painful cough throughout the day and night; expectora¬
tion scanty, and obtained only after considerable effort. Phy¬
sical examination showed both lungs involved with cavity in
right middle lobe. The patient was given Heroin, one-twelfth
grain, three times daily at first, and shortly after the dose
vias increased to one-sixth grain. After one week of Heroin
the cough was diminished to a marked extent, and the pain
heretofore associated with the cough had disappeared.

Case 3. —Patient entered hospital complaining of “smoth¬
ering sensation ” in chest, with slight pain. Heroin, one-
twelfth grain, three times daily and at midnight, was ad minis*
tered, and in three days this “ smothering ” had disappeared,
but not permanently, as the patient has since complained of
it ; but he says that it is not as severe or as lasting as before
he was put on Heroin. Of course, the cough which was
present was greatly loosened, and this it was that gave the
patient relief.

Case 4—Patient entered hospital complaining of hard,
dry and persistent-cough, most troublesome towards evening.
Expectoration scanty, and effort of coughing caused great
pain in chest. The patient was given Heroin, one-twelfth
grain, and in three days the cough became soft, and expec¬
toration became quite free. The pain iri the chest had, of
course, disappeared with the hard cough. The patient re¬
mained very comfortable for a month, when Heroin was
discontinued, because I believed it to be the cause of a certain
heavy feeling of which he complained. The cough, however,
again became severe and hard, and Heroin was repeated in
the same dose as before. In three days the patient was freed
from the distressing cough, and that “ heaviness ” has not re¬
turned. Mean respiration during period in which the patient
was taking Heroin, a. m., 24 ; p, m., 26. Respiration became
more rapid while the patient was without the drug, averaging,
a. m., 25 314 ;p. m., 27 11- 14.

Case 5. —Patient has been in hospital for some time.
Complained of severe cough beginning about midnight and
lasting until morning. Heroin, one-sixth grain, was adminis¬
tered every night at 10.30. The cough was absent on second
night that Heroin was administered, and has not since
distressed the patient.

Case 6. —Patient complained of severe night sweats, and

350

daly: a clinical study of heroin.

was given atropine, i-ioo grain, for two nights without
success ; on the third night Heroin, one-sixth grain, was
given one-half hour after atropine, and sweats ceased.

Case 7.—J. F., male, age thirty-two, laborer. If any case
can be said to be a striking example of the efficacy of a
remedy, this case is certainly that one. The patient entered
the hospital with very slight but hard cough and a history
of marked and constant night sweats. The latter had incon¬
venienced the patient for seven weeks previous to entrance,
without an intermission of a single night. Mis. codeia, one
drachm, three times daily, was administered for the cough',
and an attempt was at once made to check the night sweats.
Camphoric acid had been a favorite with me in the treatment
of this symptom, and I accordingly gave 20grains at bed-time,
and repeated the same dose for four succeeding nights, but
without result. Then atropine sulph. and ac. sulphuricaromat.
were tried in the proportion of one-fiftieth of the former and
10 minims of the latter, but again without a favorable result.
This was given for five nights. Atropine sulph. alone was
tried in dose of one-fiftieth grain for a week; still no response.
Next was tried a pill of zinc oxide, two grains, and extract
belladonna, three-tenths grain, for five nights, and this, like the
rest, failed. Pilocarpine was next tried in dose of 1-100
grain, but it only increased the sweating. Next in order
came warm baths, and then bathing with ac. sulphuric dilute,
but these met the same fate as all the preceding. Then I
decided to give the sweat glands a rest, and for a week
nothing was administered for the sweating, and at the end
of this time atropine sulph. was repeated in doses of one-
fiftieth grain, but without result, until about the fifth night
of the administration of the latter the codeia mixture was
discontinued and Heroin substituted in dose of one-twelfth
grain three times daily. On the third night of the administra¬
tion of the latter the sweats decreased to a great extent, and on
the fourth night ceased altogether. The Heroin had replaced
the codeia mist., not because of the sweating, but because of
the hard cough, which did not improve ; and since the
patient had been taking the former the cough has loosened
considerably, and he now experiences marked relief.
I regard this case as typical, not of the curative effects
of Heroin on the night sweats, but rather ol the quality of
the drug to assist the ordinary anhydrotics when, given
alone, they fail.

Case 8 . —Case of tubercular laryngitis. Patient com¬
plained of severe sore throat, which prevented deglutition.
Pills of Heroin, one-twelfth grain, were administered every

DALY: A CLINICAL STUDY OF HEROIN. 35 1

three hours, and kept the throat in a condition of anesthesia
for about one to two hours, rendering the patient fairly com¬
fortable,'and most of the time free from pain. It is unneces¬
sary for me to mention that the patient was instructed to dis¬
solve the pill slowly on his tongue. Two other marked cases
of tubercular laryngitis were temporarily relieved by the ad¬
ministration of Heroin in this manner.

These cases are fair samples oft he results obtained by
the administration of Heroin. In almost every case in which
it has been tried it has been of some service in the alleviation
of cough, be that service ever so slight. Even the advanced
cases have been to a certain extent relieved. I found, how¬
ever, that the more favorable results were obtained in those
cases in which the disease process had not advanced to too
great an extent. In this class of cases the drug never failed
to loosen a hard cough and produce free expectoration,
giving marked relief from pain when present. I regard
it as unequalled as a sedative in the treatment of cough of
pulmonary tuberculosis, and venture to say, although I have
not tested it in cases of cough in other pulmonary affections,
that it will act equally well in such cases.

The smaller dose of one-twelfth grain is sufficient to
afford relief in most cases, certainly in the milder or earlier
one, but in some instances it was found necessary to increase
the dose to one-sixth grain, as after a time the smaller dose
seemed to lose its effect upon the patient. Sometimes when
Heroin had been taken for a long time, it was found to be a
good practice to stop it and give codeine, or some other seda¬
tive, for one week, and then renew the Heroin at the end of
this time. In this way the drug acted as well when renewed
as in the beginning of the treatment. It is true, however,
that Heroin produces its effect for a much longer period than
does any of the other sedatives used in this affection.

I said it was not a hypnotic, but the fact that it relieves
the distressing cough which is often the cause of many sleep¬
less nights, and thus ensures a natural sleep, obviating the
necessity of using hypnotics, should not be over-looked.

I have very carefully watched the temperature charts for
any evidence of its action as an antipyritic, but have been
unable to find that it produces any effect whatever on the
temperature. It certainly possesses no quality as a preventive
or cure of the chills so persistently present in the later stages
of tuberculosis. Like the respiration, the pulse is rendered
fuller and slower. In 10 cases observed the mean pulse rate
was reduced about four beats per minute; in one case the
rate was reduced eight beats per minute. By its action upon

352 DALY: A CLINICAL STUDY OF HEROIN.

respiration and its ability to relieve cough and promote ex¬
cretion of secretory products, it manifests a decided effect
upon the dyspnea.

I regard the influence of Heroin on the night sweats as
second only in importance to its influence as a sedative for
the cough. In the cases cited its quality as an adjuvant to
the ordinary remedies in checking the sweats is well marked.
In six other cases favorable results were obtained in either
checking or markedly decreasing the sweat by the adminis¬
tration of Heroin in conjunction with one or another of the
ordinary anhydrotics. Its action in this particular is best
appreciated after meeting failure in using the ordinary agents
alone.

The cases of tubercular laryngitis mentioned are typical
of its action as an analgesic in the treatment of the painful
throats of this affection. In these cases it afforded consi¬
derable relief from pain for periods of about one to two
hours following the administration of the pill.

In regard to its influence on respiration, I have carefully
noted 19 cases, and have found that in each case the mean
respiration a. m. and p. m. has been reduced from two to five,
and in some cases as high as seven per minute.

No action in the intestines was observed, except,
perhaps, a slight tendency to constipate if given in larger
doaes than one twelfth grain. Of this, however, I will not
be certain, as in the great majority of cases this action was
not apparent. In some cases it has been noticed to cause
a disturbance of the stomach. One patient complained that
the drug caused considerable nausea shortly after taking,
while with others the disturbance can best be described by
using a term applied by a patient to the condition of his
stomach after taking Heroin—“squeamish.” One com¬
plained of complete loss of appetite whenever he took the
drug. In all, some disturbance was noted in five cases out
of upwards of 70 patients taking the drug. I should add
however, that two of those who complained of disturbance
of the stomach while taking Heroin were later able to use it
without noticing any ill effects. Another, and, in my opinion,
the only real objection to Heroin, is that in certain cases the
larger dose of one-sixth grain was found to cause a feeling of
heaviness during the day. To quote a patient, “ I feel heavy
and as though I want to sleep, but if I tried to do so I find
that I cannot.” This was observed in four cases. The drug
did not in any instance produce this effect when given in the
smaller dose. But the chief use to which Heroin can be put
is as a sedative for the cough and to prevent the distressing

MEDICINE AND NEUROLOGY.

353

and disagreeable stagnation of secretory products in the
lungs, particularly in cases of pulmonary tuberculosis. No
drug can compare with Heroin in this particular. Cases that
have come into the hospital with painful and almost constant
cough, with inability to raise the sputum, resulting in fetid
breath and more or less dyspnea, have been almost imme¬
diately relieved of pain, and the expectoration rendered freer,
with decrease in the dyspnea, by the administration of Heroin
in doses of one-twelfth grain three times daily .—Boston Med¬
ical and Surgical Journal, February 22, 1900.

Progress of Medical Science.

MEDICINE AND NEUROLOGY.

IN CHARGB OP

J. BRADFORD McCONNELL, M.D.

Associate Professor of Medicine and Neurology, and Professor of Clinical Medicine
University of Bishop's College; Physician Western Hospital.

SERUM DIAGNOSIS OF TYPHOID FEVER.

William G. Savage, in the Clinical Journal of May 2,
1900, says that the so-called Widal test depends upon the
clumping and cessation of movement in a broth culture of
the typhoid bacillus when seen in a hanging drop. We
cannot say in every case where clumping or cessation of
movement occurs that the patient from whom the blood was
taken is suffering from typhoid fever. Sometimes the bacil¬
lus typhosus in a broth culture will clump spontaneously.
This source of error is easily eliminated by examining the
culture before the serum is added. The cause of this spon¬
taneous clumping is not known. Another source of error is
where an examination is being made for suspected typhoid
and the disease may be either influenza, anemia, or some
other condition easily confounded with it. In such cases the
patient may have had typhoid fever years before. It is
claimed that the Widal test may be obtained years after the
infection. Errors in such cases are difficult to avoid.

Normal serum, if diluted slightly, say one in ten, may
in certain cases cause some clumping. If the serum be fur¬
ther diluted and again examined with typhoid broth, these
changes do not take place. The writer believes that if the
serum be sufficiently diluted, clumping with normal blood
never takes places. A dilution of one in thirty or one in
fifty, or even higher, is necessary to prevent failures from

354

PROGRESS OF MEDICAL SCIENCE.

this source. The sera cf diseases other than typhoid are
cited by some writers to give positive reaction. Cabot points
out that scarcely any two observers find these pseudo-reac¬
tions in the same diseases, and in all probability, with a
careful technique and perfect dilution of the serum, they
never take place.

The blood in enteric fever does not always give a char¬
acteristic reaction. This may be divided into three classes:
(a) The test may be made too early in the course of the
disease; the reaction is generally obtained about the end
of the first week. ( b ) There are cases in which the reac¬
tion is known to intermit; for example, it is present one
day, absent the next, and again present the next day or in
a few days. These cases are probably very infrequent and
do not seem to be a common cause of error. ( c ) A few
cases of proven enteric fever yield no serum reaction
throughout the disease.

The first two causes of absence of reaction obviously
teach that in negative cases we should repeat the examina¬
tion of the blood at a subsequent date. A negative reaction,
though not so valuable as a positive one, is yet of great
value. Efficiently performed, the test is correct in from 90 to
95 per cent of the cases.

In collecting the blood for making an examination, it
may be done by allowing a drop to dry on a glass slide, or
it may be drawn into a capillary pipette and the ends
sealed. The latter permits of the serum being separated
from the blood without the admixture of corpuscles, thus
making it somewhat more accurate. If the dried blood is
used it is mixed with a little water of inert fluid, and a
small quantity is taken up in a loop.

Care should be taken in obtaining the typhoid bacillus,
as those which have a tendency to clump spontaneously are
valueless. Some cultures of the typhoid bacillus give a
prompt reaction and others do not. The author describes
one case in which the test was made with four different cul¬
tures of the typhoid bacillus. In one a well marked reaction
was obtained, in another it was doubtful, and in the remain-
ng two there was no reaction. He uses a culture of agar
from two to six weeks old kept at room temperature. From
this a tube of sterile broth is inoculated and grown at 37^ C.
This culture should not be more than twenty-four hours old
if grown at a high temperature.

The serum diagnosis of typhoid may be carried out
without the aid of a microscope, by what is known as a sedi¬
mentation method. This, by some writers, is considered even

MEDICINE AND NEUROLOGY.

355

more valuable than the microscopic test, and is performed
by diluting the serum, which for this purpose must be
obtained in capillary tubes with twenty-four parts of normal
saline solution, and then added to equal parts of a fresh
broth culture of the bacillus typhosus. If at the end of
twenty-four hours the solution shows a uniform turbidity, the
reaction is negative. If, on the other hand, well marked
plugs are seen at the bottom of the fluid or along the sides
of the tube, the reaction is positive. The method requires
no watching, but performs itself.

BICHLORIDE BATHS IN THE TREATMENT OF

VARIOLA. .

H* A. Ingalls (journal of the American Medical Asso¬
ciation, April 28, 1900) has treated thirty-six cases of variola,
of which one was hemorrhagic and thirteen confluent, with¬
out mortality, by means of these baths. The first case was
seen in the papulovesicular stage, of confluent type. It was
noted that the pustulation and pitting were much less than
might have been expected in so severe a case. The baths
were comforting, and there was but a trace of the peculiar
odor of the disease. The method of giving the baths was to
take a six-foot tub which was filled with fairly warm solution
of the bichloride, i-to- 10.000. The temperature ranged from
103° to 105° F. The patient was placed in the tub and
rubbed with a soft cloth, the bath lasting from ten to twelve
minutes. Afer removal from the bath patients commonly
expressed much relief, but shortly after, owing to the drying
off, complained of a burning sensation, which led to a routine
practice of anointing the patients after a bath with a mix¬
ture of subnitrate of bismuth, carbolic acid, and olive oil.

COLD IN THE HEAD.

Dr. A. S. Barnes, in the Interstate Med. Jour., says
that a quick method to cure a cold in the head consists in
a hot bath and warm bed ; one-eighth of a grain of pilocar¬
pine muriate is then administered, and, after three-quarters of
an hour of sweating, one one-hundredth grain of atropine is
taken. This is followed by a prescription containing phe-
nacetine, salol and caffeine citrate at intervals of two hours.

CHRONIC CONSTIPATION IN CHILDHOOD.

Heinrich Dcerfler has, for the last six years, met with
flattering success in the treatment of chronic constipation

35 $

PROGRESS OF MEDICAL SCIENCE.

in children by the administration of butter. It should be
fresh, and of the best quality. It should be given in the na¬
tural state, and not by means of any vehicle. For the first
month clysmata may be given; in the second and third
month from a half to a whole coffeespoonful of butter daily
morning and evening, till the stools are normal; then only
every two days. The dose is further increased according to
the age .—Medical Recot d.

PRURITIS ANI.

An injection of ergot, hydrastis and carbolized oil of
two drachms into the rectum is given first. If the skin is hard
it is painted with a saturated solution of silver nitrate every
third day for three visits. Then every day citrine ointment
is used and bound on with a cotton pad. The itching at
night may be relieved by extremely hot water, followed by
black ointment or calomel salve, being careful not to scratch
the skin. This daily routine is followed for six weeks, then
at longer intervals for six months, never stopping in less time,
but occasionally going longer. Of two hundred cases thus
treated, permanent cure resulted in every case, many cases
having been observed for five years. As the author considers
thelithic acid diathesis a promineut constitutional cause, this
must receive internal medication and the bowels must be
moved every day.— Phil. Med. Jour.

ON THE CARE OF ARTIFICIAL TEETH.

The fortunate possessor of a healthy olfactory nerve must
have frequently observed the peculiarly offensive breath
found only in those who wear a toothplate. By a little care
and proper management, this trouble may be avoided. It
goes without saying that no one can enjoy ideal health while
compelled to breathe foul air, whether the cause be extrinsic
or intrinsic. There are dentists who advise their patients to
never remove the plate from the mouth except long enough
to clean the teeth after eating. But most of them. I think,
will say that in the vast majority of cases it is not necessary
to wear them during sleep, at which time they should usual¬
ly be kept in pure water, to which, if desired, a little salt
may be added.

It will thus be found practicable to keep the teeth free
from a bad odor, and the mucous membrane of the mouth in
a healthy condition. After each meal, if convenient, water
at near the boiling point, should be gradually poured upon
the teeth and alloweJ to remain until sufficiently cool to

MEDICINE AND NEUROLOGY.

357

permit the use of a brush. The dark stain which comes
upon the teeth and the rubber plate may be removed by a
ten per cent solution of chemically pure nitric acid, or by
pumice. After eating meat, care should be used to remove
every particle which may have found its way into the inter¬
stices.— Med. Times.

SIMPLE TREATMENT FOR PERSISTENT
VOMITING.

Dr. Mitchell states that he has succeeded frequently in
overcoming persistent vomiting by the aid of cold compresses.
The method he uses is to wring towels out of ice water and
to change them every minute until the vomiting ceases. It
takes from fifteen to twenty minutes to stop the vomiting.—
Medical Summary.

TO CONTROL HIGH TEMPERATURES.

Dr. C. C. Booth (Phil. Med. Jour.) suggests the follow¬
ing method of reducing a high temperature: “ The patient

is stripped entirely of all clothing, placed upon rubber sheet
and covered with one thickness of a piece of cheese-cloth two
yards long and the usual width, one end having been split so
that each leg can be covered separately. A nurse is directed
to squeeze water at about the temperature of the body from
a sponge,over the entire anterior surface of the body, and to
wet the gauze freely as often as necessary to supply the water
for evaporation. A case of typhoid fever, with persistent
high temperature, is reported, in which this method was used.
From the beginning of treatment the pulse, nervous system,
temperature, strength, and every symptom rapidly improved.
The idea originated upon observing the depression of the
wet bulb of a wet and dry bulb hygrometer caused by the
evaporation of the water from the gauze, which is applied
tightly to the bulb containing the mercury. All that is
claimed for this method is that it is more convenient, more
easily applied, less dangerous, cheaper and pleasantet to the
patient than any other method. The gauze is to be kept
wet until the temperature is reduced to normal.”

NIGHT SWEATS.

Few practitioners appreciate the exceedingly great value
•of agaricin as a remedy in night sweats, especially those of
phthisis. The most profuse sweat is checked almost by magic,
with a single dose. It operates by diminishing thirst and
increasing the secretion of urine. The dose may be pushed

358

PROGRESS OF MEDICAL SCIENCE.

to the extent of one grain in the course of twenty-four hours.
The single dose for an adult is from one-eighth to one-fourth
of a grain.— Technics.

INFANTILE CONVULSIONS.

Dr. R. S. Roland, of Sylvain, Tex., says the physician is
seldom called to a case until the child has had one or more
convulsions, and is often in the dark as to the cause; how¬
ever, the general treatment is about the same in all cases. If
they are due to some pathological state, special treatment
should be directed to it.

Now, when called to a case, do not spend too much time
trying to’ get at the cause, but go right to work. Place
lower extremities in hot mustard water, or give a general
warm bath from five to fifteen minutes, according to the
severity of attack, with cold to the head ; give an enema of
soap and water. Syrup of ipecac as an emetic if something
indigestible has been taken recently ; bromide of potassium
and chloral hydrate, according to age. every ten minutes-
until the convulsions cease. In those subject to attacks
their hygienic surroundings should be the best .—Medical
Summary.

PAIN.

Pain of a neuralgic or drawing character in the neigh¬
borhood of the heart is found as the result of several causes,
as a rule, in the following order of frequency :

1. Pain with palpitation of the heart from the accumu¬
lation of flatus in the transverse colon just as it turns to de¬
scend. Many patients who go to the physician complaining
of heart disease suffer only from this condition, due to
fermentation in the large bowel. Again, the pain due to
gastralgia, or, as it has been called, cardialgia, may be re¬
ferred to the heart by the patient.

2. Intercostal neuralgia due to debility. In these cases
tender spots will often be found, one in the precordium,
another in the outer edge of the scapula, and a third on the
vertebral column. These are sometimes called "spots of
Valleix.” In other cases the pain will be due to spinal
trouble, anemia, or tight lacing of corsets.

3. Pseudo-angina.

4. True angina.

5. Locomotor ataxia.—H. A. Hare, in Practical Diag¬
nosis.

MEDICINE AND NEUROLOGY.

359

AIDS TO DIGESTION.

By lying on the right side for fifteen minutes after a
meal all the liquid would gravitate out, leaving the solids to
be acted upon by the gastric juices. Also, that when the
bile flowed back into the stomach producing vomiting, tak¬
ing the recumbent position on the right side would soon
stop the vomiting. The rule of lying on the right side for
fifteen minutes after each meal is one of the best treatments
for dyspepsia. Again, before rising in the morning one
should lie a half hour on the left side, thus emptying the
colon. In dysentery and diarrhea one should immediately,
after each passage, lie down down on the right side. As
soon as it is necessary again to evacuate the bowel, then
turn on the left side a moment before rising. Thus we will
prevent accumulations in the lower bowel that produces
tenesmus. When the bile becomes very acrid, and the di¬
gested products fermenting instead of the usual healthy pro¬
ducts, this matter parboils and inflames the intestine, and
more especially the colon where the small intestine is attach¬
ed ; therefore, by freeing the colon, flushing it, the cause is
removed and the inflammation subsides and the “appendi¬
citis ” gets well. Gravity, water and common sense are
wonderful doctors.— Med. Visitor.

NASAL OBSTRUCTION.

The Medical Age says : F. R. Reynolds states that by
the successful treatment and permanent relief of nasal ste¬
nosis many diseases are prevented, relieved, or cured, Among
these are anemia, marasmus, hay-fever, asthma and laryn¬
gismus stridulus. Reflex cough may be due to hypertrophic
rhinitis. Also, gastralgia, cardiac palpitation, neuralgia of
the trigeminus, scotoma, migraine, cephalalgia, ciliary neu¬
ralgia. vertigo, photophobia, neurasthenia, spasmodic cough,
spasm of the glottis, frontal and supra-orbital headache may
all have their origin in an exciting nasal focus. Emphysema
and bronchitis often accompany nasal stenosis. Nasal ste¬
nosis not rarely has a deleterious effect on the ears.

INFANTILE SCURVY.

There are two affections occurring in children for which
scurvy is particularly mistaken ; acute rheumatism and acute
anterior poliomyelitis. There is practically no reason at all
why scurvy should be confounded with the latter disease.
There is, of course, absence of movement in the limbs in both

360 progress of medical science.

■cases, but in anterior poliomyelitis this is due to inability to
move them because of palsy ; in scurvy the failure of move¬
ment is due to pain. This can very easily be decided by
passive movements. Scurvy and acute rheumatism are not
so easy to differentiate. In scurvy, however, the hemorrhage
is not into the joint and not into the epiphysis, but practi¬
cally always into the diaphysis of the long bones. Blood
extravasations occur at times over the tissue and occasionally
even over the carpus, but these are rare exceptions. If the
bones are protected from motion, it will be found that the
joints in scurvy may be freely moved. At times, in scurvy,
hemorrhage occurs into the joints, and this may almost hope¬
lessly confound the disease with rheumatism ; but these joint
hemorrhages are very rare.—A. Jacobi, Medical News.

INTESTINAL REST IN TYPHOID.

IT IS AN AXIOMATIC PRINCIPLE IN BOTH SURGERY AND

MEDICINE THAT A CONGESTED OR INFLAMED PART
NEEDS REST.

The surgeon recognizes this when he immobilizes the
fractured bone and retains the fragments in apposition; the
physician likewise appreciates the great importance of this
principle in cases of gastric ulcer vvhen he feeds his patient
by the rectum in order to avoid irritating the inflamed part,
either directly, or by exciting gastric motility. Although
typhoid fever is essentially a systemic disease, its charac¬
teristic local lesion is the intestinal ulcer, which should, as
far as possible, be kept at rest. Milk, which has heretofore
been regarded as the only proper exclusive food, is, as a
recent writer says,“ not a liquid diet, but a deceptive solid”
—capable of filling the small intestines with dense indi¬
gestible curds which scratch and irritate the ulcerated bowel,
and in addition, ferment and cause gaseous distention, tym¬
panitis, etc. Liquid Peptonoids , on the other hand, is open
to none of these objections. Its administration affords rest
to the ulcerated intestinal tract, because :

1st. It is pre digested, and therefore promptly absorb¬
ed from the stomach, leaving no residue for the bowel
to dispose of.

2nd. No curds are formed as from milk.

3rd. It is absolutely aseptic and cannot cause fermenta¬
tion, tympanitis or increased peristalsis, resulting in diarrhea.

4th. It has the requisite nutritive power to maintain life
for weeks and even months, especially in febrile conditions.

Another advantage of Liquid Peptonoids is its paL

SURGERY. 361

at ability, which renders it grateful to the patient, especially
when given ice cold.

From one to two tablespoonfuls every two, three or four
hours, should be given as necessary. When an efficient
intestinal antiseptic is required, as it very frequently is in
this disease, Liquid Peptonoids with Creosote provides both
food and remedy at one and the same time. The unpleasant
taste of the Creosote is almost entirely abolished in this
combination. Each tablespoonful contains two minims of
pure beech wood creosote and one minim of guaiacol, its
active principle.

SURGERY.

IN CHARGB OF

ROLLO CAMPBELL,?M.D.,

Lecturer on Surgery, University of Bishop’s College ; Assistant-Surgeon, Western Hospital

AND

GEORGE FISK, M D.

Instructor in Surgery, University of Bishop's College ; Assistant-Surgeon, Western Hospital,

FRACTURES OF THE ANKLE.

There are three little practical points of importance to
be emphasized in connection with the treatment of fracture
of the ankle: First, whatever other precautions may be
taken in the treatment of this fracture to obtain a good re¬
sult, one should always place the foot at a little less than a
right angle. Second, in case of a painful joint following Pott’s
fracture, the foot should be fixed for a period of about
six weeks at a little less than a right angle, the patient being
permitted to walk without the use of a crutch. Third, this
can easily be accomplished by applying the plaster-of-paris
cast with the knee in a flexed position.

If these practical points are observed, fractured ankles
are not painful after the fracture has healed, and those which
are painful after other methods of treatment will be free
from pain in a few weeks, notwithstanding the fact that they
may have resisted the ordinary forms of treatment for weeks,
or months, or even years.—A. J. OCHSNER (Amer. your.
of Surg. and Gynec.)

3^2 PROGRESS OF MEDICAL SCIENCE.

THE TREATMENT OF WENS BY THE INJEC¬
TION OF ETHER.

Emile Sergent, Paris, has used injections of ether into
wens with good results* The quantity to be injected varies
with the size of the tumor. If the patient complains of pain
the syringe may be detached from the needle for a few min¬
utes, then reattached and more ether injected. Four or
five injections, every other day, always the same site, will be
followed by liquefaction and the contents may be expressed.
The sac will become less adherent; the few adhesions re¬
maining may be broken up by introducing a stylet through
the small original wound and the sac then slowly drawn out.
Dr. Sergent claims these advantages for his method. It is
not painful, not bloody, not dangerous, is easy to do and
leaves no scars. The latter is an especial advantage where the
wen is situated upon the face. —La Presse Med.., St. Louis
Medical Review,

FISTULA IN ANO; ITS RELATION TO
PHTHISIS.

S. G. Gant, New York, concludes his discussion of the
subject with the following observations, which summarize his
views : (i) Tuberculous fistula of the anus is usually secondary
to tuberculous disease of the lungs. (2) Pulmonary phthisis
is rarely, if ever, secondary to fistula in ano, either before or
after operation. (3) Tuberculosis of the anal region should
be dealt with radically, as is recommended when it attacks
other parts. (4) When the patient’s general condition will
permit, we should operate on all fistulas, irrespective of the
kind. (5) We should not refuse to operate on persons suffer¬
ing from a mild form of phthisis, nor on those who give a
family history of tuberculosis. Certainly, if we arrest one
destructive process, nature is all the more capable of dealing
with the other. (6) Those patients operated upon for tuber¬
culous fistula and those that are non-tuberculous compli¬
cated by phthisis, who rapidly decline and die, do so as the
result of an inflammation of the lungs induced by the anes¬
thetic, especially ether. Such accidents have not followed
any of the operations which the writer has performed under
local anesthesia. (7) He believes that we are justified in
discarding the erroneous teachings of writers who believe
that the cure of a fistula will result in a development of
phthisis.— N. Y. Med. Record.

SURGERY. 363

FORMALIN AS AN ANTISEPTIC IN GENERAL
SURGERY, GYNECOLOGY AND
OBSTETRICS.

G. E. Crawford, Cedar Rapids, lo., is convinced
from his own experience that formalin, the 40-per-cent, solu¬
tion of formaldehyd, comes nearer meeting all the require¬
ments of a perfect disinfectant than any other substance yet
employed. Its germicidal potency ranks with that of the
two or three most efficient bactericides, and its inhibiting
power is probably greater and more lasting than that of
any of them. It is not only an antiseptic, but a deodorizer
as well, and solutions of potent strength are much less irrita¬
ting, both to the hands and to wounds, than any other equal¬
ly efficient antiseptic. It is not injurious to instruments
and it is practically innocuous. Large cavities can be freely
irrigated, even the peritoneal cavity, and a considerable
quantity of the solution can be allowed to remain without
injury or danger of toxic effect. The solutions that have
generally been recommended are too strong. The strength
of a solution depends upon the amount of formaldehyd it con¬
tains, and it should be remembered that this is two and a
half times stronger than formalin. The latter is a definite
substance, and is the tangible form in which we employ for¬
maldehyd as an antiseptic in surgery; therefore the percent¬
age of a given solution should be that of formalin and not
that of formaldehyd. The solutions of formalin commonly
used are the eighth, fourth, and the half per cent.; the two
former for washing infected wounds and irrigating and pack¬
ing cavities and sinuses, and the latter for disinfecting the
hands and the surface of the body. They contain formal¬
dehyd in the strength of one two-thousandth, one one-thou¬
sandth, and one five-hundredth respectively. The half per
cent, solution is of about the right strength for the hands.
In gynecologic practice, formalin is extremely useful; the
peritoneal cavity can be freely irrigated with the one two-
thousandth solution in cases of pelvis abscess, pyosalpinx,
etc., where purulent matter has escaped into the cavity. It is
superior to iodoform in packing and drainage of sinuses,
while in obstetric practice it meets all the requirements of an
antiseptic to disinfect the hands and the external parts.— N.
Y. Med. Jour ., St. Louis Med. Review.

364

PROGRESS OF MEDICAL SCIENCE.

INGROWING TOE-NAIL.

The following treatment is very strongly recommended
by Dr. Kinsman in the Columbus Medical Journal:

1. Remove all pressure from the nail by cutting away a
piece of the shoe.

2 . Disinfect with hydrogen dioxide until no more
foam ” appears.

3. Apply a drop of soft solution of cocaine in the base
of the ulcer.

4. Apply a drop of Monsell’s solution in the ulcer, then
cover loosely with gauze. Repeat this process every second
day until the edge of the nail is released by the retraction of
the hypertrophied tissue. The patient suffers no pain
from the application, and all pain has disappeared the second
day. The cure is effected in a week or two without incon¬
venience or interference with business.— Texas Medical
News , July, 1900.

STRANGULATED HERNIA IN CHILDREN.

Coley, W. B. {The Journal of the American Medical
Association , Vol. xxxiv., No. 6) says :—

Strangulated inguinal hernia in infants and children is not
so rare as might be supposed. He has operated on eight
patients under two years of age, with one death. The fatal
case was in an infant of eight weeks who was moribund at
the time of operation.

In four of the cases the sac contained cecum, and in
three of these four the appendix was also found. The author
believes that, as a rule, the neck of the sac is not the cause of
the constriction. With scarcely an exception herniotomy
may be supplemented by an attempt at a radical cure.

The diagnosis of strangulated hernia in children is not
usually difficult, though it may be confined with hydrocele of
the cord.

Gentle taxis for two or three minutes may be tried. If,
after a second attempt to reduce the hernia has been made
by taxis, preceded by the application of hot cloths, there is
no result, the operation should be done without further delay.
Temporizing is often the cause of death.

TREATMENT OF FRACTURES OF THE
PATELLA.

Dr. Will H. Means {Columbia Medical Journal) offers
the following conclusions to an interesting article: 1. The

OBSTETRICS.

365

results of a non-operative treatment are unsatisfactory both
as to long confinement and functional disability. 2. The
methods of maintaining apposition of the fragments by
external appliances are unsatisfactory and unscientific. 3.
In open arthrotomy the fragments can be carefully approxi¬
mated and sutured in such a manner as will maintain appo¬
sition and, ultimately, bony union. 4. The operative me¬
thod saves months of confinement, and gives permanent
results. 5. The buried suture material should be absorbable,
such as catgut or kangaroo tendon. 6. The field of opera¬
tion should be continuously irrigated with a hot salt solution
during the manipulation, and the incision closed without
drainage. 7. The massage treatment begun at an early
date is an important factor in restoring functional activity of
the joint.

OBSTETRICS.

IN CHARGE OF

H. L. REDDY, M.D., L. R. C. P., London,

Professor of Obstetrics, University of Bishop's College; Physician Accoucheur Womenfy
Hospital; Physician to the Western Hospital.

MANAGEMENT OF PUERPERAL INFECTION.

F. W. Sears states that we are often called upon to at¬
tend patients when the system has beeu severely taxed by
the amount of poisons absorbed from the products of putri-
faction, and it is our purpose to arrest this absorption by the
safest and the quickest way. The finger or fingers of the
physician passed into the uterus to remove portions too large
to be washed away, or to serve as a guide to their removal
by a pair of small placental forceps, and this followed by a
thorough intra uterine irrigation with sterilized water, or any
other aseptic non-irritating solution will most effectually stop
the absorption. If, after repeated irrigations, we fail to re¬
lieve the symptoms, we may find it necessary to resort to the
curette, and this should be done carefully and thoroughly,
remembering also that there is danger of perforation, and,
if any septic material is left,an increased absorption. After
curetting, the uterus should be irrigated and packed with
gauze. If there is a sudden rise of temperature, the gauze
should be removed and the uterus irrigated. In septic cases
he believes that the curette is contra indicated. Here fre-

3 66

PROGRESS of medical science.

quent irrigations with a safe antiseptic solution should be our
main local treatment. In giving a uterine douche, Sears pre¬
fers an ordinary curved glass irrigator.— Am. Jour. Obsttt.

PUERPERAL MASTITIS.

Brouha reports such a case on account of its occurrence
at a period soon after labour. The first symptoms were no¬
ticed within twelve hours after delivery and before the child
had been nursed. No causative lesion of the breast could
be found, and no infection of the genital tract was present.
The writer attributes the mastitis to the efforts before labour
to obtain perfect cleanliness of the nipples, during which the
germs may have entered the breast through some slight
solution of continuity of its surface.

PAIN AS A PATHOGNOMONIC SYMPTOM OF
ECTOPIC PREGNANCY.

Henry C. Coestates that pain alone, when not accom¬
panied by a clear history of menstrual irregularity, symptoms
of pregnancy and the presence of a tumor at the side of the
uterus or in Douglas’ pouch known to be of recent develop¬
ment, is pathognomonic of extra uterine pregnancy only
under certain conditions, viz. : The pain is of a sharp colicky
character, distinctly localised on one side, attended with
fainting more or less marked, and is usually followed by
intervals of hours or days of complete remission. The pulse
is accelerated during the attacks, and there is no rise of
temperature. The latter is an important symptom, distin¬
guishing ectopic from inflammatory conditions. The violent
tearing pain attending intraperitoneal rupture is accompanied
by the unmistakable evidence of internal hemorrhage. In
extraperitoneal rupture the symptoms vary in severity
according to the amount of blood lost, but soon subside,
being succeeded by the usual evidences of pressure resulting
from a mass in the folds of the broad ligament which dispels
or displaces ti e pelvic organs. A persistent pain following
the acute attack may indicate localised peritonitis.

THE:

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price, $c.oo per annum in advance . Single
Copies , io cents.

Make all Cheques or P.O. Money Orders for subscription, or advertising, payable to
JOHN LOVELL & SON, 23 Sr. Nicholas Street, Montreal, to whom all business comma,
nic&tlons should be addressed.

All communications for the Journal, books for review, and exchanges, should be
addressed u> the Editor, Box 2i74, Post Office- Montreal.

Editorial.

GUN SHOT ABDOMINAL WOUNDS.

The present South Africa war is rich in surgical lessons,
but none are more striking and unexpected than that which
has reference to gun-shot wounds of the abdomen. Even as
late as the meeting of the British Medical Association held
last summer, the consensus of opinion seemed to be “ that
even if the most remote chance of wound of the gut existed,
the abdomen should be opened at the earliest possible mo¬
ment.” With this opinion, so to speak, ringipg in their ears,
the members of the Royal Army Medical Corps went to the
war determined to avail themselves of every possible oppor¬
tunity to deal scientifically with this class of wounds. This
war seemed likely to present opportunities, such as had never
occurred before, to practice modern abdominal surgery. But,
very early in the campaign, it was recognized that such
anticipations were not justified by results. Sir William Mac-
Cormac, Mr. Treeves and others who have world-wide repu¬
tations as surgeons, tell us that such anticipations were not
realized, and that just the contrary was their experience.
Water was scarce, and what was obtainable was abominable,
filthy and impossible to make pure. By reason of this want,
also that of towels and of many other needed articles, by

368

EDITORIAL.

reason of the plague of flies, and the want of sufficient help,
an ideal aseptic operation was found absolutely impossible.

But even supposing that they had been available, there
was found wanting the opportunity to attend such cases at
the precise moment opportunate to possible success. After
an engagement, the wounded were brought in, in such im¬
mense numbers that it was found an absolute impossibility
to postpone attendance upon them that a few abdominal
wounds might be attended to with that precision which a
prolonged operation requires. At first this seemed to be
viewed by the Medical Officers with deep regret. As time
wore on, however, this regret seems to have turned into re¬
joicing, for subsequent experience has shown that operation
for gun shot wounds is seldom needeJ. In the few cases
where an operation was performed, it was clear that the
puncture made by the bullet was small—so insignificant that
it was very difficult to recognize, especially after the lapse of
a very few hours, and that leaking had not occurred to any
appreciable extent. It was soon recognized that the wound
of a Mauser bullet was entirely different from anything pre¬
viously met with. The wound was found to be so small that
one, or, at most, two, Lembert sutures was sufficient to close
them. It was also noted that extravasation of the contents
did not occur, either because of the “ ponting” of the mucous
membrane or because the gut was motionless. More than
one medical officer has suggested that this condition is due
to the impact of the swiftly moving bullet inhibiting the
peristaltic movement, or, as it were, “ stunning” the intestine.
The bowel wound was found to close rapidly, and the gen¬
eral opinion seems to be held that this especially occurred
where the patient had been long without food, many of these
cases being in men who had had little or no food for a con¬
siderable time. In fact, it has been found that the majority
of abdominal gun-shot wounds were best treated by the ex¬
pectant method, and under such treatment it is estimated
that fully sixty per cent, recovered. Final deductions are,
of course, as yet out of order, but Mr. Treeves has expressed
the opinion that “ most cases of wound below the umbilicus
do well if left alone.”

EDITORIAL.

369

It has seldom happened—possibly never before—that
any steamship on a single trip has had its passengers exclu¬
sively composed of medical men. Yet this occurred when
the magnificent steamship “ City of Rome" sailed out of
New York on the 30th of June, with three hundred medical
men, many having with them their wives and members of
their families. This large party was organized by three
physicians. It was intended to make a tour of Scotland,
England, Germany and Switzerland, before reaching Paris,
where as many as desired could attend the International
Medical Congress. The trip was to last thirty-eight days
and cost $260.00, including hotel expenses, carriage fares,
and all necessary fees for sight-seeing. We feel sure the party
was a jolly one and that a good time was enjoyed by all.

We congratulate our contemporary, the V Union Midi-
cale, on its greatly improved appearance. To-day it is not
excelled by any medical journal in Canada in its outward
look, and its contents bear a most favorable comparison with
any. Long may it live and flourish, a monument of the
rapidly advancing status of the Canadian medical profession.

TREATMENT OF INOPERABLE CANCER.

We publish, as a selected paper in this issue of the
Record, an article on the treatment of Inoperable Cancer,
by Dr. Colley, of New York. It is of very great importance,
in view of the fact, admitted on all sides, that the last few
years has seen a marked increase of this disease. Owing to
our limited space we have cut out a number of the reports
of the newer cases treated, as well as some of those record¬
ing the further results in the cases first reported. Sufficient
however, remains to give our readers a good idea of this new
form of treatment. _

The Medical Fortnightly draws attention to the some¬
what singular fact that of the presidents of the American,
Medical Association elected since 1880—twenty-two in num¬
ber—eighteen have been chosen from the ranks of surgeons
or surgical specialties. Internal medicine has had two

370

EDITORIAL.

representatives, and the general practitioner has been
honored twice. This is a unique fact, and one which
emphasizes the conditions of medicine in the United States,
and is in striking contrast to its sister association—the
British Medical. While finding no fault with the personnel of
those selected to fill the chair of the American Association?
it urges the claims of medicine for a division of the honor.
It also adds that no one could more fittingly bear the honor
than our old friend, Dr. William Osier (a Canadian), of Johns
Hopkins* University, “the leader of internal medicine on
this continen', if not the English world.’’ It asks for his
election to the presidency in 1901.

PERSONAL.

The Hon. Dr. 'Borden, Minister of Militia, will, it is
said, sail shortly for England. The trip will oe to seek rest,
while, at the same time, he will transact some business with
the War Office.

Dr. Fiset, one of the surgeons of the 2nd Battalion
Royal Canadian Regiment serving in South Africa, was,
a short time ago, taken prisoner by the Boers. He was
recently released, and has rejoined his regiment. His return
was warmly greeted, for he is a universal favorite with both
officers and men.

The death in action, near l'retoria, of Lieut. Harold
Borden, of the Canadian Mounted Rifles, only son of the
Hon. Dr, Borden, Minister of Militia, is deeply regretted by
all who knew him. A Third Year medical student at Mc¬
Gill University, he gave promise of a brilliant future. The
blow is a severe one to his father, as he was an only son, and
his death breaks a record of several generations of medical
men. He died with his face to the foe—for Queen and
Empire—the Commander-in-chief, Lord Roberts, having
had his gallantry brought more than once to his notice.
Personally known to him, the writer grieves at his death and
the loss of a dear young friend.

Surgeon Capt. Sanford Fleming, Princess Louise
Guards, has been appointed A.D.C. to Major General
O’Grady—Haly, the new Commandant of the Canadian
Militia.

PERSONAL.

3 71

Dr. Craik, Dean of McGill Faculty of Medicine, was re¬
cently entertained to an informal supper at St James’ Club.
During the evening he was presented with a beautifully
illuminated address accompanied by his portrait in oil.

Lieut.-Col. Neilson, Director-General Militia Medical
Staff, has gone for two weeks’ fishing to the lakes north of
Quebec.

The death early in July of Dr. Fafard, Professor of
Chemistry in Laval University, Montreal, was an unex¬
pected event. He was a strong member of the Laval
Faculty of Medicine, and was greatly esteemed by those
members of the English medical profession who had the
pleasure of his acquaintance.

The degree of Doctor of Law has been conferred by
the University of Michigan and Dickinson College upon Dr.
Lewis Stephen Pilcher, of the Methodist Episcopal Hos¬
pital of Brooklyn, and editor of the Anna/s of Surgery.

Book Reviews.

Oancer of the Uterus. Its pathology and symptomatology
diagnosis and treatment; also the pathology of diseases of the
endometrium. By Thomas Stephen Cullen, M. B., Toronto ;
Associate Professor of Gynecology in the Johns Hopkins
University. With eleven lithographic plates and over three
hundred black and white illustrations on the text, by Max
BrOdel and Herman Becher. New York, D. Appleton &
Company, 1900.

We cannot refrain from expressing our feelings of pride and
gratification, which will, we believe, be shared by all Canadian
physicians, when we look at this monumental monagraph of seven
hundred pages, a'l on the subject of canc.r of the uterus, and
reflect th a the most exhaustive work that has ever b.en written on
this subject has been written by a Canadian. The scope of the
work may best be judged from a portion of the preface, which we
quote : “ The number of cases cf cancer of the genital tract com¬
ing too late for operation is so appalling that the surgeon is ever
seeking to d.vise ways and means by which the dread malady may
be more generally detected at the earliest possible moment—at a
time when the complete removal of the malignant tissue is still
possible. But since it is the general practitioner who as a rule in
first consulted, upon him largely falls the responsibility of arriving
at a timely diagnosis.” In this volume it has been the author’s
aim to give the family physician a clear idea of the early signs of
carcinoma, in order that he may always be on his guard and may
not tr.at too lightly any suspicious indications which may be
present. A perusal of the text reveals the high character ot the

372

BOOK REVIEWS.

work. While we would wish most earnestly that the book might
be widely read by all general practitioners, we fear that only a few
of the most advanced ones will do so. Many of the chapters are
devoted to the microfcopical diagnosis, and will be eagerly studied
by the specialists who are anxious to make an accurate diagnosis
at the earliest possible moment after seeing the case. The work is
therefore invaluable to the specialist, who cannot afford to be with¬
out it. The question as to what operation should be performed in
a given case and the dangers and difficulties of each are thoroughly
discussed. There are complete separate chapters on cancer of the
cervix and cancer of the body of the uterus. The chapters on dif¬
ferential diagnosis are simply perfect. There is a special chapter
on pregnancy complicated by cancer of the cervix, for which the
author recommends hysterectomy by the abdomen. There are two
excellent chapters on the etiology of the disease, the author leaning
to the view that heredity seems to have very little influence ; he
says the weight of evidence is against the parasitic theory. But
the best chapter of all is the appendix by Knowsley Thornton, of
London, which should be read by every general practitioner, and
from which we give a few extracts : “ How is an early diagnosis to
be made? Clearly by neglecting no menstrual departure from the
normal, however trivial it might at first sight appear, but at once to
encourage the patient to accurately describe symptoms, and, above
all, to insist in the most determined manner on a local examination.
Here it will be apparent that I, as a consultant, appeal for help to
the great body of those who are now listening to my remarks, to
my professional brethren engaged in general practice. I, in com¬
mon with those situated as 1 am, too seldom have an opportunity
of diagnosing early, because the majority of the patients come to
us too late, when the disease has advanced nearly, or quite, beyond
the limits of surgical aid. Let me, then, appeal to all engaged in
family practice who listen to me here, and to that larger body who
may read my words when reproduced in the medical journals, to
sternly cast aside that too great modesty, or that tendency to treat
as trivial, small symptoms, and to at once take alarm about, and
carefully investigate every case in which there is brought to their
notice an abnormality in menstruation or a vaginal discharge of any
kind, however trifling. A very grave responsibility lies at the door
of the medical profession for the small progress made in the early
diagnosis of uterine cancer and its successful treatment. How
constantly is the consultant told, 1 1 mentioned it to my doctor
weeks or months ago, but he said, “ Oh, it is nothing. I will send
you a little medicine or a little injection,” and never even suggested
any internal examination, so I did not like to trouble him again till
the pain became so bad or the discharge so troublesome, and ihen
he examined me and said I must have special advice at once/ ”
Space prevents us from making other extracts, but the work is full
of valuable advice, and should be in great demand. A. L. S.

Thompson’s Practical Medicine.—A Text-Book of
Practical Medicine By William Gilman Thompson!
M.D., Professor of Medicine in Cornell University Medica,
College, New York City, Physician to the Presbyterian and

BOOK REVIEWS.

373

Bellevue Hospitals, New York. In one magnificent octavo
volume of 1010 pages, with 79 engravings. Cloth, $5 net;
leather, $6 net; half morocco, $6.50 net. Lea Brothers &
Co., publishers.

Works on the Practice of Medicine have been of late years
produced with great profusion, until one is almost at a loss to make
a selection. This volume by Professor Thompson, of the Cornell
University Faculty of Medicine, New York City, is so thorough and
complete, that no one can make a mistake in putting it in a handy
place in his library. Profesosr Thompson is a well-known worker,
and the advent of a new century makes appropriate a comprehensive
review of the present status of medical practice. It is the aim of
this book to offer such a presentation. Special effort has been
made to set forth clearly and simply those facts and principles
which have received clinical proof, and to avoid those theories
which have merely a speculative basis. The recent progress in
pathology, clinical microscopy and bacteriology have greatly ad¬
vanced the realm of definite knowledge, and corresponding modifi¬
cations have taken place in previously existing views of the
etiology, prevention and treatment of disease. The work is
eminently practical, for the author has given his personal experience,
which has extended over twenty years, and he writes with faith.
He assumes that curative medicine is the avowed object for which
medical men practice their art. He has therefore given especial
care to the therapeutical sections, which are detailed and complete.
A number of photo-gravures are introduced mostly from the
author’s collection, and very much enhance the value of the work.
As a text-book for students, it must take a foremost place, and we
confidently look for it being placed among the books recommended
at all our Medical Schools. It is placed at a price within the
reach of all, which indicates the confidence of its publishers in an
unexampled sale. The type is particularly good, and reading does
not tire the eyes.

F. W. C.

The Treatment of Fractures. By Charles Locke Scudder,
M.D., Surgeon to the Massachusetts General , Hospital, Out
Patient Department; Assistant in Clinical and Operative
Surgery in the Harvard |Medical School; assisted by Frederic
J. Cotton, M.D. With 585 illustrations. Philadelphia: W.
B. Saunders, 925 Walnut Street, 1900. Canadian agents, J.
A. Carveth & Co., Toronto, Ont. Price $4.50.

The volume here given us by Scudder, on a subject of such
interest to not only the surgeon, but the general practitioner, is
really one of unusual merit and well worthy of unlimited praise. It
is especially interesting as fractures are of such frequent occurrence
at all ages, and are liable to be followed by deformity or some
permanent impairment of function, ending perhaps in litigation,
that any work of such a practical nature as the one under review,
whereby the diagnosis of these kinds of injuries may be simplified,
must receive a warm and abiding welcome. The general use of
anesthesia in the examination and the initial treatment of fractures,

374

BOOK REVIEWS,

especially of those near or involving joints, has made diagnosis
more accurale and treatment more intelligent. The application of
the Rontgen ray to the diagnosis of fracture of bone has already
contributed much toward an accurate interpretation of the physical
signs of fracture. The author says that this greater certainty in
diagnosis has suggested more direct and simpler methods of treat¬
ment. Antisepsis has opened to operative surgery a very useful
and profitable field in the treatment of fractures. The final results
after the open incision of closed fractures emphasize the fact that
anesthesia, antisepsis, and the Rontgen ray are making the know,
ledge of fractures more exact, and their treatment less complicated-

This work is intended to serve as a guide to the practitioner
and student. Many of the details in treatment of fractures are
described, and as far as possible these details are illustrated. Mech¬
anical simplicity is advocated. An exact knowledge of anatomy
combined with accurate observation is recognized as the proper
basis for the diagnosis and treatment of fractures. The expressions
closed ’’ and “ open ’’ fracture are used in place of “ simple 99
and “ compound” fracture. “ Closed” and “open" express
definite conditions, referring to the freedom from, or liability to
bacterial infection. The old expressions are misleading despite
their long usage.

This work clearly explains the latest and best methods
whereby we may correctly diagnose fractures, and then in an easy
manner shows us the proper treatment to be used. One chapter
deals with the uses of plaster-of-Paris and another takes up the
ambulatory treatment of fractures. The volume is essentially
practical, and should be in the possession of every practitioner
who is desirous of obtaining a good practical grasp of the subject
of the diagnosis and treatment of fractures. The work is more
than well supplied with illustrations which are of unusual merit.
We hare no hesitation, after a close perusal, in recommending the
book, which will prove of particular use to the general practitioner.

R. C.

A Text-Book of Practical Therapeutics. By Hobart A.
Hare, M.D., B.Sc. Eighth edition, revised and largely re-written.
Lea Bros. & Co., Philadelphia and New York, April, 1900.

This eighth edition in less than ten years proves the truth of
the aphorism that “ nothing succeeds like success." The secret
of Prof. Hare’s success in the volume before me lies in the fact
that he knows the busy practitioner needs but a hint to place him
on the right track, while the overburdened student cries aloud to
be delivered from lengthy and erudite discussions of minute physio¬
logical actions, and appreciates something he can easily remember
and make good use of in his prospective practice. In the nearly
eight hundred pages of reading matter, there is not a redundancy
of expression nor a word too much. Neither is there the jerky dog¬
matism that marks the quiz compend. The work is invaluable to
the world of readers to whom it appeals, and will, I hope, see
many revisions and editions at the hands of its capable author.

To those who, like the author, are leaching the subject, there
will be, of course, always minor differences. Among them, the peren¬
nial question of classification. Personally I incline to Schmiedeberg,
—while admitting that Hare’s is handiest in a rush.

BOOK REVIEWS.

375

The illustrations are good and the colored plates excellent J the
letter press is above reproach, and the paper, luckily, unglazed.
Next to Bruton’s Lectures, it is a book that should be on every
practitioner’s desk. W.

Atlas and Epitome of Special Pathologic History. By

Docent Dr. Hermann Diirck, Assistant in the Pathologic in¬
stitute, Prosector to the Municipal Hospital, Munich. Auth¬
orized Translation from the German. Edited by Ludwig
Hektoen, M.D., Professor of Pathology in Rush Medical Col¬
lege, Chicago. Circulatory Organs, Respiratory Organs, Gas-
tro-Intestinal Tract. With 62 colored plates. W.B. Saunders,
925 Walnut Street, Philadelphia. 1900. Canadian Agents,
J. A. Carveth & Co., Toronto, Ont. Price, $3.00 net.

We take pleasure in calling attention to this excellent transla¬
tion of Dr. Dflrck’s Atlas and Epitome. Bearing in mind how
difficult it is to correctly represent pathological appearances in
colored plates, we have no hesitation in stating that the illustrations
are, with few exceptions, faithful and typical pictures of the various
pathological processes described. They are not the idealised and
almost schematic representations of tissue changes such as adorn
certain text-books of pathological histology. The plates on arterio¬
sclerosis and arteritis, on adipositas cordis, on the pneumonias,
are worihyof special notice. The work is well up to the standard
of excellence of the Saunders’ Hand Atlases, and is calculated to
stimulate the student of pathology to personal observations of mor¬
bid histology. A. B.

A Manual of Obstetrics. By A. F. A. King, A. M., M. D.»
Prof, of Obstetrics and Diseases of Women and Children in
the Medical Department of the Columbian University, Wash¬
ington, D. C., and in the University of Vermont; President
(1885-86-87) of the Washington Obstetrical and Gynaecological
Society; President (1883) of the Medical Society of D. C.;
Fellow of the British Gynaecological and of the American
Gynaecological Societies; Consulting Physician to the Chil¬
dren’s Hospital, Washington, D. C.; Obstetrician to the Col¬
umbian University Hospital; Member of the Washington
Academy of Science; of the American Association for the
Advancement of Science; Associate-Member of the Philoso¬
phical Society of Great Britain ; and Member of the Medical
Philosophical, Anthropological and Biological Societies of
Washington, D.C.,elc. Eighth Edition, revised and enlarged.
264 illustrations. Lea Brothers & Co., Philadelphia and New
York, 1900.

The value of King’s Manual of Obstetrics is perhaps best em¬
phasised by the fact that since the first edition appeared in 1882,
there have been no less than eight editions printed. It must have
filled a want amongst students, or it most certainly would not have
become so popular. Students have not the time to read systematic
treatises, but need the facts stated as briefly and comprehensively
as possible. The manner in which Dr. King italicizes the words
that are important to convey the exact ideas he is trying to im¬
press is certainly to be commended. It is up-to-date in theory, and

3 ;6

BOOK REVIEWS.

is correct, we think, when remedies are to be used, in not simply
mentioning them by name, as so many works do, and which is
proper for larger works, but the actual combination in the form
of prescription. This, we believe, is much better for students.
Whether for student or busy practitioner, we can most heartily
recommend the work, whether for the initial study of the work or
for refreshing the memory. For its small cost it should be found on
every student’s and practitioner’s table. H. L. R.

A Practical Treatise on Sexual Disorders of the Male
and Female. By Robt. W. Taylor, M. D. Lea Brothers
& Co., New York and Philadelphia, 1900.

This work is eminently a practical one, and not a compilation
as so many are at present. It is evidently written largely from tha
author’s own experience and not overburdened, and is just what
the general practitioner requires. J. P.

PUBLISHERS DEPARTMENT,

KEEP TAB ON TIME.—Believing thoroughly that a a thing of beauty is
a joy for ever,” and that an article of beauty and utility combined is worthy of
preservation, The New York Pharmacal Association has prepared for distribu¬
tion to the medical profession a handsome and artistic perpetual calendar, which
is now ready for mailing. Instead of presenting a calendar at the beginning of
the year, according to the usual custom, the above company prefers the season
when the physician is not deluged with all sorts and conditions of chronological
recorders, and is thus better enabled to welcome and appreciate such an addition
to his office. The new Lactopeptine Perpetual Calendar is not intended for
hanging upon the wall, but to stand upon the doctor’s desk, and for this reason
ha>a strong easel back to support it. The coloring is exceedingly soft and at¬
tractive, consisting of delicate shades of lavender, purple, crushed strawberry and
buff yellow. The few words relative to Lactopeptine are entirely unobtrusive,
and do not interfere in the least with the general artistic effect. In the near
foreground on either side are two gracefully draped female figures with flowing
hair ; around the edges appear the various signs of the Zodiac.

One of these calendars will be sent to any physician who may request same.

SANMETTO IN PROSTATITIS AND CYSTITIS.—Dr. F. R. Dobson,
of New Orleans, La., late Surgeon U.S.A., writing, says : “ While Surgeon in
First Division Hospital, stationed at Jacksonville, Fla., I had occasion to see an
interesting case of prostatitis treated with Sanmetto, with entire success. The
patient was a private in the St-cond Nebraska Vol., and his condition upon en¬
tering the hospital was deplorable, the bladder being distended with urine, the
overflow dribbling constantly. His condition was traceable to gonorrheal infec¬
tion. Since my return to New Orleans I treated with Sanmetto a case of puru¬
lent cystitis, which had resisted all other treatment. The result of the taking of
one bottle of Sanmetto was permanent relief.”

AN ADDITIONAL HONOR.

We have just been advised of the award by the Judges of the Paris Exposi¬
tion to Messrs. Wm. R. Warner & Co.,of Philadelphia, New York and
Chicago, of the highest medal prize, for their justly celebrated pharmaceutical
products. This makes the 17th World’s Fair highest prize, which has been
awarded this well-known and justly celebrated firm, and we join in congratula¬
tions to Messrs. Wm. R. Warner & Co. over their well-merited and unbroken
line of victories in competition with the world’s manufacturers.

CANADA

MEDICAL RECORD

SEPTEMBER, 1900

Original Communications.

AN ADDRESS ON TUBERCULOUS LESIONS

FROM A CLINICAL POINT OF VIEW.

Being the Address in Surgery delivered before the Canadian
Medical Association at Ottawa , Sept. i$th, 1900.

By EDMUND OWEN, M.B., F B OS-

Surgeon to St. Mary's Hospital, and Consulting Surgeon to the Hospital for Sick
Children, Great Ormond Street, London.

Mr. President and Gentlemen,— Though the sub¬
stance of the Address which I have the high honor of pre¬
senting to you may entirely fail to arouse in you any measure
of satisfaction, yet I think I may, at any rate, claim your
kind appreciation for its title, for it gives you the assurance
that I am not going to ask you, even in your imagination, to
pass any of this September day in that gloomy room in which
Death is made to deliver up his grosser secrets; nor in that
other place where, in an atmosphere of methylated spirits
and oil of cloves, you are accustomed patiently to unravel
the tangled threads of morbid tissues. My remarks will d^al
with tuberculous lesions as the surgeon meets them day by
day in hospital-ward and operating-theatre, and in private
practice. And if I shall find occasion to ask you to go be¬
yond these spheres, it will be to take you to some of those
beautifully placed convalescent institutions in which, when
full of gratitude for having triumphed over the distress of
chronic disease, or the risks which are inseparable from its
operative treatment, the tuberculous patient spends possibly
the very happiest weeks of his life.

It is, I make bold to say, a good and wholesome thing
for a surgeon now and then to get away from the pathologists

378 OWEN : AN ADDRESS ON TUBERCULOUS

and morbid histologists—to play truant, as it were, from his
unbending schoolmasters. In recent years there has been a
little too much inclination to apotheosise the morbid anatom¬
ist. His brow has been decked even with roses, and now
standing high in his suit of sable, he looks upon the clinical
surgeon as if his chief duty were to supply him with ma¬
terial.

In the title of my Address are the words “ from a clinical
point of view,” and desiring to emphasise the fact that the
word clinical related solely to remarks made and work done
in the sick-room and in the theatre, I thought it well to call
attention to its exact meaning. But on looking it out in
“ Liddell and Scott,” I found to my dismay that k\ivj] was
not only that on which one lies , a conch or bed , but, secondarily,
a bier . The discovery somewhat disconcerted me. If a bier,
why not a mortuary-table ? At any rate the word clinical is
of wider significance than I supposed ; so that the patholo¬
gist might have right on his side when he claimed that clini¬
cal instruction, begun at the bed side, and carried, perhaps,
into the operating-theatre, is not complete until he has written
the epitaph.

Even on this side of the middle of the dying century,
institutions were in existence in which much pathological
work was actually done within the walls of the hospital itself.
This, of course, we know to have been wrong. But surely
we have now gone to the other extreme; the pathological
laboratory is constantly getting further and further away
from its source of supply. The pathologist is no longer a
practitioner of medicine, his interest is not in the case but in
the subject. Like the carpenter, he does not interest himself in
living material; his thought is only for dead tissue. The
surgeon sees the human tree during its life (and perhaps helps
to fell it), but he now, unfortunately, rarely follows it off his
estate. So with the student; he does his clinical surgical
work at one time and in one place, and his pathological work
at another, and he is unable, I regret to say, to follow any
individual case, or any part of it, straight from the ward to
the laboratory.

The present arrangement is, of course, incapable of

rr

LESIONS FROM A CLINICAL POINT OF VIEW. 379

alteration, but it is an unfortunate one for the student; and
on his account it behooves the surgeon to do all that he can
towards wielding the pathological details of his cases with the
clinical features, so as to represent to his class that the two
aspects arc inseparable, and must always be considered to¬
gether. If, for instance, he is demonstrating a tuberculous
knee-joint, he should, whilst discussing the clinical features of
the case, explain precisely the histological changes that are
taking place ; and supposing that a resection or amputation
is eventually resorted to, he should show on the fresh speci¬
men in what respect the morbid conditions harmonise with
or differ from the account which he had described. He
should, as far as possible, make his teaching independent of
his colleague in the laboratory, for the specimen which the
latter takes out of a jar of formalin or alcohol is no more like
the condition as it exists in the wards than canned salmon is
like a fresh-run fish.

The clinical surgeon has sometimes beena little too much
under the influence of the experimental pathologist and bac¬
teriologist. When an important surgical problem awaits a
solution which cannot be effected in the ward or on the
operating table, the clinical surgeon turns to his enthusiastic
and obliging friends in the laboratories, who, in order to help
him, straightway proceed with careful thought and gentle
hands to sacrifice upon the altar of Hygeia some mongrel
curs or a few of those tail less rodents, which, so far as I can
see, have been provided solely for the use of the experiment-
ist; then, becausesuch and such a thing happens in such and
such circumstances in the laboratory to the dog or the
guinea-pig, the pathologist is apt to assume that in different
circumstances it must happen also in man himself!

When in due course the pathological and bacteriological
Athanasius formulates his Creed, I am afraid that I shall be
burned at the stake. But in saying this I trust that no one
will jump to the conclusion that I would hinder experimental
research. Indeed, 1 think it absolutely necessary, and I am
strongly of opinion that the life of a man is of more value
than that of many sparrows (or guinea-pigs), and that the
clinical surgeon is deeply indebted to the experimentalist for
much valuable collaboration. But if there is one matter more

380 OWEN : AN ADDRESS ON< TUBERCULOUS

than another in which the work of the experimentalist has
led to faulty generalisation from a clinical point of view, it
is-with regard to the course of certain tuberculous lesions.
Nor will anyone think, I trust, that I would underrate the
value of the work of the experimental pathologist; it cer¬
tainly is not so, for it is to these workers that we owe our
knowledge of the precise cause of diphtheria as well as of
tuberculosis—of tetanus and erysipelas, and of many other
serious diseases. And knowing the cause we have been en¬
abled in many cases greatly to influence the course of the dis¬
ease by treatment Indeed, it would be almost impossible to
over-estimate the practical value of experimental laboratory
work both to the profession and to the public. Nevertheless
there are some of the public who, in their ignorant well-
. meaning, would once and for all stop such beneficent re¬
search. But stranger still, there are some members of our
own profession in England who also try to get in the way of
scientific progress. Fortunately, however, they have not the
power of doing much harm !

Not long ago we used the word “ strumous ” or “ scrofu¬
lous ” when we were in a surgical corner; but to-day these
indefinite terms are deleted from our nosology ; indeed, they
are devoid of scientific meaning, and we now call tubercle by
its proper name, our patients reaping the benefit of our
greater precision.

From the medical point of view an unusual amount of
. attention has lately been drawn to the subject of tuberculosis
by means of excellent societies which have recently been or¬
ganized to carry on a never to be-ended warfare against the
disease. Taking its birth upon the Continent, the schemehas
received a considerable amount of support in Canada, in the
United States, in England and elsewhere, and its effect can¬
not be but for good.

Three Important Facts.

There are three great facts in connection with tubercu¬
losis of which the public mast be mide fully conscious :

The first is that the disease is communicable . The truth

t

of this fact we hive ourselves only of late entirely realized.

LESIONS FROM A CLINICAL POINT OF VIEW. 381 -

The public, therefore, must be allowed a little time before
they generally accept it. But accepted it must be, and it
behooves each one of us to do all tHat we can towards pro¬
moting its acceptance.

The second is that the disease is preventable. This fol¬
lows almost as a corollary to the previous statement, and when
the truth of it becomes fully understood how great will be the
responsility of those who wilfully disregard it.

The third fact is that the disease is curable. And as we
are to-day considering certain surgical lesions of tuber¬
culosis from a clinical point of view, I shall seize this oppor¬
tunity of entering somewhat fully upon the question of cura¬
bility.

The Curability of Tuberculous Lesions.

A few years ago tuberculosis was regarded as a well-nigh
incurable affection, for the word had been chiefly reserved foi*
hopeless cases of pulmonary consumption, and of meningitis
complicating certain chronic diseases. To call a surgical
lesion, therefore, tuberculous was tantamount to-signing the
patient’s death-warrant. It was in the public estimation a
term of dreadful omen. But amang the many uncertainties
of our professional environment, one thing has of late beicome
quite certain, namely, that tuberculosis is not necessarily of
the intractable nature that it was formerly considered to bej
So far as my practical acquaintance with the disease is con^
cerned—and I have worked at a large general hospital, and
at the largest children’s hospital in London for a quartet* of
a century—tuberculous lesions are exactly what they used to
be. But we know much more about them, and careful clini¬
cal study and microscopical and experimental work haVe en¬
abled us to treat them more successfully, and, therefore, to
warrant us in taking a much more hopeful view of them. But
1 would like to know if the surgical lesions of tuberculosis
which are met with in your dry, bracing climate are just as
we have them in Western Europe. Many of y ou have studied
tuberculous lesions under your own bright skies and also in
the mother country, whose borders a're washed by' the seas
and Whose life fs sd .greatly'influenced'by the Gulf-stream.

382 OWEN; AN ADDRESS ON TUBERCULOUS

From your cradle you have been taught that the sun never
sets on the Empire of our dear Sovereign Lady, but l am
afraid that when some of you have come over to us in a bad
season you have wondered if there are not parts on which it
never rises. Well, do you find that tuberculous lesions are
exactly the same clinically in the two hemispheres ? Every
country has a climate, just as it is said to have a form of
government, which is equal to its deserts; ours is a damp
ciiinate which exactly suits the soil and the race ; but it is a
bad one for the unhappy individual in whose blood the
bacilli of tuberculosis are lurking, as well as for those who
by heredity or surroundings have acquired that condition of
tissue which renders it vulnerable by the mean bacilli of
tuberculosis, and adapts it for their cultivation.

Sometimes when I have been going round my wards I
have asked a visitor to note how large a proportion of the
cases are tuberculous. Is it thus also in your surgical work ?
Do chronic tuberculous affections of the hip-joint, knee, spine,
lymphatic glands, shoulder, elbow, foot and hand, represent
a very large proportion of lesions which come under treat*
ment by the general surgeon ? Have you, in proportion, just
about as much tuberculous disease in Canada as we have at
home; and does it take the same course ?

Muchx>f my clinical work has lain amongst senior stu¬
dents ; I come in contact with them just as they have left
the laboratories and are proceeding to put what they imagine
to be the "finishing touches” upon their professional educa¬
tion. They have spent many delightful hours in a pathologi¬
cal laboratory and in a white cotton smock; they have culti¬
vated and even tamed bacilli; they have seen how potent
they may be for evil, and they are firmly of opinion that if
once such germs gain access to a suitable spot in a suitable
individual, nothing short of the most vigorous surgical mea¬
sures can suffice for the eradication of the disease and for the
emancipation of the host. This is the students’ bacteriologi¬
cal faith, and except they act up to it their patients cannot
be saved. Many young practitioners also hold that faith.
Where do they learn it? Not in clinical surgery. The
public also have begun to believe it; but the public will be-

LESIONS FROM A CLINICAL POINT OF VIEW. 383

Keve anything that they are told if only they Sire told it Often
enough. And if the statement is couched in semi-scientific
or mysterious phraseology they seize upon it with all the
greater avidity. Otherwise, how would bonesetters, vendors
of patent medicines, and other quacks, qualified and unquali¬
fied, flourish like a green bay tree in a sunny corner of an
arboretum ?

But is the outlook in advanced tuberculous disease neces¬
sarily so hopeless in the absence of active surgical treatment?
To answer this important question I will instance an imagin¬
ary case of a young man who, a year or so previously, hurt
his back in a fall at a gymnasium. He has now pectoral
neuralgias, and dull pains between his shoulder-blades and in
his back, which have probably been ascribed to “rheuma¬
tism.” Eventually the discovery is made that the third and
fourth dorsal spinous processes are unduly prominent, and
it is evident that the bodies of those vertebrae have under¬
gone tuberculous disintegration. The disease is close behind
the arch of the aorta, and the surgeon is unable to get at it
He cannot scrape it and he cannot even irrigate it with
germicidal lotions. I believe that there are some surgeons
who would attack it if they could : rien n'est sacripour un
sapeur; but fortunately one cannot possibly get at it. What
then, is to be the future of this patient ? Is he going to die
the death, as the guinea-pig would, in the laboratory ? Most
certainly not. Everyone here has acquaintance with such an
individual, or if he does not know him personally he has
seen him in the street He is rather a short man with pecu¬
liarly high, square shoulders, and with a boss between them.
And not only has he long since outgrown his tuberculous dis¬
ease without any operative assistance whatever, but could we
See him in his own home, we might not improbably find him

_and I say it with some regret—surrounded by a number of

apparently healthy sons and daughters.

Such a case is one of great clinical importance; it shows
that a man with an undoubted tuberculous lesion of the first
magnitude can completely recover without having undergone
any operative procedure. At the end of the 19th century it
ii somewhat unusual for any patient with any surgical affec-

384 OWEN: AN ADDRESS ON TUBERCULOUS

tion to be allowed the opportunity of showing what he can
do without submitting himself to operation, so that such an ac¬
count as that which I have just instanced is not only important
but actually interesting. One rarely hears speak now of the
vis medicatrix Natures: surgical zeal has apparently rendered
it not only obsolete but superfluous.

Another instance of the favorable course which severe
tuberculous disease may run in the absence of active .surgical
interference, is seen in the case of old standing hip-joint
disease, the boy actually “ growing out of his trouble.” The
disease, let us suppose, began at that period of life when it is
customary to send a boy to school, and his school-life was
frequently interrupted and was continuously clouded by the
affection. But he is now a young man at College, and though
he walks lame and is precluded from taking an active part in
athletics, still he is vigorous, and he has evidently and com¬
pletely triumphed over his disease. I am not sure that
I have in clinical work ever before used the specious expres¬
sion, “ growing out of a diseaseand possibly I might not do
so now if I thought that there were any students or unquali¬
fied persons present, for its adoption might prove unfortunate
or even dangerous. It is a rather favourite expression, how¬
ever, amongst parents and other ill-informed persons when
confronted with a child with a tuberculous lesion. Would
they expect a garden to grow out of its weeds or a field out
of its thistles ? No; it is a popular superstition, but, like
most erroneous beliefs, it is founded on a substratum of truth.
For, as a matter of fact, many patients do “grow out of’*
tuberculous disease, and, strange to say, sometimes most
markedly so after a surgeon has made the clear pronounce¬
ment that without operation recovery is quite impossible. A
boy, for instance, =has chronic tuberculous and suppurative
disease of his tarsus; he is albuminuric and very ill. His
able young surgeon says that unless the foot is removed the,
boy will die. This is an unwise thing for any surgeon to
say, .for he cannot possibly know for certain what is going to
happen. But what may happen is this: The operation is de¬
clined, the child is put under the caie of another practitioner
who,, though not so clever a surgeon, is, perhaps, older and

LESIONS FROM A CLINICAL POINT OF VIEW. 385

better man of the world. By good luck rather than by good
management the disease clears up, and in a couple of years*
time the boy is walking about with scarcely a limp. “ See
that boy ?” says the proud father, “ well, Dr. Omniscient
wanted to cut off his foot, but his mother and I would not
let him!” According to the rules of the game the foot, of
course, ought to have been amputated ; but Nature does not
always play according to the rules, as the young practitioner
sometimes finds out to his cost. Knowledge is the prerogative
of youth, but wisdom should come with years-

I recollect that I have wandered from that case of
chronic hip-joint disease; I was instancing it merely to say
that, though the head of the thigh bone and the socket in
which it worked have been quietly destroyed by the growth
of tuberculous granulation tissue, so that the limb is greatly
shortened, still, it is now, years afterwards, solidly fixed and
fairly serviceable. The skin has remained unbroken, and
the man has completely triumphed over his disease.

In connection with this little batch of reports, I would
like to make a few disconnected statements, chiefly from a
clinical point of view:

1. Chronic inflammation of a joint in a child or young
person is always tuberculous—except in those very rare cases
in which it is due to hereditary syphilis or osteo-arthritis.

2. Tuberculous inflammation may completely destroy a
joint, and then leave it solidly and soundly synostosed, with¬
out the surrounding tissues or the skin having been impli¬
cated.

3. If tuberculous granulation-tissue breaks down into a
fluid, that fluid is not pus, and the collection is not, properly
speaking, an abscess —unless, by bad fortune, or by worse
surgery, it has become infected by septic micro-organisms.

4. The fluid collection is not to be treated as an abscess
—by incision and drainage, that is—but is to be opened and
emptied, and scraped and cleansed of its unhealthy lining of
granulation-tissue. Then the wound in the skin is to be com¬
pletely closed by sutures ; firm pressure is to be evenly applied
and the part is to be kept absolutely .at rest. It is no news
to most of you. to be told that the success attending this line

386 OWEN: AN ADDRESS ON TUBERCULOUS

of treatment leaves, as a rule, little to be desired, or that for
this important advance in practical surgery we are chiefly
indebted to the patient researches of our friends with the
smock-frocks and the guinea-pigs.

5. I have failed to discover that iodoform is of any
peculiar value in the treatment of tuberculous lesions. At
any rate I have long since discarded it, and I have not no¬
ticed any falling off in the results of my practice in conse¬
quence. Iodoform is an irritant and a poison ; it is apt to
be septic, as germs can grow upon it, but I have no knowl¬
edge of the truth of the statement that mushrooms have
actually been cultivated on it

Sometime since a lady was sent to me for my opinion
about a tuberculous ulcer of'the anus which a practitioner had
long been treating with iodoform. She earnestly begged me
to consider if T could not recommend some other local ap¬
plication, as she said that the smell of the yellow powder ren¬
dered her “ socially objectionable.” This was for her a very
serious matter, as she kept a fashionable boarding-house, and
whilst many members of her household seemed to notice the
peculiar odour, some few of her. young men “paying guests”
actually appear to recognize the drug itself.

I confess that I have a sort of feeling of sorrow for a sur¬
geon who thinks that he cannot successfully carry on his
practice without iodoform, just as I have for the lady who
deems patchouli to be indispensable for her toilet

The Forcible Straightening of Carious Spines.

The direct treatment of the angular deformity resulting
from tuberculous disease of the spine is a subject that a few
years ago was thrust somewhat vigorously upon us, not only
by articles in the medical papers, but by the reproduction of
photographic representations of ghastly clinical procedures in
the pictured journals of the lay press. This is scarcely the
way in which one would expect solid surgical work to be
advanced. One remembers that there was a somewhat simi¬
lar outburst in the lay press a few years ago, when the Koch
treatment of tuberculosis was being boomed in Berlin. For
this, however, the illustrious Koch must not be held respon-

LESIONS FROM A CLINICAL POINT OF VIEW. 387

sible; he was hurried into bringing forward his work ere he
had assured himself that the results of his injections justified
their being regarded as curative. Immediately there was a
rush to the German capital, and medical men lent themselves
and their names to lay journalism and their portraits to the
illustrated papers, passing glad to obtain notoriety in such a
beneficient, or at any rate in such a popular, movement.

I do not know how it may be with you, but in Western
Europe every new method or invention is at once greedily
accepted and not improbably made the means of unmistak¬
able advertisement. It does not much matter whether it is
to turn out a real success or not, the point seems to be to
have one’s name associated w ith it whilst it is on the crest of
the wave.

I say that I do not know how it may be with you, but I
hope and I think that in your peaceful Arcadia you can
practice your profession undisturbed by many of the anxie¬
ties, struggles and temptations by which your less fortunate
confreres are sometimes well-nigh overwhelmed in an older
country. And long may it continue with you, not only for
the good of your honorable profession, but also for your own
self-respect and happiness-

To affirm that the forcible straightening of carious
spines must needs be unsurgical simply because it is a re¬
version to the ways of the bone setter would be unfair, for the
blundering bonesetter sometimes did good by chance. But
at any rate he experienced none of that sense of responsibility
which a surgeon must feel when he is proposing to straigh¬
ten a tuberculous spine. It is obvious that in straightening
the angle the tuberculous ulcer of the vertebrae must be widely
ppened out, and that, if the neural arches have been already
cemented together, this rigid support must be broken across.
And, supposing that this is done, and that the patient sur¬
vives the risks which are inseparable from the procedure,
will the widened osteal ulcer duly heal and the neural arches
again become solid? Possibly so.. Bu^and this is the
point—will there be no further recurrence of the hump ?

Though I should be grieved to stand in the way of sur¬
gical advancement, I do not mind getting in the road and

3 &s OWEN: AN ADDRESS ON TUBERCULOUS

temporarily .impeding traffic whilst we are taking time to
consider rhe route, and are assuring ourselves that the stream
of surgical practice is going in the right direction. My
opinion is that the deformity of Pott's disease d.hei not
knd itself to operative tfeatirient; that forcibly to interfere
with it fe to thwart Nature u< her good attempts at effecting
a curative eonsdlidab'Qn in her own way—and- Nature’s ways
as a rule, are not unWorthy of bur respectful recognition. I
think, further, ihat in a short time we shall hear very little
about this method. This is what l think, but I am absolute¬
ly surt of this, that if a child of my own had an angular de¬
formity of its spine, no person on earth should be allowed
roughly to meddle with it. This is the only trustworthy way
of testing one’s opinion concerning the fhe.rapeuttc value of
speculative niethods of treatment, and when a surgeon is
planning, sortie new scheme of procedure, jf kagood thing
for him to measure' it out first with the golden rule—would he
accept -.such and such a line-of treat ment for himself, or for
those nearest and dearest to him7 But surely, after aU,
each one of us actually does this, though some apparently
have greater belief in heroic measures than others. M any
rate, let ns not be precipitate or over-.enthustastic with respect
to each untried method as it is introduced 1 fcstmi'fants.

There is a small class of cases for which forcible rectifi
cation of the angular deformity may. perhaps, eventually be
found suitable, namely, in a certain few pf those ;ih Which
pressure by bone, or by organizing inflsmmatory'deposits, has
taken place upon the anterior surface of the eord, so that the
patient has lost the power of voluntary movements iri the
lower extremities. In a lew such case-. I might perhaps be
eventually inclined to resort to forcible straightening rather
than to a laminectomy, an operation of which, by the by, I
have but a poor opinion.

The humped back of spinal disease is of course an op*
probrium. and it is small wonder that the surgeon is anxious
to efface it. But if he had given proofs of such laudable
anxiety at the beginning of his treatment of the case, he
would probably have bad no hump to deal with. 1 have no
hesitation in saying that, even at the present time, the treat-

LESIONS FROM A CLINICAL POINT OF VIEW, 3S9

ment of spinal disease in its early stages is too often ha.U-
bearted and sometimes actually blameworthy. Ii may be
urged by way of Excuse that at the very beginning of spinal
disease the symptoms are so equivocal that the practitioner
hesitate* eyed to. whisper his opinion/lest. the disappearance
of the symptoms should suggest that after .aU he is an alarmist.
He knevy' that the girl . had ^h^detdc^v'pairt'i. in her chest,
belly and legs ; he knewthatshegoi easdy ited at play, or
that she was inclined to loll and lie about When others were
full of activity, and that, regard less of nursery manners, she
persistently: sat at meal* with her elbows on the table. He
suspected spinal disease; he even told the parents that the
girl should be kept quiet. He may actually have gone so far
as to sketch out a pUn of treatment which was designed to
secure a certain amount of mt, but he was slack in seeing
that even lids small measure was carried out, in short, he
had not the courage m bii apitiipas and the case was allowed
to drift

'Oh, for the^iriTeff-Lady Macbeth, who called put to h$r
weak kdeed spouse and fellow-practitioner,

Infirm, of purpose V Give.me* thn ^

I am a. great aclmifer of Lady Macbeth, though I am fully
aware that her character is not faultless. She was not the
sort of person, perhapsy to be trusted with the rkssccitoh of
tuberculous gland-: from the neck, or of operating on a case
of torticollis, but how splendid she would have been in the
treatment of eartjrspinal disease! There would have been
no half-measure with her!

The. Treatment of Veltebrac.' Caries,

If a practical surgeon were asked what is the proper
treatment of early spina! disease, he Wbbld hhhesjtatingjy say
Uni / ' V«, ahsbluic and onhd««upted rest/ But there is
only one way of ensuring such rest for a child, and that, is by
making him lie flat in bed, As l shall set forth directly, be
is not to be kept actt^ly'’#. Acifa.il the time; berf in every
case the treatment Is at any rate it> be commenced by lia»
prisoning him in a pillowless bed. This, f feel sure, is the
only way of successfully inaugurating the treatment of r&t.

390

OWEN: AN ADDRESS ON TUBERCULOUS

But it is of little use if, when in bed, the patient is allowed to
roll about, to sit up for his meals, or to hang over the side of
the bed in order to pick up a dropped toy. The details of
the treatment must be seriously considered, and the medical
man must make it his business to see that they are loyally and
thoroughly carried out. He must not content himself merely
with giving his instructions; the parents will very likely want
careful looking after, as well as the boy, or else as soon as
the doctor has left the house, or at any rate after a short
period of rest, the boy will probably be allowed to do pretty
well what he likes, and so the case will quietly drift. What
the circumstances demand is the presence of a sort of
clinical policeman in the house, in the shape of a hospital
nurse.

I know that there are all sorts of schemes, corsets, appar¬
atus and braces (as my American friends call them) for treat¬
ing spinal caries without keeping the patient flat. But they
are all wrong ; wrong in theory and wrong in practice • and
if they could be cast into the bottomless pit, and every case of
spinal disease could from the beginning be treated by con¬
tinuous rest in the horizontal position, there should be no
more of those unsightly humps to invite speculative inter¬
ference. Of course, I do not include in my anathema Phelps’s
box-splint, the double Thomas’s splint with head piece, or
any form of cuirass which takes the child in bodily and keeps
him flat. Indeed, the design of each one of them is well-
nigh perfect; but what I want utterly and severely to con¬
demn is the modern, ambulatory treatment of spinal caries.
I think it probable that, after all the stir about the new treat¬
ment of hump backs by forcible straightening has subsided,
the chief beneficial outcome will be that every surgeon feels
himself compelled to be far more careful in the adoption of
patient and efficient prophylactic measures in the early days
of the disease.

As I look back through many years of active hospital
practice, I cannot divest myself of the thought that the
plaster-of-paris jacket treatment (of which, I confess, I have
been a warm advocate) must be held responsible for much
of the existing deformity of Pott’s disease. Many a time

LESIONS FROM A CLINICAL POINT OF VIEW. 391

have I seen the angular protection coming on and increas¬
ing when the child had been getting about in a plaster jacket
or some other form of support.

Though the child is to be lying flat for six, twelve,
eighteen or more months he is not to be shut up in a close
bedroom ; the windows are to be kept open, and he is to be
carried out every day into God’s blessed sunshine—which is
as necessary for warm-blooded animals as for plants; his
muscles are to be maintained in good trim by massage, but
he is to be kept all the time in the horizontal position. I
know that in these days of activity and progress such un¬
romantic treatment demands great confidence on the part of
the parents in the judgment of the practitioner who insists
upon it. but no little experience enables me with the utmost
confidence to recommend it Certainly it is not a new
method. Hear what Sir Benjamin Brodie says upon the
subject—this is the sentence at the very beginning of his
valuable chapter on the “ Treatment of Caries of the Spine.”
“ From the first moment, therefore, in which the nature of
the case is clearly indicated, the patient should abandon his
usual habits, and be confined altogether on his bed or
couch.” *

Naturally one turns also to see what Percivall Pott has
to say upon the question of the treatment of the disease
which bears his honoured name. And it is somewhat of a
disappointment to find him so taken up with the subject of
the Palsy of the Lower Limbs which follows destruction
of the bodies of the vertebrae, that apparently he has not the
inclination to discuss general measures. But it is all de¬
lightful reading, and even to-day it is brimful of clinical in¬
struction. What a relief it is to read a chapter or two of
Pott, or Brodie, or Chassaignac after one has been poring
over the pages of some modern text-book in order, as the
saying is, to “ keep abreast with the times !” Pott seems to
put his red velvet sleeve around one’s shoulders and to draw
one aside from the bustling crowd of the “ busy practi¬
tioners ” (in whose peculiar interest modern text-books are
quaintly said to be written), and to talk to one in the de¬
ft Observations on the Diseases of the Joints, 1850, page 34a.

392 OWEN : AN ADDRESS ON TUBERCULOUS

UghtfuL manner of those whose literary style has not been
spoilt by the habit of counting words on telegraph forms or
by compiling “ copy ” of precise length, and in a limited
time for medical publishers!

However, Ppifhas a few: pregnant remarks tp make
about the treatment c4 the later stages of spina* disease, but
1 am afraid that they will not prove quite acceptable to
most modern surgeons any. more than my own poor words
on that subject may dm Stilly it & a great pleasure to know
that one is in good company the while! Pott is talking,
about the. treatment by ‘‘spinal-supports/' and ,? s.ted bod¬
ices/' and. as ? am telling you what he says, I feel his vel¬
vet sleeve leaving my shoulders and actually passing around
my neck. He says thhb though the use of these ’‘pieces of
machinery’’ is so general, and the .vulgar prejudice in their
favour is so great, he has long been convinced of their per¬
fect inutility, and, moreover, that he is satisfied their effects
are mischievous.

Speaking generally, the acceptance of a simple un-
romantic clinical method makes a fur more serious demand
upon the parent's or the patient’s confidence than docs the
bidding of him to do some greater thing. This is under¬
stood and acted upon bylfhe. quaek who, to create an

impressibn. inserts in a lengthy prescription some rare and
perhaps rubbishing ingredient which he thinks the apothe¬
cary will be unlikely to have hr stock ; who writes Cut a
fussy dietary with. umVdrihy attention to detail, and whov
having failed to pre¬

serve an unenvied reputation' by sending his confiding
patient to some far-distant watering place, in spite of
education, people love quackery now just as much as they
did in the time of Elisha, and, strange to say, the highet they
arts in the social scale the more they seem to hanker after It.
The brief.'Clinical record which have to the tuberculous
lesion of. the Syrian Lord Roberts admirably illustrates
these points, for

Naaman wroth, sml went afrajr, and •said, “ Behold ,1 thought. He
•will surely corns out ru roe, and sund, anti call on lhe name of the Lord his
God, find strike bis hand *>fer ihe pface.’ f

No; if he was to undergo the water-cure it certainly

LESIONS FROM A CLINIC\L POINT OF VIEW.

393

should not be in a muddy Israelitish stream ; he knew of' a
couple of spas in Damascus which were really high class 4
“ So he turned and went away in a rage.” But beinig 4 ‘ a
great man” he was not obstinate; so he changed his mind,
followed out the instruction to the letter, and to his intense
delight, attained the reward which sometimes falls to those
who do exactly what their doctors tell them.

Here, so far as this Address is concerned, the clinical
aspect of the case of Naaman ends but it still contains an
important lesson from a public point of view. For when
the gallant officer found that his cure was complete he went
straight to his good doctor—whilst the tear of gratitude was
still in his eye—and begged his acceptance of a substantial
and appropriate reward for the great service which he had
rendered.

If during the unromantic treatment of spinal caries the
weather is very bad and the patient has to be kept in his
bedroom, the window should be open, and, if necessary and
practicable, a fire should be burning—not a poisonous, parch¬
ing gas-fire, however, as one finds in so many bedrooms^
The condition of the bedroom of town-dwellers in England
is a subject which greatly needs reform. The bedrooms in
many London houses have recently become the recipients of
a kind of back-wash of that unwholesome tide of aestheticism
which was so much in evidence about twenty years ago.
The walls are heavily papered and covered with fans, silly
brackets and ornaments, dirty-looking hangings and rubbish¬
ing photographs. The table or chest of drawers is spread with
an uncleaned cloth on which are arranged more photographs
and dozens of nick-nacks—every one of which is a dust and
germ collector. The furniture and window-hangings are
heavy and the room is stuffy, dusty and teeming with germs
of all sorts, I should think, and not improbably with those
of tuberculosis.

Such rooms should be stripped bare, fumigated and
washed ; the walls should be distempered, and the floors
should be treated to a weekly scrubbing. A small iron bed,
a washstand and a couple of rush-bottomed chairs would be
about all the furniture allowed. This does not sound artistfc.

394 OWEN : AN ADDRESS ON TUBERCULOUS

I admit, but it is healthy, and it is better to be healthy than
“artistic”; but art which is not subservient to intellectual
and physical health is false and unwholesome.

When much of my work lay with out-patients, I used
to have the children with spinal caries placed in the empty
boxes in which oranges are imported. Such a box could be
bought for a few pence, and an old blanket folded on the
bottom of it served as a mattress. In the process of evolu¬
tion the orange-box became for certain children a Phelps’s
box-splint. By some such means a child with caries can be
carried from one room to another or taken into the open air
without risk, and by slightly tilting up the box or tray the
child can see what is going on around him, and thus he feels
that he is not entirely excluded from the bustling world—the
bright and sunny world in which his happy friends are per¬
mitted the enjoyment of work and relaxation.

Some years ago a man of about thirty was brought to
me with the stiff, straight bjick, and all the other signs of
lumbar caries. He lived close to a cricket-held, and it was
early summer; so, having had him fitted with a rigid jacket,

I told him to spend the whole day lying on his face and
watching the games. Thus he was able to enjoy to the full
those three essentials for the successful treatment of the dis¬
ease, rest, fresh air and sunshine, and he made a complete
recovery.

But supposing that the child with dorsal caries has been
kept lying flat from the very first, the surgeon cannot even
then promise that no deformity shall ensue, because the ver¬
tebral ulceration heals by granulation-t.ssue, which is ulti¬
mately converted into fibrous and osseous scar tissue. This,
in consolidating, of necessity undergoes a considerable
amount of contraction, which may suffice to draw the front
of the vertebrae together. The more extensive the ulcera¬
tion the greater is the amount of cicatricial contraction, and
the more pronounced the deformity.

Here, in Eastern Canada, it would especially ill-become
me to speak lightly of the value of cod-liver oil in the treat¬
ment of the disease under consideration, but perhaps I may
humbly suggest that there are other remedies which may be

LESIONS FROM A CLINICAL POINT OF VIEW. 395

looked to in the circumstances. As a matter of fact, I am a
great believer in the value of the oil, but I would not, against
his will, insist on a child taking a dessert-spoonful or even a
tea-spoonful of it three times a day, as the manner of some
is. So forced down, it is apt to upset the stomach as well
as to cause diarrhoea, and it may then be found floating
upon the surface of the dejections.

We are all apt to get too much in the habit of pre¬
scribing medical and dietetic treatment by routine, ignoring
the fact that constitutions are not equally made to pattern.
You have heard of that submissive patient for whom Sir
Andrew Clark had laid down a very particular and strict
regimen which ended up as follows: “ And after dinner one
cigar; not a strong one; a single Manilla cheroot.” In
answer to the illustrious physician’s inquiry, a week later, as
to how the dietary had answered, the unhappy patient,
whilst replying that he was certainly better, pleaded to be
let off the cheroot, which had invariably had the result of
dispossessing him of his dinner. Possibly, however, after
all, it was that cheroot which had played the most im¬
portant part in effecting the gentleman’s improvement!

Cream, butter, bacon and other fatty foods are all good
for tuberculous patients, but I think that there is nothing
quite so valuable as cod-liver oil. And if a patient assures
me that he cannot take it, I often manage successfully to ad¬
minister it after breaking up a conspiracy amongst his
olfactory, optic and pneumogastric nerves. He probably
confesses that he likes sardines; so, without his becoming
aware of the trick, I have the preservative cotton-seed oil
emptied away, and keep the sardine box filled with fresh
cod-liver oil, of which every day he unconsciously takes a
substantial amount.

For a tuberculous infant I order systematic inunction of
the limbs and body with cod-liver oil every evening after
the warm bath. I fully understand that this is apt to make
the child “socially objectionable,” but this is overlooked
when the mother finds that he is improving and steadily in¬
creasing in weight.

396 OWEN: AN ADDRESS ON TUBERCULOUS

Prophylaxis.

The extermination-treatment of tuberculosis is a subject
in which every member of the community should be en¬
couraged to take a personal and intelligent interest. It is a
great mistake to allow it to be regarded as merely “a doc*
tor’s question.” And to wage a successful war of exter¬
mination the attack should be begun right early. It is a
question which is of vital importance for the nursery, the
school-room, the dwelling-house, the store, the office, the
barrack—in fact it concerns every department and every
period of life. The disease is everywhere, and its eradica¬
tion is, therefore, a matter of concern to everyone.

It has not yet been shown that the offspring of tubercu¬
lous parents are born actually tuberculous, but it is beyond
question that they are very prone to inherit a peculiar physi¬
cal condition which renders their tissues an easy prey to the
germs of the disease. The family history of many patients
who at the threshold of life become the subjects of enlarged
glands, or of chronic affections of the bones or joints, gives
incontrovertible evidence of their being a marked hereditary
disposition in the matter of tuberculosis.

So comes the question, ought there to be a law prevent¬
ing those who are undoubtedly tuberculous taking upon
themselves the responsibility of parentage ? There are some
who would answer this affirmatively and without hesitation.
But what would the Church in general say to it, and what
would the tuberculous curate in particular say to it ? He
would tell us that he reads in the very beginning of his Book
that he is to “ Be fruitful and multiply; ” and, to do him jus¬
tice, it must be admitted that in England, at any rate, he does
his best to carry out this instruction to the very letter. But
let him finish the injunction—Man was to be fruitful that he
might replenish the earth. Now, though I do not claim to be
in possession of peculiar knowledge on this point, I cannot
think that the Great Architect of the Universe who “ saw
everything that He had made and, behold, it was very good,”
could have desired that this beautiful world was eventually
to be stocked with so large a proportion of tuberculous,
rubbish.

LESIONS FROM A CLINICAL POINT OF VIEW. 397

I am fully conscious of the fact that, in suggesting the
desirability of preventing the marriage of tuberculosis persons,
I am advancing a somewhat extreme measure; but surely
the subject enters very largely into the question of prophy¬
laxis. It is one, moreover, that will have to be deliberately
approached and dealt with some day, and that, perhaps, soon.
I do not think that our Houses of Parliament as at present con¬
stituted will be anxious to occupy themselves with an attempt
to solve this question, vast as its imperial importance is, but
I think that the County Councils, which we have lately es¬
tablished through England, might find the task not uncon¬
genial. The question is fully as important as that of water
supply, or of protection from fire, or of the isolation of infec¬
tious disease, each of which is already in their grasp. Indeed,
I think that it falls in under the last heading. And what
scope it would afford for discussion !

You will remember that when Horatio and Marcellus
joined Hamlet on the platform after the appearance of the
ghost, and showed great anxiety to know what had been the
subject of his remarks, Hamlet tried to put them off by telling
them that his communication had been something of a quite
commonplace nature, on which Horatio ejaculated:

There needs no ghost, my lord, come from the grave
To tell as this.

I do not know what space the “ perturbed spirit ” had
traversed in order to deliver his Address to the unhappy
Prince, but I have travelled about four thousand miles to
deliver mine. And if you feel inclined to suggest that there
was no need for one to come so far to tell you that which I
have just unfolded—that it is commonplace, and by no
means worth my long journey or your short one—I shall
conclude with Hamlet’s retort:

Why, right; you are i* the right 5
And so, without more circumstance a t all,

1 hold it fit that we shake hands and part.

As a‘matter of fact, I have not, like the ghost, tempor¬
arily escaped for the purpose of this communication from a
place where sulphur, burned in the open, is the ordinary
domestic fuel, but I am here in Response to a kind and highly

398 OWEN: AN ADDRESS ON TUBERCULOUS &C.

flattering invitation from yourselves. I had, indeed, made
arrangements for spending my autumn holidays, which cer¬
tainly did not include two weeks of sea-sickness; but, when I
received your President’s command (for so I regarded your
invitation), I at once scattered my personal plans and con¬
siderations to the winds and decided to accept it And let
me tell you that coming to Ottawa is not to me like going
among strangers, though it is my first visit here, it arouses in
me a feeling somewhat like that experienced by a man who
is taking a homeward journey, for my father was a Canadian.
From my infancy I have had pictured to me, and have been
encouraged to interest myself in, your forests and rivers, your
orchards and wide fields of waving corn, your green pastures
and still waters, and your lingering snows (kindly notice that
I have put the snows last). I have also constantly heard
from my childhood of the intense loyalty of the peoples of
this great and fertile country, and of the loving devotion of
its sons and daughters to that dear Lady who is, indeed, a
mother to us all.

Lastly, let me tell you that your complimentary invita¬
tion came to me just after those dark days of trial in which
an ambitious, a cunning and an unscrupulous race had been
endeavouring forever to overwhelm us* Dark, indeed, were
those days; but darker still would they have been had we not
known that your strong-limbed and keen-eyed sons were
standing by us in our time of need ! It is certainly not for
a humble individual like me to presume, or to attempt, to say
what the feeling of undemonstrative England may be to¬
wards Canada—I allude to this and to other circumstances
only that you may in some measure see with what pride I
accepted your invitation, and in order that you may more
fully appreciate the sincerity of the thanks which I herewith
tender you for thus directing my course to Ottawa, with an
inclination eastwards to Nova Scotia—and to Halifax—where,
in 1812, my good father was born.

Medical Society Proceedings.

CANADIAN MEDICAL ASSOCIATION.

The tl Century 99 Meeting, which was the Thirty-Third Annual
Meeting of the Canadian Medical Association, took place in the
Academic Hall, of the Ottawa University, Ottawa, on the 12th, 13th
and 14th of Sept., 1900, Dr. R. W. Powell, the President, in the
chair, and Dr. F. N. G. Starr, Toronto, Secretary.

The Minutes of the last meeting held in Toronto were read by
the secretary and adopted.

Dr. Drewer, of Ottawa, presented the report of the Committee
of Arrangements.

The Present Status of the Eliminative and Antiseptic
Treatment of Typhoid Fever.

Dr. W. B. Thistle, of Toronto University, read this paper.
Some seven years ago he introduced th s plan of treatment of
typhoid fever to the profession. He claim :d that this form of treat¬
ment for typhoid fever had lime and again been misrepresented by
Professor O^ler and others, as he had never held to the opinion that
the eliminative and antiseptic plan could rid such organs as the
liver and spleen of the bacilli lodged in them. When once the
typhoid bacilli gain access to the intestinal tract, the multiplica¬
tion of them occurs with extreme rapidity, and the intestinal con¬
tents teem with countless numbers of them. These are not confined
to the intestine, but are to be found in the walls, and in fact in
almost every organ of the body. He was of the opinion that the
draining of the intestinal walls following upon the action of a pur¬
gative either as calomel ?or mag. sulpha’e would tend to get rid of
some of these bacilli in the intestinal wall*, but he did not claim
that it would effect their exit from the liver, etc. He thought the
treatment had been imperfectly applied in many instances without
a clear conception of the underlying principles. Under this plan
of treatment Dr. Thistle has never had a single case of hemor¬
rhage, what hemorrhage occurred having been always very slight.
He has also had very few perforations—and twenty per cent, of the
death rate is from perforation and hemorrhage. In Toronto this
plan of treatment is universally adopted. Statistics at the Toronto
General Hospital show that, from 1893 up to the present time,
there have been 833 cases in that institdtion, with 56 deaths— a
mortality of 6}6 per cent.

400 MEDICAL SOCIETY PROCEEDINGS.

In discussing this paper Dr. McPhedran said that he had been
watching Dr. Thistle’s work in this direction from the time of the
appearance of his first paper on the subject, but could not agree
with all his conclusions. He did not think that this plan of treat*
nient lessened diarrhoea, tympanites, fever or delirium. He con¬
sidered that Dr. Thistle was harboring the idea that purgatives in
typhoid were a new discovery with him ; this was not so. Twenty-
five years ago he (Dr. McPhedran) gave these for the first ten
days at least. In addition to this he used to give carbolic acid and
iodine, and in a certain class of cases he thought he had the exact
treatment. Another class would then come along in which that
treatment had no effect whatever. He considered that the
general toxaemia that existed could not be eliminated through the
bowel; it had to be done through the kidneys and skin.

Dr. Thistle, in his reply, emphasized the fact that he was not
trying to eliminate bacilli from the glands; in clearing out the
bowels he is trying to eliminate toxins from the body and not
bacilli.

A Case of Sarcoma *of the Right Nasal Fossa with Acute
Sinusitis and Orbital Cellulitis.

Dr. Perry G. Goldsmith, Belleville, Ont., presented this
paper and patient. The patient was a man of thirty-eight years, a
farmer with an unimportant family and personal history. He con¬
sulted the doctor on the fourth of August last with severe frontal
headache and double vision. Examination of the nasal fossae re¬
vealed growths, which, along with some of the bone in the right
fossa, were removed. After this swelling and pain in the eye began,
so that it was seen to project far forwards, downwards and out¬
wards. The right nasal fossa was curetted, the tissues being sent
to Professor Anderson, of the Trinity Pathological Laboratory at
Toronto, who pronounced them of sarcomatous origin, small, round
cell variety, with the walls of the blood vessels thin and poorly
developed. The discharge from the nostril was of an odor similar
to that emanating from cancer of the uterus. Up to ten years
ago Bosworth had collected forty of these cases.

Dr. R. A. Reeve stated that a number of years ago he had
presented a paper before this Association on the same subject. He
directed attention to the importance of examining the naso-pharynx
in diseases of the orbit.. He instanced a similar case to Dr. Gold¬
smith’s. In his case there was little pain, but an examination of
the nose revealed the tumor. ' ,

MEDICAL SOCIETY PROCEEDINGS.

401

President’s Address.

On the afternoon of the second day, with a packed hall for an
audience, Dr. Powell delivered the annual Presidential address.
He first recited a few reminiscences when on former occasions the
Canadian Medical Association had convened in the Capital City,
that was in 1871, 1881, 1889 and 1893. He made reference to the
South African war in order to show the unsatisfactory condition of
affairs which permitted other colonial surgeons from Australia and
New Zealand practising their profession in that land without hin¬
drance, whilst the Canadians were debarred from the same privi¬
leges. An earnest and united effort on the part of the profession
throughout the whole Dominion of Canada in an endeavor to bring
about inter provincial registration would facilitate matters in the
direction of securing these privileges for the Canadian profession in
pther parts of the British Empire. The hackneyed subject of
tuberculosis was lightly touched upon ; whilst a very important
matter relating to the profession, that of a Medical Defence Asso*
ciation, was dealt with at considerable length. Dr. Powell favored
the formation of such Association, and later on in the proceed¬
ings nominated a Committee to look into the question to report on
the advisability and practicability of forming a Dominion Associa¬
tion of this character.

Some of Mv Experiences in the South African War.

Dr. George S, Ryerson addressed the Association on this
gubject. He dealt first with the experience gained of modern
bullets. The very latest returns show that 986 officers and 11,701
non-commissioned officers and men had been wounded, of whom
only 732 have died of wounds received in battle, which is to be as¬
cribed to the aseptic character of the bullet and the prompt attention
and antiseptic treatment. Dr. Ryerson then dealt with the wounds
caused by these bullets. Referring to poisoned bullets b ing used,
this was not the truth, as the tarnish or verdigris propably accumu¬
lated in transit through the barrel. He also doubted the fact of ex¬
plosive bullets being used. The Boers made use of thousands of
Martini-Henry, a heavy bullet, which caused great destruction of
soft parts, necessitating amputation. There were few amputations
in this war. He quoted Kendal Franks, who had performed 20
amputations in 2,000 cases. Whilst abdominal section in wounds
of the abdomen was mainly inadvisable, he saw one case where
the results were excellent. He spoke highly of the magnificent
work of the R. A. M. C.

Dr. T. G. Roddick, M.P., told of the great sacrifices of Dr.

402 MEDICAL SOCIETY PROCEEDINGS.

Ryerson in proceeding to South Africa at his own expense to carry
out the work of the Red Cross Association. While in England
recently, he stated he had made it his special business to en¬
quire of returning Canadian soldiers as to the hospital management
in South Africa, and, although he had spoken to many of these, he
had failed completely to find a single Canadian who had anything
but praise for the hospital arrangements in that country.

Our Race and Consumption.

This was the title of a very able paper contributed by Sir
James Grant, Ottawa, who considered it an important fact, and
one worthy of consideration, that races had been born on this con¬
tinent, had lived and entirely disappeared, leaving mounds in the
West and other traces in Florida and elsewhere of their undoubted
existence, and that thus far there was no information as to the
exact cause of the disappearance of these races. He thought it
mained for the Anglo Saxons to see whether they will prove more
Successful than their predecessois in establishing themselves on
this continent. He referred to the loss of 3,000 lives in the fair
province of Ontario in 1898 by consumption alone, and deplored
the fact that the people were not as yet alive to their danger. Sir
James endorsed the legislation passed at the last session of the pro¬
vincial parliament designed for the purpose of assisting municipal¬
ities in the erection and maintenance of sanitoria for consumptives.

Recognition and Management of Tabes Dorsalis.

Dr. Allan McLane Hamilton, New-York prepared this pa.
per, but on account of illness was unable to be present to read it.
The President undertook this task. It appeared that, as an etiolo¬
gical factor, syphilis was not referred to by the early writers on
this disease. While some would "attempt to divide the symptoms
of the disease into the leg and eye types, the writer would consi¬
der that to be unwarranted. He considered there was a close
resemblance or rather relationship between the different forms of
cerebro-spina sclerosis. There was no disease of the nervous sys¬
tem which had drawn forth so many plans of treatment; and but
little or no good had resulted from any one thing. Most tabetic*
are favorable subjects for expectant treatment, and many derive
temporary benefit from some new drug. Looking back over a
number of years, he finds that most good has been accomplished
where little or no medicine had been given. He has found rest
by suspension and persistent cauterization of the back, good
treatment. In the opinion of the writer, syphilis cannot be traced

403

MEDICAL SOCIETY PROCEEDINGS.

in more than fifty per cent, of the cases. For the arthropathies
there is little to be done. Perforating ulcer is a rare feature of
locomotor ataxia, and most obstinately resists treatment. He has
seen three cases of this unusual condition in ataxies ; and the
ulcer rarely exceeds two or three centimeters in diameter. One
authority mentions five cases cured by means of nerve stretching.
Through out the course of the paper numerous cases were cited
with their symptoms and treatment

The Physicians’ 11 Vaster Empire.”

In this paper Dr. John Hunter, of Toronto, its contributor
dealt with the questions of sanitary science, education, social purity
and medical missions. Referring to sanitary science, he entered a
plea for the broader and freer application of the principles of this
branch of medicine, in the building and construction of our homes,
schools, churches, theatres, etc. No dwelling-house should be
constructed except under the supervision of an architect and a
physician versed in sanitary science. In the matter of sanitary
science architects had improved wonderfully during the past ten
years. Another important question was that of our educational
system—the mental and physical health and development of our
schoolchildren. The best way to secure physical'vigor and high
mentality was surely within the province of the physician to grapple
with and study. In all forms of social purity and impurity, physi¬
cians should speak ex cathedra against every form of vice and im¬
morality. The boys and the girls of the family should be enlight¬
ened as to their sexual proclivities at proper periods by their fathers
and mothers respectively. In medical missions he referred to the
vast field for medical missionary work in foreign countries.

Address in Surgery—Tuberculous Lesions from a Clinical

Point of View.

The President introduced Mr. Edmund Owen in a few well
chosen words. This address was delivered at the evening session
of the first day, and the distinguished visitor was greeted by a
crowded house. In commencing his masterly address, he stated
that he would deal with tuberculous lesions as the surgeon meets
them day by day in the hospital wards, in private practice or in
the operating theatre. Referring to the pathologists, he considered
his (the pathologist’s) thought to be only of the dead tissue, while
the surgeon sees fhe human tree during its life, and rarely follows
it after death. The student does clinical and pathological work at
ttifferent times, and he is enabled to * follow the case straight from

404

MEDICAL SOCIETY PROCEEDINGS.

the ward to the laboratory. He considered that study of the fresh
specimen was the best, for the specimen taken from formalin was
no more like the condition than canned salmon was like fresh-run
fish. He would not hinder experimental research work; it was
absolutely necessary. The life of a man was of more value than
a sparrow or many guinea pigs. It would be almost impossible to
overestimate the direct value of experimentaMaboratory work. Stru¬
mous and scrofulous are now terms devoid of meaning, and we
now call tubercle by its proper name. There are three great factors
in connection with tuberculosis which the public must be made
acquainted with : i. The disease is communicable, but the public
must be allowed a little time before they accept this statement and
fact. 2. The disease is preventable; this follows almost as a
corollary to the first statement. 3. The disease is curable. Years
ago, the subject of tuberculosis was regarded as well-nigh hope¬
less, but now we do not consider it of the untractable nature that
it was formerly considered. Tuberculous lesions are exactly what
they used to be, and Mr. Owen has worked at the largest Children’s
Hospital in London for over a quarter of a century. We now take
a much more hopeful view of these lesions. Many of you have
studied tuberculous lesions under these skies, and also in the
mother country. Do you find that the tuberculous lesions are the
same in both hemispheres. One rarely hears now of the vismedica -
trix naturae; surgery has rendered it superfluous. All have
noticed cases of old standing hip joint disease where in time the
boy actually grows out of his trouble. This may be a popular
superstitution, but, like most erratic beliefs, it is founded upon a
stratum of truth. In children these chronic diseases are always
tuberculous. Where chronic abscesses occur it will not do to
open and drain, but they must be scraped out, their unhealthy
lining destroyed. In the treatment of these diseases, the learned
surgeon stated that he had failed to find any virtue whatever in the
employment of iodoform. It is an irritant and a poison, and it is apt
to be septic, as germs can grow on it. Mr. Owen condemned the
use of complicated apparata, and also the forcible correction in
cases of spinal deformities. He considers that this deformity does
not lend itself to operative treatment. There may perhaps be a
small class of cases where it may eventually be found applicable,
as where bone or organized inflammatory deposits press upon the
cord so that the patient has lost movement in the lower extremi¬
ties. The plaster of Paris jagk^et must be held responsible for
much of the deformity of Potts’ Disease. The proper treatment
of these cases is rest in the horizontal'position, with plenty of good

MEDICAL SOCIETY PROCEEDINGS* 40$

fresh air and sunlight. At the conclusion of his extremely able and
instructing address the thanks of the Association were moved in a
complimentary speech by Professor Shepherd, of Montreal, and
seconded by Professor Cameron, of Toronto, put by the President,
unanimously carried amid great enthusiasm, and appropriately pre¬
sented to Mr. Owen by Dr. Powell. Mr. Owen made a happy
reply.

Excision ok the Knee Joint in Tuberculous Disease.

Professor Primrose, of Toronto University, minutely de¬
scribed Kocher’s method of dealing with tuberculous disease of the
knee joint, recited the histories of a few cases in which he had
obtained excellent results where this operation had been employed.
The steps of the operation were made clear by a blackboard draw,
ing, and, at the conclusion of his demonstration, Dr. Primrose
was highly complimented by Mr. Owen for his lucid exposition of
his subject.

Recent Pathologic Studies of the Blood.

The last paper on the evening of the first day was a most in.
teresting and instructing one by Dr. L. H. Warner, of Brooklyn*
At the commencement of his paper he asserted that he believed
there was a necessity for experiments for the progress of pathology.
His experimental researches were directed along three lines of en¬
quiry, viz., experiments, observation and individual observation at
clinics in hospitals. He considered that the examination of the
blood in most cases was of more importance than an examination
of the urine. Dr. Warner gave the formula of a new staining solu¬
tion which he had found very practicable: The blood specimen
should be prepared in the regular manner. The slides are heated
in a hot oven to 98 degrees. Immerse for one minute in a one
per cent, aqueous solution of methylene blue, washing in water,
then in a one per cent, alcoholic solution of eosin, washing again
with water, and then in a one per cent, solution of Bismarck brown.
Dr. Warner’s paper was illustrated with suitable diagrams.

Some Experiences in the Treatment of Hernias.

At the morning session of the second day, Dr. F. J.
Shepherd, Montreal, contributed the first paper. Some twenty
years ago surgeons began to perform these operations by the open
method. Older methods in vogue were touched upon and de¬
scribed, and he instanced one very large hernia which had come
under his observation then where the man could not put his
trousers on. The methods of operation are almost as numerous as

4^6 MEDICAL SOCIETY PROCEEDINGS.

surgeons, but there are certain general principles underlying all
operations: i. The necessity for excision or obliteration of the
sac. 2. Closure of the canal. 3. Union by first intention. Some
also held that alteration in the direction of tr»e canal is necessary.
The operation performed by Dr. Shepherd is Bassini’s, but with it
he is not always successful. He has used all kinds of sutures.
Absorbable sutures are the best, and if antiseptic they are to be
preferred. A suture that will last for three weeks is all that is
wanted. He has used chromicized catgut now for some time.
Professor Shepherd never washes out the wound, and thinks it
better to dissect out the sac with the knife than to tear with it the
fingers. He never uses a drain. For two years past now he has
used rubber gloves in all his surgical work, abdominal in character,
and he considers that he has got better results since beginning
their use. In hernia operations the mortality is practically nil.
Operations on children are now our most successful, cases;
formerly they were not advised except in strangulated cases.

Dr. Lapthorn Smith discussed this paper and the cases de¬
scribed, although his experience lay mostly in Yjntral and um¬
bilical work. In some of these he had seen them so large as to
require twenty stitches. During the past two years he has aban¬
doned silk and resorted to catgut, chromicized, which he always
prepares himself.

Replying to the criticisms, Dr. Shepherd stated if there was
any oozing in the wound he would pass a probe in between the
edges of the wound to let out the accumulated serum. This way
he finds to be quite efficacious, as then you minimize the chance of
the introduction of any germs from without.

A Case or Syphilitic Gummata of the Spinal Cord Suc¬
cessfully Treated by Enormous Doses or Iodide
of Potash.

Dr. F. W. Campbell, of Montreal, reported the history of
this very interesting case. It occurred in a man of highly
neurotic temperament who, a short time before the onset of sym-
toms of a definite character, had suffered from repeated attacks of
insomnia of a very aggravated character. When his sickness
began there were noticed retention of urine and loss of power in
the lower limbs. Patellar reflex was about normal. The loss of
power in the lower limbs was absolute. The pulse varied from 86
to 96; the temperature was never above 99. The stomach' re¬
mained in fairly good condition all the time. A consultant froth
New York was brought oh and a diagnosis established of ttiftro? of

MEDICAL SOCIETY PROCEEDINGS.

407

the spinal cord situated about the first lumbar vertebra, which
might be sarcomatous or syphilitic. The advice of the consultant
was to give 500 grains of iodide of potash per day, commencing
with a drachm three times a day. Dr. Campbell detailed
minutely the daily history of the patient whilst getting him under
the large dose, and then again whilst it was gradually being with¬
drawn. The patient is alive to-day and in gx>d health, having
recovered complete control of his lower extremities.

Address in Gynecology.

A very practical address was that delivered by Dr. William
Gardner, of Montreal, on the mistakes in diagnosing gynecologi¬
cal and obstetric cases. He states we often learn more from our
mistakes than we do from our successes. Correct and accurate
diagnosis depends mainly upon the sense of touch, which can only
be attained by long and patient practice. He referred to the ad¬
vantages of examining on a plain table instead of on a couch or
bed. The patient’s rectum should always have been emptied
before presenting for examination. As for the bladder, it is best
to empty that viscus yourself per catheter when the patient is on
the table, as in this way you will be able to notice any discharges,
etc. That the physician will have to do this often is quite clear,
from the fact that there are many women of nervous temperament
who would not be able to empty the bladder voluntarily in the
physician’s office. Another advantage of doing this for yourself is,
that you get an uncontaminated specimen for examination. In
cases where tension is present in the muscles of the abdomen, if
you make a series of circular movements over the lower abdomen,
gradually narrowing your circle, you will be able to overcome
whatever rigidity there may be present. Dr. Gardner urged cau*
tion in the use of the uterine sound. He rather considers it a
dangerous instrument, that its use ought to be extremely limited
and holds the opinion that many women have lost their lives
through this instrument. Then there is the danger and risk of in¬
fecting and injuring the uterine canal. This instrument, the
uterine sound, is a great deal too much employed by the general
practitioner. Mistakes in diagnosing displacements of the uterine
body he considers the most common. The uterus is a very movable
organ, and a distended rectum or bladder may cause it to be
diagnosed as a retroversion. Then, it is important to remember
that it may be displaced through acts of coughing, vomiting, etc.
In all examinations of the pelvic organs, Dr. Gardner has made if
a point to examine the position of the kidneys as welt Refferritfg

408 medical society proceedings.

to examination by the Sim’s method, it is necessary to have the
patient in the proper position, and, if you have not a Sim’s
speculum, a bent table fork or the finger of the opposite hand
may be used to distend the perineum. Mistakes are often made in
the diagnosis of pregnancy, but still the patients are few in whom
the diagnosis cannot be made by careful examination of history,
signs, etc. Many women are probably inaccurate as to date. Dr.
Gardner illustrated his points as he proceeded by reciting cases.
One in particular he instanced where he once found a woman in
his office on her hands and knees in the throes of a twin pregnancy,
which a fellow practitioner had failed to recognize, and had tapped
the gravid uterus, and had drawn a quantity of the liquor amnii;
Dr. Gardner referred to the mistakes made by himself as well as by
his brother practitioner. The close of the paper referred to an in¬
teresting account of mistakes which had occurred in diagnosing
extra-uterine pregnancy. The Association voted him unanimously
a hearty vote of thanks for his exceedingly practical paper.

An Unnoticed Factor in the Production of Abdominal
and Pelvic Disturbances in Women.

Dr. Clarence Webster, of Chicago, contributed an inter¬
esting paper with the above title. Symptomatology in women, he
said, was often overlooked by the general practitioner. The ques¬
tion of the normal relationship of the abdominal and pelvic contents
was dwelt upon, and then he proceeded to account for inter-ab¬
dominal pressure, holding to the view that the pelvic organs, as
well as the abdominal, were to a large extent held in their respective
positions by reason of the pressure of the abdominal and pelvic
walls. He stated the average specific gravity of the viscera to be a
Jittle more than that of water ; the liver was 1.5 sp. gr. He main¬
tained that there was 110 proof that the mesenteries acted as con¬
stant supports or were ever meant to be such ; and the main factor
in sustaining the viscera is the strength of the abdominal wall and
pelvic floor. Local weakness of the abdominal wall has been fairly
well described under hernia, while general weakness of the abdom*
inal wall has been described as pendulous belly. General weakness
in his experience is an exceedingly rare condition.. As to the
question of etiology, ihe condition is found in women who have
borne children; and so, on examination of the great majority of
women, there is found some degree of separation of the recti muscles
in the region of the navel.. All evidence later on may disappear,
but permanent widening remains. The results of all this is un¬
avoidable enterpptosis ; and this is generally found in women who.

MEDICAL SOCIETY PROCEEDINGS. 4O9

ha ve bseo addicted to the pernicious habit of tight .lacing. A very
cowinoh diapUcement seen »s that of the right kidney; Df. A¥<rb-
tterdweU upon the diagnostic symptoms of these conditions and
then proceeded to describe the operation he perronns for theft re¬
lief. This consists in bringing the edges of the two recti muscles
top tipposUioft. He firs: perfiirHied this operitidn in
Since that; he has operated upon forty-otie cases, amj fbe TcsMits
have been inosit satisfactory in all.

Ms*. f< H, CAVfeftc-s rook exception to Dr, Websfei using the
worn an noticed ’* in the title of his paper, as he thought this was
not an unknown factor in the production of the conditions mention¬
ed in the paper.

Dr, W, S. Muir, Truro, N.S„ asked Avhat effect leaving off the
lisp of the binder after confinement had to do with ihe: production
of these conditions,

1 ?»,.: 'V^'BisSter held to the opinion that ibis had not been
noticed except by himself, and challenged Mr. Cameron 10 quote
authority otherwise. The absence of the binder, in his opinion,
had no< made any special -difference.

Address in Medicine.

Tsofessor S. F. Sh.att.dck, of Harvard University, said, in
.opening bis address, that the advance in knowledge had brought
about our relation to things in general There is noticed a sub¬
division of labor to every' branch of industry. As a consequence,
Specialtzatioo has taken place in the science and srt of medicine,

In specf^lpiaiion lies the devage between medicineand surgery ;
and nowhere has the line- been more closely.drawn than in England
Anesthesia greatly enlarged the bounds of surgery. Twemy-fivc
years:ago,there was not «t pure surgeon in America, Bellyache is
now -a surgical disease. The hearth practically the only viscus
which temains theexclusive property of the physician :; and he was
not to sure tkat evon this organ would,riot soon be attacked, and
we might hear of suturing of the mitralvalves In this country the
general practitioner is clinging to obstetrics for. family practice, in
some of the larger centres there ls now even a tendency to special¬
ism .in obstetrics, where the specialist wilt preside at the ayemjvlie-
men t, and the family practitioner then step in to oversee? the attend- •
snee throughout the puerperinmi Pine gy.nter;«J(Jgy Vtrtifcety exists
to-day - and pelvic tinkering is suffering fiotrtyt rapid.decline. '-The',
gicat bulk of .major gynareol >gy is Optiiing more than abdominal
’surgery,'.which properly belongs pot, the general surgeon. Gyn*
eedqgisrs should sgudy general surgery and become general surgehns .

410

MEDICAL SOCIETY PROCEEDINGS.

first. The field in medicine is so large that no one man can grasp it
all in a lifetime. Other specialties were referred to. The desire on
the part of some to escape the hurly-burly of general practice may
be a cause in throwing them into special lines; and then there is
the fact that special knowledge draws larger fees. Ophthalmologists
get more for removing a speck of dust from the eye than the general
practitioner. When we have specialists for diseases of the young,
why not also have a specialty for the diseases of the old. In the
belief of the distinguished professor from Harvard, specialism had
come to stay. The gathering was exceedingly delighted with the
deliverance of Dr. Shattuck, and at the close voted him a cordial
vote of thanks, to which he made an appropriate reply.

Gastric Hemorrhage.

This paper was read by Dr. George E. Armstrong, of
Montreal, who believed there was a fairly w'eli determined field in
which surgictl interference may be of use in hemorrhage of the
stomach. Hemorrhage occurs in fifty per cent, of gastric ulcers and
is fatal in eight per cent. Cases are arranged in two groups, the
acute and the chronic. Rodman has reported thirty-one operations
for frequently occurring or chronic hemorrhages, with six deaths.
Dr. Armstrong has operated five times for gastric hemorrhage,.one
being a chronic case. In one of these the patient was getting along
nicely after the operation, when she expired suddenly, and,on a post¬
mortem examination being made, thrombi were found in the
branches of the pulmonary artery.

Some Cases in Stomach Surgery—Gastrostomies, Two Cases ;

Gastro-Entrostomies, Two Cases ; Pylcrectomy.

Dr. A. E. Garrow, Montreal, reported these cases. In one
paiient operated on, the patient was fed before he left the operating
table. Another, a woman of fifty years, who had a persistent hack¬
ing cough, had gastrostomy performed and discharged able to feed
herself through a tube. In another case, in a man aged 35 years,
who had vomiting and blood in the stools, the patient suddenly had
acute pain with a pale face. Duodenal perforation was present ;
and when the abdomen was opened, gas escaped from the incision.
When discharged on July 24th last, he was feeling well. Six cases
were reported.

The Modern Treatment of Retroversion and Prolapse of

the Uterus.

Dr. A. Lapthorn Smith presented an able paper with the

MEDICAL SOCIETY PROCEEDINGS. 411

above title. It referred to the proper and most successful manage*
ment of procidentia uteri in elderly women between seventy and
seventy-five years of age—a most pitiable condition. Except for
this trouble, she may be otherwise in excellent health; the perineum,
however, is so relaxed that no pessary will remain in place. Then
the majority of these cases have an ulcerated cervix. After con¬
finement the uterus remained large and the pernicious habit of
keeping women too long on their backs has a tendency to produce
the backward displacement. Dr. Smith feels certain that women who
have been relieved of this distressing condition will have little diffi¬
culty in persuading others to avail themselves of the treatment. He
removed a woman’s uterus a few months ago, which had been out
of her body for twenty years ; and the patient now assures him that
she feels like a young woman. In correcting this deformity, Dr.
Smith makes a small incision in the abdomen and performs ventro¬
fixation. After that the vaginal canal is narrowed by a large anterior
and posterior colporraphy. In selected cases, he also amputates
the lower half of the organ and then stitches the vagina to the upper
half. He considers ventro fixation, if properly performed, a most
reliable means of fastening up the uterus. The operation has given
him the most complete satisfaction of any operation he has ever
performed, especially when combined with amputation of the cer¬
vix and posterior colporraphy.

Gasoline as a Surgical Detergent.

A paper that was highly original was contributed by Dr. Bruce
L. Riordan, of Toronto, on the use of gasoline as a detergent.
With this dirty, greasy hands of machinists, who are the subjects
of injuries in these parts, can be effectively and rapidly cleaned
without the ordinary brush and soap and water. It is far better for
this purpose than any method heretofore devised for cleansing. He
now constantly carried a small bottle of this in his surgical bag. A
report from Dr. William Goldie, Toronto, showed its effects upon
germs and germ life, a report which would conduce to its employ¬
ment as indicated. One word of caution was thrown out by Dr.
Riordan in its use; as it is a highly inflammable substance, it
should not be used in any quantity near an exposed light; and then
it is painful in the eyes or ears. It is also useful in cleansing sutures
of accumulated serum, blood and dressing powder, thus freeing
these particles and enabling one to locate the stitches easier and
quicker.

Dr. J. C. Mitchell, Inniskillen, Ont., stated that he had tried
gasoline recently as a detergent in two very severe threshing-ma-

412

MEDICAL SOCIETY PROCEEDINGS;

chine accidents, where the parts were all smeared over with oil and
grease and dirt, and it was very satisfactory, as he was able to get
perfect cleanliness in a short time, both wounds healing by first
intention.

Dilatation and Prolapse of the Stomach.

Professor Alexander McPhedran, of Toronto University,
presented this paper, which dealt principally with prolapse. This
condition rarely occurs alone, but is associated with prolapse of
other abdominal organs. There is generally present as well some
degree of dilatation ; and the abdomen may be prominent or flat,
or even retracted. The case of a man aged 51 years was referred
to, a manufacturer, who had been ailing for two or three years. The
stomach was below the umbilious. He was directed to massage the
abdomen very thoroughly and to practice abdominal gymnastics.
Through this treatment, combined with dietetics and some strych-
nine, he has been restored to health and able to resume business.
Another case of a womin aged thirty-five years was reported. This
woman had been the subject of recurrent attacks of vomit¬
ing for two years. The symptoms were detailed; massage and
abdominal gymnastics ordered with satisfactory results. The differ¬
ent ways of examining the stomach were described ; and, in conclud¬
ing, Dr. McPhedran spoke of the benefits of a change of scene in
treating these cases.

Physical Training ; its Range and Usefulness in
Therapeutics.

Dr. B. E. Mackenzie, of Toronto, gave a very interesting ac¬
count of the methods employed by him in correcting deformities in
his orthopoedic hospital in that city. The paper was illustrated by
lithographs showing improvements in spinal deformities after phy¬
sical training in the direction indicated. The paper embraced the
results of his observations for thirteen years past, and was ample
justification of the benefits derived from gymnastics in the correc¬
tion of lateral curvature, club foot, etc. He had also found phy¬
sical training valuable in hysteria and chorea, especially the former.

Inter-Provincial Registration.

Dr. T. G, Roddick, M.P., read the report of the Committee
having this matter in hand. A new feature to be incorporated in
the measure was that of allowing the homoeopaths representation
on the proposed Dominion Council, as, according to the law of
Ontario, these had their vested rights in that province, and so must

MEDICAL SOCIETY PROCEEDINGS.

413

be accorded similar interests in any proposed Dominion Council*
These will be allowed three representatives, which will be equiva¬
lent to the representation from any one province of the Dominion.
Their term of office will be four years. Homoeopathy, however, as
such, will not be inserted in the measure, but they will be classi¬
fied under “ any other school of medicine having legal recognition
in any of the provinces in Canada/’ as the British Medical Council
would not recognize any such body. Dr. Roddick stated that the
Bill would be introduced at the next session, and advised the mem¬
bers of the Committee from each province to hestir themselves
before their respective provincial parliaments, as these bodies must
sanction the measure before it can be finally acted upon by the
Dominion Parliament.

Cerebral Abscess.

Dr. James Stewart, Montreal, reported two interesting cases
of abscess of the'brain situated in the tempero-sphenoidal lobe, and
referred to the unusual existing aphasia which was present in both
cases, viz., simple inability to name objects. The first case occur¬
red in a young man of twenty-two years who had otitis media fol¬
lowing an attack of influenza. Some six weeks afterwards an
abscess formed. The abscess was diagnosed as being confined to
this area simply on account of the peculiar aphasia— the simple
inability to give the name of a pen when that object was presented
to him. The patient was operated on by Professor Bell, who se¬
cured two ozs. of pus. Meningitis, however, set in and the patient
died. The second case was a girl of 21 or 22 years of age. She had
had ear trouble for a great many years, with very severe pain at
times. She, too, had difficulty in naming objects, and she could
not name any object whatever finally. She died suddenly a few
hours before the operation was to be performed for her relief. On
opening the skull at the subsequent post mortem examination, two
abscesses were found, one skirting the upper margin, of the lobe,
and the other situated about the center thereof.

In reply to a question of the President, whether we were to
take this kind of aphasia as a distinct diagnostic symptom of ab¬
scess in that region, Prof. Stewart stated, there is what they call
a “ naming centre,” and, when this is destroyed,that particular form
of speech defect is present. The cases were aptly illustrated by a
diagram.

Gangrene of the Leg following Typhoid Fever.

Dr. H. H. Chown, Winnipeg, reported two cases of gangrene

414

MEDICAL SOCIETY PROCEEDINGS.

of the leg following typhoid fever, which had recently come under
his observation. In the first case the patient had the charactaristic
symptoms of typhoid fever, the spots appearing at the end of the
.first week and being very numerous. Great pain set in in the calf
of the leg, with collapse symptoms, while the limb was cold and
bloodless. Cutaneous sensibility was lost over the leg. The third
day after the complication set in the part involved included the
lower third of the leg on the inner side and the lower half on the outer.
Operation was done at junction of upper and middle third of femur.
Patiint stood the operation well. The temperature before the
operation was ioa.6; pulse 120. On the following day the tem¬
perature was normal and the pulse no. On the tenth day the flaps
were united. There was a rise of temperature a few days later—a
relapse, with hypostatic congestion of the lungs. On the fifth day
after there was hemorihage of the bowels. The ^patient is now a
picture of health, weighing 200 lbs. The second was a somewhat
similar case in which the blood reacted early and promptly to the
widaltest. The gangrene began in the first case on the nth day
of the disease; in the second on the ninth. Keen reports gangrene
on the 14th day. The gangrene in the Second case extended to the
upper and middle third of the leg. The leg was amputated and
prompt union took place throughout.

Dr. R. B. Nevitt, Toronto, discussed these cases, and men¬
tioned a similar case coming under his observation during the past
summer. Gangrtne occurred in his case about the third week of
the fever, and the patient was seen about a week or ten days there¬
after. Amputation was peiformed through the middle third of the
femur. He also referred to a case of gangrene of the arm following
an attack of pneumonia, recently observed by him.

Notes on Atropine.

An interesting paper was that contributed by Dr. R. D. Rud¬
olf, of Torrnto University, which was illustrated by means of a
chart showing the^ action of the drug on animals and the inferences
drawn therefrom of its therapeutic uses. He finds that the drug
directly stimulates the heart, and thus the blood pressure is mark¬
edly raised. He considered that the maximum single dose as laid
down by Witherstine of i-2oth of a grain as too large unless used
as an antidote, r.nd thinks that we ought never to give more than
i-iooth of a grain of atropine sulphate at one time, except in emer¬
gencies. He also referred to its action in catarrhal pneumonias of
children and its employment before anesthesia to ward off danger.

The paper was discussed by Dr. A. D. Blackader, who con-

MEDICAL SOCIETY PROCEEDINGS. 415

gratulated Dr. Rudolph upon it, and said that he hoped he would
pursue his studies farther upon the same subject to find out the
effect it would produce in controlling vomiting after anesthesia.
He considered, however, that strychnine and not atropine was the
most powerful heart tonic in our possession. He thought that late
experiments would throw doubt upon atropine being a direct sti¬
mulant to the heart muscle ; and he thought it would be question¬
able practice to administer a drug when we wanted to stimulate the
heart’s action that would paralyse nerve endings.

Lantern Slide Demonstration of Skin Diseases.

The demonstration of these cases was conducted by Dr. George
A. Fox, of New York City, and it proved to be one which the
members of the Association thoroughly appreciated. The great
majority of the skin lesions shown were of syphilitic origin; and, as
they appeared on the canvas, Dr. Fox described the histories of the
cases. One in particular is remembered from the disfigurement
of the woman’s face. It was a large mass of excrescences on the
nose, which Dr. Fox was able to get rid off in the course of two or
three months, leaving only a slight superficial scar. He laid down a
timely word of caution in treating syphilitic conditions, that, when
the patient was run down and emaciated, thiough large doses of
mercury or iodide of potash, not to keep on pushing these drugs,
but to desist for a lime, and in the interval endeavor to build up
the patient’s strength and general condition. That accomplished,
return to the specific treatment, and the results would be found
to be more beneficial. At the conclusion of the doctor’s demon¬
stration, which will rank as one of the features of the meeting, Dr.
Fox was voted a cordial vote of thanks for his instructing work.

Dr. F. J. Shepherd showed a very interesting case, a boy of
sixteen years, * ho at the age of six sustained a severe cutting injury
of the nerves and vessels of the axilla. All the nerves of the brachial
plexus below the cords of the brachial plexus being severed com¬
pletely. At that time, ten years ago, Dr. Shepherd dissected out
each nerve separately and united their respective ends by suture.
All did well with the exception of the musculo-spiral, and as a
consequence, the lad exercises very little control over the extensors
of the forearm.

The Successful Treatment of two Important Cases of

Disease of the Eyes by the Combined Methods of
Mercury and Iodide of Potash Internally and
Pilocarpine Hypodermically.

Dr. G. H. Burnham, Toronto, reported two cases successfully

4,16 MEDICAL SOCIETY PROCEEDINGS..

treated by his combined method. . Under this method no such
result follows in other plans of treatment, and with this plan a
permanent result is got. This treatment has a wide application.
Whether iodide of potash or mercury or the iodide alone be given
internally in suitable cases without satisfactory results, if the pilo¬
carpine be added, good results will always follow.

Mental Sanitation.

The assistant superintendent of the Brockville Asylum for the
insane, Dr. R. W. Bruce Smith, contributed a scientific paper
with the above title. It was a plea for prophylaxis in insanity, and
he thought that much would be accomplished in this direction dur¬
ing the twentieth century. Insanity was on the increasein Canada,
and it can be ascribed to the fact that, while these unfortunates are
well attended when they become insane, the fact that there have been
no preventive measures employed speaks for itself. In order to
accomplish good in this direction, we must seek either to lessen
the demands on, or to strengthen the resisting power of the brain.
He condemned inter-marriages in families, and also amongst
those of a deranged mentality. Fifty per cent, of the cases of
insanity were hereditary, and the descendants of these should be
careful in contracting marriage ties. He referred to a portion of
one county in Ontario alone, where indiscriminate marriage and
inter-marriage has become most fruitful; and he has seen several
members of one family from that locality inmates of the same
institution at the same time. He considers that the day may yet
dawn when we will give the same attention to the rearing of child¬
ren as we now give to the breeding of horses. Speaking of farm life
and the tendency it has to melancholy, he thought this class of
the community should receive education in participating more in
the enjoyments of life and not to continue to rot in domesticity.
An upheaval in the sentiment and surroundings of the rural homes
would work wonders in prophylactic principles.

The Canadian Medical Association endorsed the scheme for
the formation of a Dominion Anti-Consumption League. The fol¬
lowing were recommended as provisional officers: — President
(Honorary), The Governor-General; President, Sir James Grant,
Ottawa; vice-presidents were appointed for all the provinces ; the
secretaries are to be the secretaries of the different provincial
boards of health. Secretary-Organizer, Rev. Dr. Eby, Toronto ;
Treasurer, J. M. Courtney, Esq, Deputy Finance Minister, Ottawa.

Re Medical Defence Association.

The Association recommended that Dr. V. H. Moore, Brock-

MEDICAL SOCIETY PROCEEDINGS.

417

ville, be the permanent Chairman. One member for each province
was appointed. This Committee will gather information on the
subject and bring in a recommendation at the next annual meeting.

The Treasurer’s report showed that 153 members were in
attendance, and that there was a balance in the treasury of $240.65-

Election of Officers.

Next place of meeting, Winnipeg.—President, H- H. Chown,
Winnipeg; Vice-President, P. E. I., H. D. Johnson, Charlottetown;
Vice-President, N. S., A. J. Maiter, Halifax ; Vice-President, N.B.,
T- D. Walker, St. John; Vice-President, Quebec, A. Lapthorn
Smith, Montreal; Vice-President, Ontario, A. A- Macdonald, To¬
ronto ; Vice-President, Manitoba, J. A- Macdonald, Brandon ;
Vice-President, N. W- T., J- D. Lafferty, Calgary; British Co¬
lumbia^-J. Trinstile, Vancouver; Treasurer, H- B- Small, Otta¬
wa ; General Secretary, F- N. G Starr, Toronto.

Sir William Hingston and Dr- F.W- Campbell, Montreal, were
appointed on the Board of Governors of the Victorian Order of
Nurses as representatives of the Canadian Medical Association.

THE

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price , $t.oo per annum in advance . Single
Copies , io cents.

Make all Cheques or P.O. Money Orders for subscription, or advertising, payable to
JOHN LOVELL & SON, 28 Sc. Nicholas Street, Montreal, to whom all business commu¬
nications should be addressed.

All communications for the Journal, books for review, and exchanges, shomd bo
addressed to the Editor, Box 2174, Post Office- Montreal.

Editorial.

THE CANADIAN MEDICAL ASSOCIATION.

The Thirty-third Annual Meeting of the Canadian Medical
Association, which was held in the City of Ottawa, on the 12th,
13th and 14th of September, was among the most successful
which the Association has had ; nearly one hundred and
sixty members registered. The number of papers read and
their general character was, if anything, greater in number
and superior to any presented at prevous meetings. More¬
over, the attendance was well kept up, even at the last meet¬
ing held on the afternoon of the 14th inst.

The address on surgery, by Mr. Edmund Owen, of London,
England, who came to this country specially for this purpose,
was the treat of the meeting. Couched in the most beautiful
English, and delivered with more than usual oratorical force,
it held the large audience spell-bound up to its close. Of its
eminently practical character we will not write, as we publish
it in full in this issue.

The address on medicine by Dr. Shattuck, of Boston,
was also a scholarly production, and was much appreciated.
Dr. William Gardner, of Montreal, gave the address on
gynecology, which gave full evidence that he fills a promin¬
ent place in that field of practice.

The hospitality of the professors in Ottawa was un-

EDITORIAL.

419

bounded, and all present bore away with them feelings of the
very warmest regard toward their hosts. The details of this
hospitality consisted of an electric car ride to Britannia on
the Bay, a most delightful spot on a warm day ; also a dinner
at the Russell House, and lastly a car ride through the city
and out to Rockdiffe Ranges, where a most sumptuous lunch
was served in the handsome new building just erected by the
Dominion Rifle Association. The Staff of the Protestant
Hospital also entertained at lunch those whose»ime permitted
them to visit that institution.

Winnipeg has been selected as the next place of meet¬
ing, and the time most likely will be about the middle of
August. If the officers of the Association can secure from
the Canadian Pacific Railroad terms as good as they got
when the Association met in 1889 at Banff (including special
rates to the Coast), there is every reason to look forward to a
very large attendance.

SIR WILLIAM STOKES, M.D , F.R.C.S.I.

The late Sir William Stokes died at the base hospital at
Pietermaritzburg, South Africa, on the 18th of August last.
Among the large number of medical men employed at the
seat of war, no death which has occurred among them can in
importance be compared to that of Dr. Stokes. This gentle¬
man was the son of William Stokes, whose splendid works
on Diseases of the Heart and Lungs are still read by every
educated physician, and whose kindness to the writer when
on a visit in 1861 to Dublin has always been green in his
memory. Sir William was appointed consulting surgeon to
the forces in South Africa on 29th of December last, and ar¬
rived at the Cape about the first of March. He at once pro¬
ceeded to Natal and took up his duties at the General Hos¬
pital at the Mooi River. These duties were most harrassing
in their nature, but, like a true surgeon, he was happiest
when doing his best to relieve suffering and save or prolong
life. But the surroundings were not of a nature to suit a con¬
stitution never very strong, and rendered distinctly weak by
some months of great mental anxiety owing to serious illness
in his family. He was also troubled with a chronic winter

420

EDITORIAL.

cough. When we take these facts into consideration, we can
see the courage of this brilliant and loyal Irishman in facing
the onerous duties in the field in South Africa. Sir William
was beyond any question the leading Irish surgeon, and was
in his 62nd year at the time of his death. He was Surgeon-
in-Ordinary to the Queen in Ireland, President of the Royal
College of Surgeons, Ireland,and Surgeon to the Meath Hos¬
pital, Dublin.

UNITED STATES MEDICINE.

Dr. Jacobi, of New York, read before the late Interna¬
tional Medical Association, in Paris, a paper on what he terms
rt American Medicine” (we have styled it United States
Medicine). This paper has been adversely criticised as being
too apologetic in its tone, and having read it we are inclined
to agree with its critics. Dr. Jacobi is a well-known figure
in United States medicine, and is generally held in high
esteem. But, although he has resided a great many years in
New York, we fancy that some of his European ideas have
not been entirely brushed off. In writing*of the Medical
Schools in the United States he says, “Of the 156 Medical
Schools, which exist at the present time, 3 date from 1765
to 1S00, 12 from 1801 to 1825, 22 between 1826 and 1850,
33 between 1857 and 1875, and 86 since.” He adds “ How
many more have been so good as to disappear from the face
of the American (United States) earth nobody cares to
learn or know. If we knew we should shed no tears.”

THE LONDON BRANCH OF W. B. SAUNDERS

<St CO.

W. B. Saunders & Company, of Philadelphia, the well-
known Medical Publishers, announce that they are about to
establish a branch of their business in Great Britain. Mr
Saunders has recently spent several weeks in London, where
all the arrangements preliminary to the opening of an Eng¬
lish house have been completed.

This London branch will be operated in immediate con¬
nection with the home establishment in Philadelphia, and

PERSONAL.

421

the same methods that have been so successful in building up
the business in the United States will be employed in the
conduct of this new branch.

The details of the various departments of the firm’s
affairs have now been developed to such a state of perfection
that the House feels the time has come for extending its
field of operations. For a number of years Saunders’ books
have been sold in England through the agency of a London
publisher, and, although they have already met with remark¬
able favor, the House is confident that by applying to the
English market the same policy that has proved so success¬
ful at home, the sale of its publications in Great Britain and
her colonies can be enormously increased.

PERSONAL.

Dr. E. P. -Lachapelle, President of the Provincial Board of
Health of the Province of Quebec, and President of the College of
Physicians and Surgeons Province of Quebec entertained Mr.
Edmund Owen, the well-known London, Surgeon at 'lunch at St.
James Club on the rjth September. The guests present were Dr.
Craik, Dean of McGill Medical Faculty; Dr. Rottot, Dean of Laval
Medical Faculty; Dr. F. W. Campbell Dean of Bishops Medical
Faculty; Dr. Powell (Ottawa), Ex-President of the Canadian
Medical Association ; Dr. Roddick, M.P.; Dr. Gardner, Dr. Benoit
and Dr. Lafleur.

Dr. Fuller, of Sweetsburg, was in Montreal on September 20th,
and visited several of his friends.

Book Reviews.

A Manual of Personal Hygiene.— Edited by Walker H.
Pyle, A.M., M.D., Assistant Surgeon to Wills Eye Hospital,
Philadelphia, Fellow of the American Academy of Medicine.
Contributors : I. W. Courteney, M.D., George Howard Fox,
M.D., and several others. Illustrated, Philadelphia W. B.
Saunders & Co., 1900. J. A. Carveth & Co., Toronto, Can¬
adian Agents. Price $1.50.

The object of this manual is to set forth plainly the best
means of developing and maintaining physical and mental vigor.
Throughout the book there is concise but adequate discussion of
the Anatomy and Physiology of the parts under consideration,
upon which is based the advice given. In other words, there is an
exposition of proper living upon a physiological basis. Purely
technical phraseology has been avoided, as far as compatible with
the scientific value of the text, and numerous explanatory diagrams
and illustrations have been introduced, Although each chapter
is complete in itself, there has been purposive repetition of re¬
marks jipon subjects of such general interest, as eating, drinking,
breathing, bathing, sleep, exercise, and in order that they may be
discussed more throroughly from several standpoints. The style
in which this manual is written is very pleasant, and no one could
rise from it» perusal, or of any part of it, without absorbing a very
large amount of must valuable information. As a text book, it
should find an entrance into all schools where Hygiene is taught,
and the general public will find it well worthy of perusal. It is a
sad commentary on human nature, that so few really know how
much they can do to make their lives healthy and in this way
prolong life. Even the medical professor is not guiltless in this
respect. This book deserves a very wide circulation.

Progressive Medicine. —A quarterly Digest of advances,
discoveries and improvements in the Medical and Surgical
Sciences. Edited by Hobart Amory Hare, M.D., Professor
of Therapeutics and Materia Medica in the Jefferson Medical
College of Philadelphia, etc., etc., assisted by Charles Adams
Holder, M.D., Assistant Demonstrator of Therapeutics in the
Jefferson Medical College. Vol. III., September, 1900. Dis¬
eases of the Thorax and its Viscera, including the Heart,
Lungs and Blood Vessels, Diseases of the Skin, Diseases
of the Nerve System, Obstetrics. Lea Brothers & Co.,
Philadelphia and New York, 1900.

This volume has appeared very promptly on time, and is
equally as valuable as any of its predecessors. The departments in
this volume have been collated by such well-known men as William
Ewart, M.D., F.R.C.P., Henry W. Stelwagon, M.D., William G.

BOOK REVIEWS.

423

Spiller, M.D., Richard C. Norris, M.D. Every practitioner who
desires to keep up with the rapid advance the profession is making
should subscribe for this publication, beautifully bound, which is
issued every quarter. F. W.C.

Medical Diseases of Infancy and Obildhood. By
Dawson Williams, M.D., London, Fellow of the Royal Col¬
lege of Physicians, London, and of University College, Lon¬
don ; Physician to the East London Hospital for Children;
second edition revised with additions by Frank Spooner
Churchill, M.D., Instructor in Diseases of Children, Rush
Medical College, in affiliation with the University of Chi¬
cago; Professor of Pediatrics, Chicago; Polyclinic. Illus¬
trated with 72 engravings and two colored plates. Lea Bros.
& Co., Philadelphia and New York, 1900. Cloth, $3.50 nett.

There is no class of patients who appeal more strongly to the
physician and surgeon than those who come under the designation
of infants and children. This is due to two causes, viz.: 1. They
form a very large percentage of those they are called upon to treat,
and are of immense importance, therefore, from a pecuniary sense.
2. The very helplessness of infantile life, depending almost entirely
on objective symptoms for elucidation of its diseases, appeals with
much force to the better nature of the profession. Yet, strange to
say, up to twenty years or so ago in this country no special atten¬
tion was given to diseases of infancy. The consequence was that
young graduates felt themselves at sea when confronted with an
infant, unable to tell its tale of woe except by signs which speak
to experienced eyes well-nigh as well as words. How different it
is now ? With special professors in every Medical College, and an
extensive literature on the subject, these little sufferers receive
vastly better treatment and care. Among the numerous works
which have of late years appeared devoted to diseases of infants,
that of Dr. Williams, of London, has occupied a prominent place.
The present American edition, edited by Dr. Churchill, is decidedly
of more value than the original London edition, inasmuch as it
brings the work up to date,, and represents also in addition, en¬
closed within brackets, the views of the leading physicians of the
United States. There is a very valuable chapter on infant feed¬
ing, in which the views on this subject held on this continent are
very clearly and concisely stated.

The work is one that should be in the hands of the general
practitioner, and we commend it to them as a most valuable book.

F. W. C.

Elements of Clinical Bacteriology. By Dr. Ernst Levy
and Dr. Felix Klemperer, of the University of Strasburgh.
Translated by Augustus A. Eshner, M.D. Published by
W. B. Saunders, Philadelphia, 1900.

This is the authorized translation of the second edition of this
well-known work- 1 -well-known in Germany, and deserving to be
better known here. A work by one German is usually imposing

424

PUBLISHERS DEPARTMENT.

enough, but, when three of them have had a hand in it in two
languages, it is apt to be a fine affair. Even the works on medicine,
which endure, are those which possess style. Facts are not
enough, and a laboratory is not a good place for the cultivation of
the literary quality. That is why so many of the recent books on
bacteriology will pass away. This book will not pass away,
because, while this artistic quality is absent, it contains a full and
plain record of thorough work set forth according to a plan and
easily accessible by means of a good index. A thorough test of the
book warrants the statement that it contains all that a reasonable
person requires to know upon the subject with which it deals.
Matters, not yet decided, are discussed in a temperate way, and the
authors do not try to prove too much. One who reads all of Mr.
Saunders’ publications, and they are all worth reading, seizes with
joy upon the pictures that have now become so familiar by their con¬
tinual reproduction. That admirable exercise in prespective,
“ The Boy filling the Tubes,” originally drawn by KauJa, is much
missed in the present work.

A. M.

PUBLISHERS DEPARTMENT,

SANMETTO IN SENILE IMPOTENCE, AND AS A GENERAL
REMEDY IN GENITO-URINARY CONDITIONS AND
COMPLICATIONS.

Sanmetto has, duiing the past few years, pleased me very much, par¬
ticularly in senile cases, where impotence was and had been pronounced for years.
As a general remedy in genito urinary conditions and unpleasant complications
accompaning these cases, the results are, in the majority of cases, very satisfactory.
Chas. E. Bennett, M.D., 1876 , Detroit School of Med.; Mein. Am. Med.
Assn., Ohio State Med. Soc., late Pres. Fulton Co. (Ohio) Med. Soc., Surg.
L. S. & M. S. R. R. # Wauseon, Ohio.

SANMETTO IN CYSTITIS AND PROSTATIIIS—ALSO IN GRAVEL.

I used a bottle of Sanmetto upon myself. I was suffering with cystitis and
prostatitis and received some relief. I think by continuing its use will effect a
cure. My age is sixty-five years, not so easily cured as younger persons. We
have a man in town by name J. S. K., who had been suffering with gravel for
years and had spent much with physicians. He used Sanmetto, and it would
be hard to believe the amount of calculi that passed in a few days; in fact it
was disintegrated and passed so rapidly that he was forced to stop the medicine
for several days. If desired, he will report the case himself. J. Y. DeShong,
M. D., Judsonia, Ark.

CANADA

MEDICAL RECORD

OCTOBER. 1900

Original Communications.

SYPHILITIC GUMMATA OF SPINAL CORD
TREATED SUCCESSFULLY BY VERY LARGE
DOSES OF IODIDE OF POTASH. *

By FRANCIS WAYLAND CAMPBELL. M A., M.D., C.M , L.R/7.P ,

London, D.C L.

Pean of and Professor of Medicine, Faculty of Medicine, University of Bishop's

College, Montreal.

The notes of the following case have, for obvious
reasons, not been hitherto published. I do not propose now
to do more than briefly outline the salient points of the case.

A few years ago I was consulted by R. C. S., who, for
the previous 15 years, had been general financial manager
for a large manufacturing firm, while, at the same time, he
held an interest in a factory outside of Montreal, for which
he also did the financing. His family history is highly
neurotic, his mother having been extremely emotional and
hysterical, dying from softening of the brain. She was sub¬
ject all her life to chronic diarrhoea, which was always
aggravated under anxiety, joy or grief. To her family she
communicated her temperament in a very marked degree.
The patient had always been well developed, strong and
hearty looking. About three years previous to the present
attack he suffered from insomnia, which resisted every
remedy prescribed. He was under treatment for about three
weeks, and never got more than two hours’ sleep upon an
occasional night. I ordered him to Old Point Comfort, and,
on the first night of his arrival, he slept for ten hours. His
improvement there was rapid, and after a sojourn of a month

# Head before the Canadian Medical Association, Ottawa, Out., Sept. 14, 1900.

426 CAMPBELL: SYPHILITIC GUMMATA.

he returned home in perfect health. From this date till he
consulted me for the present illness, he continued well, and
performed all the duties pertaining to the position he
occupied. He consulted me on April ist for a pain which
he felt over the region of the right kidney, and the following
day I was called to see him at his house. I found him com¬
plaining of the same pain in the same region, which was
severe and spasmodic. It was neither increased nor dimin¬
ished by pressure. A hypodermic of Battley give some ie-
lief. He was ordered a mixture containing five grains of
iodide of potash and twenty minims of wine of colchicum to
each dose, upon the idea that the pain was neuralgia of a
gouty character, the patient’s habits being free. This gave
him very considerable relief, and in eight days he was able
to return to work. From this up to the beginning of August
his health seemed fairly good. I met him occasionally on
the street, when he said that at rare intervals he had a feel¬
ing of numbness in his feet, particularly his right. Soon
after, I went to Europe, and during my absence he consulted
my friend, Dr. Ferrigo, for a somewhat persistent numbness
in both feet and legs, and a want of sensation in the rectum
when a motion was passi'g, though he had perfect control
of the sphincter. Under the medicine prescribed he made
some little improvement. On my return, the end of Septem¬
ber, his wife being ill, I saw him occasionally. They were
living at one of the summer resorts near Montreal. He said
that the pain had returned, and was, at times, very severe,
while he felt sure the numbness was increasing. He
promised to place himself under treatment when the family
returned to the city- Soon after he received a severe
mental shock by the burning of the factory, in which I have
already said he was interested, and by which fire he lost
heavily For some days afterwards he was quite unfit for
work, and the pain and numbness markedly increased,
evidently due to nervousness, as they both improved by
simple rest. Early in October I was called to visit him at
his house for intense pain again over the kidney. It re¬
quired two hypodermics of Battley’s solution gtt xx in
each, given an hour apart, before he got even partial relief

CAMPBELL: SYPHILITIC GUMMATA.

427

These had to be repeated for several days, but, under
the mixture of iodide of potash and colchicum, which was
again prescribed, he was at his office toward the end of the
month. He then left the city on a week’s business trip,
which was fatiguing both mentally and bodily. The day
, following his return, November 9th, I was sent for to relieve
the same pain. Hypodermics of Battley were useless, and I
got him under the influence of opium by giving it by the
mouth,' and he gradually got ease. On the 15th of
November he was so much better that a trip to Nassau
was arranged for. Up to this time he did not complain of
any increase of numbness in the feet and limbs, and he had
perfect control over them. On the 22nd November the pain
returned, and opium was given in full doses by the mouth.
In the early morning of the 26th November I was called for
the purpose of drawing off his urine- I attributed its reten¬
tion to overdistension due to a blunted sensibility caused by
the large amount of opium he had taken. In the forenoon
the late Dr. R. P. Howard and Dr. Perrigo saw the case in
consultation. We then noticed for the first time a distinct
loss of power in the lower limbs. He was, however, able to
get out of bed unaided, but, when seated on a chair, it re¬
quired a determined effort to cross them. The patella reflex
was about normal. Irritation of the soles of the feet showed
slightly diminished reflex action while the patient was
seated on a chair. When lying in bed the reflex action was
normal. The diagnosis was some affection of the cord, but
no absolute diagnosis was made. Patient put on ten grains
of iodide of potash three times a day. Two days later the
loss of power in both limbs was absolute. The paralysis of
the bladder continued, and, a trained nurse being placed
in charge, the urine was withdrawn four times in the twenty-
four hours. Frdm the commencement of the illness the
pulse has varied from 80 to 96, and the temperature has
never risen above 99. Notwithstanding the large quantity
of opium which had been taken, the stomach remained in
fairly good condition. On December 1st severe lightning
pains were felt in both limbs, but the pain over the*region
of the kidneys had not been felt for several days. The

428

CAMPBELL: SYPHILITIC GUMMATA.

bowels constipated and considerable tympanites, relieved at
times by passing flatus. Paraplegia still continues. The
friends of the patient suggested bringing on some well-
known specialist on Diseases of the Nervous System from
New York, and I selected Dr. Seguin. On December 5th
this gentleman met myself, the late Dr. R. P. Howard and
Dr. Perrigo. After hearing my notes of the case he made
a thorough examination of the patient, and gave it as his
opinion that we had to deal with a tumor of the spinal cord
situated about the first lumbar vertebrae. Its nature might
be sarcomatous, but he was inclined to consider it syphilitic,
although I had not been able to make out a specific history.
I may say that subsequently I was able to satisfy myself
that Dr. Seguin was correct in his opinion^ His advice was
to push iodide of potash to the limit of five hundred grains
a day, commencing with a drachm three times a day, and
increasing the dose by thirty grains daily. It was to be
taken in Vichy water, two bottles daily, half the dose being
dissolved in the contents of each bottle, and used as a drink.
If, within the following two weeks, tnere was not any im¬
provement, he thought the issue would be fatal, unless the
spine was opened and an exploratory examination made.
If the diagnosis was confirmed, he would then advise that
the spine be further opened and the tumor removed.
Although this operation had never been performed he
strongly advised it, and believed the prospect of success was
good. Dr. Weir, of New York, had expressed his deter¬
mination to perform such an operation when a suitable case
presented itself, and Dr. Seguin believed such a case was
the present one.

Same day, 10 p.m .—Lightning pains, in both! legs all
day. Spots of non-nutrition ; bed sores are evident over
maleolus and heel of left foot, and at several points on right
foot and leg. Fifteen minims of Battley gave a fair night’s
rest.

December 6 th .—Bed sore over sacrum threatening, and
the patient was ordered to lie as much as possible on either
side. Non-nutritious spots on leg decidedly increased, in
size. Lightning pains in both legs at intervals—urine has
still to be drawn off.

CAMPBELL: SYPHILITIC GUMMATA. 429

December gth .—Under the influence of Battley’s solution
patient has slept fairly well. The lightning pains or jerks
in legs are almost gone. Threatened bed sore on back no
worse, and the same may be said of the threatened sores on
the legs. Had a natural motion.

December 12 th .—Says he feels a more natural feeling in
both legs. Spots on legs improving, but bed sore on back
is worse, as he has not been able to rest on his sides nearly
as much—a slough is threatening. Complains that he feels
most uncomfortable at the rectum, and that a motion would
relieve him. He was given a large injection of soap suds
and olive oil, which came away without any faecal matter.
On examination the rectum was found loaded with faeces,
which was removed by the finger, giving great relief. Patient
is now taking 240 grains of iodide of potash daily ; no acne
or nasal irritation.

December 15 th .—As stomach is somewhat irritable (he
has been taking light diet freely and digesting it well) the
iodide of potash was discontinued. Has not had any motion
since faeces were removed on the 12th, so the rectum was
again emptied by finger, the faeces being softened by hot
soap suds and olive oil.

December 18/A.—Patient feeling better, spots on legs
sho v decided improvement, bed sore on back has sloughed
and was dressed. Iodide of potash, which was stopped at
300 grains, was to-day resumed at same dose.

December 22 nd .—For the first time there is a movement
perceptible in the toes of both feet, and the bhdder shows
signs of returning power by forcing the stream about an inch
from the catheter. Non-nutritious spots on legs rapidly
disappearing. Bed sore on back improving.

December 25 th .—Patient in good spirits. There is a de¬
cided improvement in left leg, which to-night he was able to
flex, raising popliteal space three inches from bed. Made a
vigorous but unsuccessful attempt to do same with the right
—movement in toes of both legs is very marked. Is now
taking 400 grains of iodide of potash. The increase in dose
from 300 grains has not been so rapid as up to that point.

430 CAMPBELL: SYPHILITIC GUMMATA.

January is/. —Legs continue to improve; is able to flex
left considerably, right slightly. Bed sore improving.

January 7th. —Non-nutritious spots disappeared entirely,
legs improving slowly. Is able to raise both legs several
inches off the bed, marked movement in toes. Is now
taking 500 grains of iodidfe daily ; two doses of 250 grains
are dissolved morning and evening in a bottle of Vichy, and
he sips it when wishing to relieve thirst.

January 10 th. —Legs still improving and gaining
in strength; is able to move them about the bed. Had a
natural motion and passed water three times to day.

January i6t/i, —Up to this date patient has been steadily
improving, but towards afternoon became very restless, and
complained of a sharp shooting pain down the left leg. Com¬
plained also of pain in right buttock, where I detected deep
seated ; fluctuation, ordering it to be poulticed. Temp. 102 * 4 *
pulse 120.

January 17th. — Passed a restless night ; refuses food,
but temp, has fallen to 101 F., and pulse to no.

January 20 th. —Patient has had bad nights ; opened
abscess on right buttock, getting fully 8 ounces of matter*
To-night, temperature has fallen to 99 F. and pulse to 98.

January 22 nd. —Was very restless last night, with some
delirium, but took good breakfast of light diet and says that
he feels well.

P. M. —Was restless and somewhat excited all day. At
bed time was ordered xx m of Battley’s solution. This after¬
noon 250 grains of the iodide of potash had just been dis¬
solved in a pint of Vichy, when the nurse’s back was turned
he seized the glass and drank its entire contents. No effec
from this enormous single dose was evident.

January 2$rd. —Was very delirious all night, had but
little sleep. Takes food well. Temp, normal. Pulse 86.
Fairly quiet all day.

January 24/A.—Was very delirious all night. Delirium
distinctly maniacal. Temp, normal, pulse 88. Takes food
well, but refuses his medicine. Has now fair power in both
legs. Ordered half a drachm of Battley every 4 hours by
mouth.

CAMPBELL: SYPHILITIC GUMMATA.

431

P.M .—Battley has no soporific effect ; on the contrary
seems to excite him. I may state that patient’s mother never
could take opium, as it produced great excitement. Has
been very excited all day, tearing away the dressing from
the abscess, also tearing bed clothes. Ordered sixty grains
of bromide of potash and twenty grains of chloral, and to
repeat half this dose in four hours if necessary.

January 25 th. —At 3 tbisa.m. Drs. Howard, Perrigo and
myself were called to his house, and found patient furiously
delirious, requiring three powerful men to restrain him. The
two doses of bromide and chloral had been given without
effect. Gave two hypodermics of fifteen minims each of
Battley. In filteen minutes he went asleep, sleeping steadily
till 10 a.nv, when he awoke as delirious as ever. Had a cup
of beef tea, a hypodermic of 20 minims of Battley and went
to sleep again.

January 2 %tk.— Since last report patient has slept fully
three-fourths of the time under the influence of a hypodermic
of 20 minims of Battley night and morning, waking occa¬
sionally, and very delirious. For a short time to day seemed
more rational, speaking of his illness and some business
matters, but soon relapsed into delirium. Takes food well.
Legs are not so well to-day—seem to have decidedly less
power.

January 29//*.—The hypodermic of Battley last night
had little effect. Patient was very noisy and ugly most of
the night, but takes food well; in fact, asks for it. Abscess
cavity filling up well, and bed sore healing rapidly under
very adverse conditions. Pulse has risen to 116, but tem¬
perature remains normal. Tongue clean and wonderfully
moist considering the quantity of opium patient has taken.

P. M .—It was decided in consultation to try the effect
of hyoscine, as patient has been very boisterous all day. At
10 p.m. gave i-8oth of a grain hypodermically. At midnight
patient as boisterous as ever, gave i-40th of a grain. At
3 a.m., there being no result, I gave 40 minims of Battley in
two hypodermics. In twenty minutes patient was asleep.

January $otlt .—Patient slept steadily till 10 a.m., when
he awoke very rational ; took a good breakfast. When seen
at 11 a.m. was very rational.

432

CAMPBELL : SYPHILITIC GUMMATA.

P. M .—Was very quiet all day, a little mild delirium.
About 8 o’clock without warning became maniacal, requiring
some considerable effort to restrain him from injuring him¬
self and others. I was sent for, and had hardly reached his
bedside when he seized his penis with his* right hand and
extended it to a far greater length than I thought it was
possible for a human penis to be extended, at the same time
exclaiming loudly, “ you are the cause of all my trouble.”
Unfortunately, his wife heard this remark, and it gave me
endless trouble afterwar Is. It was, however, the ground
work for that subsequent investigation which enabled me to
establish the specific character of the disease. Forty minims
of Battley was given, producing sleep in less than half an
hour, which continued till 4 a.m., when he awoke and became
noisy, when 40 minims of Battley were given and he fell
asleep in a short time, sleeping well till 9 a.m. Blue oint¬
ment was ordered to be rubbed into each groin night and
morning.

February $th .—The history of the case during the past
five days has simply been a repetition of the previous eight
days, with the exception that the delirium was not quite so
violent. Sleep was obtained most of the time by Battley
solution, but, having again failed, hyoscine (Merck’s crystals)
was again tried. It did not produce sleep, but it evidently
made the patient quieter. Has steadily taken the 500
grams of iodide of potash daily. The blue ointment
was discontinued to-day.

February 7th .—Patient slept well last night under a
single dose of Battley. Is decidedly better; very little
delirium.

February Sth .—Slept well last night after a 15m dose
of Battley, and is fairly rational. Battley discontinued to¬
night, and to have 1-25 gr. of hyoscine.

February gth .— Had an excellent night, and is mentally
quite himself. The last few days, in spite of his general
condition, power in the legs has been gaining. To day is
able to lift his left leg extended straight off the bed at
least six inches and right about four inches. Can draw up
both legs and place sufficient force on them, with aid of

CAMPBELL: SYPHILITIC GUMMATA.

433

his hands, to lift his body off the bed. For the last three
days urine was passed involuntarily, i.e., he knew when he
was about to make water, but could not retain it till the
nurse brought a vessel. To-day he can do so. To have
1-25 of a grain of hyoscine every night. Bed sore almost
well and' abscess cavity contracting rapidly. The latter to
be washed out with Edinburgh red wash.

February \<$th .—Patient has made steady progress.
Legs gaining in strength, can lift left leg off bed three feet,
can flex and extend it twice without touching bed, and
then, without any rest, hold it extended and elevated for a
good minute. Can do same with right leg, except that
power is not so great, and the movements are done more
slowly. Has had several natural motions. Can retain his
urine for several hours and give timely notice of his desire
to urinate.

February 2 ",th .—During past eight days patient has
made wonderful progress. The bed sore has closed ; has
now good control over both legs and bladder. Abscess
cavity, not showing any improvement of late, was to-day
brushed out with solid stick of nitrate of silver. Has
been taking 500 grains of iodide of potash daily since Jan.
7. To-day it was reduced to 400 grains daily. Sleeps
well. Hyoscine discontinued.

March $th .—Still improving; was to day able to get
out of bed without assistance, but required a little help to
keep him on his feet. Continues to sleep well. Iodide of
potash reduced to 250 grains daily.

March 10 th .—Was to-day placed on sofa, and wheeled
into the sun, where he remained for two hours. Abscess
cavity about entirely closed. Iodide of potash reduced to
150 grains.

March 1 5 th .—To day is able to move about room with
slight assistance from a pair of crutches. Began the use of
the Faradic current. Legs hypersensative to a mild current,
which causes some pain in legs.

March 20th .—Faradic current stopped, as patient is
now able to move about room fairly well with the aid of a
stick. To-day received a letter from Dr. Seguin, of which

434

CAMPBELL: SYPHILITIC GUMMATA.

the following is an extract: “ I am delighted to hear such

good news of our case; it now looks as if there would be
complete recovery, which is rare, as you know. What
would you think of giving him alternate courses of mercury
and iodide—say 1-30 grains of bi-chloride, three times a
day for two weeks; then 75 to 100 grains of iodide of
potash three times a day for two weeks. That is the way
I usually manage the convalescent of my cases of cerebral
and spinal syphilis. I have treated several cases with the
large doses, such as our patient has been taking, and with
marked success, and have never had in any case gastric
irritability, acne or coryza. My case of cerebral sarcoma,
operated on by Weir, went home to-day well, except a
slight degree of right side paresis (much less than before
operation). The wound was completely healed by the
fourth day. Now fora spinal tumor.”

Patient was accordingly placed on the treatment
suggested by Dr. Seguin, giving the full dose of iodide of
potash 100 gr. three times a day.

March 25 th .—With a little assistance patient was to¬
day able to walk down the stairs to the first flat, and then
12 steps into the street, enter a sleigh and go for a dtive.

From this date the improvement was steady, and by
the 15th of April patient was able to go for a short walk
without any assistance. Mercury and iodide still continued.

May 1 st .—Patient is practically well, and thinks of
soon returning to his work. Treatment still continued.

May 15 th .—Patient went down to his office for the first
time.

June is /.—The iodide of potash was to-day reduced to
50 grains.

July I st .—The iodide to day reduced to 25 grains.
There never has been any sign of ptyalism. Patient
resumed his full work on the 15th of June.

August is /.—Iodide reduced to 15 grains.

September 1st .—Iodide discontinued and the mercury-
continued night and morning. This was continued for
several months, stopping now and again for a few days.
Patient is alive to-day and has never had an hour’s illness

CAMPBELL: SYPHILITIC GUMMATA.

435

since. Connection with his wife was forbidden for two
years, and I believe was faithfully carried out. About 3
years from date of illness I confined his wife of a fine
healthy male child, now alive.

This case is especially interesting on account of the
enormous doses of iodide of potash which the patient took.
At the time I was treating this case, my son, Dr. Rollo
Campbell, was clinical clerk to Dr. Stephen McKenzie at
the London Hospital, and had under his care a similar one.
He mentioned my case and the dose of iodide of potash I
was giving, to which Dr. McKenzie replied that it was
impossible for the system to assimilate such enormous doses.
I told this to Dr. Seguin, who said he did not care whether
the system assimilated them or not, they cured the patient.
This is the theoretical and practical sides of the question.
An interesting point also was the delirium, which greatly
complicated matters, and greatly alarmed the friends.
During the progress of the case I was in constant communi¬
cation with Dr. Seguin, and his opinion was, that it was
either septicemic or embolic. Concerning it he advised me
as follows: “ I took the liberty of telegraphing you to try
hyoscine again, your dose having been too small for an
active delirium. In the active delirium of general paralysis
I give from the 1-33 to the 1- 25 of Merck’s crystalized hyos¬
cine with wonderful effect.”

So far as I Can ascertain, no one has before or since in
Canada taken such enormous doses of iodide of potash.
The result in this case certainly justified them, and, if a
similar case should present itself to me, I would not hesitate
to adopt similar treatment.

1006 Sherbrooke St., Montreal, Sept., 1900.

436 HEBBERT : PROCEDURE IN POST-MORTEM

PROCEDURE IN POST-MORTEM MEDICAL
LEGAL EXAMINATION.

CHARLES A HEBBBBT, M ft C P., London,

Lecturer on Anatomy, Bishop’s College, Montreal.

CASE 5 .

The body is that of a male aged fifty-three, stoutly
built and muscular, height 5 ft. 8 in., dark hair, bald over
vertex, on which was a small wen half an inch in diameter,
moustache and beard brown, face and head much swollen
anJ discolored, lips black, protruding and greatly swollen,
tongue clenched between the teeth, some sand and mud on
the face and beard, a smill quantity of grumous fluid es-
ciped from the mouth on moving the body, rigor mortis
present in wrists and lower extremities, skin of surface of
the' body detached or detachable over arms, legs and abdo¬
men. The thighs showed fair skin somewhat suggestive of
cutis anserina, bulls were noticed over lower part of back
and abdomen, skin of hands white, corrugated and partly
separable, nails undetached, decomposition most advanced
over upper part of head, neck, chest and shoulders, with em¬
physema of the subcutaneous tissues, lower part of abdomen
green discoloration, superficial veins of trunk and outer side
of thighs mapped out by purplish discoloration, no signs of
ecchymoses (verified by superficial and deep sections) hands
half clenched, no carpopedal contractions, no sand or foreign
substance under nails or in the hands, peflis retracted, left
side of body and scrotum much distended by gas-

Trunk and limbs protected by clothing, head and hands
bare.

Head. —Scalp removed, no ecchymoses or injuries notic¬
ed, no fracture of skull, meninges nothing noticeable, brain,
substance greyish color, soft and decomposing, no apparent
congestion of vessels, no sign of previous hemorrhage,
medulla and pons in fair state of preservation, and apparent¬
ly normal, no fracture or injury of neck.

Thorax.— On opening thorax the viscera were found
in a normal position, the pericardium being uncovered and
the lungs not unduly prominent.

Heart.- -The pericardium contained about an ounce of

MEDICAL LEGAL EXAMINATION.

437

blood stained fluid ; all the cavities of the heart contained
a small quantity of black fluid blood, the walls were flaccid
and dilated, muscular tissue fairly good color and firm,
endocardium dark red color, valves normal, no atheroma
of the aorta, coronary arteries showed a slight atheromatous
condition, but the openings were patent. Lungs, no adhe¬
sions, about half a pint of blood stained fluid in each cavity,
mucous membrane of trachea, larnyx and bronchi was dark
red, soft, and showed commencing decomposition ; no froth
or fluid in the tubes; lungs’ were of a universal dark
color, almost black, and on section some dark bloody fluid
exuded, no froth in the main divisions of bronchi, though a
little could be pressed out of the smallest tubes.

, STOMACH. —Contained from five to six ounces of food,
consisting of mutton, green peas and potatoes; the peas were
mostly intact and the mutton had hardly been exposed
to the digestive process; a very small amount of food was in
the stomach. There was no perceptible odor beyond that
usually found. Walls of intestine normal, small amount of
semi-fluid faeces in both small and large intestine ; bladder
contained about three ounces of clear urine; walls were nor¬
mal. Kidneys, right capsule adherent, cortex diminished,
surface granular, color dark red ; left, similar condition though
less marked ; adrenals normal; liver congested, but other¬
wise apparently normal; spleen enlarged and congested.

COMMENTS.

It is well known to medical jurists that often a difficulty
arises in determining the exact cause of death in cases of sup¬
posed drowning.

The first assumption when a body is found in the water
is that the individual has come to its death by drowning,
especially when there are no external marks of violence,
but in the careful investigation of the cause of death it must
be recognized that there is no one sign, which is always pre¬
sent, and every case has to be decided on its merits, that is,
on the whole picture suggested by the details.

The first question is, did the body enter the water
alive ?

438 iiebbert: procedure in post-mortem

In cases of commencing putrefaction, miny of the signs
are lost, such as pallor of the surface/mottling and reddish pat¬
ches, etc., but there may be still evidences present of cutis
anserina on the extensor aspect of the thighs and arms
and retraction of the penis, and these two signs were suffi¬
ciently recognizable in this case to decide in the affirmative.

The next question was death due to drowning. Death is
the complete cessation of the functions of the brain, heart and
lungs, the so-called tripod of life. It must ensue primarily by:
I. Asphyxia, total interference with respiration; 2. Syncope,
or failure of the heart’s action ; or 3. Shock to the nervous sys¬
tem, the neuroparalysis of Casper. Any one of these condi¬
tions may be found in the bodies of the drowned, the most
frequent being asphyxia, This is caused b)' the mechanical
interference by the water of the proper entrance of air into
the lungs and the consequent non-aeration of the blood. The
signs in such a case are, first, a great congestion and increased
volume of the lungs ; this increase of volume is sometimes so
great as to quite overlap the heart area and even bulge out¬
wards on opening the chest cavity, and this sign is said by
Casper, and his statement is in accordance with my own
experience, to pfrsist even in cases of advanced decomposi¬
tion of the internal organs ; secondly, engorgement of the
right side of the heart, with fulness of the whole venous
system, the blood being a dark red or black color. There is
also much frothy and reddish mucus, on the lips, in the mouth,
larynx, trachea and bronchi down to the smaller divisions
caused by the efforts to breathe during partial or total sub¬
mersion. It has been noticed in bodies which sunk at once
to the bottom, though to a lesser extent. There is also red¬
ness of the membrane of the air passages. These signs are
more evident in cases of robust men making a supreme effort
for life, and even a suicide, however determined, must at the
time of losing consciousness instinctively struggle to breathe.
If a person be submerged while unconscious the signs would
be similar to those sinking at once, and evidence of asphyxia¬
tion, though present to some extent,would not be pronounced.

In the next series of death by drowning, the walls of
the heart are flaccid and contain about an equal quantity of

SMITH: UTERUS IN F.LERLY WOMEN.

439

blood in each side. There is little or no increase of volume of
the lungs and no marked congestion of the nervous system.

In the third series, the brain is frequently much congest¬
ed, but the heart and lungs show nothing special.

I have narrated the above case as illustrative of some
of the difficulties encountered by the medical jurist, in cases
of bodies found in the water and presumably drowned.

The indication was that the death was due to drowning,
as the lungs were congested though not increased in volume,
nor showing any frothy mucus in the air passages. This
latter would probably be absent in the upper passages, en
account of the'length of time in the water (3-4 days), but one
would have expected to see more evidence in the smaller
divisions of the bronchi or section of the lungs. The heart,
too, showed flaccid walls with a small amount of blood in the
cavities, and were not engorged on the right side.

The most reasonable theory is that a man so strong and
muscular and so capable of making an effort for life, if con¬
scious of his danger, must have been insensible at the time of
submersion. I think the above facts justify me in dispos¬
ing of either accident or suicide, as, in either case, I believe
there would have been more distinct evidence of drowning
by asphyxiation, and in believing that the presumption was
that of the homicide of a man previously rendered unconscious.

ABSTRACT OF PAPER ON THE OPERATIVE
TREATMENT OF COMPLETE PROLAPSE
OF THE UTERUS IN ELDERLY WOMEN *

By LAPTHORN SMITH, B-A. M.D., M.R.C.3., En».

Surgeon-i 11 -Chief of the Samaritan Hospital for Women, Montreal ; Clinical Professor
of Gynecology, Bishops College, Montreal.

The author comes to the following conclusions :
ist. That a woman suffering from procidentia or prolapse
of the uterus out of the body, though not in much pain, is
yet very miserable.

2nd. She is in some danger, owing to the cervix becom-

* Read before the Canadian Medical Association, Sept. 14,1900, at Ottawa, Ont

440 CATHELL : A RELIABLE AND HARMLESS WAY

ing ulcerated and the ulceration frequently becoming can¬
cerous. ’ /

3rd. It is a mistake to think that she is too old to undergo
an operation because she is forty-five or fifty or even seventy-
five years of age.

4th. Elderly women support these operations remark¬
ably well ; they only require from twenty to thirty minutes
for their performance ; and, even if we knew that the patients
were only going to live one year afterwards, it would be well
worth while operating for the sake of the comfort it affords
them.

5th. The operation of vaginal hysterectomy is especial¬
ly easy and <afe in these cases, having not more than one
per cent, of mortality, and probably not even that.

6th. Ventrofixation gives good results when the uterus
is short, but fails when it is long. In some cases the vagina
and bladder pull down and elongate the cervix, after the
fundus has been firmly attached to the abdominal wall.

7th. In either case, whether hysterectomy or ventrofixa¬
tion be employed, it should always be followed by an anterior
and posterior colporrhaphy.

8th. These patients sh mid remain in bed for six weeks
after their operation, in order to give time for the new tissue
to become strong.

Selected Articles.

A RELIABLE AND HARMLESS WAY TO DIMIN¬
ISH AND CURE OVER-FATNESS.

By WILLIAM T. CATHELL. A M., M.D., of Baltimore.

[Read at the Ninety-Ninth Annual Meeting of The Medical
and Chirurgical Faculty of the State of Maryland ’.]

Mr. Chairman and Gentlemen :

Before all else, I shall state that I have neither medicine
to sell, secret to extol, nor scheme to make money out of the
public, as “ Eureka” titles like this are apt to suggest, but,

TO DIMINISH AND CURE OVER-FATNESS.

441

agreeing that every addition to true knowledge is an addi¬
tion to human power, 1 intend to lay before you to-day the
results of nearly five years’ observation upon a reliable and
harmless way to remove over-fatness and the evils it
creates.

That you may have a clearer conception of what is to
follow, I shall first remind you that, by the natural law of
proportion, fat should constitute about the one fifteenth or
one-twentieth of one’s weight, and that a person’s heft may
vary ten or fifteen pounds either way, from the standard of
weight to height, without its being significant of either dis¬
comfort or disease; also, that a certain quantity of fat is a
blessing, at it not only improves personal appearance, but is
necessary to protect the various organs and to maintain their
temperature ; and also to serve as nutrition in time of need.
For these purposes it is stored in cells in various parts of
the body, but more plentifully in some regions than in others.

If any one has a much less proportion than one-twentieth,
leanness, lankiness or emaciation is observable ; a very much
greater proportion than say one-ninth or one-sixth con¬
stitutes corpulence, obesity or over-fatness, and although
stoutness, to a moderate degree, is considered an element of
good health and indicative of the successful working of one’s
physiology, yet, fatness alone is a very poor criterion of
health, but, on the contrary, it is an element that possesses
the power for serious mischief, because a very great amount
of fat necessarily creates heaviness, impedes respiration,
circulation, locomotion, digestion and other vital functions
to such a degree that the person who carries such a load of
bulky ballast is more burdened than blessed.

In very fat persons all the cellulo-adipose structures are
filled to distension, more noticeable about the subcutaneous
tissues, the breast and the abdominal walls ; also in the
omentum and mesentery, on the surface of the heart and
about the kidneys, and, if this mot bid accumulation grows
to be excessive, these all become buried in fat, which mechan¬
ically interferes with both function and nutrition.

According to my observations, there are four common
causes of over fatness:

Congenitally small lungs with defective oxygenating
capacity.

Eating excessively of all kinds of food.

Want of lung-expanding exercise.

Alcoholics to excess.

There are numerous well-known agents that more or less
effectually reduce surplus fat, and also counteract its return.
Among these, Iodine, Bromine, Mercury, Lead, Arsenic.

442 cathell: a reliable and harmless way

Liquor Potassium, Lemon Juice, Sour Wines, Vinegar, purga¬
tives, sweating, semi-starving, baths of various kinds, smok¬
ing and chewing, fish diet, Bladder Wrack, Phytolacca, Gulf
Weed, and various quack nostrums, each have more or less
reputation for diminishing weight.

Some of these, when taken sparingly or for a brief while,
have a proper place and a useful power, but, unfortunately,
when used in quantities sufficiently strong, and long enough
continued, to destroy any considerable amount of fatty tissue,
they likewise injure other structures ; therefore, are neces¬
sarily dangerous to health. Besides, they all act either by
saponifying the fat or by producing numerical cell-atrophy,
either of which exerts powerful influence on the lympathic
and absorbent systems, not only cause re-absorption and de¬
struction of olein, stearin, margarin, protoplasm, nuclei and
other physiological constituents of the fat-cells, but go further,
and annihilate myriads of cell-membranes, red blood glo¬
bules, and other normal and essential elements of the econ¬
omy ; and as these perish, all histologists know, vitality is
reduced and health is impaired.

It is also well known that, while affecting the fat, many
of these articles also act as slow poisons, and damage or ruin
the alimentary mucous membranes and the functions of
digestion, and thus cause mal-assimilation and mal nutrition,
with repugnance to food. These, therefore, are all doubly
injurious; and, if used too heroically, or continued beyond a
certain period, anemia, general debility, marasmus, consump.
tion or other fatal affections may be induced.

None but an idiot, however fat, wishes to endanger his
health by unwise efforts to reduce it, and many over¬
weighted persons, anxious to throw off their fleshy burden,
and aware of the danger of using anti-fat drugs, determin-
ately avoid them, and resort to pedestrianism, bicycling,
gymnastics, rowing, massage, electricity, restricted sleep,
thyroid extract, skimmed milk and other popular means;
while a few begin a regular dietary system: Banting's,
Ortel’s, Ebstein’s, Bruen’s, or others, which all aim to limit
the supply of elements that form fat, and to increase its re¬
absorption ; and I am glad to say, to the honor of their
founders, that every dietary system with which I am ac¬
quainted seems to be based on rational principles.

But ball-and-chain rules and iron-clad regulations re¬
quiring daily discomfort, long suffering, semi starvation,
abstemious dieting, etc., no difference by whom recommended,
are rarely persevered with to a successful degree by persons
with simple over-fatness, and we rarely meet anyone wreathed

TO DIMINISH AND CURE OVER-FAT NESS.

445

in fat who has not begun on one or another, or several dif¬
ferent plans, and after awhile become either careless or dis¬
gusted, and—quit.

Neither with cases of enormous obesity, nor with cele¬
brities of fabulous proportions, nor with over-fat invalids or
semi invalids have I had any special experience, but if any
healthy person, whether male or female, weighing less than
300 pounds, with simply uncomplicaitd mer-fatness , wishing
to make a fair, honest and faithful trial of my plan to dimin¬
ish over fatness, will begin and drink a large glass of Kis-
singen Water twenty or thirty minutes after each of the three
daily meals one day, and a similar glass of Vichy Water
after each of the three daily meals the next day, and per¬
sistently continue to take them thus, week after week, he will
begin and gradually lose fat, until he comesdown to medium
weight and stoutness, and be correspondingly relieved of the
discomforts and the dangers of obesity ; after which their use
should be discontinued.

The natural Kissingen and Vichy waters, when fresh,
answer our purpose equally well, but I have learned to prefer
the artificial compound made by the chemist’s ingenuity to
imitate the natural waters when the springs (Rakoczy and
Grande Grille) are at their best, because, to be successful,
both waters should be used while still fresh, and, as the
natural waters are brought from afar by the cargo and car¬
load, there is danger of their becoming so stale and altered
before use as to be wholly unreliable, and in actual practice I
have found the artificial waters, made from the Kissingenand
Vichy powders to be equally or even more definite in qual¬
ity than the natural waters, therefore more certain in their
action on fat.

Kissingen and Vichy Salts, taken in ordinary water,
are said to reduce fatness, but in a lesser degree, owing pro¬
bably to the absence of carbonic and other gases; with
them, given this way, I have no experience.*

It is useless to take either Kissingen or Vichy alone, as
they act only when both are taken, and taken alternately.
The temperature at which they are used is immaterial.

While using the Kissingen and Vichy, the person
should, as a necessary guide, keep tally on his girth and
weight; by taking his measures, and by carefully weighing
his body, in the same clothes, and on the same accurate
scales, every two or three weeks, and if he has lost more

* Since the above paragraph was written, I have been furnished with abun¬
dant proof that Kissingen and Vichy Salts, both plain and effervescing, do act
efficiently.

444 CATHELL : A RELIABLE AND HARMLESS WAY

than a couple of pounds for each week, take a smaller glass
of each at every drink, and if he has lost less than a couple
of pounds for each week, squeeze a few teaspoonfuls of lemon
juice into each glass of the Kissengen, to increase its acidity ,
and also add one teaspoonful of the A romatic Spirits of A m-
mtnia to each glass of the Vichy, to increase its alkalinity.
He can further aid them by using acidulous food and drinks
on the Kissingen days, avoiding them with the Vichy.

He should also lend assistance to the action of the
waters, not by a too restricted diet, which is not good even
for the obese, but by using starches, sugars, fats, alcoholics
and all other fat-forming food, but sparingly; avoid over¬
eating, and use neither food nor alcoholics except at the
regular meals; also take early and light suppers, so that
from that time until breakfast, the longest of the three in¬
tervals between meals, there may be but little pabulum for
fattening, and favorable conditions for reduction ; and
especially that there may be complete emptiness of the
stomach during sleep, so that nature may then utilize some
of his surplus fat as fuel for the ceaseless wear and tear. He
should also take moderate out-door exercise, on foot or
wheel, or in any other way that will increase and deepen his
respiration and promote tissue oxidation.

After drinking these waters and following these rules
for awhile, he will find that he is losing part of his girth and
a couple of pounds of avoirdupois every week ; and that the
loss consists entirely of useless fat; and that his appearance,
activity and feelings will all be improved—just as if there
exists some natural antagonism between these waters, taken
thus, and adipose tissue; more especially that located in the
great fat-centres already mentioned.

Now, while it is extremely difficult to search out the
ultimate of anything in physiology—for instance, why opium
relieves pain, and colchicum benefits gout—yet. after study¬
ing this subject thoughtfully, I am quite sure theie exists
either a specific physiological action or some definite che¬
mical affinity between Kissigen and Vichy, taken by this
rule, and abnormally fat human tissues, that results in a
lessening of the fat, with neither purging nor sweating, or in¬
jury to brain, blood, muscle or general health ; but how, or
why, I cannot yet explain.

They may reduce adipose and prevent further infiltration
or storage, in either of several ways : One is, by merely in¬
hibiting or controlling the disproportionate activity of fat¬
cell nutrition; thus placing less fatty pabulum and more
blood, brain, muscle, nerve and gland elements, at the dis-

O DIMINISH AND CURE OVER-FATNESS.

445

posal of the absorbents, while the fatty tissue and oily ma¬
terial of the body, being the most lowly organized, are
naturally the first to be removed by the corrected physiolo¬
gical processes.

Or, we may find that they act as alteratives, and restore
equilibrium to the nutritive processes, by destroying or neu¬
tralizing some morbic fat-forming agency, occult derange¬
ment of digestion, or perversion of assimilation, that have
been causing diminished oxidation, and a consequent accumu¬
lation of fat.

Again, when we study their analysis, and consider the
complexness of'the potent medicinal ingredients that lie
hidden in each glass of these waters, another rational hypo¬
thesis arises : Kissingen being an acidulous saline ,and Vichy
an alkaline, and both containing salts of calcium, magnesium,
potassium, sodium and other minerals, in decided and definite
quantities, united with carbonic acid and other gases, it seems
logical to suppose, that when alternately mingled with the
food-pulp or chyme in the stomach and intestines, day after
day, their special combination of ingredien s brings about
reduction by some chemico-physiological readjustment of
the alkalinity and acidity of the blood and the visceral
fluids, or possibly of both humors and solids ; and that this
readjustment makes the fat-yielding pabulum less plentiful
and less favorable for fat-creation, and metabolically explains
why increase of fatness ceases, and why reabsorption of the
surplus contents of the fat-cells begins, and also why this
physiological reduction and reconstruction results, all uniting
to prove that Kissingen and Vichy, taken by this plan, are a
reliable combination for preventing increase and reducing
surplus fat to the normal proportion of one to fifteen or
twenty.

But, whatever their exact mode of action may be, there
certainly exists some natural and well-marked antagonism
between these two waters taken thus, and adipose material,
that tends to restore normal balance between the quantity of it
and of other tissues. This has been proven again and again.
In some cases, however, the direct and immediate effect of
Kissingen and Vichy is more perceptible than in others,
because some types of fatness reduce more easily and more
rapidly than others. The more firm and solid the flesh, and
the longer one had been fat, the more slowly it yields. Such
a one, if quite fat and belonging to a constitutionally fat
family, with proportionately small lungs, might require a
persistence with Kissingen and Vichy methodically tor six
months or even longer, unless the ammonia and lemon juice

I

446 CATHLLL : A RELIABLE AND HARMLESS WAY

are added regularly. Ungovernable appetite, failure to
exercise, tippling, etc., may also retard or prevent success.

In some of these "stubborn” cases, a considerable de¬
crease of size with but little lessening of weight has been
observed.

In addition, Kissingen and Vichy not only reduces
over fatness, but also tend to permanently correct the irre¬
gular and excessive fat making activity on which it depends
without injury to health. The person gradually becomes
thinner, looks healthier and feels younger and more active,
as his (or her) superabundance disappears. At the same time,
the skin, being an elastic and active tissue,, contracts corres¬
pondingly, leaving neithtr flabbiness nor wrinkles, bagginess
nor crow’s feet, while train, muscle, nerve, blood and glan¬
dular nutrition and strength all remain normal, proving that
this method does not cause either pathological diminution
or morbid shriveling from inanition or loss of strength, or
constipation with cachexy, from impaired digestion, as the
various “anti fat ” blood depurativesand glandular elimina-
tives are notoriously apt to do.

To properly appreciate this fact, it must be remembered
that a person in normal flesh has as much blood, and usually
better blood, than a similar person whose weight has been
ever so much increased by fat, and that Kissingen and Vichy
act on the fat and not on either the blood, the glands or the
bowels.

My atttention was first called to the peculiar power of
this combination over fat fully five years ago, in this way:

Mr. McK-, a hearty looking, middle aged gentleman,

who was consulting me for an unimportant affection of the
throat, informed me that, in addition to this, he had lost
about thirty pounds of flesh within the last half year, without
sickness, loss of appetite or any other apparent reason, and
that he was mystified and unable to discover the cause.

On inquiry I gleaned nothing important, except that
for several months he had been following the habit of drink¬
ing artificial Kissingen and Vichy waters daily, under the
belief that, being called for so often by soda water patrons,
they must be good for one’s health.

His throat being better, he soon passed from my care,
with his loss-of weight mystery unsolved.

The following year, Mr J. H. H-, a young man of

thin visage and notable leanness in general, asked me the
cause of his losing nearly nine pounds in weight. Among
other things, I learned that for a year or more he and a com¬
panion had been daily visitors to a near-by soda water

TO DIMINISH AND CURE OVER-FATNESS.

447

fountain, and tiring of the various syrups, they had changed,
five or six months before, to Kissingen and Vichy, and that
shortly thereafter they both noticed that they were getting
thinner and thinner.

Remembering Mr. McK-’s decrease, and putting this

case and that together, I told him of the resemblance, and
caused him to discontinue Kissingen and Vichy immediately.
Emaciation shortly ceased, and under tissue-building tonics
he gradually regained what had been abstracted from his
scanty stock of fat.

Feeling quite sure that I now had a clue to the mystery,

I sought out Mr. McK-to tell him, but suspecting the

wattrs himself, he had long since quit them, and his loss of
weight ceased, making him quite sure as to the cause.

A few months after this, friend McK—— called at my
office with a young Canadian, Mr. W. D. W-, a bar¬

tender, whom he had incidentally met, and wished me also to
see him. His weight, under the liberal use of Kissingen and
Vichy, had fallen, during the past summer and fall, from 223
to 180 pounds. He explained to me that, being a bar¬
tender, he was kept in constant contact with liquor drinking,
and. being pledged against all intoxicants, yet, not wishing
to offend customers, he would take a dozen or more small
shell glasses of either Kissingen or Vichy daily, drinking
whichever they had most of in stock.

He further informed me that his decrease in weight, and
a striking rejuvenescence in his appearance, activity and
feelings, began shortly after commencing this habit. His
lessening in weight had also ceased promptly after Mr. Mc-
K-had caused him to quit them.

This was more than three years ago. His size still re¬
mains at comfortable stoutness, and his weight keeps below
200 pounds.

Anxious to utilize this discovery, and determined to
neglect nothing in pursuit of the truth, Kissingen and Vichy
have since been experimented with by me, and by others,
on different fat-laden persons at various hours and in varying
quantities, and, as the result, I would recommend their use
in the quantities and at the hours already mentioned, since
these, in my opinion, constitute the most effective time and
quantity.

At a recent interview Mr. W. D. W-, the bar¬

tender, told me that constantly fearing h»s superabundant fat
may again force him above ordinary stoutness, he has
adopted the habit of drinking a few glasses of Kissingen and
Vichy daily, for ten or fifteen days, several times a year.

Governed by this and other cases, I would advise those

44 8 CATHELL : A RELIABLE AND HARMLESS WAY, ETC.

with the smaller degree of over-fatness, who wish to effect a
slight and gradual reduction of size; and also, those merely
seeking to reduce unsightly chin, facial, bust, hip or abdo¬
minal fat, or to keep their general bulk down to the natural
to drink Kissingen and Vichy now and then, instead of
adhering rigidly to the regular system.

When the excess is chiefly below the waist, causing
what is called “large stomach,” wearing a snug abdominal
supporter or a moderately tight abdominal binder, while
pursuing the method, makes the fat disappear much more
promptly from this locality, and also braces up the reduced
form as absorption progresses.

My father, Dr. D. W. Cathell, has recently, at my re¬
quest, tested this method on nearly a dozen cases of over¬
fatness with favorable results, and I hold in my hand now
the records of eleven cases, seven males and four females,
who have used Kissingen and Vichy, more or less meth¬
odically, with the following positive results: A fat grocer, re¬
duced from to 289 pounds in eleven weeks; bar¬

keeper, reduced from 223 to 180 pounds in nineteen weeks ;
a lawyer, reduced from 191 to 173 pounds in fourteen weeks ;
young real estate agent, from 173 to 15 I pounds in twelve
weeks; clergyman reduced 16 pounds in nine weeks; lady,
aged 28 years, from 286^ pounds in thirteen weeks; stout
actress, from 173 to 166 pounds in seven weeks; young
English lady, from 149 to 142 pounds in five weeks ; con¬
ductor on steam cars, from 183 to 174 in six weeks; lady,
aged 41, from 173^ to l6o*4 pounds in eleven weeks, and
that of a well-known physician, who was reduced by an
irregular use of Kissingen and Vichy from 211 to 156^
pounds in nine weeks.

Fortified by such observations, I do not hesitate to
assert, that the heavy laden , who are suffering with the fat¬
forming diathesis, and wish to reduce their surplus to healthy
limits, and to regulate its further formation do so by avoid¬
ing over-eating, limiting the use of sugary and starchy arti¬
cles, fatty and oily food and the alcoholics, and using
Kissingen and Vichy Waters by the rules already men¬
tioned.

Based on equally clear proof, I am also equally convinced
that the lean, the puny, the slim, the pale and the flabby ;
those with weak hearts, irregular circulation, poor vitality or
limited health; together with all that numerous class of
feather-weights , whose percentage of fatty tissue is so scanty
that they should either try to increase the number and
fulness of their fat-cells, else let them remain as they are,

shoemaker: treatment OF DIARRHCEA. 449

should seek good, nutritions food, fresh air and moderate
exercise, and avoid mineral waters in general, and Kissingen
and Vichy in particular.

My sole object, Mr. Chairman, in bringing before you a
subject's© far separated as this from the specialty to which
I limit my practice—the Nose and Throat—is, that having
observed what I believe to be a valuable therapeutic fact, I
feel it to be my duty to lay it before the profession.

1308 N. Charles Street,

THE TREATMENT OF DIARRHCEA.

By JOHN V. SHOEMAKER, M. D., LL. D.,

Professor of Materia Medica and Therapeutics in the Medico-Ohirnrgical College of

Philadelphia.

The residue of incompletely digested food acts as a foreign
body and irritant to the mucous membrane of the bowel,
augmenting the secretion of the follicles and exciting peris¬
taltic movements. These represent nature’s efforts to remove
offending material. They are in so far conservative that,
after expulsion of the irritating mass, its pathological con¬
sequences, and the symptoms to which they give rise, tend
to subside.

Fermentative changes, especially in amylaceous articles
of food, cause pain and aggravate the mischief. Indigestion is
the starting-point of ordinary cases of diarrhoea. Prominent
causes of indigestion are irregular and hurried meals, active
bodily or mental exertion directly after substantial meals,
nervous agitation or depression, insufficient mastication, and
the influence of summer-heat. With the exception of the
last named factor, they are operative every day all the year
round. High temperature favors the occurrence of indi¬
gestion and diarrhoea by its powerfully depressant action on
the nervous system. Indiscretions which would produce
little result in colder weather may provoke a severe attack
of diarrhoea in summer. Beyond doubt the rapid and fre¬
quent drinking of ice-water assists in the development of in¬
testinal disorder. It goes without saying that all these mor¬
bific elements act particularly upon infants and young
children, and summer is pre-eminently the season of infantile
diarrhoea. Furthermore, along with diminution of digestive
power, the milk supplied by dealers may have itself undergone
changes which render it a direct cause of disease. The fer¬
mentation of the intestinal contents is due to the activity of
bacteria, which abound in the canal.

45° SHOEMAKER : TREATMENT OF DIARRHOEA.

These brief considerations already furnish us with some
guiding points relative to the prevention of diarrhoea. The
first thought which suggests itself relates to the importance
of careful hygienic and dietetic habits. The active and
persistent efforts of the medical profession have brought
about a great and beneficial improvement in the nature of
our milk supply. It is now generally possible for citizens to
obtain a pure, unadulterated, and sterilized milk. The arti¬
ficial rearing of infants has received close study within the
same period, and conspicuous advances have been m ide in
our methods. Together with these alterations, it has become
much more customary for people to make holiday excursions
to the country or sea-side. It is now within the means of
most persons to take such summer trips. A sojourn of only
a few days in the purer air of the country accomplishes great
good, both as a prophylactic and remedial agency'. A ride
to the park on open trolley-cars or a trip on a river steam¬
boat are other short outings which can be taken at a moment’s
notice and which soon transport ailing children and wearied
mothers to more favorable surroundings. For such reasons, al¬
luded to thus cursorily, and others which act in a similar
direction, severe cases of infantile diarrhoea and cholera infan*
turn are, I think, considerably less numerous, in Philadelphia
at least, than during the earlier years of my practice in
this city.

Scrupulous cleanliness of the integument and attention
to the gastro-intestinal mucous membrane are of much avail
in the prophylaxis of diarrhoea. The utility of bathing or
sponging the body with cool water is unquestionable. The
direct abstraction of heat quiets the nervous centres and
invigorates resistance to deleterious influences.

Our patients, however, generally come to us when disease
is already established. The time for prophylaxis is past.
A regulated diet has much remedial influence. If an acute
case is seen early, and, above all, if particles of undigested
food are passed with the discharges from the bowel, I adhere
to the old, but sound, parctice of giving a dose of castor-oil
and laudanum. A laxative dose of the oil is ordered together
with five or ten drops of laudanum ora proportional fraction
in case of young children. This combination sweeps away
offending material, reduces turgescence of the intestinal
mucous meml.rane, and assists in checking the discharges.
In severe cases it paves the way for the administration of
other agents.

In infantile diarrhoea, and more especially in the graver
forms, or cholera infantum, it is necessary to restrict the

SHOEMAKER: TREATMENT OF DIARRHIEA. 45 I

diet. It is at all times too much the custom for parents to
allow young children to “have the run of the table,” as they
express it, or, in other words, to partake of the same food as
their elders. In numberless instances this pernicious prac¬
tice is the foundation of indigestion and diarrhoea. Those
of tender years should be fed upon simple, nutritious and
easily digestible food in accordance with .the physiological
laws of digestion. In such cases I forbid the use of bread,
meat and potatoes. If a babe is at the breast, it is, of course,
getting the sustenance which nature designs for it, provided
that the mother’s milk is of normal quality and sufficiently
abundant. In artificially reared infants I restrict the little
patient to sterilized cows’ milk, modified as regards the water
and sugar according to the age of the child, to barley-water,
rice-water, or rice-water and milk; the white of egg whipped
up with milk and slightly sweetened; to junket,or the ex¬
pressed juice of meat. A good variety of artificial food also
often answers a useful purpose in this class of cases.

In the medicinal treatment of diarrhoea the combination
of an opiate and astringent was long the accepted method.
To a large extent this plan has been abandoned with our
altered conceptions of the pathogenesis of inflammation.
It is now generally regarded as a more rational procedure to
disinfect the alimentary canal, to check the development of
bacteria, and neutralize their deleterious products.

Ipecacuanha is a drug which I often employ in small doses>
particularly in the diarrhoea of infants and young children.
Used in this way it possesses a stimulating influence on the
functions of stomach and liver, acts upon the intestinal glands,
and strengthens the digestive functions. It should be remem¬
bered that the digestive fluids themselves are inimical to the
growth of bacteria. Bismuth has a valuable sedative action
upon the intestinal mucous membrane, and is of decided
service in diarrhoea. Its influence is directly local, and to a
certain extent mechanical. On account of its comparative
freedom from toxicity it can be given to young subjects in
appreciable doses. The subnitrate is the salt most frequently
employed, although the subcarbonate is also an excellent
preparation. The salicylate of bismuth is likewise service¬
able in summer diarrhoea, and is more decidedly antiseptic
than the subnitrate or subcarbonate. One or other of these
salts may be effectively given in conjunction with ipecacu¬
anha. In cases accompanied with much pain the last drug
may be advantageously prescribed in the form of Dover’s
powder. Some of the preparations of calciu 1 n are also of benefit,
especially when the feculent d scharges are unusually acrid.

45 2 SHOEMAKER : TREATMENT OF DIARRHCEA,

Liquor calcis, creta preparata, the carbonate, phosphate, or
silicylate of calcium may be beneficially added to some such
combinations as have just been indicated. Salol is an ef¬
ficient disinfectant of the intestinal tract and is of undoubted
value in diarrhoea. By reason of the proportion of carbolic
acid which it contains and the consequent possibility of dam¬
aging the kidneys the urine should be watched while a pa¬
tient is taking salol. I customarily order it in the dose of
five or ten grains for the adult, and in amounts graduated
tothe age of young children. Salicin is an analogous reme ly
which I often employ. It is well tolerated by the stomach,
is tonic and antiseptic. It can be given in doses of one grain
to children one year of age. Naphthalin and naphthol, both
the alphanaphthol and betanaphthol varieties, also antagon¬
ize diarrhoea in a similar manner to the salicylates. I have
myself generally given the preference to betanaphthol. This
preparation is of rather exceptional antiseptic power, though
comparatively innocuous.

Camphor is a valuable remedy in diarrhoea. It checks
the growth of germs, dispels flatulence, arrests discharges,
and combats the debility which has been caused by excessive
drain. Carbolic acid or creasote may likewise be employed
with advantage. They act by disinfecting the intestinal ca¬
nal and by arresting fermentation. Another agent which pos¬
sesses a distinctively favorable influence in most forms of
diarrhoea is coto-bark. This remedy has proved of value
in functional diarrhoea, cholera infantum, and gastro intestin¬
al catarrh, but is contra-indicated where there is decided
hyperaemia or ulceration of the bowel. A number of mineral
and vegetable astringents have been employed from time
immemorial. Many of these are endowed with antiseptic
properties, and are, perhaps, as efficient for this reason as on
account of their astringency.

Chloral is an efficacious drug, particularly where the lower
bowel is affected and tenesmus is present. In this substance
likewise we have an excellent antiseptic. Chloral reduces
the excessive peristalsis which is one of the factors in diar¬
rhoea. I have generally used this remedy in the form of a
suppository, and in the class of cases which I have indicated
it is undoubtedly of decided value. It is often well to asso¬
ciate a little opium with the chloral. In severe cases an effi¬
cient method is the irrigation of the bowel with large quan*
tities of plain or medicated water. This procedure is capable
of producing an antiperistaltic movement whereby the fluid
passes through the ileo caecal valve and obtains admission to
the small intestine. In this manner we are able to exert a'

MEDICINE AND NEUROLOGY.

453

powerful and direct impression upon the inflamed gut. For an
adult the quantity of water used is four pints, in which is in¬
corporated from two to four drachms of tannic acid, one and
one-half ounces of pulverized gum arabic, and thirty drops of
the wine of opium. For children the amounts must be pro¬
portionately reduced.

There are many more substances which I might enumer¬
ate and which have been used with more or less success, but
the foregoing outline sketch includes those upon which I have
been accustomed to rely. They are synergistic, and may be
often variously combined with much benefit.— The Medical
Bulletin.

Progress of Medical Science.

MEDICINE AND NEUROLOGY.

IN CHARGE OP

J. BRADFORD McCONNELL, M.D.

Associate Professor of Medicine and Neurology, and Professor of Clinical Medicine
University of Bishop’s College; Physician Western Hospital.

, UROTROPIN AS A URINARY ANTISEPTIC.

At a recent meeting of the Leeds and West Riding
Medico-Chirurgical Society, Cammidge (British Medical
Journal, March 17, p. 641), after briefly referring to a case
of cystitis complicating enteric fever in w hich urotropin had
proved beneficial, gave details of investigations that he had
carried out with regard to the action of urotropin on the urine
from patients who had taken it, on the bacillus typhosus,
the bacillus coli communis, and the staphylococcus pyogenes
aureus under various conditions. He also described some
chemical experiments designed to determine the mode of
excretion of the drug in the urine, and the cause of its
marked antiseptic and inhibitory powers over the growth of
micro organisms possessed by such urine. The result of
these experiments seemed to show that, although this action
is in part probably due to the urotropin itself, excreted un¬
changed in the urine, another and more powerfully inhibi¬
tory substance is present. This was not thought to be free
formaldehyde, but possibly a sodium compound of this
substance. There is both clinical and experimental evidence
tending to show that one condition necessary for success in
using the drug as a urinary antiseptic is that the urine should

454

PROGRESS OF MEDICAL SCIENCE.

be acid in reaction, as it is secreted in the kidney. Stress
was laid on the marked inhibitory action of urotropin, and
still more of urine containing urotropin on the typhoid
bacillus, and it was pointed out that there is a wide field of
usefulness for this drug, both in the treatment of cystitis
and other conditions liable to complicate enteric fever, and
as a preventive against the dissemination of typhoid bacilli
by the urine. It was suggested that all patients suffering
from enteric fever should receive ten grains three times a
day from the end of the second week on, during convales¬
cence. Reference was also made to the usefulness of the
drug in the cystitis accompanying enlarged prostate and
stone, as well as the benefits to be derived from its adminis¬
tration in the presence of bacteriuria, some cases of nocturnal
enuresis in children, and as a preparation for operations on
the urinary tract.— The Journal of the American Medical
Association.

DIET IN NEPHRITIS.

According to David, when cases of acute nephrectomy
first come under treatment, it is best to enjoin rest in bed,
withhold all food for twenty-four to thirty-six hours, give
water freely, and cleanse the alimentary canal by purgation.
Milk should then be given, first in small quantities at inter¬
vals of two hours, the amount gradually increased until two
quarts are taken daily. It is best given in small amount,
one or two ounces at a time, especially if there is any distress
on taking it. Where the patient can not take it, either plain
or flavored water-gruel may be given, but there is really no
substitute. When the urine becomes copious, farinaceous
foods may also be prescribed, and, when albumin disappears,
egg can be tried. Close watch must be kept on the addition
of albuminous foods in the diet. Red meats should not be
eaten until recovery is complete. When the stomach is
intolerant at the beginning, water should be given hypoder-
matically by the rectum, to insure renal elimination, but as a
rule, when the bowels are well emptied, the kidneys begin to
act and vomiting ceases. In chronic diffuse nephritis the
indication for milk diet is similar, but the disease is so
prolonged that it can not be maintained continuously and
may be given intermittently, or sometimes modified by the
addition of bread, starches, fruits, etc. Vegetables can
generally be given, but rhubarb, sorrel and tomatoes should
be excluded, perhaps also cabbage, asparagus, spinach and
artichokes, on account of the oxalates they contain. Eggs
are the least harmful of albuminous foads. The effect of

MEDICINE AND NEUROLOGV.

455

fish is questionable, but, if fresh, it is probably as little harm¬
ful as any. Salt and smoked meats, excepting ham, should
be avoided, and fried articles generally. In chronic inter¬
stitial nephritis an abstemious diet is advisable ; even simple
animal food should be used in small quantities, excepting
milk. Tea, coffee and chocolate can be used in moderation.
Water is the beverage; alcohol is forbidden.— Jour. Am.
Med. Association.

INTESTINAL INDIGESTION, DIET IN.*

In prescribing a special diet one principle should always
be kept in mind, which is that a well-adjusted mixed diet,
when it can be perfect’v digested and absorbed, is the
height of perfection.

In almost every instance of intestinal indigestion the
mixing of the various kinds of foodstuffs will not be tole¬
rated by the enfeebled and already-defective digestive ap¬
paratus. So long as this plan is pursued the case will not
improve. In all cases of intestinal indigestion, from the mild¬
est to the most intense type, it is absolutely necessary to
limit the diet to a greater or less extent, both as regards
quantity and the kind of foodstuffs taken. In many instances
it may be necessary to limit the diet to a few articles of food,
as milk, barley-gruel, or broths, and even these in very
limited amounts, so much so that, at times, the patient may
even lose flesh, while the digestive function is being slowly,
but surely, re-established. The fancy of the patient must
not be considered, but that form of diet must be chosen which
will be most effectually digested and yield the largest amount
of nutrition.

The mixed diet which most effectually meets the fore¬
going demands, as soon as it Can be tolerated, is one com¬
posed of milk, eggs, meat and toast, or stale bread and
butter. The ideal mixed diet, as personally arranged, makes
very good working standard :

For breakfast.—Two eggs, 8 ounces of milk, 2 ounces of
wheat-bread and butter.

For the midday meal.—From to pound of beef¬

steak, 8 ounces of milk, 3 ounces of wheat-bread and butter.

For the night meal.—From to ]/ 2 pound of beef¬

steak, 8 ounces of milk, 2 ounces of bread and butter.

At bed-time.—Eight ounces of milk.

Beefsteak is taken as the working standard among the

* From the Monthly Cyclopedia of Practical Medicine, Jane, 1900.

456

PROGRESS OF MEDICAL SCIENCE.

meats, as it is the most easily digested of all the foodstuffs.
Under the heading of meat is included lamb, mutton, occa¬
sionally veal (the word “occasionally” refers to the frequency
of use); all kinds of fish, including the shell forms, such as
oysters, clams, lobsters and crabs ; poultry and game of all
kinds.

The meats to be broiled, boiled or baked.

The fish to be boiled or baked.

The oysters and clams to be eaten raw or stewed in their
own liquor.

A little crisp bacon may be taken from time to time,
also ham and corned beef, without cahbage.

Eggs may be boiled, poached or scrambled.

The milk is best taken w_,rm or with a little lime water
added.

Wheat bread is taken as the standard, because it is the
most easily and perfectly digested. It should be at least
twenty-fcur hours old or toasted ; rye, graham, zwieback or
the health-food breads may at times be substituted.

Weak coffee, without milk or sugar, or with a dash of
milk, may be taken freely as a beverage.

Coffee taken clear aids digestion, but with milk and
sugar often disturbs digestion.

To enlarge the above diet the following may be used :

In the line of vegetables: string beans, green peas, Lima
beans, spinach, lettuce, asparagus and cauliflower. They
should be well cooked, and only one vegetable at a meal.

When a vegetable is taken with the meal there must be
a reduction in the quantity of meat or milk as given in the
above table.

In case one particular form of meat cannot be tolerated,
another kind must be substituted. In like manner, if milk
or eggs cannot be tolerated, another kind of food must be
substituted. The same rule holds true in the selection of the
vegetable substances.

The following foodstuffs are excluded :

All fruits, either cooked or raw ; all cereals and break¬
fast foods ; nuts, sweets and pastry of all kinds ; potatoes in
all forms; onions, tomatoes, turnips, parsnips, carrots, celery,
radishes, cabbage, egg and oyster plant, corn, etc.; pork in
all forms, except as before stated. Rich gravies, and all
forms of soups are excluded.

The medicinal treatment of intestinal indigestion and its
sequences is equally as varied and important as the dietic
management. W. H. Porter {Phil. Med. Jour., May 26,
1900.

MEDICINE AND NEUROLOGY. 457

THE TREATMEN T OF ACUTE INTUSSUS¬
CEPTION.

When in a previously healthy infant we observe severe
abdominal pains occuring in paroxysms, each paroxysm
being attended by vomitting and more or less collapse, and
when there are present tenesmus and mucous or bloody
stools, we most probably have to deal with an acute intes¬
tinal intussusception. When, in addition to these symptoms,
we can make out an elongated tumor on abdominal pdpa-
tion, or can feel a protrusion on rectal examination, the dia¬
gnosis of this condition can b* made with almost absolute
certainty.

What should the general practitioner do to relieve this
condition ? If the symptoms are urgent, it will probably be
impossible to reduce the intussusception by injections when
the condition has lasted for many hours. If we try this
method of treatment, the child had better be anesthetised
and inverted, and hot salt solution injected into the colon
under a pressure of only three or four feet. The amount the
colon will hold differs very much in different cases. There
is certainly some danger of rupturing the gut, even with
slight hydrostatic pressure, if it be gangrenous. Whether
it is gangrenous or not at the time of the injection, we can
only judge by the acuteness and duration of the symptoms.
The actual number of cases in which rupture of the intestine
from hydrostatic pressure has occurred is very small ; never¬
theless, some excellent authorities state that this method
should never be employed in acute cases when the disease
has lasted more than twelve hours. A great objection to it
is that it is apt to lead the timid into placing too much con¬
fidence in it, and so cause most valuable time to be lost.
When the situation of the obstruction is in the small intes¬
tine, reduction by hydrostatic pressure need not be at¬
tempted, as water will not pass the ileo-cecal valve, except in
the rare instances when it is congenitally deformed. Air is
more apt to be successful in these cases, and has been particu¬
larly advised here because it is more likely to pass the valve.
Dr. Rotch has pointed out that, as the invaginated portion of
the intestine is not on a line with the axis of the canal, but
at an angle to it, hydrostatic pressure when persisted in may
tend to push the different layers of the intestine together, and
so actually prevent reduction.

Intussusception must be regarded from the beginning as
a surgical and not a medical affection. By some surgeons
injection is only tried in very recent cases, and then only
after every preparation has been made for laparotomy should

45$

rROGRESS OF MEDICAL SCIENCE.

the former method fail. Others do not attempt reduction
by injection at all, but proceed at once to operate. Injection
is only of value when it is easily successful, so that, like taxis
in strangulated hernia, it should not be persisted in. Opera¬
tion is far more likely to result favorably if done early, be¬
fore adhesions have formed or gangrene occurred. Even
the occasional operator is more likely to be successful early
in the affection than if, beguiled by ultra-conservatism, he
continue to try the injection treatment until inflammatory
changes have occurred. Firm adhesions greatly increase
the difficulties of the operation, while gangrene makes the
prognosis almost hopeless.

Again, it is often impossible to tell with certainty
whether the intussusception has been reduced when the injec¬
tion method has been employed. It is highly probable that
the so-called recurrence after reduction is only a recurrence
of the symptoms, due to partial or complete failure to effect
reduction. It would seem then that early operation is in¬
dicated both because the operation is much simpler and more
likely to be successful at this time, as well as because it is the
only method by which we can be absolutely certain that re¬
duction has been accomplished. That young children stand
abdominal operations badly is denied by excellent authori¬
ties, and, even if true, should not deter operation in what is
nearly always a fatal affection when reduction is not accom¬
plished easily by injection or early surgical interference.—
Pediatrics.

A STUDY OF LESIONS OF THE LIVER IN
YOUNG CHILDREN.

Rowland Godfrey Freeman, M.D. (Archives of Pedia¬
trics , 1900, xvii., p. 81), in a paper on this subject concludes
as follows ;

1. Descent of the liver down the right side of the abdo¬
men, so that tlje right lobe reaches below the crest of the
ilium, occurs not very rarely in infants, and particularly in
those whose liver is enlarged.

2. Fatty liver occurs very frequently in the infants and
children which die at the Foundling Hospital, or in about 41
per cent, of all cases.

3. The condition of nutrition of the child, as expressed
by the absence of fat in general and wasting of tissue, appar¬
ently has no connection with the fatty condition of the liver,
the condition of nutrition’in the cases having fatty livers
averaging about the same as in the whole number of cases.

4. Fatty liver occurs rarely in the following chronic

MEDICINE AND NEUROLOGY.

459

wasting diseases: Marasmus, malnutrition, rachitis and
syphilis, unless such condition be complicated by an acute
disease.

5. With tuberculosis fatty livers occur not more often
than with other conditions.

6. Fatty livers occur most often with the acute infec¬
tious diseases and gastro intestinal disorders.

7. The two cases of cirrhosis of the liver examined by
the writer ran a comparatively acute course. The livers on
section showed a marked hyperplasia of the so-called new-
formed bile-ducts.

8. Focal necrosis of the liver may be a lesion of measles.

SURGERY.

IN CHARGE OF

ROLLO CAMPBELL, M.D.,

Lect irer on Surgery, University of Bishop’* College j Assistant-Surgeon, Western Hospital ;

AND

GEORGE FISK, M.D.

Instructor in Surgery, Uuiversity of Bishop's College ; Assistant-Surgeon, Western Hospital

GENITOURINARY TUBERCULOSIS.

The introduction to this lecture contains some general
references to genito urinary tuberculosis, primary and
secondary. The affection may be of the “ascending” or
“descending” type, and as regards relative frequency of
tuberculosis in each system, Guyon found in 264 cases that
the genital system was affected alone in 41, the urinary
system alone in 88, and both together in 135. Tubercu¬
losis of the urethra appears to be rare, but may occur in
the upper part secondary to disease of the prostate, and to
tuberculous cystitis.

The epididymis in the male seems to be the part of the
genital organs most frequently affected with tuberculosis, and
in adults it seems probable that in the majority ol cases the
disease commences in the epididymis.

The lesions in almost all cases are, or ultimately
become, bilateral. Bacilli may reach the affected organ in
various ways, as from the urethra (though Cheyne regards
this as doubtful), from the blood, from thelymphatics or by
descent along the vas, or (rom the peritoneum, especially in in-

460 progress of medical science.

fants, where often the testicle is invaded before the epididy¬
mis. In the epididymis and testis acute tuberculosis may be
part of a general acute tuberculosis, or may be a limited
disease, and then usually involves the testicle first, and leads
to the rapid destruction of this organ, with early extension
to the epididymis. In the other local form, which is more
common, the process is chronic, affects the epididymis, either
invading the connective tissue outside the vas, or commen¬
cing in the interior of the duct. Beginning in globus major
or minor, it spreads quickly to testis and to cord, involving
later the vesiculae seminales and prostate. The treatment of
tuberculous epididymitis may be nonoperative or operative.
It is certainly the case that a considerAble number of cases
of tuberculous epididymitis become quiescent, either without
suppuration, or after suppuration has occurred, and the
thickening may after a time completely disappear. This is,
however, difficult to fortell in any given case, and it is to
be noted that there is a tendency in all for the disease to
spread to other parts of the genito-urinary system, or to the
other side, even where the primary disease is improving.

Non operative treatment is indicated in very chronic
cases, or when other parts of the genito-urinary system are
already affected. It consists in good hygiene, support to
the testicle, and avoidance of injury. Cod liver oil, guaiacol
and iodoform may be given. Operative treatment consists
of scraping and epididymectomy, and of castration. In
early cases epididymectomy may be classed as a radical
operation. This method was first advocated by Barden-
heuer, and Cheyne gives a description of the technique, and
advises that the vas deferens should always be removed as
high as possible. The relative merits of castration and
epididymectomy are discussed at some length in this paper,
and Cheyne thinks that the latter operation is well worthy
of more consideration than it has yet received in this
country, though it is by no means applicable to every case.

Tuberculosis of the prostate, is described next, and its
treatment by antiseptics and injections de ailed ; and it is
pointed out that surgical intervention is practically limited
to those cases where suppuration is occurring.

Tuberculosis of the bladder, usually secondary, may
occur primarily, and is more frequent in males than in
females, and attacks by preference young adults, and then
most commonly in the region of the trigone. The bladder
capacity is diminished and its walls thickened. Treatment
may be medical or surgical, but a cure by either method is
not a matter of certainty though much may be done to
alleviate suffering. Operative measures consist in opening

SURGERY.

461

the bladder and draining it, in attempting to remove the
tuberculous ulcerations, or in applying antiseptic substances
to them. The essential point is to obtain rest for the blad¬
der. About 80 per cent, are much relieved by the opera¬
tion, and about 20 per cent, apparently cured. Tuberculosis
of the kidney may be primary or secondary, and is not
uncommonly unilateral in the early stage. .Surgical treat¬
ment is becoming more and more frequent, and the various
measures that may be adopted are :—

1. Nephrotomy and lumbar drainage to prevent infec¬
tion of the urinary passages.

2. Nephrotomy combined with scraping out as much
as possible of the tuberculous material.

3. Nephrectomy often associated with removal of part
of the ureter.

4. Partial nephrectomy in which only the diseased
portions of the kidney are taken away.

Nephrotomy in such cases must be looked on as a
preliminary operation, with the view of getting rid of the
fever and generally bad condition of the patient, and after a
time the question of nephrectomy as a curative procedure
must be considered. To justify nephrectomy one must be
pretty sure that the other kidney is intact, and also that the
bladder is free from disease. It is by no means easy to
make certain of these points, even with the aid of a cysto-
scope and urethral catheter, or by means of laparotomy and
palpation of the kidneys through the wound.

Of late some good results have attended partial nephrec¬
tomy.— W. W. Cheyne, Brit. Med. Jour; Med. Chronicle.

A NEW METHOD OF STERILIZING THE HANDS
AND THE FIELD OF OPERATION.

R. Kossman, of Berlin, in Centr.fur Chir., November
23, 1899, proposes a method which may be described as a
substitute for the rubber gloves. It is, more correctly speak¬
ing, a very thin, yet accurately fitting glove, 'since it is a
really impervious covering applied to the hands by soaking
them in a substance which quickly dries by evaporation,
leaving a smooth, flexible, yet sufficiently durable, coating,
as thoroughly protective as any rubber glove can be, with¬
out its disadvantages. It remains only for further exper¬
ience of other surgeons to say whether the claims of the
Inventor shall be substantiated.

The material is a fluid holding in solution “ certain
hard resins and fatty oils in a mixture of easy-boiling ether
and alcohol.” The substance has been patented under the

4^2 PROGRESS OF MEDICAL SCIENCE.

name Chirol, which name has also been protected by law.
The fluid is applied to the hands by immersion after they
have been first thoroughly cleansed and disinfected, and then
well dried. In two to three minutes it is quite dry, and the
hands are covered over with a beautifully fitting glove. It
is easily removed by soaking in spirit.

We sum tip the foliowing advantages of the plan :

It has all the advantages of the rubber glove without its
objections; it is veiy thin, very soft and pliable, and therefore
does not so much interfere with the sense of touch, and does
not in any manner constrict or cramp the hand, and yet it
is so resistant and adhesive that it will withstand the manip¬
ulations of the longest operation without flaking off; it takes
no longer to apply than the ordinary glove, since it dries in
about the time it would take to get a well-fitting rubber
glove on, and yet it is absolutely without stickiness; and
finally it seems not to be at all irritating while on, or in the
subsequent taking off with the spirit.

It has a further advantage over the glove in that it may
be just as easily applied to the prepared field of operation,
protecting this, and at the same time making it much easier
to pick up the skin with the fingers.

Hands covered with this coating may without smarting
or damage to the skin be washed in a five-per cent, solution
of formalin, which is not an inconsiderable advantage in
disinfection.

A further recommendation is the employment of the
material in the holding of post-mortem examinations or in
doing any thing which would be apt to infect the surgeon’s
or the accoucheur’s hands. It ought to be found very useful
in obstetrics .—American Practitioner and News.

TREATMENT OF COMPLICATED FRACTURE OF
THE NECK OF THE HUMERUS.

Farquhar Curtis (Annals of Surgery, March, 1900)
reports three ca-es ot fracture of the neck of the hu-
rqqrus with dislocation of the upper fragment treated by
operation. Careful consideration, based on his own and
previously recorded cases of the relative merits of reduction,
has led the author to the following conclusions: (1) In
fracture of the upper end-of the humerus with displacement
x>f the upper fragment from .the glenoid cavity, when
proper attempts at simple reduction under general .anes-
•thesiA have failed, operative measures should be resorted
■po} unless, shock, other injuries, or extensive dapiage to
.the • . soft- part? about the shoulder justify delay ; . ,(2)

SURGERY.

463

anterior displacements require an anterior incision, and
subglenoid or posterior displacements require a posterior inci
sion, probably by Kocher’s method ; (3) the head of the hu¬
merus should, if possible, be restored to its place, and resection
should be resorted to only when reduction is impossible or
likely to cause such extensive damage to the parts, or such
prolongation of the operation, as to increase the risks of
wound infection or of shock ; (4) resection will probably givo
a better result in fracture of the anatomical than in that of
the surgical neck of the humerus, but reduction is to be
preferred in both cases ; (5) asepsis is an indispensable require¬
ment for a good functional result, and operative interference
in this class of injuries should not be undertaken except
under aseptic conditions; (6) motion should be begun in the
joint as soon as the wound has healed—in ten to fourteen
days after the operation.— The Medical Age; American
Practitioner and News..

SOME REMARKS UPON THE TECHNIQUE OF
OPERATIONS DESIGNED TO CURE, RADI¬
CALLY, OBLIQUE INGUINAL HERNIA.

F. D. Bird lays stress on the following points: the skin
incision to be made well above Poupart’s ligafnent and well
away from the pubes, the separation of the fibres of the
external oblique aponeurosis at a suitable spot, the separa¬
tion being carried well toward the muscular portion; the
sparing of the external ring; the dislocation but partial of
the cord from its bed, and the elimination of the sac from
above and therefore the preservation of the nerves, the
whole to be accomplished with little or no bleeding—an
advantage to be attained with great gentleness and the use
of dissecting forceps. Apart from the unworkmanlike appear¬
ance of a sloppy operation area, bleeding much inconven¬
iences the surgeon and damages the tissues. It obscures
the view, necessitates constant sponging, and irritates the
delicate areolar planes, which become more or less loaded,
with blood not capable of being removed. The serous
exudation is much greater and the tissues are much weaker
and sodden. In addition to these immediate disadvantages
there is the grave though unlikely occurrence of thrombosis
in the veins of the cord with its possibilities of pneumonia
and other distant disasters. The absence of the deep sutures
is a gain in two directions: the unimpeded muscle acts as
natjire meant it to, and ^here is qo foreign body,at all in the
depths of the wound, no silk with tension .an it, and qoover-.,
chemicalized catgut.— LanczT<Nl,Y\\Med. Jlec.\,

464

PROGRESS OF MEDICAL SCIENCE.

ANKLE SPRAINS.

Edward H. Ochsner recommends a method of treat¬
ment which consists in careful and systematic strapping
with rubber adhesive straps. These are cut from half to
three quarters of an inch in width, and the proper length,
the width depending upon the size of the limb. The foot is
held at slightly less than a right angle and a trifle everted.
One end of a long strap is applied to the inner surface of the
foot near its posterior end, brought under the heel, and up
on the outer posterior surface of the leg to within a few
inches of the knee. At the lower end this falls into the
depression just posterior to the external malleolus. A
shorter strap is now applied by placing one end to the inner
surface of the heel near the sole of the foot, then bringing it
around over the tendo Achillis to the outer surface of the
foot, making it cover the first strap at a right angle, and
passing along parallel to the under border of the sole of the
foot, then over the dorsum of the little toe. Another long
one is now applied, anterior to the first, overlapping it about
one-third of its width ; then a short one, and so on alternately
until the outer anterior aspect of the ankle is reached. A
hard-rolled bandage is placed over all, and the patient
directed to lie still with the foot elevated until the warmth
of the body has caused the plaster to adhere firmly. As a
rule, the patient can walk with reasonable comfort after a
few hours.— Medicine.

METHYLENE BLUE IN GONORRHEA.

Methylene blue administered internally will cure gonor¬
rhea in from four to seven days. It is specially fatal to the
diplococccus which is the specific cause of the disease. The
pyrogenic bacteria that make gonorrhea a mixed infection
succumb very rapidly to this germicide. It should be given
in one-grain gelatine capsules three times a day, and after
the fourth day reduce to twice a day. If it causes an irrita¬
tion of the neck of the bladder, combine with oil of nutmeg.

The following may be used :

R Methylene blue. gr. I.

Oil of nutmeg... gtt. I.

Oil of sandalwood. gtt. II.

M. ft. Caps. No. 1.

S. One capsule three times a day.

It should not be continued for more than ten days. Dur¬
ing this time instruct the patient to drink plenty of water.
—J. A. O’Neil in Medical Record.

Therapeutic Notes.

Cystitis.

R Liquor potassse.

Mucil. acaciae .

Tinct. hyoscyami..

M. S. Teaspconful every four

hours.

-

-Burnside Foster.

Pruritus Ani.

R Sodii hyposulphit.

Acid, carbol...,...

.- 5 “

Glycerini.

Aquae.

. 45 o “

Apply frequently by means of wet compresses.

— Practitioner.

Mouth Wash and Gargle for Sweetening

the Breath.

R Acid, salicylici,

Sodii bicarb.,

Sacchari.

Spt. vini rect.

. 3 i.

Spt. menth. pip.

M. S. Teaspoonful in a small cupful of hot water.

—Palmer.

Hemorrhoids.

R Chrysarobin. gr. xij.

Iodoformi. gr. v.

Ext. bellad..•. gr. viij.

Petrolati. § i.

M. S. Apply.

— Jour.de Med.

Painful Menses.

R Codein. gr. i.

Chloral

Ammon, brom.a& gr. xv.

Aq.camphoric. Si.

M. S. From a quarter to half the quantity before retir¬
ing. Repeat as indicated.

4 66

THEREAPEUTIC NOTES.

Creosote Wine.

R Creosote. s p s *

Tinct. gentian. S ••

Spir. vini rect. 3 v*'j*

Vinixerici..q.s. ad Oij.

In tuberculosis a dessertspoonful several times a day
unless much fever is present.

—Nouveaux R emidcs.

Dysentery in Childhood.

R Cocain muriat.05 cgm.

Ergotin...*. 5 ° “

Ext. opii.10

Aristol.25

01. teobrom. q s.

M. ft. supposit. No. x. S. One every two to three
hours.

— Medical Times and Hospital Gazette, June 9.
Pruritus-

Alkaline baths ; starch and linseed meal baths ; the
continuous bath; Turkish and vapor baths.

R Ac. carbol, liq.•.. <5 i-

Liq. potassie. 3‘ss-

Aquae...ad 5 v >'j-

M. ft. lotio. S. Apply as required.

—Evans.

Gastric Catarrh.

R Ac. hydrochl. (C. P.). 2.5 gm.

Ac. azotic..... 0.8 dgm.

Spt. vini rect. 18. gm.

Aq. font...... 150. “

Syr. llmonis. 100.

M. S. Teaspoonful in half a glass of water after meals.

Jottings.

Erysipelas.

Apply mercurial ointment either in its full strength or
diluted with other, ointments according to the nature of the
case.—D ematteis. , , ;

THERAPEUTIC NOTES.

467

Measles with unconsciousness, delirium, carpologia,
involuntary evacuations, etc., was markedly improved by
an injection of 10 c. c. of antistreptococcus serum.—E dgar
Gillrie.

Myocarditis.

Caffeine in small dose varying from day to day may be
kept up for years with benefit in a great variety of chronic
heart affections. It is especially indicated in weakness due
to disturbance of pulmonary circulation.— LEMOINE.

Eclampsia.

In coma introduce a stomach tube and inject a solution
of chloral (gr. xlv. to lx.) directly into the stomach. If given
by the rectum it is often expelled. When the mouth can¬
not be opened, pass through the nasal fossae.— FOCIIIER.

Morphine is depended upon at the Willard Parker
Hospital to maintain the heart’s strength in diphtheria.
Small doses hypodermatically (gr. 1 1 ..are given. Strych¬
nine, alcohol and nitroglycerine are also employed.

Reflex Cough in Children.

Treat the cause. Hacking night-coughs are mostly due
to nasopharyngeal obstruction. Paroxysmal hacking cough
in emaciated children with normal temperature is held by
Warner, of London, to be due to unbalanced central nerve
action.— Pediatrics.

Enteric Fever with Excessive Diarrikka.

Give compound tincture of bezoin beginning with n I v»
in water every two hours, and double the dose if the diar¬
rhoea does not markedly decrease within twelve hours
Besides the antiseptic there is supposed to be an antipyretic
action.— J. C. Potter.

To Bring on Labor.

The use of the Krause sound or the Farnier balloon
are meins largely employed. They prepare for rather than
.provoke; labor. The Farnier divulsor at times gives good
results when the part presses upon the neck. Manual dilat¬
ation.is the method of choice, for it permits of complete and
‘rapid dilatation, and should be adopted in all cases in which
it'becomes necessary ; to terminate labor quickly.— LfiON
iWs>L* - • ' ,

THE

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price , $c.oo per annum in advance . Single
Copies , 10

Hake all Cheques or P.0. Money Orders for subscription, or advertising, payable to
JOHN LOVELL & SON, 28 St. Nicholas Street, Montreal, to whom all business commit
ideations should be addressed.

A11 communications for the Journal, books for review, and exchanges, should bi
addressed to the Editor, Box 2174, Post Office Montreal.

Editorial.

FRIGHTENING CHILDREN.

People who have the care of little children vary in opin¬
ion as to the best means of punishing them, for even the best
of little people need correction at times. The mother is with¬
out doubt the person to whom this duty belongs, and it is her
paramount duty to see that it is never deputed to any one
who will frighten the child. Nurses who are properly enough
forbidden to administer corporeal punishment are very apt
to fall back on some such methods if not carefully warned
against them and due supervision exercised to see that these
admonitions are not neglected. It is true, perhaps, that the
imaginary person who was supposed to be always coming
after naughty children—the bogeyman, in fact, of our own
childish days—is a being of the past. But he has many re¬
lations closely resembling him, and on so important a matter
mothers ought to be watchful,

If a child is constitutionally nervous it is no use to think
that it can be made different by force. Argument, too, in
many cases,’only intensifies the terrors which children often
feel if left alone in the dark, and gives definite expression to
fears which are purely imaginary. Many people argue that a
child who is afraid to be left alone or to go into a dark room

EDITORIAL.

469

ought to be made to do either of these things in order to find
out that no harm will come to him. Now, children are sel¬
dom really afraid unless they have been made so, and it is a
curious fact that the most timid child shrinks from disclosing
his fears to any one. In such a case some one has certainly
warned him that worse things will happen if he dares to dis¬
close the reason of his alarm. Very often it is the simplest
thing which has been made to appear so terrible under cer¬
tain conditions.

TAKING COLD.

Colds are probably the most common ailment in the
world. They are always disagreeable and oftentimes dan¬
gerous. A person in good heath, with fair play, easily resists
cold, but when the health flags a little and liberties are taken
with the stomach or with the nervous system, a chill is easily
taken, and, according to the weak spot of the individual,
assumes the form of a cold or pneumonia, or it may be jaun-
dice. Of all causes of “cold ” probably fatigue is one of the
most efficient. A jaded man, coming home at night from a
long day’s work, a growing youth losing two hours’ sleep
over evening parties two or three times a week, or a young
lady heavily “doing the season,” young children overfed and
with short allowance of sleep, are common instances of the
victims of “ cold.” Luxury is favorable to chill taking ; very
hot rooms, feather beds, soft chairs create a sensitiveness that
leads to catarrh. It is not, after all, the “ cold ” that is so
much to be feared as the antecedent conditions that give the
attack a chance of doing harm. Some of the worst “ colds ”
happen to those who do not leave the house or even their
beds, and those who are most invulnerable are often those
who are most exposed to changes of temperature, and who
by good sleep, cold bathing and regular habits preserve the
tone of their nervous system and circulation. Probably many
chills are contracted at night or at the fag end of the day,
when tired people get the equilibrium of their circulation
disturbed by either overheated sitting or underheated bed.
rooms and beds. This is specially the case with elderly

470

EDITORIAL.

people. In such cases the mischief is not always done in¬
stantaneously or in a single night. It often takes place
insidiously, extending over days or even weeks.

LAUGHTER AS MEDICINE.

For every good hearty laugh we indulge in there is
a day taken off our age. Why should we take life so seri¬
ously ? Cannot we labor as well, or better, accomplish as
much and enjoy life as we go along, if we keep on the watch
for every possible opportunity for a good, blood-stirring,
pulse-tingling laugh ? Let us try it for a year. Let us put
away all those wrinkle-producing, skin-withering, blood¬
drying, heart-narrowing feelings of envy, spite, jealousy and
secret hatred ; those petty, penny-grasping, soul-contorting,
narrow minded ambitions and desires, and make up our
mind to live to enjoy living as long as we do live, and to live
as long as we can. Joy is the sunshine of the heart, and cheer¬
fulness and honest mirth bring forth the blossoms and unfold
the leaves, and their fragrance sweetens all our lives and the
livesof others. Let us not worry. Worry drains the system
of its vitality and shortens our lives. Fun is better for a sickly
child than medicine, has been said. Are we not children
grown a little older ? and is not rnkth the best of medicines ?

Let us laugh, then, as we go along, and enjoy every mo¬
ment of time as it passes, keeping with us eternal youth.

CANADA A HEALTHY COUNTRY.

The result of the Dominion Census has proved long ago
that Canada was one of the healthiest countries in the world
to live in. Some, however, were inclined to doubt the data
upon which this fact was based. It has, however, quite re¬
cently been established by one of our largest Canadian Life
Companies—the Canada Life—that the Census was correct.
The data which forms the foundation for this statement con¬
sists of tables, recently published, in which 35,287 lives are
considered. Of this number 19,419 were living at the close
of the observations.

Book Reviews.

Saunders’ Question Compends—Essentials of Diag¬
nosis. By Solomon Solis-Cohen, M.D., Professor of
.Clinical Medicine and Therapeutics in the Philadelphia
Polyclinic, etc., etc., and Augustus A. Eshner, M.D., Pro¬
fessor of Clinical Medicine in the Philadelphia Polyclinic, etc.
Illustrated. Second edition. Revised and enlarged. Phila¬
delphia, W. B. Sauniers, 1900. Canadian agents, J. A.
Carveth & Co., Toronto. Price, $1.00.

This volume, which represents the second ediiion of “ Essen¬
tials of Diagnosis," is a neat work of four hundred pages. It is
well hound and well printed. It is reliable, concise and up to date.

It opens with a very complete chapter on the general prin¬
ciples and methods of diagnosis. Then follows a special descrip¬
tion of each disease by which it may be distinguished. This is
followed by the differential diagnosis. The different diseases re
sembling the one in question, and the [joints of difference are
clearly pointed out.

It is a little book that will be found exceedingly useful to the
practitioner as well as the student. W. G. S.

Annual and Analytical Cyclopaedia of Practical
Medicine. By Charles E. de M. Sajous, M.D., and one
hundred associate editors, assisted by corresponding editors,
collaborators and correspondents. Illustrated with chromo
lithographs, engravings and maps. Volume V. The F. A.
Davis Company, publishers, Philadelphia, New York and
Chicago, T90C.

This volume includes a consideration of subjects between
“ Methyl Blue and Rabies ” in alphabetical order. The editor
states that this fifth volume ‘‘has proved the most arduous one to
prepare of the entire series, involving as it does almost every
specialty—otology, laryngology, ophthalmology, neurology, paedia¬
trics, obstetrics, therapeutics, etc., besides the sections usually
classed under general medicine and surgery.’'

It contains a number of excellent articles; in these and
throughout, in all, the chief features are pointed, terse descriptions,
giving all the newer aspects o( the various questions, and only
that which has a practical bearing. Morphinom inia, by Norman
Kerr, is ably treated. The symptoms and treatment are given fully,
as well as the bearing of such cases towards life insurance. He is
of opinion, contrary to Mattison’s view, that heredity has something
to do with these cases, and that every variety of inebriant, inherits
either the inebriate diathesis or some germane neurosis; myxoedema
is exhaustively treated by Chas. E. de M. Sajous, the article
being illustrated by a beautifully colored plate showing the
physiological importance of the thyroid gland as illustrated by its
vascular rela’ion.

“Nursing and Artificial Feeding,” by L. Emmett Holt,
and Lintnaus Edfard La Ferra, is an exceedingly valuable
article, giving the latest points in regard to modification of milk,
sterilization and pasteurization rules, for artificial feeding, etc.
Other important articles are: The Disorders of Pregnancy, by Dr.

472

PUBLISHERS’ department.

Currier, ard Abnormal Parturition, by Drs. Grandin and Marx
Pleurisy, by Dr. Alex. McPhedran, Toronto; Catarrhal Pneu¬
monia, by Dr. Solomon Solis-Cohen; Lobar Pneumonia, by Dr.
Thos. G. Ashton; Orthopaedic Surgery, by Gwilym G. Davis,
etc. This volume more than sustains the claims of this Annual
and Cyclopaedia, to be an exhaustive yet condensed presentation
of the most modern views and advances in all the branches of
medicine. J. B. Mc.C.

Simon’s Clinical Diagnosis. A Manual of Clinical Diag¬
nosis by Microscopical and Chemical Methods. For Stu¬
dents, Hospital Physicians and Practitioners. By Charles E.
Simon, M.D., late Assistant Resident Physician Johns Hop¬
kins Hospital, Baltimore. In one very handsome octavo
volume of 563 pages, with 136 engravings and 18 fuli-page
colored plates. Cloth, $3.50 net. Lea Bros. & Co., Phila¬
delphia and New York, 1900.

Clinical diagnosis interests every practising physician, and the
more proficient he is in the various methods employed towards this
end the greater will be his success. This new edition of Dr.Simon's
popular book deals with the latest and most approved methods of
employing the microscope and chemical tests in recognizing dis¬
ease, and, as might be expected, with the thorough revisal and
new matter added, is much more complete than either of the pre¬
vious editions issued during the last four years. The description
of meth:ds is clear and readily comprehended, so that, with the
reagents and the instruments indicated and this work a physician
can, with a little practice, apply these latest methods, for precise
diagnosis.

The blood is first studied in regard to its general character¬
istics, its chemical examination, then its microscopic examina¬
tion, its bacteriology and parasitology ; this chapter has received
more additions than any other, and represents the most recent
aspect of the methods now approved. Chapters are devoted to
the secretions of the mouth ; the gastric juice and gastric contents ;
the feces; the nasal secretion; sputum; urine; transudates and
exudates; cystic contents; ccrebro-spinal fluid ; semen ; vaginal
discharge, and the secretion of the mammary glands. The book is
embellished by numerous colored plates, and cuts, illustrating instru¬
ments, organs, tissues, secretions, parasites, micro-organisms, blood,
crystals, etc. It is perfection itself as a guide to student, prac¬
titioner or teacher in this important department of daily work.

J. B. McC.

PUBLISHERS DEPARTMENT,

The Quarterly Review for October—published in London October 24—
will contain an important article on <c The Coming Presidential Election,”
analysing the issues of the campaign and forecasting its result. The article
will be reprinted entire in The Living Age (Boston) for November 3—ready
November 1. According to the custom of The Quarterly the article is un¬
signed, but it is written by Mr. Edward Stanwood, author of il A History of the
Presidency,”

CANADA

MEDICAL RECORD

_ NOVEMBER, 1900

Original Communications.

PROGRESS OF GYNECOLOGY.

By A. LAPTHORN SMITH, BA., M.D., M.R.C.3., London.

Professor of Clinical Gynecology in Bishop’s University j Surgeon-in-Chief of the
Samaritan Hospital for Women ; Gynecologist to the Montreal Dispensary ;

Surgeon to the Western Hospital, Montreal.

One of the most practical articles written during the
last three months is the one read by Dr. William Gardner, of
Montreal, at the Ottawa meeting of the Canadian Medical
Association, every word of which will be endorsed by gyne¬
cologists generally throughout the world. Much of it was
devoted to the mistakes he had met with among cases sent to
him by general practitioners, although he did not spare him¬
self, frankly admitting and describing some of the mistakes
he had made himself. In order to reduce the number of
these errors in diagnosis, he urged the examination of the
patients on a hard deal table instead of on a soft bed or
couch. Also many of the mistakes were due to the exami¬
nation being made with the rectum and bladder full. The
rectum, of course, should be emptied by enema at home, but
the bladder, he thought, might with advantage be emptied by
catheter in the office by the physician, as thereby a pure
specimen of urine could be obtained for analysis. It is often
difficult to make a thorough bimanual examination without an
anaesthetic on account of the tension of the abdominal mus¬
cles. Dr. Gardner suggests making a series of circular move¬
ments over the lower abdomen, gradually narrowing the
circle which will cause the muscles to relax by taking them
off their guard. Dr. Gardner urged greater caution in the
use of the sound, believing that many women had lost their

474

SMITH : PROGRESS OF GYNECOLOGY.

lives by it. He thinks it a very dangerous instrument,the use
of which should be extremely limited. I know of one general
practitioner who does not believe in specialists in general, nor
in gynecologists in particular, who, by attempting to put up a
fixed and retroverted uterus with the sound, not only per¬
forated the uterus but also tore open a sealed up pus
tube, with the result that the patient immediately developed
a general peritonitis, and died three days later. Although I
use the sound less and less, as I am more and more able to
diagnose the size and position of the uterus by bimanual
palpation, I still use it occasionally in clearing up the diagnosis
when the whole pelvis is filled with a solid mass. When I
am in doubt whether the mass at the back of the uterus is a
pus tube and ovary or a retroflexed and retroverted uterus, I
very gently try which way the sound enters. But, if there is
the slightest difficulty in introducing it, my invariable rule is
to stop at once and to make the best diagnosis I can without
its aid. The experienced gynecologist is the only one who
can use the sound with safety, and he is the one who requires
to use it least. Dr. Gardner finds that mistakes in diagnos¬
ing displacements of the uterus are the most common ; I can
also endorse this statement and can remember a great many
cases which have come or been sent to me because they
could not endure a pessary, which was inserted for a supposed
retroversion of the uterus, but which on examination I found
not to be a retroversion at all, but, on the contrary, a pair of
diseased tubes and ovaries cemented into Douglas’ cul de sac
and against which the pessary was pressing. Dr. Gardner
also calls attention to the importance of diagnosing displace¬
ments of the kidney. This is emphasized by some experi¬
ences of my own, for, after removing both tubes and ovaries
and the vermiform appendix and performing ventrofixation,
mu:h to my disappointment the patient has still complained
of reflex symptoms which were at once removed when I
had discovered that the right kidney was displaced, and
fastened it up. He thinks that mistakes are often made in
the diagnosing of pregnancy, and he mentions a case where a
woman had been tapped several times for a supposed ovarian
cyst when all the time she was pregnant. While agreeing

smith: progress of gynecology.

475

_ with him, I would add that, if we rely upon the woman’s
statements, yet we will often be led into error, but if we
rely upon our own bimanual examination we will rarely be
so. Over and over again have women come to me for
some uterine trouble, some of them even having urged me to
operate on them for a tumor, who on examination I at once
declared to be pregnant. This they indignantly denied being
possible, basing their assurance on the fact that they were
widows or that their husbands had promised not to impreg¬
nate them or because they were wearing a little piece of
sponge which of course was lost in the vaginal vault; or
they were using a syringe after intercourse ; all of which
reasons, of course, weigh as nothing as compared with the
result of a bimanual examination.

Dr. Gardner’s paper closed with a reference to some
mistakes which had been made in diagnosing tubal preg¬
nancy. These mistakes would be very much reduced in
number if every one were to adopt the rule I have laid down
for myself, namely, to make a careful vaginal examination
in every case of irregular hemorrhages, or of supposed mem¬
branous dysmenorrhcea, and if a mass is felt on either side
or behind the uterus which should not be there, and if this
mass remains after the bowels have been well emptied, then
to take it for granted that it is an ectopic gestation unless
we have proof to the contrary. Since beginning this article
I have operated on my fourteenth case of tubal pregnancy, all
of whom have recovered so far. Some ten of these were
removed before rupture. But the women came with a pain
in their side and more or less temperature, and on examin¬
ation a mass was felt which should not be there. This I
considered quite enough to justify me in operating. With one
exception al^ these fifteen cases were diagnosed before oper¬
ation, the exception being one case diagnosed as a fibroid
tumor, owing to the pregnant tube being intimately cemented
to the uterus, and the two as large as a foetal head, being
wedged into the pelvis under great tension, which gave it a
solid feeling. The prolonged and irregular bleeding was
thought to be due to the fibroid, when it was really from the
tube. It is true that, by following my rule, I opened the abdo-

476 SMITH: PROGRESS OF GYNECOLOGY.

men and removed dangerous pus tubes in about ten, and two
twisted ovarian cysts, and thus proved that they were not
tubal pregnancies, as I had half suspected.

Insanity in Women. —There have been several recent
papers of great interest on this topic, one of the best being
the one by Dr. McNaughton Jones, entitled : Affections of the
female genitalia, as causal factors in the etiology of neuroses
and insanity and their special bearing upon the operative
treatment of the insane. Dr. McNaughton Jones before
writing his article took great pains to obtain the opinion of
many superintendents of insane asylums, as well as of leading
gynecologists, and the following are the general conclusions
to which he has come: 1st. That a great many of the
women who fill the asylums for the insane are there directly
because of some disorder of the genital organs. This is
proved by the considerable number of complete cures follow¬
ing operations for the removal of the diseased conditions.
Dr. Hobbs, for instance, of the London, Ont., asylum reports
that during five years he had eight hundred insane women
under observation, and, of these, two hundred and twenty
underwent a gynecological examination. One hundred and
eighty-eight or eighty-five per cent, of those examined had
distinct and in many cases serious lesions of the pelvic
organs, there being 371 lesions in the 188 patients. It is
interesting to note the nature of the*e lesions; sub-involu¬
tion or endometritis in 132, diseased or lacerated cervices in
sixty-two, retroversion or prolapses in sixty-six, myomata
in sixteen, malignancy in two, disease of the adnexa in
thirty-three, various lesions of the vagina in thirty-seven.
Eighteen women suffered from dysmenorrhoea or menorrha¬
gia. These were cases especially selected as likely sufferers
from pelvic disease, and were about twenty-five per cent, of
the entire patients in residence, during the time in which
these investigations were conducted. There were 311 oper¬
ations performed on the 173 women, with the result that 42
per cent, were completely cured mentally ; 24 per cent, were
improved mentally; in 32 per cent, there was no change
mentally, and 2 per cent. died. Since gynecological surgery
has been introduced into that asylum, the percentage of

SMITH : PROGRESS OF GYNECOLOGY.

477

recoveries has risen from 33 per cent, to 51 per cent. I
have noticed in about twenty of my own cases that a mild
form of insanity was cured by a gynecological operation.
The most striking results followed ventrofixation in women
who were suffering from retroverted uterus with diseased
tubes. Several of these had a suicidal mania, which disap¬
peared immediately after the operation, and has not since
returned. 2nd. It would appear that gynecological oper¬
ations are very rarely followed by insanity in women who
were previously sane. The cases of acute delirium lasting
only for a day or two do not count, for they are mostly due
to sepsis or iodoform poisoning. As far as I am aware, very
little gynecology has been done on the insane women of
this province, but a great field for doing good lies open to
some one- In my opinion every insane woman, married or
single, should be submitted to an examination under anaes¬
thesia, for even single women very frequently suffer from
severe retrbversion and prolapse.

Selected Articles.

PRESIDENTIAL ADDRESS ON THE STUDY OF
CLINICAL MEDICINE.

Delieered at the First Meeting of the Clinical Society of London for the

Session 1900-01.

By SIR R. DOUGLAS POWBLL, BART-, M.D., F.R.C.P.,

Consulting Physici.n Middlesex Hospital; President of the Society.

Empirical Use of Remedies.

Sir Thomas Watson, in his inaugural address, 1868, laid it
down as the great object of the Society to attain “ more exact¬
ness of knowledge and therefore more direct and intelligent
purpose and more successful aim, in what is really the end
and object of all our labours—the application of remedies for
the cure and relief of disease.”

Whilst rational therapeutics must follow in the wake of
advancement in pathology and etiology, it is very remarkable
how many of our remedies have preceded in their employment
any adequate knowledge of the maladies for which they were

478 POWELL: PRESIDENTIAL ADDRESS ON THE

used. Thus for nearly four centuries mercury has been used
for syphilis, and I doubt if anyone could even now tell the
precise method of its action. Dr. Withering 115 years ago
was shown a family receipt for dropsy concocted by an old
woman in Shropshire, in which he recognised foxglove as
the essential ingredient. Yet, familiar as we have so long
been with digitalis, it is only within very recent years that we
have had, piece by piece, explained to us, by physiological ex¬
periment. the phenomena of slowing and increased regularity
of pulse with concentration of force and an increased flow of
urine, which bedside observation had taught us to be the be¬
neficent effects of the drug. Cinchona bark has for three
and a-half centuries been used for intermittent fever, and
Fowler’s ague drops were employed in the same disease more
than a hundred years ago, yet it is only with the discovery of
the ague plasmodium by Laveran (1880). twenty years ago,
that the use of quinine and arsenic could be regarded as
rationally justified. Again, no one who has any recollection
of rheumatic fever in the days preceding the introduction of
the salicin treatment by Dr. Maclagan in 1874 can fail to
appreciate the great value of that therapeutical discovery,
yet our knowledge of the exact method of its action is at
present but inferential.

We may then be thankful for much in empiricism which
is but unexplained observation, the well-attested results of
which we should be as foolish to reject because unexplained
as to refuse to profit by the sunshine until we knew the com¬
position of its rays. The great object of this Society is to gain
increased knowledge of practical medicine by "the collection
of cases, especially such as bear upon undetermined questions
in pathology and therapeutics,” and by pursuing it concur¬
rently with the advance of contributory scientific research and
discovery we have vastly improved our handling of drugs often
empirically found, in decision and definiteness, when to em¬
ploy, how far to push, and when to withhold.

The Etiology of acute Specific Diseases.

Great strides forward have been made since twenty five
years ago; Sir W. Jenner spoke here of “the contagious
quality of acute specific diseases ” as “a something given
off from some part of the sick which can, when properly
applied, excite the same disease in another person, and which
can excite no other disease." What that something is has
been rendered plain to us mostly within the last fifteen years
in nearly every one of the acute specific diseases, and in some
others which, although specific, are not acute. Leprosy,

STUDY OF CLINICAL MEDICINE.

479

pyaemia, dysentery, enteric fever, ague, tuberculosis, pneumo¬
nia, diphtheria, erysipelas, cholera, tetanus, syphilis, plague
may be enumerated, the organism specific to each of them
having in the sense employed by Jenner been discovered.
This exactness of knowledge of the materies morbi of
these maladies must ultimately give greater precision and
effectiveness in treatment, and especially in prophylactic
treatment. The report of a Committee of this Society on
the periods of incubation and contagion of specific fevers is
of standard value and authority, and the further inquiry as to
the duration of infectiousness in convalescence, which must
be based upon bacteriological observations, is now possible,
and might properly be undertaken by the Society. Already
some fruits have been gathered in therapeutics. The tri¬
umphs of surgery that have ensued upon increasingly exact
recognition of the organisms responsible for suppuration so
fill the mind’s eye that it can scarcely penetrate to the Dark
Ages that ended less than a generation ago. The great terror
of the early days of diphtheria has been almost removed
by antitoxin treatment; the prophylactic treatment of tu¬
berculosis has been greatly stimulated. A measure of suc¬
cess, encouraging for the future, has at least been attained in
tetanus, scepticaemic conditions, plague, cholera, anthrax,
and we hope, this session, to receive some valuable contri¬
butions presenting for discussion and comparison the exper¬
ience of those who have in the African war and in India
watched the results of the preventive inoculations against
enteric fever devised by Professor Wright. Important, how¬
ever, as are these increased powers of prophylaxis and treat¬
ment, the direct fruits of recent combined laboratory and
clinical labours, encouraging, too, as they are for further
work, we must yet admit disappointment that they have
failed to help us in some of our more homely diseases—
diseases which in so great a degree account for the discom¬
forts and death-rates of large communities.

The death-rate from pneumonia has remained unaltered
for fifty years ; the influenza bacillus thwarts our best efforts
and carries on its guerilla warfare year after year, with a gay
elusiveness worthy of a DeWet, nor can we yet cure a
common cold.

Proclivity, Heredity and Immunity.

In the light of recent combined laboratory and clinical
work the ideas of proclivity, heredity, immunity and epidemic
influence have acquired a more definite and practical
shape—nay, have been resuscitated from an oblivion threat-

480 POWELL : PRESIDENTIAL ADDRESS ON THE

ened by the natural intolerance of new inquiry for old
notions. We are learning how such accidents as shock, chill,
pyrexial incidents, local injury, checked secretion, etc., may
supply the exciting cause of acute general disease—for ex¬
ample, rheumatic fever, ague, pneumonia, influenza, coryza,
acute tuberculosis—since in some cases we know, and in
others we may infer, that the organism, specific to such
diseases, may long dwell with us in abeyance until permitted
to assume active cultivation by depression or modification
of the vital conditions under which they have been held
restrained. The same conditions that lead up to a com¬
mon cold in an otherwise healthy man would elicit an attack
of ague in a fair propoition of persons who harbour the germs
of that disease. And, as I have elsewhere hinted, a careful
study of the antecedents and bacteriology of a common cold
would probably prove rich in illustrations and elucidations
of this thesis in its application to many allied diseases, and
in competent hands would furnish matter for a paper well
worthy the attention of this Society, or to form the gradua¬
tion thesis for a university degree.

The question of artificial immunity must become one
of increasing importance to our military, naval and civil
services, as our improving home sanitation renders us increas¬
ingly sensitive to diseases which must for long remain en¬
demic in the distant or tropical regions of our vast empire.
With our home populations, except for small pox, the need
of artificial immunity is unlikely ever to be felt, and it is
to be hoped that the day will even come when we shall no
longer need to devitalize our milk and drinking water, killing
the kindly ferments in order to protect us from adventitious
and poisonous microbes.

Sir Prescott Hewett, in his presidential address in 1872,
noted the fact that pyjemia occurred, not only amongst
the crowded inmates of hospital wards, but also in private
patients isolated in luxurious and sanitary houses. Dr.
Greenhow—a great sanitary authority in his time—referring
in 1879 to Sir Prescott’s experience, suggested “ that it would
seem to indicate some state of the patient predisposing him
to the disease, or possibly some peculiarity of season favour¬
ing its development. We smile with the lofty tolerance of
more exact information that such inferences should pass
muster in this Society only twenty years ago. Cases, how¬
ever, I venture to think, come within the experience of phy¬
sicians and surgeons that would justify Dr. Greenhow’s
shrewd remark, cases in which incidents of a septic kind—
for example, phlebitis and secondary embolism of organs—
occur after operations for appendicitis, varicocele, varicose

STUDY OF CLINICAL MEDICINE. 481

veins, thyroid resections, not to mention parturition and
operations about the nose and ear passages. In some of
these cases which have come under my observation the ac¬
cidents could be accounted for by no imperfection in the
operation nor in the sanitary surroundings of the patient.
The wounds have soundly healed, yet the patient has per¬
haps an embolic pneumonia or a cardiac embolism. These
cases are not very frequent, but one meets with them, and
they are more common, if I may judge from my own ex¬
perience and inquiry in private than in hospital practice.
They are, too, the more striking when met with, since they
are relatively more frequent in slight than in very severe
operations. My impression is that they are accounted for
by an unpreparedness of the patient for surgical injury. In
some acute and urgent cases, for example, of strangulated
hernia, suppurative appendicitis, and the like, the surgeon has
no option but to take the risks and operate immediately, but
in chronic cases a few days’ preparation, or, if necessary, a few
weeks' regulation of the patient’s habits and secretions would
serve to purify him of those effete products of impaired, im¬
perfect or exuberant tissue change and inadequate excre¬
tions which cause a morbid reaction to local injury. The
methods of procedure may be aseptic, but the patient in
many instances can scarcely be said to be so.

Electricity, Myxcedema and Organotherapy.

In the lifetime of our Society the use of electricity for
diagnostic purposes has made great strides, the employment
of the electro-magnet for detecting and removing foreign
bodies, especially from the eye, of electric light for explor¬
ing hollow cavities, and lastly of radiography, have been
closely watched and studied here with excellent results for
diagnosis, but little, so far, of a direct kind for treatment.
One of the most valuable contributions to the science of medi¬
cine to which this Society has largely contributed is the
description and through elucidation of the disease now known
as myxcedema, having been first so named by our esteemed
member and late treasurer, Dr. Ord. Sir William Gull was
the first to describe the disease under another name, and it
was afterwards thoroughly investigated by Dr. Ord, and
reported upon in a special volume of our Transactions by a
Committee presided over by him. Apart from the intrinsic
value of investigations which have thoroughly established
the nature and treatment of this important disease, the study
of myxcedema and its treatment by thyroid extract gave an
impetus to, if it did not actually originate, the pathological

482 PROGRESS OF MEDICAL SCIENCE.

and physiological lines of thought and experimental inquiry,
which have shown the influence of secretion products ab¬
sorbed from ductless glands, and from some glands which
are not ductless (ovary, testicle), upon mental and physical
health and upon formative symmetry. The sexual glands,
the adrenals, bone marrow, spleen and pituitary body have in
this comparatively new light been reinvestigated, and the
practical physician is "already reaping the fruits therefrom
in a greater insight into many previously inexplicable groups
of symptoms. The most recent and suggestive outcome in
this category is that of the relationship between disease of
the pituitary body and that want of growth-control which
characterises acromegalous disease, the first case of which
recognised in this country was brought before this Society
by Mr. God lee.

Another idea that has arisen from the closer association
of laboratory and clinical research is the analogy between the
affinity of stains for certain tissues and the selective tissue-
affinity of certain poisons. The affinity, for instance, of the
toxins, of the tetanus and diphtheria bacillus for nerve tis¬
sues, and the very analogous selection of the nervous system
by the influenza poison, are rendered tangibly intelligible
to us from our laboratory experience of the affinity of differ¬
ent stains for muscle, nerve, fat, cell nuclei respectively.

1 must not further trench upon your patience by re¬
flection founded upon the work done by this Society and a
glance at some of the questions which it has helped to solve.
The retrospect is laden with encouragement and suggestions
for work yet to do .—British Medical Journal.

Progress of Medical Science.

MEDICINE AND NEUROLOGY

IN CHARGE OP

J. BRADFORD McCONNELL, M.D.

Associate Professor of Medicine and Neurology, and Profeasor of Clinical Medicine
University of Bishop's College; Physician Western Hospital.

SOME “SIGNS” IN APPENDICITIS.

In the course of a series of clinical lectures on the
various forms of intra-abdominal suppuration, now in course
of delivery at Westminster Hospital, Mr. Tubby called

MEDICINE AND NEUROLOGV. 483

attention to'the importance of certain “signs” in the diagnosis
of appendicitis. In his opinion the most common sign
is rigidity of the abdomen. As a rule the whole abdomen
is distended and somewhat rigid or tympanitic; later on, at
the second or third day, local rigidity and tenderness are
more marked. If the rigidity remain persistent it indicates
acute general peritonitis. The tenderness, he observed, is
best marked at Me Burney’s spot, and the reason that this
the point of greatest pain is that it is just at this part that
the appendix arises from the caecum. Though we may have
appendicitis without the sign of any tumour, a swelling is
generally present on the second or third day in the right
iliac fossa; with a long appendix hanging in the pelvis the
tumour cannot be felt. The tumour may consist of intestine,
peritoneum, exudation, and possibly pus, and therefore
dullness is not persistent. Should, however, a tympanitic
note remain persistent, the signification is that there is gas
in an abscess cavity. The formation of pus. without its
evacuation, causes the patient to rapidly waste, and the
presence of indican in the urine is noticed. In acute
appendicitis, with the formation of pus we have an excessive
number of leucocytes in the blood, and this has been relied
upon by some as one means for the differential diagnosis of
appendicitis from typhoid .—Medical Press .

. THE TREATMENT OF ASTHMA BY
COMPRESSED AIR BATHS.

This peculiar form of treatment can be seen in progress
at Ben Rydding and at the Brompton Hospital for Con¬
sumption, in connection with which Dr. Wethered recently
described the method in the course of a clinical lecture.
The curative agency is a system of compressed air baths.
The "air bath” holds five or six people, and resembles a
huge diving bell. The bath is continued for a couple of
hours. The first half-hour is occupied in increasing the
pressure of the air from one to nine atmospheres, at which it
remains for an hour, and then it is gradually lowered to the
normal. It has been found that, if the alterations of pressure
are made with any suddenness, the patients experience much
discomfort. When the pressure is first put on, the patients
feel an uncomfortable sensation, chiefly in the ears and
throat, but they can get rid of this by swallowing some
liquid. The relief afforded seems permanent. The air is
compressed by steam power. A whistle is provided by
which, if any patient feels unwell, communication can be
established with the attendant, who looks in at one of the

484

PROGRESS OF MEDICAL SCIENCE.

windows provided. The attendant is always close at hand
while the bath is being taken, and periodically looks through
the window. In case of any accident occurring to one of
the patients, the pressure is of course lowered comparatively
suddenly .—Medical Press

CONCLUSIONS REACHED AFTER A STUDY OF
TYPHOID FEVER AMONG THE AMERICAN
SOLDIERS IN 1898.

(Oration on State Medicine before the Fifty-first Annual

Meeting of the American Medical Association at Atlan¬
tic City. N. J., June 5-8, 1900.) (By Victor* Vaughan,

M.D., Journal American Medical Association ; Ann

Arbor, Mich., June 9, 1900.)

1. Every regiment in the United States service in 1898
developed typhoid fever.

2. More than 90 per cent, of the volunteer regiments
developed typhoid fever within eight weeks after assembling
in the state encampments.

3. Most, probably all, of the regular regiments de¬
veloped typhoid fever within less than eight weeks after
going into camp.

4. Typhoid fever not only appeared in every regiment
in the service, but it became epidemic, both in the small en¬
campments of not more than one regiment, and in the larger
ones consisting of one or more corps.

5. Typhoid fever became epidemic in camps located in
the Northern as well as in those located in the Southern
States.

6. Typhoid fever is so widely distributed in this coun¬
try that one or more cases are likely to appear in any regi¬
ment within eight weeks after assembling.

7. Typhoid fever usually appears in military expeditions
within eight weeks after assembling.

8. The miasmatic theory of the origin of typhoid fever
is not supported by our investigations.

9. The pythogenic theory of the origin of typhoid fever
is not supported by our investigations.

10. Our investigations confirm the doctrine of the speci¬
fic origin of typhoid lever.

11. With typhoid fever as widely disseminated as it is in
this country, the chances are that, if a regiment of 1,300 men
should be assembled in any section and kept in a camp, the
sanitary conditions of which were perfect, one or more cases
of typhoid fever would develop.

MEDICINE AKD NEUROLOGY.

48S

12. Typhoid fever is disseminated by the transference
of the excretions of an infected individual to the alimentary
canals of others.

13. Typhoid fever is more likely to become epidemic in
camps than in civil life because of the greater difficulty of
disposing of the excretions from the human body.

14. A man infected with typhoid fever may scatter the
infection in every latrine of a regiment before the disease
is recognized in himself.

15. Camp pollution was the greatest sanitary sin com¬
mitted by the troops in 1898.

16. Some commands were unwisely located.

17. In some instances the space allotted the regiments
was inadequate.

18. Many commands were allowed to remain on one
site too long.

19. Requests for change in location made by medical
officers were not always granted.

20. Superior line officers cannot be held altogether
blameless for the unsanitary condition of the camps.

21. Greater authority should b? given medical officers
in matters relating to the hygiene of camps.

22. It may be stated in a general way that the number
of cases of typhoid fever in the different camps varied with
the method of disposing of excretions.

23. The tub system of disposal of fecal matter as
practiced in the Second Division of the Seventh Army
Corps is to be condemned.

24. The regulation pit system is not a satisfactory
system of disposing of fecal matter in permanent camps.

25. Our board has recommended that in permanent
camps where water-carriage cannot be secured, all fecal
matter should be disinfected and then carted away from
camp.

26. Infected water was not an important factor in the
spread of typhoid fever in the national encampments in
1898.

27. Flies undoubtedly served as carriers of the infec¬
tion.

28. It is more than likely that men transported infect¬
ed material on their persons or in their clothing, and thus
disseminated the disease.

29. Personal contact was undoubtedly one of the
means by which the infection was spread.

30. It is probable that the inlection was disseminated
to some extent through air in the form of dust.

486

PROGRESS OF MEDICAL SCIENCE.

31. A command badly infected with typhoid fever does
not lose the infection by simply changing location.

32. When a command badly infected with typhoid
fever changes its location, it carries the specific agents of the
disease in the bodies of the men, in their clothing, bedding
and tentage.

33. After a command becomes badly infected with
typhoid, change of location, together with thorough disin¬
fection of clothing, oedding and tentage, is necessary.

34. Even an ocean voyage does not relieve an infected
command of its infection.

35. Except in case of most urgent military necessity
one command should not be located on a site recently
vacated by another.

36. The fact that a command expects to change its
location does not justify neglect of proper policing of the
ground occupied.

37. It is desirable that the soldiers’ beds should be
raised from the ground.

38. In some of the encampments the tents were too
much crowded.

39. Medical officers should insist that soldiers remove
their outer clothing at night when the exigencies of the
situation permit.

40. Malaria was not a prevalent disease among the
troops that remained in the United States.

41. The continued fever that prevailed among the sol¬
diers in this country in 1898 was typhoid fever.

42. While our investigations show that coincident
infection with malaria and typhoid fever may occur, the
resulting complex of symptoms does not seem to be suf¬
ficiently well defined and uniform to be recognized as a
separate disease.

43. About one-fifth of the soldiers in the national
encampments in the U. S. in 1898 developed typhoid
fever.

44 Army surgeons correctly diagnosed a little less than
half the cases of typhoid fever.

45. The percentage of deaths among cases of typhoid
fever was about 7.5.

46. When a command is thoroughly saturated with
typhoid fever it is probable that from one-third to one quar¬
ter of the men will be found susceptible to the disease.

47. In military practice typhoid fever is often apparent¬
ly an intermittent disease.

48. The belief that errors in diet with consequent

MEDICINE AND NEUROLOGY. 487

gastric and intestinal catarrh induced typhoid fever is not
supported by our investigations.

49. The belief that simple • astro intestinal disturbances
predispose to typhoid fever is not supported by our investi¬
gations.

50. More than 80 per cent, of the men who developed
typhoid fever had no preceding intestinal disorder.

51. '1 he deaths from typhoid fever were more than 80
per cent, of the total deaths.

52. The shortest period of incubation in typhoid fever
is probably something under eight days.

53. One who has lived in a camp in which typhoid
fever is prevalent is liable to develop this disease any time
within eight weeks after leaving such a camp.— St. Paul
Medical Journal.

CHARACTERISTICS OF THE DESCENDANTS OF
HEREDITARY SYPHILITICS.

In an exhaustive article, in which all the literature is
carefully digested, and to which he adds his own wide exper¬
ience. Finger comes to the following conclusions regarding
the transmissibility of syphilis and the syphilitic manifesta*
tions:

1. It must be regarded as theoretically possible that an
inheritance of syphilis can take place upon the second and
perhaps further generations as upon the first; in this wise
that three different manifestations of parental syphilis can be
transmitted independently of each other, namely (A) true
virulent syphilis, (B) syphilotoxic dystrophic disturbances,
and C) immunity.

A. 7 ransmission of true virulent syphilis to the second gener¬
ation.

2. Although this is theoretically possible, up to the present
no case of this nature has been brought forward which is en¬
tirely free from objections.

3. In order to prove the transmission to the second genera¬
tion, the following postulates must be proven : (a) The here¬
ditary syphilis of one of the parents must be proven beyond
a doubt; (b) Acquired syphilis in the second generation must
be conclusively ruled out; (c) The nature of the syphilis in
the third generation must be proven to be inherited.

4. In order that there be no doubt that it is a case of inher-
rited syphilis in the second or third generation, it must mak«
its manifestations at the time of birth, or shortly afterwards.

5. The question of exclusion of acquired syphilis in the sec-

488

PROGRESS OF MEDICAL SCIENCE.

ond generation is a difficult one, since it is dependent entirely
upon negative arguments, and since in each separate case it
is impossible to the most conscientious observer to bring his
subjective conviction acquired by intimate knowledge of the
s ; ngle case into an objectively unobjectionable form.

6. From the standpoint of the above-mentioned postulates,
the majority of the twenty-four observations which up to now
have been made in this connection is open to objection, al¬
though some (cases of Nunn,Mensinga,Hutchinson) are striking
in the highest degree. Still the latter are not conclusive,
and, in fact,to be regarded as absolutely conclusive a case would
have to conform to the following type:—The mother is heredi¬
tarily syhilitic and gives birth to a hereditarily .syphilitic
child. Shortly after the birth of the same the father of the
child is infected with syphilis illegitimately.

B. 7 ranstnission of syphilotoxic dystrophic disturbances upon
the second generation.

7. This question'is still more difficult to answer than the
first, since the conception of syphilotoxic dystrophic distur¬
bance as manifested by transmission to the first generation is
not as yet completely settled and fixed.

8. In spite of previous works in this connection, this question
has not been cleared up as yet, because : (a) These syphi-

' litic dystrophies furnish nothing absolutely characteristic,
(b) Analogous dystrophies are found in families where all
known etiological factors, especially syphilis, tuberculosis,
intoxication with alcohol or lead, are wanting, (c) Such dys¬
trophies, if of syphilitic nature, should appear most frequently
in the genuinely, hereditarily syphilitic children, but, on the
contrary, up to the present, in contrast to a small number of
children, who furnish dystrophies together with genuine inher¬
ited syphilis, we have a much larger group of children
showing no genuine inherited syphilis, but only dystro¬
phies.

9. If we have undoubted general nutritive disturbances, de¬
bility, asthenia, infantilism in children of syphilitic parents,
still the question would remain whether such disturbances
would not have arisen even if syphilis had not been present.

10. In regard to the question of the transmission of dystro-
ph ies to the second generation, each case must conform to the
following postulates: (a) Hereditary syphilis must be proven
beyond a doubt in the second generation ; (b) Acquired
s> philis in the second generation must be eliminated, (c)
Also in the third generation syphilis acquired at an early age
must be eliminated.

11. This last point, the elimination pf acquired sypfijlis in

MEDICINE AND NEUROLOGY.

489

the third generation, is necessary, because we know now from
many observations that dystrophic disturbances in a child
may be developed not only after inherited, but also after
syphilis acquired early in the suckling period, which may be
easily mistaken for a hereditary dystrophy.

12. From this point of view, the thirty-one cases of this kind
hitherto described are interesting, but not fully conclusive.
Here the especial difficulty lies in the elimination of ac¬
quired syphilis in the second generation.

13. From a study of these dystrophies, which have been re¬
garded as syphilotoxic, we must conclude that they become
milder and rarer from generation to generation.

14. From this it would follow that syphilis in its influence
upon posterity leads less to a degeneration than to a dimi¬
nution of the race.

C. Transmission of absolute and relative immunity upon
the descendants.

15. For many years it has been known that the offspring
of syphilitic parents possess an absolute or a relative immuni¬
ty towards the syphilitic infection. This view was based upon
several observations : (a) The observation that where syphi¬
lis has been endemic for a long time it runs a markedly mil¬
der course, (b) The observation that syphilis, brought to
people who have never had syphilis, appears there at first
with severe manifestations, (c) The finding of sporadic cases
of malignant syphilis where the victim’s ancestors had been
free from syphilis for several generations, (d) The observa¬
tion that mothers in the contagious stage of syphilis do not
infect their healthy offspring (Profeta’s law).

16. These observations, although worthy of notice, furnish
no unimpeachable scientific proofs of the inheritance of im¬
munity, and can be satisfactorily explained along other
lines.

17. On the other hand, there is a considerable number of
facts which go to prove that the inheritance of immunity is
incontant, to say the least, and which suggest that the doctrine
of the inherited immunity of syphilis needs a complete
revision.

18. These are: (a) The fact that in acquired syphilis itself
the immunity is often transient, reinfection is observed, and
that reinfections would perhaps be more frequent if certain
factors, social and otherwise, care, routine, marriage, old age,
impotence, did not stand in the way of a reinfection, (b)
The fact that not a few cases are known in which hereditarily
syphilitic (fourteen cases) or syphilotoxic-dystrophic (137
cases) or entirely healthy children (twenty-nine cases) of
syphilitic parents infect themselves with syphilis, (c) The

49 ©

PROGRESS OF MEDICAL SCIENCE.

fact that in these cases not only absolute, but also relative
immunity, i. e., an especially mild course of the disease, is not
to be found.

19. The fact that in a number of children of syphilitic
parents the immunity, if indeed present, was lost at the time
of puberty, proves to us that these individuals could not trans¬
mit an immunity to their children and descendants.

20. The facts given above, which oppose the view that
immunity to syphilis can be inherited, must make us wonder
whether we have the right to hold any longer to the doctrine
of the unlimited duration of immunity in acquired syphilis, or
still further to the thesis of the inheritance of immunity.
Maryland Medical Journal.

THE INTERNATIONAL CONGRESS AT NAPLES
AGAINST TUBERCULOSIS.

On April 25th this Congress was inaugurated by the
King and Queen of Italy in the historic opera-house of San
Carlo. The President, Professor Baccelli, welcomed the
delegates, who had been sent from every European country
(except England), the Congressists who numbered some
1,200, and the members of the “League’s” adherents in
Neapolitan Society. He alluded to the King’s efforts dur¬
ing the cholera in 1884, and to his present visit to wage war
against the “ phylloxera of human life.’’ He explained the
objects of the meeting, and briefly reviewed the question of
tuberculosis from Morgagni to Koch. The recent legislation
and the prizes offered for the best-planned sanatorium were
mentioned. He insisted that the mortality from tuberculosis
in Italy was less and more rapidly decreasing than in any
other country in Europe, in spite of the number of cases at¬
tracted there by the climate, but trusted that the original
example set in England would be eagerly followed by Italy
in the proper institutions for consumptives. The arrange¬
ments for the following days were on the lines of the British
Medical Association’s meetings. From the mass of com¬
munications which covered all the old ground are taken the
more original items.

Professor Lannelongue explained his attempt to deduce
results as to climate. He inoculated one hundred and fifty
guinea-pigs in the pleura with similar doses of tuberculous
material. The one hundred and fifty were divided into three
lots of equal weights and put to live under different climatic
conditions, one lot being retained in the laboratory at Paris,,
the second lot being sent to Yalmont in the country, and the

MEDICINE AND* NEUROLOGY.

49 1

third lotto the seaside at Grandes Dalles. The conditions
other than climatic were rendered as similar as possible, the
experiment lasting eleven months. The mortality curve of
the country lot was the highest from the start, the other two
lots keeping level for a long time. Toward December the
seaside curve rose, and the laboratory curve had the be^t of
it. A second experiment was marred by an accident to one
of the lots, but here again the laboratory lot suffered the
least, and Professor Lannelongue concluded that the equable
temperature and repose of the laboratory were the reasons.
The greater thermometric variations of the country and the
seaside were followed by rises in the mortality curves. An
experiment on these lines, if carried out with men instead of
guinea-pigs, might give definite information regarding the
sites of sanatoria.

Professor Menella pressed for legislation against the mar¬
riage of phthisical persons, since investigations proved the
transmission of tuberculous toxin, and even of bacilli, by the
placenta and semen.

Dr. Sanarelli read a most suggestive paper on the dan¬
gers of infection in railway carriages, etc. He especially
pointed to the wagon-lits, and asked that there should bj not
merely a general disinfection of such vehicles, but alterations
in the material and arrangement of the upholstery, so as to
allow of daily cleaning. He asked for special carriages for
consumptives. The model railway carriages now on review
at Rome were mentioned.

Dr. Posner gave the result of 1,300 necropsies in Vir¬
chow’s clinics, showing that of the tuberculous cases 30 per
cent, had tuberculous disease of the genito urinary organs.

In the therapeutic section there was little new, iodoform
being the favorite remedy, administered in every possible
way. Professor Cervello had been expected to demonstrate
his method of inhaling formic aldehyde. A proposal to abol¬
ish vaccination because of the risk of tuberculous infection
received no support.

Dr. Germano gave an interesting account of the facility
with which fish, especially the carp tribe, could be rendered
tuberculous by feeding them on the sputum of consumptives.

Professor Iranzo had good reason to point out that the
objects of the Congress would be more surely attained by the
education of the public than by the passing of resolutions
urging the Government to legislate on an infinity of profes¬
sional whims.— Lancet . — The American Practitioner and
News.

492 PROGRESS OF MEDICAL SCIENCE.

THE CHARACTERISTICS OF A PLAGUE
INVASION. ,

The characteristic of invading plague, which is at once
most dangerous and almost constant, is its insidiousness.
In whatever latitude the plague aopears this quality of the
disease is displayed. Weeks and months may pass before
epidemic propmtions are reached. Even where plague is
familiar, the stealth of its progress, so Barker tells us, fre¬
quently betrays health officials into premature annouce-
ments that the disease has been stamped out. In this
respect the invasion of plague is to epidemic plague about as
a slow-burning fuse is to a charge of dynamite. Hasty
action upon the belief that the fuse has gone out is extreme¬
ly dangerous.

This unperceived progress suggests to the sceptical
mind the existence of very mild unrecognized cases, and
there are instances among recent epidemics which support
this suspicion. In Hong-Kong cases of mild adenitis were
observed for some time before the first case of plague was
recognized, and it is probable that the wide distribution of
the infection was accomplished . through these cases. For¬
tunately, epidemics usually begin with cases showing the
typical bubo, other v.rieties of the disease appearing later.
In this form the diagnosis is easy, and it is well within the
ability of American physicians to recognize it If an out¬
break should begin with pneumonic cases, the probability
of correct diagnosis is small. The recent outbreak at Kolo-
bovka in Russia was of this type, presenting twenty-four
cases with twenty-three deaths, all of the pneumonic type.

The quality of insidiousness is probably due in most
instances to the spread of plague by rats. Many histories
of epidemics begin with a single case, of one infected house.
Two or three weeks pass without any apparent spread.
Then a commotion appears among the rats, dead bodies are
found, and the rats disappear from the vicinity. Following
this, human plague occurs, perhaps at several points distant
from the original focus. Sometimes the behavior of the
rats attracts no attention in the infected locality, nor is their
nvgration observed. The earliest premonition of a plague
visitation has sometimes been a notable increase in the
number of rats, coming from none knows where. A recent
outbreak in Bombay, and one in Calcutta, followed such a
migration of rats.

Possessing routes of travel so well hidden from the eyes
of men, and clinical disguises so baffling, plague may put
physicians and health officers to confusion about as easily in

MEDICINE AND NEUROLOGY.

493

our American cities as in the East. It is quite usual for
those who write about plague to tell us that under the con¬
ditions of Western civilization plague will be easily control¬
led, and these views have a calming influence upon the
popular mind. The hygienic condition of American cities
and the habits of American citizens are probably not favor¬
able to the spread of plague, but those of us who must bear
the probable opprobrium of a first encounter will do well to
examine whether our defenses are in fact as strong as they
appear. No infected port is near enough to bring the time
of transit to our shores within an incubation period of
plague, and it is therefore unlikely that an unrecognized
case in man will pass quarantine. But plague infected rats
on board ship might escape observation. The rules of the
United States Marine Hospital Service do not require the
examination of cargo for the bodies of dead rodents. This
suggestion was made by the Oporto Flague Commission,
and affords one more safeguard along that most obscure
route of invasion .—Maryland Medical Journal.

TREATMENT OF SYPHILIS IN GENERAL AND
OF TABES POST-SYPHILITIC A IN
PARTICULAR.

BY H TSCHIRIEFF.

Seventeen years’ experience in the neurologic service of
the military hospitals at St. Petersburg and at Kieff has con¬
vinced Tschirieff that syphilis is a constitutional disease and
is never completely cured, and that iodide given with the mer¬
cury prevents the absorption of the latter. He describes
tests which confirm this prevention of absorption of mercury
by the iodide, and explains the more frequent recurrences of
syphilis, and especially of syphilitic affections of the central
nervous system, when iodide was combined with the mercury.
The method he recommends is a daily bath at 35 ° C.,
twenty to thirty minutes in length. Half an hour to an hour
after the bath the inunction is made, for which he prefers
mercurial soap, as it requires less time than the ointment.
The back and sides he considers best adapted for the inunc¬
tions, which are made for six days, then omitted the seventh,
repeated for five to six weeks; the mouth rinsed with satur¬
ated solution of potassium chlorate seven to eight times a
day. After five or six weeks of inunction and an interval of
one or two weeks, a daily bath at 35 0 C. is taken three times a
week and .5 to 4 gm. of a preparation of iodin three times a
day, after meals in a glass of milk or milk and Seltzers’ water.

494

PROGRESS OF MEDICAL SCIENCE.

Sleep is regulated with bromides and the heart supervised.
This method of treatment requires three months and, usually
gives remarkably fine results, not injuring the organism in any
way, but actually raising the general tone and increasing the
weight. One of his patients is a man of sixty, who for forty
years has taken a hot bath every day and makes several in¬
unctions every week, and his health is as perfect as is possible
for a man of his years. The causes of the frequent affections
of the central nervous system are inadequate treatment of the
syphilis, abusus spirituosorum, exce-s of all kinds, including
intelleciual work, and frequent chilling of the body, especially
the lower extremities, from climatic conditions. He treats
post-syphilitic tabes with specific treatment, Charcot douches
to the back, electrization of the spine and medulla oblongata,
cauterization of the spinfe with the Paquelin every tenth to
fourteenth day, strychine pills to restore the function to the
centers of erection and defecation, and subcutaneous injec¬
tions of atropine and morphine for the lancinating pains. This
treatment arrests and may possibly cure the sclerosis of the
posterior columns of the spinal cord, which he considers the
specific lesion of post-syphilitic tabes. Every case thus
treated showed marked improvement.— Dermatoloqisches
Zeitischrift ( Berlin ) - The American Practitioner and News .

MONOGAMY AND LONGEVITY.

In the Lancet (London), of June 9, Dr. Harry Campbell
F. R. C. P.’ Lond., contributes an article on the increase in
the death rate from cancer, in the couise of which he d s-
cusses monogamy in its relation to longevity and the diseases
of late life. The author says :

“The increase in the death rate from cancer has of late
attracted, and rightly attracted, the attention of medical
men, and various opinions have been advanced to account
for it One reason doubtless is that, owing to the increased
average length of life, more people live into the cancerous
age now than formerly. Some hold this to be the entire
explanation, and doubt if there has been any increase in the
individual tendency to the disease. I believe, however, that
I can see no reason why the individual tendency should
increase, and though the suggestion I have to offer may at
first sight appear chimerical, I yet hope to advance a con¬
vincing argument in its support. My contention is that
monogamy tends to favor the increase in our race of all late-
life diseases, cancer among them, and to shorten the vital
span. # * # While, however, monogamy is thus exer-

MEDICINE AND NEUROLOGY.

495

-rising an injurious influence on our race, polygamy is a
sociological impossibility, and happily we have at our dis¬
posal a much more efficacious means than is afforded by it
of securing to the fittest the largest number of offspring—of
giving full play to that searching process of elimination
which alone can sustain a high level of racial fitness. Na¬
ture’s method of elimination is a merciless one; she uncere¬
moniously sacrifices the individual for the benefit of the
race—so careful of the type is she, so careless of the single
life. The sole object of individual elimination, racially
considered, is to prevent the unfit individual from leaving
offspring to inherit his unfitness, and Nature in her rough-
and ready way achieves this object by simply wiping him
out of existence. The same end can be attained, however,
by the unfit abstaining from getting unfit offspring and
choosing to join the ever-increasing army of the non-marry¬
ing. Elimination from the racial standpoint means not hav¬
ing offspring, and all who do not leave offspring are racially
eliminated—unrepresented in posterity.”

INJECTIONS OF ETHER IN SEBACEOUS CYSTS.

Emile Sergent, in La Presse Medicate of June 30, 1900,
has an interesting article on the treatment of sebaceous cysts
by injection. The proceeding was first employed by Vidal
in 180*3, and was practiced extensively by Lermoyez. Sergent
has treated about thirty cases, all of which were radically
cured. The manner in which the injection acts has been
variously explained. By some it has been thought to be
due to an inflammation excited in the wall of the sac, and by
others to the power which ether has of dissolving the seba¬
ceous matter contained in these cysts. The writer is of the
opinion that the latter explanation is correct, for he says that
inflammation is an accidental concomitant due to a failure in
aseptic technique. It is possible to treat cysts of all sizes in
this way, but those which are small, composed mostly of
fibrous tissue with very little sebaceous matter, are not likely
to be benefited. The method is inapplicable to cysts that
'have already undergone inflammatory changes.

Pure sulphuric ether is employed, and the usual operative
aseptic procedures are used. A hollow needle connected
with a sterilized syringe is thrust directly into the cyst. The
cyst is then distended with ether, the needle being allowed
to remain in position. The ether immediately dissolves the
Sebaceous contents of the cyst, and some of it escapes. Then
more ether is introduced. The number of injections required

496

PROGRESS OF MEDICAL SCIENCE.

will depend upon the size of the cyst and the condition of its
walls ; commonly from four to twelve are necessary. When
the cyst is much softened or fluctuation is apparent, and a
brownish crust appears at the margin of the point where the
needle is thrust into the sac, the contents may then be readily
expressed by opening up the tract with a stylet If this
cannot be done, an additional injection or two may be given.
After the contents of the sac have been evacuated, it is pos¬
sible to remove the sac through a comparatively sma llopen-
ing. It is claimed that this is the best treatment for cysts of
medium size. It is not painful, no blood is lost, there is no
danger, and no cicatrices are left. The latter the writer
regards is of especial importance, as he says there is really
little to choose between a head which is covered with wens
and one which is covered with scars left by their removal.

THE ABORTIVE TREATMENT OF BUBO.

H. M. Christian, in the Therapeutic Gazette of August
i 5, 1900, says that highly satisfactory results have been ob¬
tained by the abortive treatment of bubo. Successful appli¬
cation of the method depends upon its being instituted early,
before suppuration has set in. Another condition is that it
shall be due to gonorrhea, chancroid, or herpes, as tubercular
infiltration of the gland is not influenced by the treatment
The treatment recommended by the writer consists in the
direct application of the following ointment:

Ung. hydrarg.

Ung. belladonnae.

Ichthyol.

Lanolin.da 3 ij.

The ointment is spread upon a piece of surgical lint, and
applied directly to the swollen gland. Cotton is next laid
over the gland, and the whole is held in its place by a spica
bandage, with firm pressure. This treatment is carried out
every day until resolution takes place, which is usually
accomplished in from ten days to two weeks. Twenty buboes
have been treated in this manner, of which twelve were suc¬
cessfully aborted. Eight of the cases followed gonorrhea
and four chancroid. Of the eight cases where the abortive
treatment failed, six were cases of tubercular adenitis. The
result of this treatment has convinced the writer that fully
50 per cent, of buboes other than tubercular can be success¬
fully aborted by this treatment, provided only that it be em¬
ployed before the formation of pus.

SURGERY

IN CHARGE OF

ROLLO CAMPBELL, M.D.,

Lecturer on Surgery, University of Bishop’s College ; Assistant-Surgeon, Western Hospital ;

AND

GEORGE FISK, M D.

Instructor in Surgery, University of Bishop's College ; Assistant-Surgeon, Western Hospital.

PEROXIDE OF HYDROGEN IN HIRSUTIES.

r

Dr. L. Duncan Bulkeley (Jour A. M. A.) says that the
bleaching properties of peroxide have long been used for
changing the color of the hair, and advantage may be taken
of this in connection with the growth of superfluous hair on
the face of women. In a very considerable number of cases
he has employed it. where the hair was top fine to admit of
removal by electrolysis, and yet where it was very percep¬
tible and troublesome. Especially on the upper lips of girls,
this condition is often the source of much distress. Here the
slight downy mustache will be composed of innumerable
fine hairs, perhaps with a few stronger ones at the ends, and
it is quite impracticable in the early stages to practice
electrolysis. Here the free and repeated use of the peroxide
will produce a very material improvement in the appearance
in a very short time. By blanching the hairs a moustache
which was very striking will hardly be noticeable at a short
distance. But another advantage in the use of the per¬
oxide in hirsuties is a certain retarding influence which
it exerts on the growth of the hair. This he has noticed
in a number of instances for the past two or three years,
much to the delight of some patients. In applying the
peroxide to such cases it is often well to begin by dilut¬
ing it one-half with water, and increasing the strength
gradually, for when a strong specimen is applied to the
healthy skin it will sometimes cause a desquamation which
is extremely unpleasant to the patient .—Indiana Lancet.

THE DIAGNOSIS OF TUBERCULAR DISEASE

OF BONE.

Acute tuberculosis of bone is comparatively rare. It
Visually occurs in the course of a general milliary tubercu?
losis, or as a secondary infection of the diaphysis of the long

49 8 PROGRESS OF MEDICAL SCIENCE.

bone from an epiphyseal focus. In these cased the diagnosis
is usually easy.

By far the most common form of the disease which we
meet with is the chronic tubercular osteomyleitis. In fact,
about 95 per cent, of the chronic affections of bone may be
classified under this head. It is essentially a disease of early
life, as most tubercular affections are. It is safe to say that
almost all affect'ons of the long bones, especially when
located in the epiphyses, and occuring in early life, are tuber¬
cular. If abscess is present the diagnosis is positive, for
there is cnly one other condition which might produce it,
—actinomycosis.

The family history in these cases is frequently tuber¬
cular, and should always be inquired into in every case of
bone disease.

The subjective symptoms are : I, Pain. This is present
in all degrees of severity, from a mere tired, uncomfortable
feeling, following prolonged use of limb, to the severe excru¬
ciating pain resulting from the destruction of the subarticular
layer of bone, and involvment of the joint. In children,
restlessness, and the so called •* night-cries” frequently occur.
As a rule, however, especially in the early stages, the pain is
not severe, the function of the limb not being markedly in¬
terfered with, the only discomfort being an “ aching ” or
disinclination to use the limb. With the infection of the
periosteum and formation of granulation tissue, resulting
later in abcess, the amount of pain is much increased, or if
the joint become involved, it usually becomes severe. The
pain in the early stages is very often referred, as instanced
by pain in the knee-joint, in diseases of the neck or head of
the femur.

2. Tenderness. This symptom Dr. Senn considers of

great diagnostic importance, especially in the early stages. He
says: “ existence of an area of tenderness over a point cor¬
responding to a tubercular focus in the interior of a bone is
one of the surest indications of the existence of osteotuber-
culosis.” This symptom can be elicited by pressure with the
thumb or finger over the epiphysis of the bone. It is due to
the presence of a circumscribed periostitis, situated above the
tubercular focus. t

3. Loss of function. This symptom should be con¬
sidered under the head of tubercular arthritis, as it is unim¬
portant in the early stage of tubercular osteitis.

The objective symptoms are :

I. Atrophy. This is usually present early, though in a
slight degree, and is probably due to reflex causes, Vulpiart

SURGERY.

499

was the first to bring forward the theory that the atrophy is
due to irritation of the terminal filiments of the articular
nerves, which is reflected the centers of the muscular nerves.
That in some cases the atrophy is direct is shown by its
resulting from a neuritis involving both the articular and
muscular branches of the same nerve, and from the fact that
the atrophy is more or less permanent, even after the tuber¬
cular process has been cured.

2. Swelling. This symptcm is usually not present in
the early stage, and does not occur until the joint or perios¬
teum becomes affected. There is usually no enlargement of
the bone itself in cases of tubercular osteomyelitis, except in
the condition known as spina ventosa, or in an extensive
diaphyseal infection of the bone.

3. Changes in the color of the skin. With the occur¬
rence of much swelling, the skin becomes very pale and is
traversed by large blue veins. In the latter stages, when
abscess formation occurs and the skin becomes involved, it
has a purple or livid hue.

4. Abscess. Sooner or later, unless resolution occurs, the
products of the inflammation undergo caseation and liquifac-
tion, resulting in the formation of an abscess, which, sooner
or later, finds its way into the joint or through the perios¬
teum, burrowing in the direction of the last resistance until
it opens through the skin, resulting in the formation of one
or more sinuses. This is known as a cold abscess. It is
usually slow in forming, and the symptoms of inflammation
are not marked, whereas in those cases in which there is a
mixed infection the local and constitutional signs are dis¬
tinct.

5. Sequestration. As a result of the inflammation and
disturbance of circulation, the formation of sequestra of
greater or less size takes place. This can be demonstrated
by the probe, or when of small size they are frequently seen
in the discharge, which is of a peculiar, thin sanious charac¬
ter.

6. Rise of temperature. By carefully taking the tempera¬
ture at frequent intervals, a rise of only perhaps one-half
degree may be detected, especially towards evening, and is
decidedly significant of tubercular trouble.

7. Anemia, emaciation, asthenia and hectic are not
usually marked until we get a mixed infection. Then these
symptoms become very pronounced.— Dr. Chas, G. Foote, in
Cleveland Medical Gazette.

500 PROGRESS OF MEDICAL SCIENCE.

LARGE TRACT OF CHRONIC BURN ULCERATION
HEALED BY SKIN-PROPAGATION IN
BLOOD, FROM MINUTE POINTS OF
DERMAL TISSUE

By T. J. BIGG M.D., Stamford, Conn.

Mary C-, aged 22, came on the 7th of February,

1895, to the surgical ward of Demilt Dispensary, showing a
tract of four or five square inches on the right side of her
face completely denuded of the skin and superficial fascia,
in consequence of a burn which had been unsuccessfully
treated by the usual methods in vogue at two of the city
hospitals. The wound extended over the right malar bone,
from a point just below the margin of the lower eyelid, down¬
ward and sideways over the nose and cheek, a distance of
three inches, with an inferior diameter of an inch and a half.
The sore was now covered with unhealthy granulations, and
exuded smelling mucopurulent discharge. After cleansing
the wound with Thiersch solution, its entire surface was cau¬
terised with a 25 per cent, etheral solution of pyrozone, and
was dressed for three days with wet Thiersch dressing, until
healthy granulation became established.

Ten minute points of skin, about one-sixth of an inch
in diameter (shrinking to half that size) were then taken
from over the right scapula, and distributed in an elliptical line,
about half an inch within the periphery of the wound, leaving
a like distance between the opposite sides of the elliptical
line. These were protected with strips of sterilized rubber
tissue, which does not adhere to the grafts so as to displace
them when it is removed. The dressing was of gauze soaked
in salt and water, i dr. of salt to the pint, which is found to
be the application most favorable for the setting of the grafts.
Over this, more rubber tissue, cotton and a bandage.

The dressing was removed on the third day, when every
graft was found feebly adherent, and the general surface in a
healthy condition. After cleansing with Thiersch solution,
fresh rubber tissue was applied, and the dressing was now
made of plain sterilized gauze soaked with bovinine, and
covered with oiled muslin, cotton and bandage. On remov¬
ing this dressing on the second day, the wound was found
in a healthy granulating condition, with every graft firmly
adherent and healthy in color. The blood dressing was
repeated in the same manner every day for a week, when
all the grafts were found- to be doubled in diameter and in a
promising condition, which continued healthy granulation'.
Thenceforth, sterilized gauze soaked with bovinine, and
nothing else, was applied directly and daily to the surface

SURGERY.

501

treated, for seventeen days, to March 9th, making thirty-one
days in all from the first appearance of the patient at the
dispensary, when the whole diseased tract was found to be
perfectly healed and covered with new delicate skin. Dress¬
ing was discontinued and patient instructed to wash the
part four or five times a day with sterilized water, reporting
for observation, and after three days was fully discharged.

PERITYPHLITIS, CASE DESPERATE, BLOOD
CURED WITHOUT OPERATION.

By T. J. BIGGS, M D , Stamford, Conn.

Ellen F-, 27 years of age. American, admitted June

5th. Diagnosis: Perityphlitis.

Case had been brought to the hospital by Dr. B—, with
a request that I operate immediately. So severe was the
condition that I agre-d with the Doctor thatc laptrotomy was
advisable. This, however, the patient refused to have done,
saying she preferred to die. Consequently, after assuring
the patient of an unfavorable prognosis, I determined to do
the next best thing.

The condition began two days previous with a feeling of
weight, soreness and paroxysms of acute pain extending into
the hip, thigh and abdomen. Examination of her after
entering the hospital revealed a hard swelling in the right
iliac fossa region. The patient had a temperature of 102*4,
had irregular chills, followed by profuse sweats. The bowels
were regular. In my mind two things were immediately
indicated here :

1. That the digestive tract be given as near as possible
absolute rest.

2. To try to reduce the inflammatory process. This I
knew could be combated by bovinine.

The patient was put to bed, an fee pack put over
the vascum and a teaspoonful of bovinine given every hour.
For the first three days the patient showed no improve¬
ment, but held her own fairly well. On the fourth day she
said the feeling of weight and soreness in right side was less,
and she had fewer paroxysms of pain which were, by the
way, confined to the right side. The temperature was now
101. Bovinine was now ordered a tablespoonful every two
hours in sterilized milk, and once every three hours a tea¬
spoonful of bovinine-Thiersch was given.

June 14th, the swelling and pain had entirely disappeared,
temperature normal, and although well nourished was

502

PROGRESS OF MEDICAL SCIENCE.

pretty weak. Bovinine was now ordered a wine glassful
every three hours in milk.

On the 20th the patient was feeling well and strong.
Bovinine continued.

On the 27th she was discharged, cured.

The action of the bovinine in this condition is three¬
fold ;

1. It requires little or no digestion, and at the same
time, supplying perfect nutrition, gives the alimentary canal
almost absolute rest, as no form of food will do.

2. It being a sterile preparation/acts as an antiseptic,
which is exactly indicated in this condition.

3. It t uilds up and restores to normal the degenerated
mucous membrane, by its nutritive power, and at the same
time acts as an antiphlegistic.

NOTES ON THE ENEMATA EMPLOYED AFTER
ABDOMINAL SECTIONS.

For the thirst which is sometimes so distressing after an
abdominal section, an enema consisting of 500 cc. (one pint)
of tepid water may be slowly administered, being repeated
if necessary.

Nutritive enemata are often employed at intervals of
three or four hours. They should not be given more fre¬
quently than this for fear of rendering the rectum intolerant
of them. The enemata should consist of milk with whisky
or brandy, together with white of egg and a little common
table salt. The following proportions make a good combina¬
tion and may be given by means of a hard rubber syringe or
through a rectal tube:

R Peptonized milk, 30 cc. (si)

Whisky, 30 cc. (3i)

The whites of two eggs
Common table salt, 1.5 (grs. xxiv)

The rectum should be thoroughly irrigated every
morning with warm physiological salt solution, which will
keep it clean, so that the nutritive enemata will be better
absorbed.'

For opening the bowels a high enema consisting of 500
cc. (one pint) of soap-suds in warm water should be given.
The rectal tube having been introduced well up into the rec¬
tum, the mixture of soap-suds and water is poured into a
glass funnel attached to the external end and allowed to run
slowly into the bowel. Sometimes a litre can be introduced

SURGERY.

50 J

in this way. If the enema does not prove effectual, it may be
repeated after three or four hours, or we may substitute one
consisting of warm water, oil, turpentine, in the following
proportions:

R 1’lain wirm water, 500 cc. (<>j)

Olive oil, 60 cc. (si )

Turpentine, from two te.ispoonfuls to a tablespoonful.

This may be repeated once or twice at intervals of two or
threehours, but generally the first enema is followed by a
satisfactory evacuation of the bowels. If preferred, from 120
to itSO cc. (4 to 6 oz.) of warm olive oil or glycerine may be
first injected in order to soften any fecal matter that is in
the rectum, an enema of soap-suds and warm water being
given an hour or so later. Occasionally the addition of an
ounce of £psom salts to a pint of warm soap suds and water
will prove effectual when other enemata have failed.

In a series of 114 consecutive, unselected, abdominal
sections without a death one or more of the above enemata
were employed as a routine practice.—Dr. Hunter Robb,
Cleveland Medical Gazette.

HEROIC TREATMENT FOR SOFT CORNS
BETWEEN THE TOES.

Physicians should be more fully informed upon disturb¬
ances of the feet. Too often they brush aside these com¬
plaints and leave the victims to their own awkwardness or
the tender mercies of itinerant and often ignorant chiropo¬
dists. We should realize that, owing to neglect of proper
cleanliness, the feet may become potent dangers in the direc¬
tion of general infection where self treated or improperly
handled by others.

In discussing recently, at the New York Post-Graduate
Medical College, the suhject of soft corns, Dr. A. M. Phelps,
the eminent orthopedic surgeon, said:

“We all frequently meet with cases of soft corn, occurring
particularly in the working classes, between the toes. They
are extremely painful, crippling the patient and rendering
life almost unendurable. These cases come to the hospital
and ask to have the toes amputated. Such corns are
usually treated conservatively, and are cured, but immediately
relapse. Deep sluffing ulcers are frequently seen.

“A simple procedure which I have followed many times
duripg the past two years answers admirably and saves the toe.
It consists in removing all of the soft tissues on the inner

504

PROGRESS OF MEDICAL SCIENCE.

side of two of the toes, removing the corn, and stitching the
two toes together. This procedure does not in the least im¬
pair the usefulness of the foot, whereas, the removal of the toe
must necessarily do so to a certain extent.

“Patients upon whom I have operated in this manner
have expressed themselves as entirely satisfied, and I am
certain that if I had a soft corn that caused me much trouble I
would have no hesitancy in having the operation performed,
and the toes ‘ webbed.’ The nail of the little toe should be
removed .”—Gail lard’s Med. Jour.

ANKLE SPRAINS.

Sprains are by far the most common joint injuries, and
of all the joints of the body the ankle is the one most fre¬
quently involved ; in fact, ankle sprain i are probably as
numerous as all other sprains combined.

If one looks through the literature on this subject, one
cannot help but be impressed with the chaos that exists on
so simple a subject as the treatment of ankle sprains A
considerable number of text books and teachers state in
unmistakable terms that the only proper treatment for ankle
sprains is a plaster-of-Paris cast, applied directly after the
injury, and worn some weeks. Another almost equally large
and authoritative number state with equal emphasis that the
only satisfactory treatment consists in subjecting the sprain¬
ed ankle to active and passive motion and massage directly
after the injury. A minority recommend cold or hot appli¬
cations with elevation of the limb and firm bandages; later,
plaster-of-Paris cast, and, finally, massage and active and
passive motion.

After thinking the matter over, it seemed strange to me
that any one would care to confine himself so rigidly to
either of the first two methods, as some of the authors
would have one believe that they do. Of the three general
methods outlined, the third certainly commends itself most
highly to one’s common sense, and it is the one that I would
adopt were it not for the fact that I have seen a method
demonstrated which is far superior to it in its results.

The method which I wish to describe comprises practi¬
cally all of the good features of the three, without any
of the objectionable ones. It consists in careful and
systematic strapping with rubber adhesive straps. The
straps are cut from half to three-quarters of an inch in
width, and the proper length. The width depends upon
the size of the limb. If a small ankle, the straps should

SURGERY.

505

be half an inch wide ; if a large ankle, they may be
three-quarters of an inch, but no wider. Upon this, and
upon the accuracy with which they are applied, depends
the success of the method. If the straps are too wide, or if
they arc applied in a haphazard manner, failure is sure to be
the result.

The foot is held at slightly less than a right angle and a
trifle everted. The former element in the position is observ¬
ed because it is easier to walk on a painful ankle if it is held
slightly in the calcaneum position than if held in the equinus
position. The latter element is observed because, as you
well know, ankle sprains are usually caused by a sudden
inversion of the foot, thus injuring the external ligaments;
hence, slightly everting the foot relieves the tension of
these ligaments and places them at rest. With the foot in
this position, one end of a long strap is applied to the inner
surface of the foot near its posterior end, brought under the
heel and up on the outer posterior surface of the leg to
within a few inches < f the knee. At the lower end this falls
into the depression just posterior to the external mdleolus.
A shorter strap is now applied by placing one end to the
inner surface of the heel near the sole of the foot, then
bringing it around over the tendo Achilles to the outer sur-
face of the foot, making it cover the first strap at a right
angle and passing along parallel to the under border of the
sole of the foot, then over the dorsum to the little toe.
Another long one is now applied, anterior to the first, over¬
lapping it about one-third of its width ; then a short one,
and so on. alternately, until the oute: anterior aspect of the
ankle is reached. Over all this a hard rolled bandage is
now carefully and snugly applied. The patient is directed
to lie still with the foot elevated until tlie warmth of the
body has c .used the plaster to adhere firmly. In a great
majority of instances the patient can walk, with reasonable
comfort, after a few hours.

The question that all who have not tried this treatment
are prone to ask is, “ IIow is it possible that so simple an
appliance, or dressing, can give such excellent results ? ” I
can answer this only in part. Where it is applied before
the swelling has taken place, it prevents, or at least limits,
the effusion of blood and serum into the joint and surround¬
ing tissues. It partly immobilizes the joint, and supplants,
in a measure, the lacerated ligaments. It relaxes the mus¬
cles and gives the joint a feeling of security.

In older sprains, it supplies the very best kind of mas¬
sage possible. The massage which a joint gets by the

506

THERAPEUTIC NOTES.

unconscious or subconscious motion under a dressing which
exerts uniform pressure, besides being much cheaper and
more accessible to all, is infinitely better than the massage
which the most experienced masseur can give. This con¬
stant massage and motion rapidly dissipates the swelling by
causing absorption of the effusion. It quickly and surely
relieves the pain. It overcomes the tendency to stiffness.
It restores the muscles and ligaments to their original vigor
and strength. It reduces the period of treatment from
weeks to days. It does all this, while the limb may be used
with reasonable comfort and perfect safety from the day the
bandage is applied.— Dr, E. H. Ochsner, in the Virginia
Medical Semi-Monthly.

Therapeutic Notes.

Hepatic Troublfs.

R Phosphate of soda. i drachm

Chionia. 8 ounces

M. Sig. A dessertspoonful three times a day.

Sore or Cracked Nipples.

K Castor oil. i drachm

Subnitrate of bismuth. I tlrachm

This is applied freely to the sore nipples.— Hirst , Med.

Rec.

To Check Milk Secretion.

R Atropinae sulphat. grain

Magnes. sulphat. 2*4 ounces

Infus. gentianae. 7 ounces

M. Sig. Tablespoonful every two hours. — Gaz. Heb¬
domad.

Pigment Spots of Pregnancy.

R Zinc oxide. 1 drachm

White precipitate. 1^4 grains

Castor oil. 2 drachms

Ess. of rose. 10 drops

Cacao btitter. 2 drachms

M. Sig. Apply morning and evening.— Ex.

THERAPEUTIC NOTES.

507

For Inflamed Rheumatic Joints.

Osier recommends Fuller’s lotion:

R Sodii carbonat. 6 drachms

Tincturae opii. 1 ounce

Glycerini . 2 ounces

Aquae . 9 ounces

M. Sig. Saturate hot cloths with the lotion and apply
to the parts — West. Med. News.

Remedy for Rigid Perineum.

Dr. Southworth says the following he considers indis¬

pensable and infallible:

R Chloroform. 2 drachms

Ether. 1 drachm

Cologne spirits. 1 drachm

M. Sig. Apply locally.

He further says he has had large heads pass perineums
which seemed impossible without extensive rupture, without
even the beginning of a tear, when this preparation was
used .—Medical Times.

For Delayed Resolution in Pneumonia.

Small blisters over affected areas, and

R Potassii iodidi. 1 drachm

Ammonii chloridi. 1 ]/ 2 drachms

Misturae glycyrrhizae comp.. 6 ounces

M. Sig. Tablespoonful four times a day .—De Costa,
Texas Medical Ncius.

Palatable Effervescing Quinine.

R Quininae sulphatis. 3j

Acidi citrici. Sijss

Syrupi simplicis.. ) ...

Syrupi aurantii cort. j aa ^ xv

Aquae destillatae.q. s. ad. §vj

M. Sig. Add 10 or more drops to about two ounces of
water, in which gr. v. of bicarbonate sodium has previously
been dissolved, ar.d drink while effervescing.— The Prac¬
titioner.

Jottings

Salt Withheld in Epilepsy.

Richet and Toulouse announced, at a recent meeting of
the Paris Academy of Sciences, that their experience with 30
female epileptics has demonstrated the fact that depriving
the nervous system of the usual amount of salt in the blood
renders the nervous tissue more susceptible to the absorption
of medicinal salts, which it takes up to a remarkable extent,
thus rendering an extremely small dose effective. Thus 2
grams of sodium bromide a day, administered under the con¬
ditions referred to, arrested the epileptic attacks, sometimes
in less than a week, no matter how frequent they had been
before. Several patients had shown no recurrence for six
months since treatment. Richet proposes to call this the
metatrophic method, and suggests that it may possibly
apply also to affections treated with quinine, digitalis, atro¬
pine, etc., as well as those in which the alkaline salts are
administered. The saltless food has no bad effect on the
patient.— Exc.

Ice for Nausea.

A physician advances the theory that the distressing
sensation of nausea has its seat in the brain and not in the
stomach, and that relief may be obtained by cooling the base
of the brain. He claims to hive tested this often and
thoroughly in the case of sick headache, bilious colic, cholera
morbus, and other ills in which the nausea is a distressing
symptom without a single failure; also, that he once re¬
lieved the nausea resulting from cancer of the stomach by
the application of ice to the back of the neck and occipital
bone. The ice is to be broken and the bits placed between
the folds of a towel. Relief may be obtained by holding the
head over a sink, or tub, and pouring a small stream of water
on the neck. This is worth remembering, as a relief for sick
headache, to which so may are subject. — Exc.

Urticaria.

The agent to which I desire to call attention in this arti¬
cle is carbonate of potassium. Simple carbonate of potash
—kali carbonicum. It is the remedy of all others for that
common affection, hives, or, more specifically, urticaria.

The prescription is simple : Add ten or fifteen grains of

JOTTINGS.

509

kali carbonicum to half a pint of water, and order a tea-
spoonful every hour until relief follows. Three or four doses
a day for a day or two afterward may be required to confirm
the cure. The size of the dose does not matter so much, so
it is small enough to insure immunity from unpleasant drug
action, and large enough to produce slight therapeutic effect
— Amer. Med. Jour.

Fifteen to twenty grains of camphoric acid will, as a
rule, stop night sweats, especially of phthisis, better than
does any other drug, it being free from all the objections
against atropia or belladonna, and may be given even in
larger doses.— Med. Council.

Minute Doses of Conium.

Conium acts as well upon the urinary organs as
upon the reproductive. In feeble people, with frequent
drippling urination, especially at night with burning, cutting
urethral pain, a turbid, thick, whitish or bloody urine, and a
sense of weight or pressure about the bladder, it is the
remedy that will satisfy patient and physician. — Ec. Med.
Journal.

A Cough Mixture.

Dr. L. M. Taylor (Merck’s Archives, August) has used
the following prescription with most satisfactory genera^

results:

B Chloral hydrate....;. 64 grains

Ammonium carbonate. 32 “

Fluid extract of ipecac. 1 fluid drachm

Spirits of nitrous ether

(Squibb). 2 fluid drachms

Syrup of tar.

Syrup of wild
cherry,

Syrup of tolu, )■ of each, 1 fluid ounce.
Camphorated
tincture of
opium, J

Shake well and take a teaspoonful when the cough is
troublesome.

Incontinence of Urine.

According to the Buffalo Medical Journal, lycopodium
has been used with success for this affection in children.

5io

JOTTINGS.

Twenty drops of the tincture should be given three times a
day, and this dose may be increased to 40 or 50 drops. It is,
in some cases, more efficient than belladonna.

To Keep the Hands Soft and White.

In these days of asepsis the hands o( the physician, and
especially of the surgeon, suffer greatly from frequent scrub¬
bings and immersions in antiseptic solutions. A preparation
that will keep the hands soft and white and that will not at
the same time be inelegant to use is always in demand. The
following formula will be found to be one of the very best
ever proposed for the purpose:

R 01 . rosse, 15 drops.

Glycerin, 1 drachm.

Spt. of myrciae, 3 drachms.

01. cajuput., 20 drops.

M. Apply at night before retiring, first washing the
hands thoroughly in hot water. In cold weather this can
also be applied to the hands before going out .—California
Medical Journal.

Chronic Eczema.

A confrere asserts that he obtains the radical cure of
eczema where it occurs in isolated patches on the upper ex¬
tremities, and so rebellious to the ordinary method of treat*
ment, as follows: After having washed thoroughly with
soap and water the part and dried it, he rubs in vigorously
a 50-per-cent, solution of caustic potash by means of a plug
of cotton tied to a rod; he then washes the spot freejy with
water, and, finally, paints it over with a 50-per-cent, solution
of nitrate of silver, and envelops the whole in aseptic cotton.
This dressing is left in place until the cicatrix is formed be¬
neath the slough, or from one to two weeks. The itching
ceases immediately after the application of the caustics. Out
of thirty cases thus treated, only one required the operation a
second time.— Med. Press and Circular.

Nocturnal Emissions.

Gould & Pyle thus sum up the treatment of nocturnal
emissions.— “Too frequent emissions reduce the strength^
make the patient irritable and weak, and gradually prey
upon the mind. Nocturnal emissions occurring in normal
males who are continent and chaste are not to be interfered
with unless excessive. Unchaste literature and lascivious

JOTTINGS.

5 11

thoughts are to be avoided. A nard mattress and light cov¬
erings are advisable. Avoid sleeping on the back. Tie a
spool on the loins, so that if the sleeper roll upon the back
he will be awakened by the pressure. Potassium bromid, 20
grains. Or the same amount of chloral may be taken on re¬
tiring. Cold sponging of the perineum and loins night and
morning has been of great benefit. Potass, citrate, 20 grains
in water, three times a day, will render the urine unirritating
and alkalin and allay a provocative cause of emissions.
Arsenic alone, or in combination with strychnine, is often of
service when given in full dose. Stimulating foods and
drinks are to be avoided.

The Contagiousness of Pulmonary Consumption.

(Shurly, Phy. and Surgeon, Dec., 1899). Tuberculosis is
considered by many observers to be contagious. The author
thinks that, although the tubercle bacillus is an important
factor in a large majority of cases of pulmonary consumption,
other organisms, such as the streptococcus, staphylococcus and
pneumococcus may play the greatest part in most cases,
and that a predisposition to the disease must exist. Although
the disease may be transmitted by the inhalation of dried
sputum to animals which have a tendency for it and are in an
unhealthy condition, the attempt often fails in those in good
health and the best sanitary environment. There is not an
instance based upon unmistakable evidence of a case of
human pulmonary tuberculosis having originated, under
ordinary natural circumstances from the inhalation of dried
sputum in the air. The existence of a hereditary tendency
to the disease is a very important factor. Until we have more
unmistakable evidence we cannot formulate a principle upon
which to decide whether consumption is contagious in the
ordinary sense of the term, and, until this has been shown,
we have no right to deprive patients of their natural rights.

THE

Canada Medical Record

PUBLISHED MONTHLY,

Subscription Price , $i .co per annum in advance . Single
Copies , io

Make all Cheques or P.O. Money Orders for subscription, or advertising, payable to
JOHN LOVELL & SON, St. Nicholas Street, Montreal, to whom all business oomnitw
nications should be addressed.

All communications for the Journal, books for review, and exchanges, should be
addressed to the Editor, Box 2174, Post Office Montreal.

Editorial.

ANNUAL DINNER OF BISHOP’S MEDICAL AND
DENTAL COLLEGE.

The Thirtieth Anniversary of the formation of the
Medical Faculty of Bishop’s College was celebrated by the
Faculty, graduates and students by a Dinner on the 8th of
November, at the Place Viger Hotel. The Dental College
of the Province of Quebec, with its students, affiliated with
Bishop’s College, participated in the celebration. Over one
hundred and twenty persons sat down to as fine a bill of
fare as the Hotel could produce. Mr. E. A. Tomkins, Medi¬
cine ’oi, occupied the chair, supported on his right by
Chancellor Heneker, Principal Whitney, Dr. McConnell,
Vice-Dean L. H. Davidson, Q.C., Rev. Dr. Abbott Smith
and the Rev. Dr. Ker. On his left sat Dr. F. W. Camp¬
bell, Dean of the Faculty, Dr. Wolford Nelson, of New
York (a member of Bishop’s first Medical graduating class),
R. Wilson-Smith and C. F. Smith, Esq., President of the
Western Hospital. The Vice-chairs were occupied by B. A.
Planche, B.A., Dental ’oi, and I. A. Gillespie, L. Ph., Med.
oi. A few of the graduates, who resided near Montreal,
showed their continued interest in their Alma Mater by
being present. Especial mention, however, must be made
of Dr. Nelson, who came from New York especially for this
Dinner, also of Dr. H. B. Chandler, the well-known eye

EDITORIAL.

5*3

specialist, of Boston (M.D. Bishop’s, 188o), who, having pur¬
chased a ticket, asked that his chair be kept vacant, if not
there to fill it, for he would be with them in spirit. The
speaking was of a high order ; the address by the new Prin¬
cipal of the University, Rev. Mr. Whitney, was most note¬
worthy. He held his audience captive for fully half an hour,
with his beautifully constructed English sentences- The
University has in him a strong man for a most important
post. Chancellor Heneker and Mr. Leo. H. Davidson spoke
eloquently. Dr. Woltred Nelson spoke in response to “ Alma
Mater,” and noted the good work Bishop’s sons were doing
in the United States. Mr. R. Wilson Smith, in replying to
the toast of our guests, said that he knew the great work
which Bishop’s Faculty of Medicine was doing, and he be¬
lieved that they were on the eve of this work being recog¬
nized. Once the turn was made, all who had labored so
nobly would receive their reward. Mr. C. F. Smith, as
President of the Western Hospital, spoke of the good work
that Hospital was doing, but felt that the present building
was unsuited for its work. He felt sure that, just as soon as
the public knew what that Hospital was doing, it would be
surrounded by friends who would rally to its support. With
their assistance he hoped ere long to have erected a new
building on the Hospital property, which he believed to be
one of the best sites for an hospital in Montreal. This build¬
ing he hoped would contain fifty private wards. With
speech, song and story, the hours flew quickly past, and, as
God Save the Queen was started, one could hardly realize
that the clock had already struck the hour of two. Principal
Whitney remained to the last.

A PERFECT CURE FOR TYPHOID FEVER.

A late number of the Dublin Medical Press and Circular
says:—According to Dr. Virgil Hubbard, of Atlanta, U.S.A.*
a treatment has been discovered by him under which typhoid
fever ceases to have any mortality. Undeterred by the
ridicule with which his proposals and statements were greeted
at last year’s meeting of the Medical Association of Georgia,

5H

PERSONAL.

he again comes forward to insist on the unvarying success of
his method. As the New York Medical News has thought
the paper worthy of reproduction in full, we may mention
that the treatment in question consists in giving the patient
a capsule containing half a grain of calomel, two grains of
carbonate of guaiacol, and from a twentieth to a fortieth of a
grain of podophyllin, every two hours, for the first 24 or 48
hours. After four or five intestinal evacuations he stops the
calomel and substitutes half a grain of menthol. This com¬
prises what the author calls the antiseptic and eliminative
treatment of typhoid fever. Should the bowels tend to be¬
come inactive he gives small doses of Hunyadi Janos water,
and, if the temperature remains high alter four or five days of
treatment, calomel is again resorted to. In addition to this
he frequently resorts to the administration of normal saline
solution, per rectum, especially in cases where the skin and
kidneys fail to act well. Unfortunately, the author does not
give us any statistics to go by, but, after all, the real test of
a treatment—we hesitate to call it a tiew treatment because
the antiseptic treatment of typhoid is quite old, and the
choice of a particular antiseptic scarcely justifies the claim
to constitute a new treatment, is the result obtained in the
hands of others.

PERSONAL.

Sir Henry Ackland, Regius Professor of Medicine in
the University of Oxford, died on the 16th of October. ' He
was born in 1815. r

Dr. John B. Murphy has accepted a Professorship in
Surgery and Clinical Surgery in the Northwestern University
Medical School—Chicago Medical College. Dr. Murphy has
been appointed Surgeon-in-Chief of Mercy Hospital, with
the direction of the surgical teaching in that Hospital.

Dr. Archibald Church has been recently appointed Pro¬
fessor of Nervous and Mental Diseases in Northwestern.
University Medical School—Chicago Medical Col'ege—and
head of the Neurological Department.

Book Reviews.

“Bacteriology and Surgical Technique for Nurses”
By Emily M. A. Stoney, Superintendent of the Training School
for Nurses, St. Anthony’s Hospital, Rock Island, Ill., Author¬
ess of “ Practical Points in Nursing,” “ Practical Materia
Medica for Nurses,” etc. Published by W. B. Saunders &
Co., Philadelphia, 1900. Canadian agents, J. A. Carveth &
Co., Toronto, Ont. Price, $1.25 net.

This work is rather a new departure in the way of a text-book
for nurses, and may be looked on as a sign ofthetim^s. Formerly
a nurse was considered equipped for nursing who spent some years
in an hospital gaining practical knowledge but little theory ; now
a nurse not only receives lectures on anatomy, physiology, etc.,
and passes exams, on these subjects, but she must also read one or
several text-books on the subject of nursing. The present work
can be highly recommended to nurses who desire to grasp the
reason why asepsis is so important and how to become and remain
aseptic during operative work. It is written in a simple, easy
manner so that anyone reading it can understand it. Its faults are
few, perhaps the worst being the putting of Carbolic Acid at the
head of the list of antiseptics. Taken altogether every nurse who
desires to have a thorough knowledge of her work should possess a
copy of this well-written text-book for nurses.

H. L. R.

A Manual Of Otology. By Gorham Bacon, A. M., M.D.,
Professor of Otology in Cornell University Medical College,
New York. With an introductory chapter by Clarence J.
Blake, M.D., Professor of Otology in the Harvard Medica.
School, Boston. In one handsome i2mo. volume of 422 pagesj
with 114 engravings and 3 colored plates. Cloth $2.25. net,
Lea Brothers & Co., Publishers, Philadelphia and New York.

The Manual of Otology is written in a clear and interesting
manner, and, while the author treats his subject in a scientific and
thorough way, he shows a conservative temper.

The pathology of the various diseases is given the prominent
place it deserves. In discussing the treatment of chronic catarrhal
otitis media, the operative treatment which exposes the patient to
great risk, and holds out but little hope of betterment, is justly con¬
demned. The chapters treating of mastoid disease and intracranial
complications are especially good. On the whole the book is an
admirable text-book for the student of Otology. That Dr. Bacon’s
Work has been appreciated is shown by the demand for a second
edition in less than two years since the publication of the first.

G. H. M.

5i6 book reviews.

Lessons on the Anatomy, Physiology and Hygiene
of Infancy and Childhood for Junior Students. By

Alfred C. Cotton, A.M.,M.D. Chicago Medical Book Co.,1900.

This little volume (price $1.50) of 174 pages is neatly ex¬
ecuted, with numerous illustrations, many of them from excellent
photographs. #

Throughout the book the author has essayed not so much to
give a treatise on Anatomy, Physiology and Hygiene, but to com¬
pare and emphasize the points of variance as seen in the infant and
adult. To be able to absorb properly the many valuable points
male in anatomy, and to some extent in physiology, the student
must be well trained in the anatomy and physiology of the adult.
To get the full benefit of this work it should be read conjointly
with the larger works on Anatomy and Embryology, and certainly
would aid the student materially in his subsequent clinical work.

In the consideration of the physiology of the body temperature,
many useful hints are given, which influence clinical treatment, and
the general care of the child in many ways. Among them we are
glad to see that the old method ot reducing respiration in the new¬
born by means of the cold plunge bath has been discountenanced
as hurtful; surely there are as useful methods without the same
drain on the vitality of the fender babe. The various foods receive
due attention, and finally the hygiene of later infancy is discussed.
We shall look forward to the more extended work which the author
hints is to come. G. F.

A Practical Treatise on G-enito Urinary and Vener¬
eal Diseases and Syphilis, by Robert W. Taylor, A.
M., M.D., Clinical Professor ofVenereal Diseases at the Col¬
lege of Physicians and Surgeons (Columbia University), New
York ; Surgeon to Bellevue Hospital, and Consulting Surgeon
to City (Charity) Hospital, New York. Second edition
thoroughly revised, with 138 illustrations and 27 plates in
colors and monoline. Lea Brothers & Co., New York and
Philadelphia, 1900.

This volume is one of the most elegant which has this year
been issued by medical publishers. Its entire get-up is most cred¬
itable. Its illustrations are beautifully produced and are so life¬
like that the disease can be recognized by any one of ordinary ex¬
perience, without reference to the foot-note. The author has pro¬
duced undoubtedly an up to-date, practical and compact treatise.
His aim has evidently been to avoid on the one hand tediousness,
and at the same time the disappointing brevity of an epitome. He
has presented a thorough, systematic description of the various
subjects embraced under its title, and it is given in terse and con¬
cise language. The text is not overburdened by describing in de¬
tail as morbid entities, symptoms and conditions which form part
of well-recognized abnormal states. Over-elaboration of rare and
unimportant diseases has been avoided, and there is no needless

BOOK REVIEWS.

517

repetition. The history and description of out-of-date operations,
has evidently been avoided. Subjects are presented as the medical
man encounters them in practical work. In the matter of treatment,
surgical or medical, Dr. Taylor has been conservative and practical
in his direction*, and, while Surgery proper has received full consid¬
eration, he has recognized that its performance is but a part (and
not the one aim) of the subject of general Therapeutics.

The subject of Gonorrhoea, in all its phases, is exhaustively
written upon, and its treatment is full and practical. We are more
than pleased to note that attention is directed to the fallacies, short¬
comings and dangers in some of the views now-a*days advanced for
the treatment of this disease. In fact, as regards some of them, an
emphatic protest is made. No one who was in practice thirty to
forty years ago, after reading this portion of the work, can but feel
that the methods he then followed were deserving of the success
which ensued.

Syphilis, in all its conditions and relations, has been compre¬
hensively considered, and much care has been exercised in the pre¬
sentation of a concise, practical and methodical method of treat¬
ment. F.W.C.

Pathology and Morbid Anatomy. By T. Henry Green,
M.D., F.R.C.P., Physician and Special Lecturer on Clinical
Medicine at Charing Cross Hospital, etc. New (9th) Ameri¬
can from ninth English Edition. Revised and cn a ged by
H. Montague Murray. M.D., F.R.C.P., Lecturer on Patho¬
logy and Morbid Anatomy at Charing Cro-js Hospital ; Re¬
vised for America by Walton M min, Ph.IL, \l.l), of the
College of Physicians and Surgeons, New Vork City. Hand¬
some ocmvo volume or 57S pages, with 4 colored pi ite^ and
339 engravings. Cloth. $3.25 net. Lea Pros. & Co., pub¬
lishers Philadelphia and New York.

In presenting this volume to the profession the Messrs. Lea
make the following statement :

“ When the first edition of “ Green’s Pathology M appeared it
at once became the favorite text-book for medical students, and
since that time it has easily maintained that position both in Eng¬
land and America. The frequent revisions that have been called
for have enabled the author and editois to keep the book fully
abreast of the times, and it is hoped that thus ninth edition will be
found n ore than ever to meet all the wants of the student of
medicine. The English edition has been thoroughly revised by Dr.
H. Montague Murray, who has rewritten nearly half the subject
matter, re-arranged the text, and added several new sections, as well
as no less than one hundred and eighty new illustrations. In order
to adapt the work still more fully to the needs of Americ an saidents
it has been carefully edited by Dr. Walton Martin, who has sup¬
plied complete chapters on Malaria and on the Blood, and has
added a chapter on the preparation and staining of tissues tor
microscopic study.”

This statement adequately describes the work in question,

S*«

BOOK REVIEWS.

which is the ninth edition, and to trace the various issues is to
read the remarkable advance that has been made in Pathology
since the first appeared. Another fact revealed by this quick suc¬
cession of editions is the demand for fresh information and new
ways of presenting accepted views. Students are no longer con¬
tent to read their Pathology from books taken down from their
fathers* shelves.

“ Green’s Pathology ” was a pioneer, and it is pleasant to see
it keeping well up in ihe present and more strenuous race.
Teachers like it, and students like it, so that the new edition is
sure to be popular and useful. The plates and illustrations, of
which there are 343, really do illustrate the text, which, in itself, is
both full and clear.

A. M.

A Text-book upon the Pathogenic Bacteria for Stu¬
dents of Medicine and Physicians. By Joseph Mc¬
Farland, M.D., Professor of Pathology in the Medico-
Chirurgical College, Philadelphia, etc. 1 hird edition. Pub¬
lished by W. B. Saunders & Co., Philadelphia. Price, $3.25.
J. A. Carveth & Co., Toronto, Canadian Agents.

The first edition of this work was published in 1896, the
second two years later, and now the third has rppeared. Three
editions of a book in four years by a publisher who knows the
needs of the maiket prove its acceptance by students who, after
all, are the final judges as to the usefulness of a work. Dr. Mc¬
Farland’s writings have been and are useful in presenting from
time to time a fair and comprehensive view of the work tn which
he is engaged. Comparing the last with the other two editions,
there are evident signs of maturity in the author’s ideas and his
expression of them. The outburst of poetry, for example, by
“Mr. Dryden ” has disappeared, though the lond dedication of
the book remains. In other ways, also, the diction is improved,
chiefly in the direction of simplicity and clarity. The only other
instance, so far as the present reviewer remembers of a work in
Pathology being adorned with versification, is Collins Warren’s
excellent book by the same publisher, and its insertion shows a
very laudable intention.

Dr. McFarland s book has grown from 359 to 621 pages, and,
as a result, many new subjects are treated and old ones receive
more consideration. The most valuable chapters are those deal-
irg in a general way with the deeper problems of Pathology, that
on immunity and pro ceptibility being particularly good. The
book is by no means elementary; indeed, it is decidedly learned
and quite adequate to the needs of both students and physicians.

A. M.

Atlas and Epitome ot Gynecology.— By Oscar Ichaeffer,
pnvat docent of Obstetrics and Gynecology in the University of
Heilelb.:rg. Authorized transla ion from the second revised and
enlarged German edition. Edited by Richard C. Norris, A. M. f
M.D., Surgeon-in-Cha ge, Preston Retreat, Philadelphia; Gyne-

BOOK REVIEWS.

519

cologist to the Methodist Episcopal Hospital and to the Phila¬
delphia Hospital; Consulting Gynecologist to the Southeastern
Dispensary and Hospital for Women and Children ; Lecturer on
Clinical and Operative Obstetrics, Medical Department Univer¬
sity of Pennsylvania, with 207 colored illustrations on 90 plates
and 62 illustrations in the text. Philadelphia, W. B. Saunders &
Company, 1900. Price, $3.50 nett. Canadian Agents : J. A.
Carveth & Co., Toronto.

The value of this <c Atlas” to medical students and to the
general practitioner will be found, not only in the concise explana¬
tory text, but in the illustrations. It occupies a position midway
between the quiz compendand the more pretentious works on gyne¬
cology. The large number of illustrations and colored plates, re¬
producing the appearance of fresh specimens, will give the student an
accurate mental picture and a knowledge of the pathologic changes
induced by disease of the pelvic organs that can not be obtained
from mere description. Next to the study of specimens, which for
evident reasons are not available outside of large clinics, well-
chosen illustrations must be utilized. The “ Atlas” serves that pur¬
pose well. The text is divided into two parts. The continuous
text is written from a practical standpoint; the text of the plates
on the contrary contains the purely theoretic, scientific, anatomic,
microscopic and chemic notes, and facts of general significance
(concerning sounds, pesaries, etc.,) so that, in referring to the work,
the one text will not have a disturbing influence on the other. While
the text is both interesting and instructive, the plates and drawings
are by far the most striking feature of the book. We have hardly
ever seen them equalled, and certainly never excelled, and both
author and publisher deserve the highest praise for having g)ne
to so much trouble and expense as they evidently must have done.
The careful observation of one of these plates will give one abetter
idea of the subject than the reading of many pages of description.
The therapeutic table near the end of the book is a new departure,
and one of great value. Altogether, the book is a remarkable one,
and must be seen to be appreciated.

A. L. S.

Fractures. —By Carl Beck, M.D., Visiting Surgeon to St. Mary’s
Hospital and to the New York German Poliklmek, formerly Pro¬
fessor of Surgery, New York School of Clinical Medicine, Con¬
sulting Surgeon Sheltering Guardian Orphan Asylum, New
York. Octavo, 225 pages, 170 illustrations. VV. B. Saunders
cV Co., Philadelphia. Canadian Agents : J. A. Carveth & Co.,
Toronto, Price $3.50.

The author has dedicated this work to “ William Conrad
Roentgen, without whose work much of this book could not have
been written,” and this statement shows that this volume owes its
existence to the increase in the understanding of fractures, which
has resulted from the frequent use of the X-ray in their diagnosis.

Before Roentgen’s discovery, it was, of course, not possible

520

BOOK REVIEWS.

to make portraits of fractures from life ; the illustrations in the
older works were mainly made from the cadaver, and consequently
the minute arrangement and disarrangement of frag nents and
splinters, especially in their relation to the joints, were necessarily
disarranged by even the most careful dissection*. The Roentgen
ray depicts these details and all others undisturbed, and as they
are in life, and thus leads to clearer understanding and conse¬
quently better treatment of fractures. The author has not at¬
tempted to produce an exhaustive work on fractures, but has dealt
with all the ordinary varieties, which he has fully illustrated with
ordinary cuts and skiagraphs. The skiagrams and most of the
drawings presented in this volume are originals, being taken from
the author’s private and hospital practice, the whole representing
a vast amount of excellent original work. The typography and
illustrations, as well as the quality of the papers, are excellent, and
the publishers are to be complimented on being able to give to the
profession a work of this eminently practical character on a subject
which is brought daily to our notice.

R. C.

Atlas and Eptiome of Diseases Caused by Acoidents.

By Dr. Kd. Golcbiewski, of Berlin. Authoriz 'd translation
from the German. With editorial notes and addi i ms by
Pearce Bailev, M.D., Consulting Neurologist to St. Luke's
Hospital and the Orthopedic Hospital, New York, and to St.
John’s Hospital, Yonker-; Assistant in Neurology, Columbia
University; Author of ‘’Accident and Injury, their Relation
to Diseases ot the Nervous System.” Forty col »rcd plates
and 143 illustrations in black. Philadelphia: W. 1 >. Saunders
N: Co., 1900. Canadian agents : J. A. Carve;h & Co*,
'Lor onto

The b >ok under notice is another of the series of atlases which
Saunders Co. have been publishing during the past c >uple of
years, and this little volume will und mbtedlv prove to be one of
the most interesting and instructive of the series. 'The “ Atlas
and Epitome of Diseases caused by Accidents ** is divided into
two parts, one dealing with injuries in general and the other with
injuries of special parts of the body. The subject with which this
little volume deals is important, only recently having been
recognized and d ait with as a special subject, and is growing in
extent all the time. This book contains much useful information
upon the nature and effects of various form', of accidental injury>
and should prove very useful to both practitioner and student.
Both the translator and the editor have done their work ex¬
cellently. and the colored plates are extremely good. A good
index concludes the volume.

CANADA

MEDICAL RECORD

_ DECEMBER, 1900 _

Original Communications.

ODDS AND ENDS IN ORDINARY PRACTICE.

By A. D- STEVflNS, M.D-, Dunham. Quebec.

A Plea for the Country Doctor.

I can quite understand your anxiety to furnish your
readers each month with a high-class periodical, and that
you have, for the most part, reached the mark there is no
doubt. It is only natural that the desire to attain to a high
standard should possess you, or, if you prefer it, that your
journal should compare favorably with your exchanges or
contemporaries. In the meantime, be kind enough to let
me ask how are slow and unpretentious men like your
humble servant ever to be benefited by the ideal you set up
unless you descend more often to their level—down, I say,
where matters of every-day, all-round professional life in the
country parts are disposed of? We are not anxious for as¬
sistance or instruction in opening the abdominal or cranial
cavities. No one expects or asks us to master these details,
but they do expect us to understand our midwifery and the
management of diseases proper, with always surgery of a cer¬
tain kind thrown in. What we seem to require most of the
ordinary journalist is that light shall be let in upon our work
in such a way that we can use it; we must be always prepar¬
ed to act in emergencies upon our own resources independ¬
ently, and stand or fall by the consequences. For the future,
then, try and remember us; let us have our share of your
pages.

And now, please, do not mind, publish or take seriously
to heart this scolding, for I wish to get down to business as

522

STEVENS: ODDS AND ENDS

soon as possible. Do not send me elsewhere for the kind of
literature I describe, for I am just now out of change and un¬
able to pay for it.

Paralysis Agitans.

In a couple of cases of Paralysis Agitans—one recent,
the other several years ago—nothing appeared to give as
good results as the tincture of Hyoscyamus. It was first sug¬
gested for the purpose of allaying the nervousness both suf¬
fered from, but I have a strong impression that it effected
more than that. Both were males and past the meridian of
life when taken ; both were previously as fine specimens of
our race as you will ever meet in a community of farmers. I
did not try Hyoscamine or Hyoscine, for the simple reason
that I was not aware, at the time, that either the alkaloids
or tincture had been recommended in the disease. But the
end came at last; both are now sleeping with their fathers
after an illness that lasted for years.

A Possible Case of Poisoning.

A gentleman living here has five children ; the youngest
is a year and a half old and the eldest is twelve years of age.
Two were at schools a half a mile apart; two were at home and
the remaining one out driving with the father. The young¬
est one was suddenly seized with vomitingand cardiac depres¬
sion, to be followed almost immediately after by the other
child, who, it wifi be remembered, was at home, and show¬
ing precisely the same symptoms. Next, one of the children
from one of the schools appeared and was suffering exactly
like the other two. Directly after this, the fourth child was
brought home from the other school in a strikingly similar
condition, and, in a few minutes, the father drove in with the
fifth and last child, who was in no way different from the
others.

Just about this time it occurred to me that I had better
examine the ground I was standing on, and on turning to
the parents for light I was informed that the only one sort
of food that all of the children had partaken of was milk.
It seems that the father had, the day before, purchased

IN ORDINARY PRACTICE.

52-J.

two cows, and the whole five had drank of the milk at break¬
fast for the first time.

And now, if it was not the milk that was at the bottom
of the affair, what was it ? It is not necessary to say that I
claim no very great exercise of skill in the treatment. Atl,
however, recovered in a few hours, and whatever anxiety we
experienced soon disappeared.

Hour-Gl\ss Contraction.

Is it not remarkable that I should have been in the
practice of medicine all these years and meet with only
one instance of hour-glass contraction at the internal os
(fully twenty years ago) and one case (a few days since)
of contraction at the middle of the uterus? With the
single exception of ectopic gestation, I fancy I have seen
about everything else that a medical man is expected to con¬
tend with in the practice of midwifery.

The confinement that I wish to describe went on well
enough apparently until the delivery of the placenta was at¬
tempted, when I failed to find it where I expected. As there
was then no reason to suspect that there was anything wrong,

I waited a few minutes for its arrival down near the mouth,
and in the meantime the nurse compressed the womb. How¬
ever, soon after this it became evident that the patient was
flowing badly, and the second attempt was made to reach
the afterbirth, with the result that the uterus was found con¬
tracted in the middle and the placenta well shut up above
the constriction. The next thing to do was to get it out of
its prison or enclosure and control the haemorrhage. With
the hand, or rather fingers, arranged conically, the constric¬
tion was dilated, the placenta detached and delivered, but
not without a little pain and loss of blood on the part of the
patient and the loss of more or less perspiration on the part
of the doctor. This accomplished, and a full dose of ergot
given, a good contraction was secured, and an arrest of the
haemorrhage obtained. The only after-treatment she received
beyond the ordinary consisted in washing out the cavity of
the womb with a mild antiseptic the next day. Her hus¬
band told me yesterday that his wife was all right—as well

524

CAMPBELL: NOTES FROM THE CLINIC.

as ever. Previous to this she had quite easily given birth to
■two children. And here would you mind if I express the
opinion that it is not necessary to insist upon the douche,
or injection, if you prefer the word, after every case of ac¬
couchement ? It seems to me that, if the womb is thorough¬
ly cleansed out and well contracted, nature may be safely
relied upon to do the rest. So far as my memory serves me
rightly, I have never seen a case of auto-infectior: except in
consultation,—that is, in midwifery.

NOTES FROM THE CLINIC

OF

DR. F. W. CAMPBELL,

Montreal General Hospital,

Professor of Medicine University of Bishop's College.

Calomel in doses of i-io of a grain, combined with a
little white sugar, is a very valuable remedy in chronic diar¬
rhea. Calomel is one of the best of gastro intestinal seda¬
tives.

The Bi-Sulphide of Carbon poured on cotton in an
open-mouthed bottle and held against the forehead will, it
is said, promptly relieve nervous headache.

The addition of a small amount of white sugar greatly
increases the solubility of borax.

Wine ofColchicum in doses of five to ten minims is use¬
ful in obstinate sciatica.

Slippery elm, infused in hot water, is excellent in throat
diseases. It is especially valuable in obstinate cases of
ptyalism, met with sometimes' in the pregnant condition.

Obstinate cases of epistaxis are often benefited by hav¬
ing the patient soak the hands and feet in water as hot as
can be borne.

Ergotole for hypodermic injections is preferable to
ergotine. In a recent case of haemorrhage from the bowels in
typhoid fever it acted promptly and well. Two injections
were given of 20 minims.

If during typhoid fever you notice a sudden fall in
temperature, look out for haemorrhage from the bowels. Give

CAMPBELL: NOTES FROM THE CLINIC. 525

a hypodermic of a drachm of ether, and follow it by a hypo¬
dermic injection of ergotole (Sharpe & Dome, of Baltimore,
make it).

A drop of castor oil, it is said, will relieve the irritation
and pain caused by a grain of sand in the eye.

Scarlet fever in colored children is not often seen. In
them the eruption is a rich purple.

A combination of caffeine and digitalis is said to pro¬
duce excellent results in cardiac ]dropsy. The caffeine in¬
creases the diuretic action of the digitalis.

Guaiacol mixed with an equal part of glycerine, applied
-over the seat of pain (neuralgic), or muscular pain, will often
give relief.

The attention of the class is frequently drawn to the
study of the physiognomy of disease. The tuberculous
physiognomy is a common visitor to the Clinic, and is indi¬
cated by marked prominence of the ears, a wedge-shaped
face, large eyes and prominent malar bones. Clubbing of the
nails is almost constantly present. These indications are
often met with before any definite evidence is found in the
chest.

Women with varicose veins often present themselves at
the Clinic, complaining of a tired, aching, hot feeling in the
limbs. This feeling seems aggravated on going to bed, and
the legs are moved about from place to place in the hope of
finding a cool spot and getting relief. Surgical interference
may come to the relief of the patient. Outside of this, very
marked benefit may be obtained by careful bandaging with
a bandage made of fine flannel. These should be worn
night and day, and, if the stockings are worn at night and
the bandages are properly applied, they will not need re¬
newing for several days. A set of four bandages will last at
least six or more months. They require to be damped and
ironed and well rolled, before being applied, after being once
on the legs. Patients very soon learn how to properly apply
a bandage.

During the past spring several severe cases of urticaria or
hives presented themselves at the Clinic. The patients com¬
plained of much acute discomfort, and there was consider-

526 CAMPBELL : NOTES FROM THE CLINIC.

able systemic disturbance. Fortunately, the cases were of
comparatively short duration, and were traceable to some
idiocyncrasy or disturbance of the digestive tract. The
diagnosis, Dr. Campbell said, was comparatively easy, and
can be. assisted by learning that the patient has been indulg¬
ing in some form of shell-fish, or possibly largely of some
common fish. According to the severity of the attack,' the
body will be more or less covered with raised wheels or
blebs—white on the summits and red at the base. The le¬
sions are generally pretty uniform, and closely resemble the
rash caused by the common nettle, “ urtica urens.” As a
rule, the wheels are not more than an inch or so in size, but
occasionally they are several inches, and such cases are call¬
ed “ giant hives.” Still more rarely this may become con¬
fluent and cover the greater part of the body. Such cases,
fortunately, are not common, but when met with the patient
is driven to the verge of insanity, so intense is the itching.
It occasionally comes out on the palms of the hands and the
soles of the feet. Patients so afflicted suffer intensely. In
treating this disease, the cause should be discovered,and, if
possible, removed. Then a good full dose of sulphate of
magnesia ought to be given, with a view of clearing the
alimentary tract. The patient should be immersed in a full
bath of a temperature of 90 ° , in which a pound of Bi-Car¬
bonate of Soda has been dissolved. The immersion should
last about ten minutes, and relief will be obtained in most
cases. If the irritation returns, immerse the patient again.
Subsequently put the patient on either Salicylate of Soda t
fifteen grains every three or four hours, or Liquor Arsenicalis,
two drops every four hours. When the remedies suggested
do not give relief to the patients suffering, some Anodyne
will be required, and none act better than Nepenthe in doses
of twenty drops every four hours till relief is obtained.

Styes are not uncommon at the Clinic. Sometimes they
are large and cause a great deal of discomfort. Sometimes a
patient is met with who says “ he has had a crop ” of them.
Occulists—some, at least—attribute them to eye-strain. Dr,
Campbell says he has had much benefit from bathing the
eyes every two or three hours with warm water, or a lotion

CATON : VALVULAR DISEASE OF THE HEART 527

of warm water containing one drachm of Boric Acid to every
four ounces. Internally he invariably gives a pill of gr. 1-4
of Sulphide of Calcium three titnes a day. After they have
disappeared, he puts the patient on a mixture containing
Compound Tincture of Gentian, Tincture of Nux Vomica and
Hydrochloric Acid, which should be taken for at least a
month.

Selected Articles.

A CLINICAL LECTURE ON THE PREVENTION
OF VALVULAR DISEASE OF THE HEART
IN CASES OF ACUTE RHEUMATISM.

Delivered at the Liverpool Royal Ip firmary.

BY RICHARD CATON, M D., P R C.P.

Physician to the Infirmary.

Gentlemen, —It is your constant experience and mine
day after day on the medical side of this hospital to meet
with cases of organic heart disease. These poor people come
to us suffering from dyspnoea, dropsy and weakness after too
often a severe struggle to accomplish the daily task needfull
for the earning of a livelihood. They have striven hard
against increasing difficulties, until at length Nature can
do no more, and they come to us almost in despair. We
treat them as out-patients, or more frequently take them,
into our wards, and give what temporary help we can.
Nearly always we get the same sad story from them—a bad
attack of rheumatism, 'after which they were never the same
as before ; increasing breathlessness, then swelling of legs
and feet, and inability for hard work. It is a painful expe¬
rience for the doctor, especially when, as so often happens
the patient is young, and his whole life is blasted by this
terrible breakdown of circulation, a breakdown the urgent
symptoms of which we can often alleviate, but the underly¬
ing essential defect of which we can never repair. Under
these ciicumstances it is not wonderful that some of us have
felt the urgent need for efforts to prevent this injury of the
cardiac valves in rheumatism from which so much suffering
and disablement result. No one can deny that the inquiry
is important and is worthy of our best efforts. Nevertheless
it is the fact that the great majority of our profession at pre¬
sent, while treating the rheumatic affection to the best of

528

CATON : VALVULAR DISEASE OF THE

their ability, leave the cardiac risk to fate ; they are deeply
concerned if endocarditis occurs,but believe themselves power
less to prevent or influence it in any way.

Many of you have observed the care with which in my
wards the heart is examined daily in every case of acute
rheumatism, and also that certain rather unusual measures
of treatment are applied. They are employed with the
object of preventing organic valvular disease. I have told
you why I employ these measures ; let me explain to you
the theory on which the measures are founded, and give you
a brief summary of the results which have hitherto been
attained, and, finally, I wish to lay down one or two princi¬
ples which it seems to me we should always keep in mind in
the treatment of these cases :

I. On what theory can we reasonably hope to exert any
influence on the endocardium, to prevent or assuage rheuma¬
tic inflammation, to remove the products of such inflamma¬
tion, and prevent the crippling of the valve ?

In the first place we must stop the rheumatism as rapidly
as possible, and prevent all aggravation of it by chills. We
therefore keep the patient absolutely at rest in bed ; profuse
sweats usually occur, in which there is great danger of chill,

I therefore clothe the patient from head to foot in a warm
flannel garment ; a large stock of these vestments is kept in
my wards expressly for rheumatic cases. Salicylates are given
in full dose, often with alkalies, and cholagogues in such
measure as to cause free evacuations but not diarrhea.
The diet is confined to milk and light farinaceous food ; no
red meat is given for a long time.. The patient is kept in
bed long after all pain and fever are gone, for never forget
that the salicylate treatment, while removing pain and fever
in twenty-four or forty-eight hours, does not remove the rheu¬
matic entity itself (what ever that unknown entity may be)
after less than two or three weeks of steady administration.
The treatment I have thus far mentioned has nothing parti¬
cularly new in it, but if you carry this out with strictness you
will have a low percentage of cardiac complication. Out of
many hundreds of cases, I have only had about 15 per cent,
of cardiac troubles, which is a low average.

But, even if you do all that, you will have some cases of
cardiac trouble, and of course it will often happen that the
mischief in the heart has begun before you see the patient.
What are you to do when you find that the first sound at the
apex isgetting soft, that a bruit has developed which you can
often hear in the axilla,and tnat the second pulmonary sound
has become accentuated in consequence of reflux through the
mitral ? (a) You must keep the patient most stringently at

HEART IN CASES OF ACUTE RHEUMATISM 5 2 9

rest ; no raising the head, no excitement ; he must have the
most perfect physiological repose you can devise. And why ?
In order to give the heart all the rest possible, to make the
intervals between the systoles as long as you can, to keep
down blood pressure as far as is praticable. The endocar¬
dium when inflamed has dilated vessels and effused lymph and
leucocytes in its deep layer. The valve cusps, being thickened
and softened, become unable to withstand the pressure waves
produced by a powerful systole ; it is possible, in fact, that the
regurgitation which occurs, and which alarms us so much, is
in itself a beneficial and a protective arrangement of nature
lessening the pressure on the cusp of the valve. You know
that there are no vessels in the valve cusp itself, but there are
many connective tissue canals ; these are affected by the
inflammatory process,and from them are effused those vegeta¬
tions which project from the inner border of the free margin
of the valve. Well, in order to protect the damaged valve
during its period of infirmity and to give a chance to the
restorative processes of nature to repair the damage done, we
must give the heart a long and complete rest of several
weeks, say five or six at least, (bj Next, is it possible to
give any help to the natural powers in their strife with the
rheumatic dyscrasia in the endocardium ? Can we give Nature
local help against rheumatic ailrnen s anywhere, in the
joints, for example ? Yes we can unquestionably ; by the ap¬
plication of small blisters close to or just above a joint we
can almost with certainty remove rheumatic swelling and
pain. No one who has witnessed the results of the late
Dr. Herbert Davies’ method of treating acute rheumatism
by blisters can doubt this for a moment. How is this relief
afforded by these very small blisters ? I believe it is solely
through their action on the cutaneous nerves and by the re¬
sulting stimulation of the trophic nerves of the affected part ;
that, I believe, is the explanation of the efficacy of every form
of so-called “counter-irritation.” We get a stimulation of
trophic and vasomotor nerves, and in consequence extra nutri¬
tive and reparative activity, and iestoration takes place which
without such aid might not have been accomplished. We see
the same principle exemplified in a most simple and rudimen¬
tary form in the healing of an ulcer ; if nature is making no
progress towards a cure, we stimulate the indolent tissues by
applying such an agent assilver nitrate or some other exci¬
tant, and then healing and cicatrisation begin.

Can we in any way stimulate the trophic and vasomotor
nerves of the heart ? Is there any channel by which we can
reach an organ which seems so peculiarly inaccessible? Yes,
I think there is one way, and only one. Every viscus has

530 CATON: VALVULAR DISEASE OF THE HEART

relations with cutaneous sensory surfaces, as we have learned
from the work of Gaskell, Sherrington, Head, Ross and
other observers; the heart is in special relation with the first
four dorsal intercostal nerves. As those of you who have
been clinical clerks have olten observed, morbid trophic
changes in the heart, such as those involved in angina, degen¬
eration, over-strain, etc., constantly manifest themselves by
referred pains in the region supplied by those nerves. Now
these are afferent nerves. Is it not at least possible that we
can influence the heart by transmitting afferent impulses
along these channels ? If we stimulate these nerves, a portion
of the impulse traverses the cord and reaches the cerebrum
in a sensory form, but, as they are in special relation with
the cardiac plexus, is it not probable that a portion of the
message produces its effect on the heart, not in a sensory
form, but as a stimulus to trophic (unction, as appears to be
the case when we stimulate the nerves adjacent to a joint ?

This is, of course,merely a hypothesis, and an entirely new
hypothesis so far as I am aware, but it does seem to have
much to support it, and as our methods of reaching the heart
were so few, it seemed worth while to make all the use one
could of this one. I have, therefore, for the last fifteen years
applied small blisters, each in size rather larger than a shill¬
ing, in the course of these nerved—that is to say, over the
upper part of the chest, between the clavicle and the nipple
on either side. Only one blister is applied at a time, and
after each a small poultice is placed on the blistered surface.
Practically no pain or discomfort results if the small blistered
surfaces are properly dressed and attended to.

(c) It is important that all inflammatory exudation should
be absorbed and removed from the endocardium and valve
cusps as early as possible. If the effused products remain in
the substance of the valve and organise, probably the cusps
never regain their normal mobility. I have seen a mitral
cusp thickened after endocarditis to fully the extent of one
eighth of an inch. Such a cusp, of course, cannot flap back
in the quickly changing flux and reflux of the blood current
with each systole and diastole. It must necessarily cause
stenosis or regurgitation, or both. We have some drugs
which are believed to influence absorption, and particularly
to attack such effusions into the tissues as are not fully organ¬
ised and foTtified by the ingrowth of nerve filaments and
capillaries. The iodides and mercury are of this order. I
always give one of the iodides, usually sodium iodide, during
the treatment of one of these cases ; and sometimes with
caution amercurial.

2. What has been the result of following this method of

HEART IN CASES OF ACUTE RHEUMATISM.

531

treatment which I have now carried out for fifteen years ?
Let me first tell you what were the results following a mere¬
ly expectant treatment carried on during several previous
years, treating only the rheumatism and leaving the heart to
take care of itself. In a number of my cases which I watched
and followed carefully, the patient went out of hospital with
a bruit , which unhappily was the origin of permanent heart
disease, in almost all cases the mitral being the valve in fault.
It was this succession of ill consequences which caused me to
seek after some better system. After that I experimented
the several methods which had been proposed by old wri¬
ters, but without any encouraging result.

During the last fifteen years I have treated 85 cases of
valvulitis in hospital on the plan above described. Of these,
54 already had signs of cardiac trouble, apparently recent
when they came under my charge. Of these, after being
subjected to the treatment above detailed, 54 left hospital
with apparently sound hearls, while zo had, I fear, valvular
disease. Of course in many of these cases one could not be
sure that the valvular mischief was really of recent occurence.
Thirty-one cases came into hospital with sound hearts (or at
least having no bruit) and valvulitis occured in hospital; they
were treated ab initio. Of these, 27 went out with apparent¬
ly sound hearts, 3 lapsed into permanent disease of the valve,
and 1 remains under treatment. This has been a highly satis
factory result. Some of you have seen certain of these
cases, but rarely more than one or two, because the series has
extended over a period of fifteen years.

After prolonged tieitment the bruit is found to become
soft and to be heard with increasing difficulty; it then becomes
variable ; sometimes heard and sometimes not. A time comes
when it is heard when the patient is recumbent, but dis¬
appears when he sits up : at length it disappears altogether
and the accentuatfon of the second pulmonary sound also
vanishes. But even after this satisfactory point has been
reached, rest and care are required for a time. Many such a
case have we watched in these wards. Whenever practicable,
we keep the patient under observation for months or years
after, and, provided no fresh rheumatic attack occurs, he
usually does well.

3. Let me now briefly sum up the principles which in
my judgment shouid regulate our treatment of acute en¬
docarditis : (1) The chief importance of rheumatism consists
in the cardiac risks involved. The complaint itself is rarely
fatal, and, since the discovery of the utility of the salicy¬
lates, it involves a greatly lessened amount of pain and
suffering. Its great seriousness consists in the fact that it

532' CATON: VALVULAR DISEASE OF THE HEART.

may, and very often does, cripple the heart for life, leaving
the patient incapacitated for much of the enjoyment and for
all the physical activity which were his birthright, not to
speak of the sufferiing and the brevity of such life as remains.
If there are any means by which there is even a hope of this
great calamity being averted, surely we ought to give it a
trial. (2) My own experience has convinced me that in the
great majority of cases this calamity can be averted, but
only at the cost of a prolonged rest, which in itself is more
irksome to the patient than the other details of treatment
which accompany it. If, however, the patient is told, in such
a manner as not to alarm or distress him, what are the issues
involved, he is usually quite willing to give himself a fair
chance of recovery. So far as I can judge, the treatment is
more efficacious if begun early ; if delayed beyond a certain
time, it is of no use, at any rate, in the case of adults. In
childhood it has seemed to me that the restorative power is
greater. I have seen a few cases of restoration of a damaged
heart when no treatment but rest was adopted, and even
one or two in the absence of a sufficient amount of rest,
but my experience tells me these cases are few. Among
children rheumatism is not infrequently devoid of pain. A
sore throat, a li:tie fever, some aching in limbs, perhaps a
few largish spots on the skin, may be all that indicates
an attack of rheumatism which, if unobserved, may leave
the heart crippled. I advise you to examine the heart
carefully in all such cases. Lastly, two brief cautions: If
your patient’s heart after rheumatic endocarditis appears
to have become normal under treatment, warn him to avoid
active or violent exertion for two or three months, and
also to take every precaution against another attack of
rheumatism. If that recurs within three months, the heart
is almost certain to be again involved.

THE TREATMENT OF THE BREASTS AND
NIPPLES DURING PREGNANCY AND
THE PUERPERIUM.

By

GEORGE L. BRODHBAD. M. D..

Professor of Obstetrics. New York Post-Graduate Melical School and Hospital: In¬
structor in Obstetrics in the University and Bellevue Hospital Medical College :
Assistant Attending Physician to the Mothers’ and Babies’ Hospital; Fellow of
the New York Obstetrical Society, etc.

With reference to the treatment of the breasts and
nipples during pregnancy, there is little in my opinion to be
said. In most cases the breasts and nipples do well with
no preparatory treatment whatsoever beyond the usual

BRCDHEAD : TREATMENT OF THE BREASTS. 533

precautions for cleanliness. In other cases, in spite of the
most careful preliminary measures, there will be no end of
trouble, especially with the nipples. As a rule, the breasts
require no treatment, but where the nipples are tender, or
small and undeveloped, much good can be accomplished by
proper care, especially during the last few months of preg¬
nancy. In all cases the breasts and nipples should be bathed
each day with warm water and castile soap. If the nipples
are prominent, and not tender, this will be sufficient. If
tender, a small quantity of albolene can be applied each
night upon retiring, the ointment being placed upon a
small piece of sterile gauze. Where the nipples are small,
flat or only slightly protruding, the woman should, with
perfectly clean fingers, draw them out by careful manipula¬
tion for a period of fifteen minutes each day of the eight
weeks immediately preceding the time of confinement. For
this purpose a lubricant, such as albolene, is to be used.
The nipples can in some cases be made eminently suitable
for nursing, where without the use of manipulation it would
be impossible for the child to take hold. It seems to me
that our purpose in the case of the nipples should be, not to
harden them, thus making them more liable to crack, but on
the contrary tokeep them soft and pliable, in which condi¬
tion cracking iscertainly less likely to occur.

Taking up, now, the consideration of the breasts and
nipples during the puerperium, it will be best to commence
with the treatment of the nipples, for the reason that, if pro¬
per care be given them, serious trouble in the breasts will be
of comparatively rare occurrence. The most direct and
most common source of infection in the breasts is through
imperfect or careless treatment of the nipples. It is my firm
conviction that if the nipples are kept absolutely clean
there will be no infection in the breasts themselves. The
most essential element then in successful treatment of the
breasts and nipples is that of strict attention to the detai s
of surgical cleanliness. The nipples themselves, the child’s
mouth, the applications and the fingers of the nurse must all
be kept as nearly sterile as is practicable. The child’s
mouth and nipples are to be washed both before and after
each nursing with a saturated solution of boric acid made in
sterile water. Gauze and albolene that are used for the nip¬
ples must be sterile, and the fingers of the nur.-e or attendant
must be clean as well. The patient should not be allowed
to touch the nipples at all, and she should be instructed that
trouble as a rule takes its origin from dirt coming in contact
with the nipple. In the intervals between nursing the nip¬
ples are kept covered with albolene on small squares of ster-

534

BRODHEAD : TREATMENT OF THE BREASTS.

ile gauze. ‘There is no other treatment which in my expe¬
rience equals that just described, and, if carefully carried out,
no fear need be felt of abscess of the breast. The plan as
outlined was first tried by me some years ago, when Resident
Physician of the Sloane Maternity Hospital, with such suc¬
cess in a large number of cases that I have used the same
method in pr vate practice ever since. If the nipples become
cracked or eroded, there is no treatment comparable to that
of the application of ten per cent, nitrate of silver solution.
After each nursing, when the nipple has been bathed with
the boric acid solution, the crack or erosion it carefully and
and gently exposed with the clean fingers of one hand,
while with the other the silver solution is applied to the raw
surface by means of the cotton.wrapped end of a match or
tooth-pick. Just enough solution is used to coat the raw
surface of the crack with its albuminous covering, after
which the excess of silver is removed with dry cotton and
the albolene applied as usual. After several applications
have been made the cracks usually heal. If the lesions are
large and the nipples very tender, it is advisable to use a
nip°ple shield, at least until marked improvement has taken
place. In using the silver solution great care should be used
not to apply it in such amount that the entire nipple is
blackened and made ugly looking. It is of no use anywhere
except in the crack in the nipple, and with care its applica¬
tion can be confined to that portion alone. Breast cases for
treatment may be divided into two classes, the first class
being comprised of those women who do not nurse and the
second of those who do. For various reasons many
women either never nurse or nurse for a variable time, then
give it up. But in any case where the breasts are not to be
used for nursing, the treatment should be as follows : a tight
breast binder should be applied immediately after nursing
has ceased (or in case of still-birth, on the second day after
labor), the nipples being protected by small pieces of sterile
gauze! Cotton should be placed in the axillae, around and
between the breasts, and the binder applied as firmly as the
patient can bear it with any degree of comfort. When once
the binder has been evenly and carefully put in place, it
should not again be removed, except for purposes of cleanli¬
ness, until the breasts are soft and painless. If the binder
becomes loose it should, of course, be tightened ; unless there
is good reason for changing the binder, it is much better to
leave it in place for the reason that the breasts are often
very tender and painful, and manipulation tends to increase
h e discomfort. The binder should be applied to the breasts
ici th: patient lying in the horizontal position, for the

BRODHEAD: TREATMENT OF THE BREASTS. 535

reason that in that position the breasts are the more easily
held in place, well up on the front of the chest. In many
cases the tight binder alone will be sufficient to accomplish
the end desired, the milk drying up quickly and with little or
no discomfort. In other cases it will be necessary to limit
the amount of fluids taken in cder to reduce the distention
in that way. . In all cases where the breasts become caked
and tender it is a good plan to administer large doses of salts,
the Rochelle being the most pleasant, and as efficacious as
any. Salts may be given in plain water, or preferably in
Vichy, a half ounce every hour until the bowels have been
freely evacuated. The large watery movements will relieve
the distention to a great degree, and in the vast majority of
cases these measures (binder, limited amounts of fluid and
Rochelle salts) will prove successful. There are a few cases
where it may be necessary to give small doses of morphine or
codeine to relieve the pain, but the treatment as outlined will
be found satisfactory in most of the cases. I have relied
upon the plan to the entire exclusion of massage, the use of
the breast pump, hot fomentations and belladonna ointment.
When the binder has been nicely applied it is less painful to
leave it in position than to remove it, and resort to the other
measures just mentioned for the relief of distention.

In the second class of cases we have to deal with nursing
women. In many of our patients nothing more will be
necessary than to support the breasts upon the front of the
chest during the intervals between nursing, by means of a
binder applied in such a way that the breasts are merely held
in position, no pressure being made upon them. If the
breasts are over-distended, pressure may be used, but, where
the milk supply is only moderate, pressure should be avoided
for fear of decreasing the amount of milk. The breasts in
all women should be supported in some way to prevent the
caking which is often the result of a pendulous position. If
there is pain and tenderness, the breasts shou'd be carefully
massaged by the nurse with clean hands about once every
four hours, or less often as occasion may demand. The object of
such massage, where caking exists, is not to remove a large
quantity of milk from the breast, but to distribute the milk
equally throughout the gland. Where the pressure is even
throughout there will be little pain, and the supply will soon
be regulated to a large extent by the demands made by the
child. Fluids should be taken in such cases in limited
amounts in order to prevent further distention. Great care
should also be taken in such cases to see that the infan
nurses well, for when nursing is properly established troubl
will usually come to an end. Again, much good can b

536 BR0D1IEAD : TREATMENT OF THE BREASTS.

accomplished in cases of over-distended breasts by the use of
repeated doses of Rochelle salts, a tablespoonful in a glass of
Vichy every hour until the bowels are freely evacuated. The
breast pump creates to my mind an artificial demand, and
with its use a longer time is required to establish a proper
balance between supply and demand. Where, on the other
hand, milk is desired for the purpose of feeding a premature
infant, or one for any reason too weak to nurse, a breast
pump carefully cleaned and properly used is of the greatest
possible advantage. Where the milk supply is deficient,
massage should be used three or four times each day—large
quantities x>f rich milk, eggs, butter and cream taken and
some form of malt extract administered there times a day.

A moderate rise of temperature may accompany dis¬
tention and pain in the breasts, but as a rule the pulse does
not become accelerated to a degree corresponding to the rise
of temperature. Where the pulse and temperature suddenly
rise to a marked degree, infection is, as a rule, to be strongly
suspected, and to those cases, on careful palpation, a painful
indurated area may be found in the breast. Where every
possible precaution is taken to keep the nipples and breasts
absolutely clean, abscess of the breast is exceedingly rare.
In a service of several thousand cases at the Sloane Mater¬
nity Hospital, there were but few in which abscess was
threatened and but three cases in which operation was per¬
formed for the relief of such a condition. Even where
infection has taken place and we have a painful indurated
area in the breast with increased pulse rate, rise of tempera¬
ture and perhaps a chill, the inflammatory process can be
checked and a cure brought about in many of the cases
by prompt, energetic, careful treatment. In these cases I
believe massage to be of the greatest value, for by that means
the pus, which is at first located in the ducts themselves the
process not having extended into the connecting tissue
surrounding them) can be slowly and carefully removed in
part at least and wiped away from the nipple as it appears there
with as terile wipe. Massage should beat first made lightly,
then gradually with more pressure, the aim being to bring
the pus from the gland to the nipple, there to be sponged
away. The pain is oftentimes very great, but the patient
generally prefers to have it done rather than run the risk of
having an operation performed. Massage should be used
once every four hours, and during the intervals an ice bag
should be constantly applied to the painful area, the breast
being held up in proper position with a breast binder. Here
again large doses of salts are of great value, and for great
pain small doses of codein are of service. If pps is present

BIGGS: EXTREME CASE OF BLOOD CURED. 537

the child should discontinue nursing, but, if not, nursing
should continue. I have repeatedly seen recovery follow
this plan of treatment, in one case inflammation having
occurred in both breasts. One point must be emphasized,
and that is, treatment must be commenced immediately
upon the appearance of suspicious symptoms and kept up
continuously until all danger has passed. I know of no
greater satisfaction than to save a woman from operation in
case of abscess of the breast by careful systematic treatment.
Where treatment fails, the area of inflammation increases and
the skin becomes reddened, there is, of course, the necessity
of free incision, curettage and the usual treatment for abscess
in any other part of the body. The incision should be in a
line radiating from the nipple so as to cut as few ducts as
possible, and should be extensive enough to open up all
the pockets which may exist in the inflamed area. After
hemorrhage has been checked by packing the wound with
iodoform gauze, a wet one per cent, carbolic acid dressing is
applied. On the following day the wound should be lightly
packed with a strip of wet carbolic gauze (one per cent.) and
the wet dressing changed each day until the wound is ready
for a dry dressing. Breasts treated in this way heal in the
course of several weeks, and in subsequent puerperiums
nursing may go on in a natural way unless too much of the
glandular tissue has been destroyed by the inflammatory
process.

TYPHLITIS: EXTREME CASE OF BLOOD

CURED.

By T J. BIGGS, M.D., Stamford, Conn.

Henry S., aged 39; American; admitted June 2nd,
1900. Diagnosis: Typhlitis.

The patient had been suffering for a week prior to en¬
tering the hospital. It appeared that his condition began
with pain and tenderness in the right iliac fossa, and along
the ascending colon. An examination at the time of his
entering the hospital revealed a slight prominence in this
region. At first the bowels had been constipated, but now
small liquid stools occurred every two or three hours. This
was due to accumulation of the hardened faeces in the sac¬
culated periphery of the caecum. He also suffered with
much local pain and tenderness. Temperature was 103^ ;
he was very restless and had occasional attacks of vomiting,
and almost constant nausea. The vomited matter at first con¬
tained the contents of the stomach, but in 24 hours the con-

53 $ BIGGS: EXTREME CASE OF BLOOD CURED.

tents of the duodenum contained a great deal of bilious mat¬
ter. He was suffering from great depression of the vital
powers. Peritonitis had developed on the right side.

The patient was put to bed, placed on a strict bovinine
<Jiet, a tablespoonful in milk being given every two hours.
He was also given a thorough rectal purge, followed by
small doses of morphine to control the pain.

For the first 24 hours he retained the bovinine nicely,
but on the afternoon of the third he vomited everything,
even water. The quantity of the bovinine was now reduced
to twenty drops in a little iced grape juice every hour. The
bowels were cleaned out, first by injecting a pint of olive
oil, then later a soap suds and glycerine enema. This was
followed by a large evacuation.

On the 5th the patient could not retain anything by
stomach, so it was decided to treat him per rectum. Conse¬
quently, he was given three times a day a high rectal feed¬
ing, cqnsisting of four ounces of bovinine, four ounces of
milk and an ounce of lime water. These were retained, and
the patient began to show improvement.

On the 10th the pain and tenderness in the right iliac
fossa had almost subsided, the fever had dropped down to
100 1-5, bowels were moving normally. The bovinine was
now resumed per stomach, half a teaspoonful every hour in
lime water, and the rectal feedings employed twice in
twenty-four hours.

On the 16th the temperature was normal, pain and
tenderness over the right iliac fossa had entirely disappeared,
patient not nervous, and the stomach retained the bovinine
feedings without any inconvenience. The rectal alimenta¬
tion was now discontinued, and bovinine ordered, a table¬
spoonful every two hours in a little peptonized milk and
lime water.

On the 20th the patient was up and about, complained
of no pain, bowels regular, all soreness and swelling had dis¬
appeared from the abdomen, and his strength was excellent
The bovinine was now ordered, a wineglassful every three
hours in peptonized milk.

On the 26th he was allowed a light general diet, and
the bovinine was given three times a day. On the 28th he
was discharged cured.

This case, prior to coming into the hospital, had been
under treatment by two competent surgeons, and they both
advised immediate operation. Consequently, I deem this to
be a remarkable case, and one of much clinical interest to
the ptofession at large.

Progress of Medical Science,

MEDICINE AND NEUROLOGY

IN CHARGE OP

J. BRADFORD McCONNELL. M.D.

Amociate Professor of Medicine and Neurology, and Professor of Clinical Medicine
University of Bishop’s College; Physician Western Hospital.

THE PREVENTION OF TUBERCULOSIS.

The Tuberculosis Commission of Munich (.Philadelphia
Med. Jour., March 24) has formulated regulations for the
prevention of tuberculosis :—

“ 1. The periodic disinfection of all localities much fre¬
quented by the public, especially rooms in which irtany in¬
dividuals congregate, such as schools, society rooms, churches,
cafes, restaurants, hotels, orphanages, barracks, libraries, con¬
vents, hospitals, dispensaries, stores, tramways, railroad cars
and cabs.

“ 2. The prohibition of spitting on floors in rooms and
public conveyances ; the placing of cuspidors in parks and
other public places and in vehicles of transportation.

“ 3. The establishment of special play-grounds for chil¬
dren, in order to avoid their playing in localities which phthi¬
sical patients might visit.

“ 4. The disinfection and whitewashing of rooms where
a case of phthisis or a death from that disease has occurred.

“ 5 - The annual medical inspection of persons frequent¬
ing schools, academies, offices, factories, etc. Any cases found
should be reported to the authorities.

“ 6. The establishment of people’s sanatoriums.

“ 7. The hygienic instruction of the tuberculous, so that
they may be able to protect themselves and those coming in
contact with them.

“ 8. The isolation of the phthisical cases in military
and general hospitals ; if possible, the erection of separate
pavilions.

“ 9. The prohibition of the bathing of the tuberculous
with healthy persons; the establishment of separate bath
houses for the former, under medical supervision.

“ 10. The removal of all tuberculous individuals from
the schools, and their transfer to colonies in the country,
where they may be treated.

“ 11. The formation of committees with the object of
sending the children of poor persons who are suffering with

540

PROGRESS OF MEDICAL SCIENCE.

tuberculosis, or who have died of that disease, into the coun¬
try in order to remove them from the infected homes. The
children of rich families should also be removed from their
homes fora certain length of time.

“ 12. The improvement of the hygienic and dietetic con¬
ditions of the poorer classes by the erection of public kit¬
chens, wayfarers’ lodges, bath houses, etc.

“ 13. Philanthropists should make it their object to im¬
prove the nutrition and hygiene of individuals in poor fami¬
lies in which tuberculosis has occurred.

“ 14. The linen of tuberculous persons must be disinfected
before being brought into contact with the linen of others.

“ 15. The marriage of very young persons whose ap¬
pearance suggests that they are inclined to tuberculosis
should be opposed. Persons in whose sputum bacilli are pre¬
sent should be prohibited from marrying.

“ 16 The compulsory periodic examination of domestic
animals which might become tuberculous.

“ 17. The monthly inspection of stables ; supervision of
the hygiene of the kitchen, of milking and milk vessels ;
scrupulous care in creameries.

“ 18. The supervision of markets and abattoirs.

“ 19. The erection of stations at the borders of coun¬
tries for the inspection of imported animals.

“ 20. Strict regulations regarding the products of fac¬
tories.

“ 21. The giving of weekly lessons in hygiene at public
schools.

“ 22. Each child at school must have its own drinking
cup and its own towel.

“ 23. Instructions to second-hand dealers in books,
clothing, etc., to have their wares disinfected. Disinfection
of library books, as well as of objects that serve for school or
general use, must also be performed at certain intervals.”—
Modern Medicine.

RATIONAL TREATMENT OF NEURASTHENIA.

Dr. Frederick A. McGrew (Journal of the American
Medical Association , June 9, 1900) classifies his cases of neu¬
rasthenia under three heads: (1) development neurasthenia;
(2) overstimulation neurasthenia; and (3) developmental
plus overstimulation neurasthenia. The developmental neu¬
rasthenic needs such exercise (not rest) as shall tend harmon¬
iously to develop and strengthen every part of the physical
organization, change of diet and surroundings, combined
with stimulating and eliminative hydrotherapeutic measures

MEDICINE AND NEUROLOGY.

541

and massage. The overstimulation neurasthenic will be best
benefited by complete rest. Dieting, general massage com¬
bined with passive movements, special abdoihinal massage,
fomentations along the spine and over the stomach and liver,
saline sponging and general faradism are measures promot¬
ing the elimination of fatigue and waste products and in¬
creasing the general muscular and arterial tone. In a neu¬
rasthenia in which the developmental and overstimulation
elements are both concerned, it is a delicate matter to deter¬
mine how much is due to insufficient nervous vitality and
how much to the abuse of what vitality there is. For the pur¬
pose of treatment an approximate estimate must be made,
and a course plotted accordingly.— New York Medical
Journal.

THE INFLUENZA HEART.

Saundby (“ The Influenza Heart,’’ Birmingham Medical
Review , November, 1898) divides the cardiac troubles of in¬
fluenza into functional and organic. The functional troubles
are alterations in the rate and rhythm of the heart’s action,
more often of the nature of bradycardia, less often of tachy¬
cardia. Those of an organic nature are cardiac dilatation,
with indications of insufficiency of the left ventricle. The
treatment Dr. Saundby finds most valuable in functional
cases is rest, careful attention to diet and the functions of the
stomach and intestines, with small doses of iron, arsenic, and
in some cases, when there is persistent rapid action of the
pulse, digitalis. When the heart is dilated, in addition to the
above measures, Dr. Saundby desires to urge very earnestly
the supreme utility of the Schott or Nauheim treatment. After
four years’experience of this system, he is convinced that for
cases of simple dilatation of the heart no other treatment can
approach it in value.

Bunch (“On some cardiac affections due to influenza,”
Treatment, February 8, 1900) for the influenza heart
advises rest for a large portion of the day, and Oertel’s or the
Schott treatment when there is cardiac dilatation. Of drugs
he finds strychnine very useful in curing arhythmia, and for
relieving precordial discomfort and the sense of anxiety and
sleeplessness, there is nothing so valuable as morphia.

Abee (“ Favorable results of compression of the cardiac
region in patients with organic lesions of the heart,” La
Semaine Medical , 31st January, 1900), noticing that the sub¬
jects of organic disease of the heart often are relieved by
pressing with their hands over the cardiac region, has tried
the effect of pressure by the aid of a thick pad on the im-

542 PROGRESS OF MEDICAL SCIENCE.

provement of certain troublesome cardiac symptoms, which
resist all other methods of treatment, fje tried this in 29
patients, of ages varying from 30 to 45 years, suffering from
valvular lesions, aneurism of the aorta, arterial sclerosis with
myocarditis, and Graves’ disease, with cardiac hypertrophy.
In all these cases, and especially in those with cardioptosis,
wearing the pressure pad has wonderfully improved the
dyspnceic and painful phenomena, and made it easier for the
patients to sleep .—Medical Chronicle.

THE CHEMICAL DIAGNOSIS OF GASTRIC
DISEASES.

Vaughan Harley think? that chemical methods in the
diagnosis of gastric affections have been greatly neglected
in England, although the stomach tube and an analysis of
the gastric contents are frequently indispensable. The only
contra-indication is recent haematemesis. Since the stomach
reacts differently to different stimuli, standard meals must be
employed. In analyzing the contents Ewald’s, which con¬
sists of two cups of weak tea and two slices of dry toast
taken an hour before the contents of the stomach are remov¬
ed, gives the best results. For the investigation of the
motor power of the stomach Leube’s meal, consisting of

lb. of freshly-minced meat and a little bread taken while
fasting, is the most satisfactory. Four, five to seven hours
afterwards the tube is passed, and any remains of the meal
are noted. Normally there should be no residue after five
or six hours. When there is increased gastric irritability,
and consequently increased mobility, the stomach may be
empty between the third and fourth hour, but with lessened
motility a residue may be found even sixteen hours after
the meal without any pyloric stenosis. The motor power
may also be investigated by giving salol and testing the
urine every ten minutes with perchloride of iron until a red
color appears. This occurs normally tn about one hour,
but in a case of deficient motility may be delayed for
four or five hours. It is an obviously inconvenient
method. Alter having analyzed the contents and tested
the motor power, the size and position of the sto¬
mach should be determined by percussion after dis¬
tending it with gas, either by blowing down a stomach
tube or by giving half a drachm of tartaric acid and
followed directly by the same quantity of bicarbonate of
sodium. This is preferable to the other numerous methods,
including gastrodiaphany. 1. The total acidity and the
free HC1 are increased in gastric ulcer, digestion being usual¬
ly quicker than normal. 2. Acid dyspepsia may be divided

MEDICINE AND NEUROLOGY.

543

into cases where (a) the excess of acid is due to HC 1
(hyperchlorhydria), and (b) where it is due to increase of the
volatile acids. These latter cases are those which benefit
the most by bismuth and sodium carbonate taken some time
after meals. On the other hand, in hyperchlorhydria, unless
the cause is removed by dieting (plain food with no pepper,
mustard, or spices, and but little table salt), bismuth and
prussjc acid mask the symptoms while fermentation increa¬
ses and at once dilatation supervenes. Hyperchlorhydria is
usually accompanied by increased motor power; its chief
symptom is pain, coming on three or four hours after food,
and relieved at once by taking more, (c) Another form of
hyperacidity is gastro-succorrhoea, where, though fasting, the
stomach may contain a considerable amount. It is generally
due to worry, and may be intermittent or constant. 3. In
malignant disease a deficiency or absence of free HC 1 may
help the diagnosis in a doubtful case, though there may be
a complete absence of it in other conditions also, such as
neurotic dyspepsia. Mucus and lactic acid are increased.

4. All cases of gastric trouble, usually described as function¬
al, rtovv come under the head of neurotic dyspepsia. In
this HCl is absent or diminished, the volatile acids are
increased, often enormously, the digestive power is delayed
or totally absent, the motility is diminished, dilatation is usu¬
ally and gastroptosis nearly always present. In an uncom¬
plicated case mucus is not increased. The ordinary signs of
neurasthenia, though commonly, are not always present.
Analysis in these cases is of the utmost importance ; for in¬
stance, in one of the author’s cases a diagnosis of gastro-
succorrhoea would have been made from the symptoms, but
in reality HCl was entirely absent. Treatment is largely
hygienic. Internal faradism is most useful, though Weir
Mitchell’s treatment also is essential in bad cases. NaCl
should be withheld as much as possible. The diet should
be dry, and liquids taken only as hot water an hour before
or three hours after meals, the chief of which should be in
the middle of the day. Of drugs strychnine and arsenic are
the most useful, though opium is occasionally necessary.
When HCl is deficient sodium bicarbonate may be given an
hour before meals. Regulation of the bowels is a necessity.

5. Since the introduction of the stomach tube most cases of
what used to be called gastric catarrh are now placed among
the neuroses. Genuine gastric catarrh almost always
depends on some irritant, such as alcohol, tobacco or spices.
The gastric contents resemble those fouud in ordinary neu-
retic dyspepsia, though mucus is always present, generally
in excess.— Practitioner.

-544

PROGRESS OF MEDICAL SCIENCE.

CONTINUOUS USE OF DIGITALIS IN
HEART TROUBLES.

J. Groedel, in the Practitiotier for April, 1900, says that
cardiac insufficiency is an inevitable result of advancing
heart changes. Compensation is established in most cases
of valvular disease and may last for months or years, but if
the patient lives there is sure to come a time in which heart
failure is more or less pronounced. In these cases he recom¬
mends continual administration of digitalis, and advises
that we should not wait until signs of want of compensation
develop, such as dropsy, anemia and tachycardia. He
recommends that the digitalis be given in doses of from
eight to ten grains once each week. At such wide intervals
the drug has no cumulative effect, but during its administra¬
tion the quantity of urine should be carefully determined,
and if it is not augmented the drug should be withdrawn.
In the great majority of cases the digitalis is well borne by
the patient, and the charge which is made that the drug
causes a loss of strength and increases the weakness of the
patient is unfounded, these changes occurring as a result of
the disease for which the drug is given, and not of the drug
itself. He is convinced that where fatty degeneration is
markedly benefited by digitalis there is sometimes a subjec¬
tive cure of these cases.— Gaillard's Medical Journal.

1

HOT AIR IN CHRONIC RHEUMATISM.

T. L. Satterthwaite recently read a paper before the
New York Academy of Medicine on this subject, an abstract
of which appears in the Medical News of April 14, 1900. He
says that the application of superheated air was originally
suggested in Medicine by Turkish .baths, A patient in a
simple warm chamber rebreathes the products of his own
respiration. In a Turkish bath the temperature cannot be
raised above 170° F. ; in the hot air, parts of the body can
be subjected to a temperature of 400°. The main idea in
the apparatus so far devised for giving the hot-air treat¬
ment has been to keep the skin dry while the air is heated
all around the limb or part of the body that is to be subject¬
ed to the high temperature. For this purpose, when the
temperature to be borne is not very high, the part is simply
covered with a Turkish towel. When temperatures above
300 0 F. are to be employed, the part must be carefully wrap¬
ped and no spaces allowed to exist between the cloth and
the skin; otherwise the perspiration at these points will
become so heated’ as to scald the patient. Machines
properly constructed should be so lined with asbestos that

MEDICINE AND NEUROLOGY.

545

the patient may not come in contact with the heated metal.
Glycosuria is not a contraindication for the hot-air bath, but
in anemia, fatty degeneration and arterial sclerosis it may
be dangerous. The rise of pulse and temperature, and a
certain tendency to increase of blood-pressure, would seem
to make it unadvisable to use it in such cases.

When a limb is subjected to hot-air treatment, there is
first a lessening and then an increase in the circulation of
the skin, with the injection of the peripheral capillaries and
a sense of warmth. The pulse gradually rises until it is
from ten to twenty-five beats higher than it was when the
treatment began. There is a rise of temperature of from
one to five degrees. There is usually an increase of respira¬
tion up to twenty-two or twenty-four per minute. A gene¬
ral sense of comfort comes over the patient and continues as
long as the treatment is doing good. After a time, which is
variable in different patients, a nervous depression super¬
venes, which should not be allowed to continue. As a rule,
the treatment should stop just short of this, and then it will
have its maximum effect.— Gaillard's Medical Journal.

THE RATIONAL TREATMENT OF
PNEUMONIA.

SIR Hermann Weber, in a recent article in the Prac¬
titioner , gives some interesting summaries respecting the
results of different methods of treatment pursued in Bonn
and in London in the treatment of pneumonia. The mor¬
tality is higher in Bonn than in London, being from four¬
teen to seventeen per cent, while in London the death rate
is twelve to fourteen per cent. The remedies recommended
are blood abstraction and tartar emetic, opium and salicy¬
late of sodium. One would not expect to see a very great
difference in the results, whichever one of these remedies
might be employed.

It is very strange indeed that the profession is so slow to
lay hold erf the powerful therapeutic means offered by hydro¬
therapy for combatting this disease. It has been shown
again and again by statistics of undoubted reliability that
the mortality in pneumonia may be reduced to four or five
per cent, by the judicious use of hydriatic measures. The
cooling compress (applied at 6o°, changed every fifteen to for¬
ty minutes), the prolonged neutral bath (88°-34°). and espe¬
cially wet-sheet packing prolonged to the sweating stage, have
been shown to be therapeutic measures of the highest value
in the treatment of this grave malady.

The writer had a good opportunity to observe the value o

546

PROGRESS OF MEDICAL' SCIENCE.

the hydriatic method of treating this disease a few months
ago on the occasion of a visit to Old Mexico. While spend¬
ing a short time at the Guadalajara Sanitarium, Guadalajara,
Old Mexico, we were asked to visit a Mexican gentleman
who had been sick with pneumonia for one week. He had
employed six physicians, and had finally been given up to
die. We found the patient extremely low,—pulse 146,
respiration 44, temperature iootf°. The patient was so
feeble that he could barely whisper, his lips were blue, and
the skin cyanotic. Shortly after we first saw the patient he
became so wildly delirious that four men were required to
hold him in bed. He had had no sleep whatever for
several days.

Vigorous hydriatic treatments were at once employed.
The means consisted chiefly in a short fomentation to the
chest every three or four hours, followed by the heating
compress at 6o° and changed every twenty minutes. Cold
mitten friction (for description, see Modern Medicine for
May) and the cold towel rub administered every two to
three hours. The wet-sheet pack was applied and contin¬
ued until evidence of perspiration appeared. The patient fell
asleep during the second application of the pack, and awoke
with his mind clear. At the end of three days convales¬
cence was established, and the patient made an excellent
recovery. It is interesting to note that so eminent an
authority as Sir Samuel Wilkes ( Practitioner , February,
1900) condemns the employment of digitalis, asserting that
it will not lessen the pulse except when given in injurious
doses. He also condemns blisters on the chest, and speaks
disparagingly of the use of cold, but evidently because it has
not been properly used. Continuous cold to the chest is not
to be recommended in pneumonia, but intermittent cold
applications, such as tjie cold compress applied at 6o° and
allowed to remain from fifteen to forty minutes, or a
sufficient length of time to become warmed by the body
heat, are exceedingly valuable. By this means the tenden¬
cy to stasis in the pulmonary vessels is antagonized, and
leucocytosis is encouraged. With each application of cold
the blood vessels are contracted, and the lung is, so to speak,
squeezed, and the blood vessels are emptied of their contents.
As the compress warms, the blood vessels of the lungs
relax, and new blood flows in, bringing with it a fresh supply
of leucocytes. By this means a continuous procession of
fresh leucocytes is supplied to the lungs, passive congestion
is antagonized, the vital resistance of the tissues is increased,
the temperature is lowered, the heart action is sustained, and
the healing powers of the body are thus aided in the restori-

MEDICINE AND NEUROLOGY.

547

tion of the patient. Insomnia, cerebral congestion, delirium
and elevation of temperature are easily combatted by
means of the wet-sheet pack. In cases of hyperpyrexia a
cooling pack may be employed. In this the wet-sheet is re¬
newed several times, the duration being lengthened each
time. The first sheet is changed at the end of eight or ten
minutes, the second at fifteen minutes, the third after twen¬
ty minutes. The patient is allowed to remain in the fourth
sheet until reaction is complete and perspiration is encourag¬
ed, although the pack should not be continued longer than
from one to two hours, even if perspiration does not appear.
The pack is especially valuable in cases of this sort, for the
reason that it congests and stimulates the skin, thus reliev¬
ing both the pulmonary and cerebral congestion.

Hydrotherapy certainly affords the most rational measures
for the treatment of pneumonia. With the extension of
the practical knowledge of hydriatic methods, the mortal¬
ity may be reduced to one third or even one fourth the
present rate .—Modern Medicine.

THE EHRLICH DIAZO REACTION.

By Dr. J. B. ABN BILL.

Am. Jour. Mtd. Sc., Post Gmduotc.

The author states that if the diazo test is applied in a
routine way, and alone depended upon for the diagnosis of
typhoid fever, the vast majority of the cases can be correctly
diagnosticated. The crucial part of the test, he says, is the
production of a pink foam after the characteristic red ring.

The Ehrlich diazo-reaction is a color reaction, and de¬
pends upon the production of dyes by the chemical union of
suitable organic substances with a diazo compound. In
carrying out this test two solutions are required, which are
termed respectively Solutions I and II.

Reagent.

f Sulphanilic acid.

• I

Solution I.

... < Hydrochloric acid.

. 50

( Distilled water, ad....

.. IOOO

Solution II.

f Sodium nitrite.

\ Distilled water, ad.

• 0.5

.100.0

To fifty parts of Solution I. add one part of Solution
II. and shake. To a few c.c. of this mixture, and an equal
quantity of urine, add a quantity of ammonia equal to about
one-eighth of the combined volume of the mixed urine and
solution, letting it run down the side of the test tube*

548

PROGRESS OF MEDICAL SCIENCE.

At the point of contact of the ammonia and the mixture,
colored rings of various tints form, ranging from light
yellow, through dark yellow, orange and brown, to eosin or
garnet, depending upon the urine. The formation of a red
zone is an indispensable part of the true Ehrlich diazo re¬
action. It is also essential that, on shaking, the foam takes on
a pink color. Th : s color varies considerably in its intensity,
depending upon the strength of the reaction, from the palest
rose to the deepest pink, but must not be any other color , such
as salmon, orange, etc. A third part of the reaction, which
the author disregards, consists in the separation of a greenish-
black or violet-black precipitate, which forms a layer on the
surface of the light-colored sediment when the tube has been
allowed to stand for 24 hours.

If the mixture of Solutions I. and II. is not used imme¬
diately it should be placed in a dark bottle and kept as cool
as possible. The^urine likewise should be as fresh as possible.

The cause of the reaction is not known. It has been
attributed to diacetic acid and to acetone. In polyuria the
reaction may disappear, but on concentration of the urine the
test becomes positive. Various materials, such as bilirubin,
urobilin and carbol, interfere with the reaction somewhat,
but can be removed by sugar of lead or animal charcoal.

The author uses 40 parts of Solution I. instead of 50,
and no attention is paid to the green precipitates.

The author gives a table, comprising the results obtained
in 405 cases, representing eighteen different diseases in
which it is seen that the diazo reaction is practically limited
to one acute and one chronic disease, namely, typhoid fever
and tuberculosis. Out of 81 positive reactions, 19 were in
typhoid fever and 42 in tuberculosis.

The question often arises, does the intensity or duration
of the reaction correspond with the severity or length of the
fever ? The author answers in the affirmative as to the dur¬
ation of the reaction. If a patient with the clinical symptoms
of typhoid fever comes under observation toward the end
of the second week of the disease and diazo is absent, the
chances are that the infection is on the decline and a mild
course is to be prognosticated. If, on the other hand, the
diazo continues and increases in intensity, the case is liable
to be prolonged and more serious.

To illustrate the constancy with which this reaction is
present in typhoid fever, the author gives the statistics of
different investigators. In his own series it was present in
19 out of 22 cases. Hewetson found it in 136 out of 196
cases. The combined cases of Ehrlich, Spiethoff, Brecht,
Brewing, Paterson, Jez and Nissen number 178, of which

MEDICINE AND NEUROLOGV.

549

174 gave the reaction. Rivier has collected 536, of which
520 gave the reaction. Gerhardt says that in his clinic during
a period of five years only one bona fide case of typhoid fever,
which was proved post mortem, failed to give the diazo
reaction. Zinn found the reaction in 75 per cent, of cases.
Clement found it in 135 of 156 cases. Greene obtained a
positive result in 28 of 29 cases. Friedenwald found it in
20 of 21 cases, and Dawson in 44 of 85 cases.

Out of a total of 82 cases of tuberculosis observed by the
author, the reaction was shown in 42. In cases of pulmonary
tuberculosis in which the diazo reaction is found continuously
for some days, the author believes, with Michaelis, that grave
prognosis should be made. Furthermore, he states that all
such cases of tuberculosis may be considered in the third
stage of the disease. According to Clemens, on an average
between 20 and 30 per cent, of consumptives give the re¬
action. The prognostic value of the reaction in this disease
can be gathered from the fact that in 100 of Clemens’ fatal
cases 87 of them gave the test. Michaelis states that the
great majority of consumptives who show a marked diazo re¬
action for several days die within half a year. In 88 cases,
which he collected since 1896, 63 gave a positive, 25 a nega¬
tive reaction. Of the 63 diazo cases, 50 died in the hospital,
5 left unimproved, 2 were transferred and 6 improved. Of
the 25 cases without diazo, 20 improved, 1 left cured, 2 died
and 2 did not improve.

In measles, statistics show the reaction to be very con¬
stant. Combining the statistics of Brewing, Brecht, Fischer,
Nissen, Rivier and Clemens, we have 96 cases, in which the
reaction was positive in 86.

In deciding upon the clinical value of Ehrlich’s diazo
reaction, says the author in conclusion, we can fairly discard
the work of all investigators who have not performed the
test in accordance with the directions laid down by Ehrlich
or who have not considered the pink foam as the important
factor in the test.

FECAL IMPACTION.

The diagnosis of retained feces is really a very simple mat¬
ter, and it is, on account of its simplicity, very often neglected
by the practitioner, whose prevailing fault is to shoot with
raised sights, and oftener overshoots the mark than other¬
wise. The color of the daily evacuation is a very good in¬
dex. Black or very dark green stools indicate that the feces
are ancient. Feces that pass promptly through on time are
of a light yellow color. Offensive odor is a certain sign of

55o

PROGKESS OF MEDICAL SCIENCE.

decomposing feces in the bowel. Normal excreta do not smell
offensive, and are nearly odorless. A foul, fetid breath is an
almost certain indication, and is often erroneously referred to
other conditions. But, above all these, a physical examina¬
tion is so simple and so satisfactory that we need never be
mistaken. Place the patient on his back with the knees
well brought up; place one hand on the abdomen below
the tenth or eleventh cartilage, with the fingers of the other
hand in the posterior hypochondriac region. Either the
ascending or descending colon can then be pressed forward
against the hand on the abdomen. Keep this hand firm
and immovable and there will be no difficulty whatever
in detecting any accumulation. Percussion sounds are often
unreliable, owing to accumulations of gas, which give a
resonance where dullness should indicate impaction ; but
conjoined manipulation is quickly practiced and completely
satisfactory in all cases except extremely obese patients, and
in these the rectal tube will soon tell the tale .—Medical
Era.

NEURALGIC PAIN.

I noted, somewhere, that a writer recommended for the
spasmodic contractions of the uterus, during some cases of
childbirth, ten or twelve drops of guaiacol rubbed gently
over the uterus ; it quieted the pains, rendering them more
steady and lasting. I thought that, if it eased such neuralgic
pain, it might also ease facial neuralgia, and tried it in a case
of ciliary neuralgia—five or ten drops were gently stroked
into the skin and the relief was immediate. I tried it in
several cases of muscular pain with same results. In one
case, a negro woman, who had suffered all night from pain
in the neck resembling torticollis, went to sleep in less than
five minutes. I would have reported it sooner, but thought
everybody knew it. Wet the finger from mouth of vial and
gently rub it into the skin; that is all, and the pain stops.
It is, as Dr. Burgess says, “ wonderful ” how quickly it
eases pain. Do not rub it in hard on delicate skin, as it
sometimes causes a little smarting—D r. Brodnax. — Sum¬
mary.

CHOREA.

S. D. Hopkins, in the Journal of the American Medical
Association , reports on the treatment of nineteen cases of
chorea. He has obtained the best results with antipyrin, which
is given according to the method of Dr. Eskridge. The drug
is given in increasing doses, the initial dose being as many

SURGERY.

551

grains as the child has years, and increased 1 grain a day. In
mild cases the antipyrin is given in the evening, but if severe
it is given three times a day. In the mildest cases the patient
is allowed to sit up part of the day, but in severe cases
absolute rest in bed is enjoined. Antipyrin is not given if
there is fever, or if the heart is weak. As soon as the cho¬
real movements cease, or become greatly diminished in
severity, the antypyrin is stopped and small doses of arsenic
and iron are ordered.— Pediatrics.

SURGERY.

IN CHARGB OP

ROLLO CAMPBELL, M.D.,

Lecturer on Surgery, University of Bishop’s College ; Assistant-Surgeon, Western Hospital ;

AND

GEORGE FISK, M D.

Instructor inJSurgery, University of Bishop’s College ; Assistant-Surgeon, Western Hospital*

SPINAL COCAINE ANESTHESIA.

J. B. Murphy, in the Chicago Clinic for September,
19CO, calls attention to the fact that cocaine injection in the
subarachnoid space of the spinal canal was first administered
by J. L. Corning, but of late it has been exploited and its
practicability demonstrated by Tuffier. The writer claims
that in this new method of anesthesia we have one that is
easy of application and by it all tissues are rendered analgesic
below the diaphragm. The sense of touch is not impaired,
the reflexes are absent, and the consciousness of the patient
is retained. Tuffier has had an extensive experience with
the method, and reports no untoward results. The article
reproduces the communication of Tuffier, which appeared in
La Setnaine Medicale of May 16, 1900.

The operative technique as described by Tuffier is as
follows : The patient is in a sitting posture, both arms car¬
ried forward. The fluid is thoroughly ascepticized and the
iliac crests located. An imaginary line connecting these two
crests passes through the second lumbar vertebra. The
medullary canal is easily penetrated at this point. As soon
as this is located the patient bends forward, which causes a
separation of about 1.5 centimeters between the vertebrae.
The needle is inserted to the right of the spinous processes
about one centimeter from the middle line.

552

PROGRESS Of MEDICAL SCIENCE.

As soon as the needle enters the subarachnoid space
cerebro-spinal fluid escapes drop by drop, which' is an indica¬
tion that the needle is in proper position. The cocaine solu¬
tion should not be injected until the spinal fluid is observed
to flow out. About one cubic centimeter of a two-per-cent,
solution is injected slowly, the whole quantity being introduc¬
ed in about one minute. The total quantity of cocaine should
not exceed fifteen milligrammes. In from four to eight
minutes the patients complain of a tingling sensation and
numbness of the feet. At this time operation may begin.
In from four to ten minutes after the injection, analgesia is
usually complete. Most frequently it extends to the thorax,
and occasionally as high as the axilla. The author has em¬
ployed this method of anesthesia in nine cases; one was for
an operation for a pyosalpinx ; two operations for varicose
ulcers, one an amputation of an ulcerated and painful stump,
one for tumor of the ovary, one for strangulated hernia, one
for suppurative epididymitis, one for arthrectomy of the left
knee-joint, and an appendectomy. In several of the cases there
was nausea and vomiting, but in none were there untoward
symptoms.— Medicine.

INGROWING TOE-NAIL.

For that very painful affection, ingrowing toe-nail, the
following treatment is very strongly recommended by Dr.
Kinsman in the Columbus Medical journal.

1. Remove all pressure from nail by cutting away a
piece of the shoe.

2. Disinfect with hydrogen dioxide until no more
“ foam ” appears-

3. Apply a drop of strong solution of cocaine in the
base of the ulcer.

4. Apply a drop of Monsell’s solution to the ulcer, then
cover loosely with gauze. Repeat this process every second
day until the edge of the nail is released by the retraction of
the hypertrophied tissue. The patient suffers no pain from
the application, and all pain has disappeared the second day.
The cure is effected in a week or two without inconvenience
or interference with business.

A NOTE OF THE SAFEST METHOD OF
REMOVAL OF THE APPENDIX.

A. A. Warden advocates Doyen’s method, which he
describes as follows : The little mesentery of the appendix
is first ligatured with a small silk ligature to free the appen-

THERAPEUTIC NOTES.

553

dix laterally. Then (i) the base of the appendix is gently
crushed with Doyen’s small clamp. Almost any forceps
suffices for this purpose if strong enough and broad enough
completely to occlude the appendix for a breadth of, say, a
quarter of an inch ; (2) a fine silk ligature is thrown round
the base of the appendix in the furrow left by the clamp; (3)
the appendix is then removed by the thermo-cautery cutting
close to the ligature; (4) a purse suture is then made in the
serous covering of the caecum close round the base of the
appendix (as this purse-stitch is drawn tight the little stump
is invaginated so that all is completely closed); (5) for safety,
a second fine silk purse-stitch is made and the little pucker
of the first stitch is similarly invaginated and the ligature is
gently tightened. The result technically is perfect, and cer¬
tainly this is the most aseptic method of removing the appen¬
dix.— Lancet , N. Y. Med. Rec.

Therapeutic Notes.

Chronic Urethritis.

Sulph. hydrastiae.20 grains.

Listerine . 1 ounce.

Solution of morphine (Magendie’s)....5 drachms.

Aquae, q.s. ad.8 ounces.

M. Sig.: Inject three or four times daily, and retain in
urethra three to five minutes.

Salicylate of Methyl in Painful Erections.

Dr. Baratier, of Jaugory, describes a method which he
used with success in three patients suffering from gonorrhoea
attended by extremely painful nocturnal erections. He pre¬
scribed baths and large doses of Vichy water. Inunctions of
the penis were made for several minutes with :—

R Salicylate of methyl.15 grains.

Liquid vaselin.drachms.

The penis was enveloped in a light layer of absorbent
cotton, kept in place by a bandage of gummed taffeta.

The inunction soon diminished the pain and seemed to
reduce the force of the erection. In other respects the gon¬
orrhoea followed its usual course .—(La Tribune Abdicate)

554

THERAPEUTIC NOTES.

Perspiration of Hands.

R Sodii boratis,

Ac. salicyli, of each.6 drachms.

Ac. boric.80 grains.

Glycerini,

Spiritus dil., of each. 3 ounces.

M. Sig.: External use. To be applied with friction
three times a day.

Impetigo of Face and Scalp in Nursing Infants'

R Ac. salicylici. 15 grains.

Bismuthi subnitrat.5 drachms.

Pulv. amyli.,.. drachms.

Ungt. rosae.i X A ounces.

M. Sig.: External use.

If the impetigo is of the dry, squamous variety, use the
ointment by inunction, frequently repeated. If moist, apply
a thick coat of the ointment on gauze. Pruritus and conges¬
tion will rapidly diminish while the new, healthy epidermis
forms under the ointment-crust. (Kistler Medical News.)

ENTERALGIA.

11 Spiritus ammoniac aromatici...,.t ounce.

Spiritus chloroformi.I ounce.

Spiritus camphorae. 2 drachms.

Tincturae hyoscyami.4 drachms.

Ext. cannabis Indicae fluidi.i drachm.

Tincturae cardamom comp., q.s. ad...6 ounces.

M. Sig.: Two teaspoonfuls in water every hour or two
until pain is allayed.— {journal of the American Medical
Association .)

Fatty Heart.

Dr. A. Robin recommends the following :—

R Sodii arsenatis.1-64 grain.

Potassii iodidi.grain.

Pulv. nucis vomicae. }A grain.

Pulv. rhei... .# grain.

Ext. dulcamara.1 grains.

M. et ft. pil. No. j.

Sig.: One pill daily .—(Journal of the American Medical
Association .)

Migraine.

Hirtz states that 4 grains each of caffeine and sodium
benzoate often act very well, repeating the dose, if need be,
every two hours until four doses have been taken. Graeme
Hammond recommends 1 1 / 2 grains each of methylene-blue
and powdered nutmeg in capsule four times a day.

THERAPEUTIC NOTES.

555

Irritating Cough of Phthisis.

When not accompanied by much expectoration, the
following mixture is recommended —

B Codeinae. 4 grains.

Acidi hydrochlorici dil.drachm.

Spiritus chloroformi.1 drachms.

Syrupi limonis.I ounce.

Aqum destil., q.s. ad.4ounces.

M. et ft. emulsio.

Sig.: One teaspoonful at short intervals when cough is
troublesome.— {Murrell.)

Brittle Nails.

An ointment of 60 grains of oleate of tin to 1 ounce of
ointment of rose-water is an elegant and efficient application
to the finger-nails when brittle or marked with spots and
ridges.

Intestinal Fermentation with Constipation.

R Ext. aloes,

Pulveris rhei, of each.6 grains-

Benzosol. .9 grains.

Ext. hyoscyami.6 grains.

M. et ft. caps. No. 12.

Sig.: One after meals .—{Stuckey )

Inflamed Rheumatic Joints.
Osier recommends:—

B Sodii carbonaiis.6 drachms.

Tinct. opii. 1 ounce.

Glycerini.2 ounces.

Aq. 9 ounces.

M. Sig.: Saturate hot cloths with the lotion and apply
to the parts .—(Pennsylvania Medical Journal.)

An.-emia with Dysmenorrhcea.

Anaemia, with constipation and painful or difficult
menstruation (dysmenorrhoea):—

R Ferratini. 2 drachms

Rad. rhei pulv.4 drachms.

Sodii bicarb.2 drachms.

01. foeniculi.30 drops.

M. Sig.: Take a teaspoonful at night, in a wafer or dry
in the mouth, and wash down with a draught of water.—
{Medical Fortnightly .)

Jottings

NOSE BREATHINGTHE CITADEL TO PHYSICAL
AND MENTAL HEALTH.

When an organ of the human body is not used as nature
intended that it should be, it becomes useless and too often
diseased. 1 believe that atrophied and hypertrophied con¬
ditions of the nasal passages are intensified because we use
our mouths to breathe through instead of the nose. The
long moist nasal passage intercepts dust, germs and various
impurities. The air is fairly alive with floating dust and
bacteria, as often seen in streaks of sunshine, and at the
same time, the air is warmed and tempered for the lungs.
But when the breathing is through the mouth, the dust is
■carried right into the delicate cells, and trouble ultimately
follows. The unfortunates who inhale and exhale the
breath through the mouth have but little lung power, and
easily become victims of disease because 'they are not
using the physical machinery given them for that purpose.
By not breathing properly, the lower cells in the lungs are
unaired and unswept year after year. Is it any wonder
human beings so neglectful become anemic and consumptive.
The lungs can be termed the engine of the body, and must
be kept in good order; and this good order is only to be
maintained by full, deep and regular inhalations through the
nose. Few persons who use the nose appreciate the fact that
they are less liable to various diseases than those who have
allowed the nose to become closed. Few persons, too, under¬
stand how beneficial a simple breathing exercise is. Ten
minutes of steady and deep breathing right down to the
abdomen will, in many cases, cure nervousness and irrita¬
bility. It sends newly vitalized blood to every part of the
body. Consumptives can increase their chest measurements
by daily exercises of this kind, and add years to their lives.
Semi-invalids can paint roses in their cheeks by taking
regular and systematic inhalations of fresh, pure air, but the
breathing should be through the nose, and, if the nasal
passages are closed because of disease, the growths therein
must be removed and nature given a chance. Another
thing that proper breathing will do, and that is to allay a
cough. Nothing more irritates a cough than coughing, and
much of it can be obviated by right breathing. When there
is a tickling in the throat draw in a full breath through the

JOTTINGS.

557

nose, and hold it in until it reaches and warms and soothes
every air cell. It is said that the nitrogen liberated and
confined in the cells acts as a sedative to the irritated mem¬
branes, and in some manner controls the desire to cough.
Whatever the philosophy is, there is no doubt that a person
can help cure a cough by'regular and full breathing to the
extent of expanding the lungs, “expansion” without politi¬
cal significance, and holding the breath in until every cell
gets its full share of new air. And in closing let me impress
upon all the importance of full breathing and of keeping the
nose open and using it as nature intended. The unused nose
is as prone to abnormal and sometimes dangerous growths
as the spark is to fly upward ; therefore let us keep our noses
open and clean.—O. W. Archibald, M.D., in Northwestern
Lancet.

LINSEED MEAL POULTICE.

Warm a basin, pour in boiling water; sprinkle in the
meal, stirring vigorously, till it becomes of the consistency
of thick porridge; spread on tow or old linen, turning in the
edges all around ; before applying put it against one’s cheek
to feel that it is not too hot. Retain in position with abroad
flannel roller, secured with safety-pins. Renew every four
hours or oftener. The poultice should not exceed half an
inch in thickness. Caution : s necessary in poulticing the
chest of infants 'n order not to overload the chest and tire
out the respiratory muscles.--Ashby & Wright, Pediatrics.

CURING A BOIL.

A writer in the Peoria Medical Journal describes his
method of treating boils. To render the procedure painless
a few drops of cocaine are introduced into the tissue and
cavity of the boil, using a very fine needle, which is at first
allowed to rest with its point upon the inflamed surface with
merely the weight of the syringe to gradually force it be¬
neath the skin. If there is a drop of cocaine on the point of
the needle it will soon prepare the way for the further and
more forcible introduction without pain, and then the cavity
is made the recipient of enough to completely anesthetize its
surrounding tissue. When that is accomplished a little larger
needle is readily introduced and several drops of ninety-five
percent, carbolic acid pressed tightly into the cavity. Ab¬
solute sterilization is invariably secured, and with absolutely
no suffering to the patient whatever. A felon may be treated
in the same way.

55^ JOTTINGS.

RESIDUAL URINE IN ENLARGED PROSTATE.

Residual urine in cases of enlarged prostate is due at
first, according to A. G. Miller (Scottish Med.-and Surg.
Jour.) to neglect to empty the bladder. Accumulation is
due to this becoming a habit.

The writer’s advice is : After passing water in the usual
way the patient should wait a minute or two and then try
again. Practice this as fiequently as possible, till only a very
small quantity can be squeezed out (one drachm) ; when that
point has been reached, twice or thrice daily. This acts in
two ways : First, the small residuum of urine that may re¬
sult from a careless act of micturition is pot rid of. In the
second place, the bladder tone is improved, and its function
restored. It might be added that the habit of completely
emptying the bladder is acquired. A still more important
result is that the residual urine being diminished cannot
possibly increase. Obsta principiis is a good working prin¬
ciple.

“I do not,” says the writer, “bring this forward as a
cure, or as a means of preventing residual urine frofm forming
in every case of enlarged prostate. I merely suggest a safe
and simple procedure which has apparently checked the in¬
crease of residual urine in several cases, and which may in
some others at least postpone the almost inevitable cathe¬
ter.”

IMPORTANT TIPS.

1. The value of small doses of tincture of aconite
frequently repeated in the treatment of amygdalitis and in
the initial stage of febrile diseases.

2. The value of painting the chest and back with liquor
iodi fortis—diluted if necessary with an equal quantity of the
tincture—in all cases attended with cough.

3. The value of a pill of exsiccated ferrous sulphate in
conjunction with the administration of purgatives in the
treatment of anemia.

4. The value of grain doses of gray powder with an
equal quantity of Dover’s powder from three to six times a
day in the treatment of syphilis.

5. The value of large doses of the iodides in the treat¬
ment of tertiary syphilis.

6. The value of large doses of bromide of potassium in
the treatment of the “ heats and flushes ” and other symptoms
from which women 'suffer about the time of the menopause.

7. The value of large doses of quinine in the treatment

JOTTINGS. 559

of supraorbital neuralgia, and in the periodical febrile dis¬
turbances from which old malarial patients suffer.

8. The value of small doses of, a saturated solution of
camphor in alcohol in the treatment of autumnal or choleraic
diarrhoea.

9. The value of small doses of perchloride of mercury
in the treatment of infantile diarrhoea when the stools are
green, slimy and offensive.

10. The value of sulphide of calcium in doses of a tenth
of a grain in the treatment of boils, carbuncles and abcesses.

11. The value ot nitro-glycerine and nitrite of amyl in
the treatment of angina pectoric and allied conditions.

12. The value of alcohol in the treatment of fevers.

13. The value of flying blisters in typhoidal conditions.
—William Murrell in Medical Record. — St. Louis Med. and
Snrg. Jour.

Tired Feet.

The Doctor's Magazine recommends a hot foot-bath
with an ounce of salt as very restful. Rapid relief from
fatigue is also obtained by plunging the feet in ice-cold water,
keeping them immersed until a sensation of warmth is ex¬
perienced. Alcohol, in the form of spirit-baths, is a good
tonic for the feet.

Persistent Vomiting.

Mitchell has used cold water in the treatment of per¬
sistent vomiting with much success. He applies to the
epigastrium towels wrung out of ice-water, which are changed
every minute until the vomiting ceases. The treatment will
be successful usually in fifteen or twenty minutes, and may
then be discontinued, to be resumed if necessary. By these
simple measures he has succeeded in stopping dangerous
vomiting in a large number of instances—after childbirth, for
example, when medicines and other external applications
have failed to give relief. ( Virginia Medical Journal, April

14, 1 8990

Guaiacol Ointment.

Guaiacol applied locally seems to be a safe and efficient
remedy in relieving the pain of arthritis deformans, acute
articular or muscular rheumatism, sciatica, orchitis and epi¬
didymitis. One part of guaiacol to 10 or 15 parts of vaselin
or lanolin should be applied to the painful parts. {New
England Medical Monthly .)

JOTTINGS.

560

Acute Bronchitis.

According to the Indian Medical Record , the most painful
period in acute or subacute bronchitis is at the onset, when
the expectoration is absent and the cough very severe.
According to Dr. F. Edgeworth, of Bristol, caffeine, espe¬
cially when associated with an alkali, facilitates the expulsion
of the sputum and shortens the stage. He employs every
three or four hours a dose of from 15 to 25 grains of citrate
or acetate of potassium, and in addition at bed-time 5 grains
of caffeine. Administered in this way he finds that caffeine
quickly overcomes the spasm of the bronchial muscles, which
checks the expulsion of the sputum and thus relieves the
patient.

ICHTHYOL IN THE TREATMENT OF FISSURE OF THE ANUS.

Conitzer obtained most satisfactory results in the treat¬
ment of anal fissures with ichthyol. The fissure is first anaes¬
thetized with cocaine, and pure ichthyol is applied with a bit
of cotton on a glass rod. For subsequent applications, which
are made every other day, anaesthesia is generally unneces¬
sary. Cicatrization is usually very rapid, and stretching of
the sphincter is not necessary. The bowels must be kept
free. ( New York Medical Journal.)

Scarlatinal Desquamation.

Williams says that the process can be shortened by three
or more days by means of regular inunctions all over the
body (except the scalp) with a mixture of 1 part glycerin and
9 parts of 15-volume hydrogen peroxide acidulated with 1
per cent, of hydrochloric acid. ( Medical News.)

Incontinence of Urine.

According to the Buffalo Medical Journal lycopodium
has been used with success for this affection in children.
Twenty drops of the tincture should be given three times a
day, and this dose may be increased to 40 or 50 drops. It is,
in some cases, more efficient than belladonna. (Nnv York
Medical Journal.)

An Itching Ear.

Alexander D. Stirling writes to the Laryngoscope that
itching of the auditory meatus is often due to irritation aris¬
ing near the pharyngeal mouth of the Eustachian tube, and
transferred to the ear. It follows that treatment, to have a
permanently good effect, must be directed to the pharynx as
well as the ear.

THE

Canada Medical Record

PUBLISHED MONTHLY.

Subscription Price , $c.co per annum in advance . Single
Copies, io cents.

Make all Cheques or P.O. Money Orders for subscription, or advertising, payable to
JOHN LOVELL & SON, 23 St. Nicholas Street, Montreal, to whom all business cornmu*
ideations should be addressed.

All communications for the Journal, hooks for review, and exchanges, should DO
addressed to the Editor, Box 2174, Post Oftica Montreal.

Editorial.

UNNECESSARY DEATH.

It is a common saying that it is the unexpected which
is constantly occurring. How often do we hear of the
death of some one well known in the community whose
death is a surprise—a surprise because of its suddenness, and
the individual unknown to have and did not have that form
of cardiac disease where sudden death was to be expected.
We have for several years felt that some of these sudden or
comparatively sudden deaths might be called unnecessary
deaths. We call them unnecessary, because on the onset of
the symptoms the proper treatment was not carried out.
This was because medical men could not be had before the
condition was practically beyond their power. To the
public we must look for that early treatment which might
possibly avert the fatal issue. Two cases in point occur to
us at the moment. A few years ago a very prominent
gentleman in Montreal was ill with pneumonia. In this
disease, as is well known, the cardiac muscle is very
apt to undergo fatty degeneration, and perhaps in it, more
than any other, death from the much-abused term of
heart failure is apt to occur. We all know how carefully
and gradually we allow convalescents from pneumonia
assume the erect position with a view of avoiding this

562

EDITORIAL.

occurrence. The gentleman referred to was doing exceed¬
ingly well, and a speedy convalescence was looked for.
On the sixth or seventh night of his illness, findiug the
nurse asleep, he arose from his bed and walked a few paces
to a table where his medicine was, and took it. The noise
of his movements awoke the nurse, who at once assisted
him towards his bed. Before reaching it he fainted, and in
a few moments was dead. The second case which occurs
to us was that of a fairly well-known gentleman, but who
was generally known among his friends as being far from
robust. He was taking his mid-day meal at a cafe when he
was seen to sway backwards and forwards. Several rushed
to his assistance, and he complained of being dizzy and
weak. A dose of brandy was given and a carriage obtained,
in which he was driven to his residence, nearly a mile dis¬
tant. He reached it alive, but was in a semi-conscious
condition, and never rallied, dying in a very short time.
These are only a sample of not a few cases which have
occurred in Montreal within the last twenty years. In these •
two cases there can be no question but that anemia of the
brain was the condition present, and that the logical treat¬
ment was to have as speedily as possible placed the patients
in the recumbent posture—nay—lowered the head and
elevated the feet. Medical men know well how essential such
early—in fact immediate—treatment is necessary in threat¬
ened death. Fortunately, in a somewhat extended practice
in the administration of anesthetics, we have been spared
the occurrence of a fatal issue. In one case, however, where
apparently there was sudden paralysis of the heart, indicated
by cessation of the pulse, and death was indeed imminent,
complete inversion of the patient relieved that condition of
the brain—anemia—which, it is admitted, is apt to occur in
profound anesthesia. In such cases as we have referred to,
if the positions we have named did not promptly give
favourable results, we would not hesitate, and those promptly
on the scene should not hesitate to invert the patient. In¬
terest in cases of sudden death, due to the causes we have
referred to. has, within a short time, been revived by a paper
from Dr. Paulesco, of the Physiological Laboratory of Sar-
bonne, which appears in a late number of the Journal de

PERSONAL.

563

Medicine Interne. By experimental research he proves that
sudden death is very apt to occur where a condition of anemia
of the brain is intensified by the brusque assumption of the
erect posture. Dr. Paulesco points out as an interesting fact
that the respiratory activity which in these cases is the first
to come to a standstill is, under certain conditions, temporarily
intensified by the cerebral anemia consequent on assuming
the upright posture. The logical deduction from these re¬
marks is that the public should know that, under any condi
tion where faintness is a prominent symptom, death is
imminent if the patient is kept in the erect or semi-erect
position, and that, till medical assistance arrives, it is the best
practice to place the person on the back. Were this
generally known, we believe we would have fewer cases of
what we think we not misaptly have called “Unnecessary
Death.”

PERSONAL.

Dr. S. E. Tabb, of Sherbrooke, died on tbe 6th of November
after an illness of about six months. He was a graduate of Mc¬
Gill University, and for a short time practiced in Montreal, sub¬
sequently removing to Sherbrooke. On the formation of the Medical
Faculty of Bishop’s College he accepted the chair of Botany,
which he filled till he left the city.

Dr. Frederick A. Hopkins, of Montreal, was killed at St.
Henri, near Montreal, on the 1st of December by being struck by
an express train. So far as can be gathered from a medical friend
who was with him, he boarded a local train for Montreal, when his
friend lost sight of him. He had originally intended returning to
the city by an electric car, and, it is believed, seeing one approach¬
ing, he jumped from the car on which he was, landing just in front
of a passing train, the engine of which struck him, killing him in¬
stantly. He graduated from McGill University in 1892, and began
practice at Cookshire, where his family resided. About four years
ago he removed to Montreal and began practice, and we believe
was rapidly surrounding himself with a large circle of patients. He
was an Assistant Sutgeon to the Samaritan Free Hospital for
Women. He was of a somewhat retiring disposition, but among
those who knew him well he was highly thought of, and, if his life
had been spared, we have no doubt he would have made his mark
among his professional brethren. He was married about two
years ago, and leaves a wife and one child.

Surgeon-Major C. W.' Wilson, of Montreal, who went to South
Africa as one of the medical officers of the 2nd (service) Bat-

£64

BOOK REVIEWS.

talion of the Royal Canadian Regiment, returned with that portion
which sailed direct from Capetown to Halifax. He is looking
peculiarly “ fit,” as indeed has every one who has returned Irom
South Africa.

Dr. Wolf.ed Nelson (C.M., M.D., of Bishop’s and McGill,
1873) was in Montreal on the 8th of November to attend the
Annual Dinner of the students and graduates of Bishop’s College
Medical Faculty. He returned to New York next day.

Dr. Maishall, of Huntingdon (M.D., of Bishop’s, 1879), anc ^
Dr.de Monilpied, of Hemmingford (M.D. % Bishop’s, 1881), came
to Montreal to attend the Annual Dinner of students and graduates
of Bishop’s Faculty of Medicine on the 8th of November, held at
the Place Viger hotel.

Dr. R. E. Leprohon (M.D., Bishop’s, 1879), is practicing at
St. Henri, one of the suburbs of Montreal.

Dr. Edmond Robillard, one of the best known physicians of
Montreal some seventeen years ago, and who since that time has
resided in France and at Monte Carlo, has returned to this city
with the intention of permanently residing here. He finds many
of his friends have passed to the great majority, but those who re*
main extend to him a hearty welcome.

The issue of the present number has been delayed by the
serious illness of the Editor, who was confined to bed from the 6th
December to the 17th December. We are glad to say that he is
now perfectly convalescent, and the first day of the new century, it
is believed, will find him quite fit for work.

Dr. Lacombe, one of the Demonstrators of Anatomy in the
Medical Faculty of Bishop’s College, has been re-elected by a large
majority to represent one of the divisions of Montreal city in the
Quebec Legislature.

Book Reviews,

A Manual of Syphilis and the Venereal Diseases, by

James Nevins Hyde, A.M., M.D., and Frank Hugh Mont¬
gomery, M.D. Second Edition, revised and enlarged. Pub¬
lishers, W. B. Saunders & Co., Philadelphia. Canadian
Agents: J. A. Carveth & Co. Toronto, Ont. Price, $4.00
net.

This work is beautifully prepared, the paper, printing and col¬
ored plates being rather better than the average. The text is very
well written, the style clear and elegant. A great deal of thought
is apparent in a careful consideration of the many-sided social
questions in connection with these diseases, and forms part of the
introductory chapter. Syphilis is carefully considered, and it is in¬
teresting to note the axiom appearing in the first paragraph on
the treatment of Syphilis, viz.: “ The worst errors committed in the

BOOK REVIEWS.

565

management of Syphilis are due to trusting exclusively to the ef¬
ficacy of drugs for the relief of the disease. 1 ’ This points to hygienic
care and proper diet as the great keys to successful treatment in
syp u ilis as in other diseases. A discussion of the use and abuse
of mercury contains valuable information ; the authors wisely ad¬
vocate a rational treatment, and not allowing conventional rules to
restrict the adaptation of remedy to each patient. The considera¬
tion of gonorrhoea and its sequelae is excellent. The entire work is
a credit to those who have assisted in its production.

G. F.

Modern Surgery, General and Operative, by John

Chalmers DaCosta, M.D. Third Edition, revised and en¬
larged. Publishers, W. B. Saunders & Co. Canadian agents:
J. A. Carveth & Co., Toronto. Price, cloth, $5.00; half
morocco, $6.oo.

It is only two years ago that the second edition of this popular
work was placed before us. In this third edition much material
has been added, increasing the volume by more than two hundred
pages, and containing over one hundred new illustrations. It would
appear, however, that the original plan of the work remains un¬
changed, as the branches of Opthalmology, Gynecology, Rhinology,
Otology and Laryngology have not been considered. Throughout
the text c an be seen the insertion of valuable matter, which ampli¬
fies the former terse consideration. In considering the tertiary
treatment of Syphilis it is interesting to note the explanation of the
action of Iodides as given by Cyon that “small dose3 combine*
with some products of the thyroid gland and form toxic iodo-
thyrjn. Large doses are diuretic from soluable salts, and are rap¬
idly eliminated.*’ Many practical therapeutists pin their faith to
large doses of the Iodides, and with good reason too, and yet have
not accounted for their action in such a simple manner. As a
whole, this work is probably the most satisfactory published short
of the elaborate works of two or more volumes YVe recommend
it with great pleasure, not only to the student, but to the busy
practitioner.

G. F.

A Text-Book of the Diseases of Women. By Henry I.
Garriguer, A.M., M.D, Gyneocologist to St. Mark’s Hospi¬
tal, in New York City, Gynecologist to the German Dispensary
in the City of New York, Consulting Obstetric Surgeon to the
New York Maternity Hospital, Consulting Physician to the
New York Mother’s Home and Maternity Hospital, ex-Presi-
dent of the German Medical Society of the City of New York,
bellow of the American Gynecological Society, Fellow of New
York Academy of Medicine, Member of Society for Medical
Progress, of Eastern Medical Society, of New York County
Me Jical Society, etc., with 367 illustrations. 3rd edition,
thoroughly revised. Philadelphia, W. B. Saunders & Co.,
1900. Canadian agents : J. A. Carveth & Co., Toronto, On¬
tario. Price, cloth, $4.50 net. Sheep or half morocco, $5.50.
For the third edition the author has carefully and thoroughly
revis.'d the whole work. What seemed antiquated or of minor im-

566

BOOK REVIEWS

portaoce has been left out, while considerable and new material has
been admitted bringing the work up to date. Many new illustra¬
tions have been added. The index has been improved and increased,
thus facilitating research in a work containing information upon so
many different subjects. The first and second editions of this work
received most favorable comment by the reviewers connected with
the leading medical journals on both sides of the Atlantic. The
Medical Record , of New York, said : 41 It has by the sheer force of
its intrinsic merit shouldered its way through a crowd of more
ambitious works up to the front rank/ 1 while the American Journal
of the Medical Sciences said: “It is one of the most complete
treatises on Gynecology which we have.”

After a careful perusal of this third edition, and judging from a
reference to several chapters on subjects in which we are especially
interested, we can safely say it is one of the best text books for
students and practitioners which has been published in the English
language ; it is condensed, clear and comprehensive. The profound
^earning and great clinical experience of the distinguished author
find expression in this book in a most attractive and instructive
form. Any practitioners to whom experienced consultants may
not be available will find in this book invaluable counsel and help,
and, although in the cities difficult and dangerous gynecological
cases should have the benefit of the specialist's advice, yet in the
country, where the latter cannot be had, the family physician, by the
aid of such a bock as this, will be able to safely guide his patient
•back to health.

Two chapters in particular will be welcomed, although they are
innovations, namely, on Hemorrhage and Leucorrhoea. As the
author says they are not diseases but symptoms, but they play so
great a part in the diseases of women, and so often require sympto¬
matic treatment, that he considers it to be in the interest of the
general practitioner to treat them separately.

We were pleased to notice in this connection that he lays more
stress on the constitutional than on the local treatment, especially
in young girls, on whom he says it is seldom necessary to apply
anything locally. Among the drugs he speaks highly of the value
of hydrastis, aletris and cimicifuga internally.

A. L. S.

A Book ot Detachable Diet Lists for Albuminuria,
Anaemia and Debility, Constipation, Diabetes, Diarrhoei,
Dyspepsia, Fevers, Gout or Uric Acid Diathesis, Obesity,
Tuberculosis and a Sick-room Dietary, compiled by Jerome
B. Thomas, jun., A.B., M.D.; Instructor in Materia Medica,
Long Island College; Assistant Bacteriologist to Hoagland
Laboratory. Second edition, revised. Published by W. B.
Saunders, 925 Walnut Street, Philadelphia, 1900. Canadian
Agents : J. A. Carveth & Co., Toronto. Price, $1.25 nett.

This is a very valuable collection of diet lists and sick-room
dietary, and is offered to the profession as a practical aid to the
better practice of therapeutics. The busy practitioner has seldom
the time to write out systems of diet for his patients, and yet to do
so is of the greatest importance.

BOOK REVIEWS.

567

It is an acknowledged fact that a great deal of »the success
which the late Sir Andrew Clark met with was due to the care and
preciseness with which he wrote out a diet for his patients- If
that well-known physician were al.ve 10-dav, he would find this
book of inestimable value to him, and it deed it ought to be to
every practicing physician. In a portable form there is offered him
a set of ten lists (compiled from standard works on dietetics), in¬
cluding the pathological conditions, in the treatment of which diet
plays so important a part. Physicians who, after enumerating
milk, beef tea, milk toast and gruel, find their mental list of bland
foods rapidly growing hazy, will find the sick room dietary of
practical benefit, when we have to humor the appetite, as, for ex¬
ample, a typhoid patient who rejects milk. An Appendix gives ai
brief description of the technique of rectal alimentation, and of the
special pitparation cf foods for such use. The lists are numbertd
and the kty to the numbeis is reserved for the physician. The
woik is one of those practical treatises which must be seen and
examined to appreciate its value.

F.W.C.

Saunders’ Pocket Formula, with an Appendix containing
Posological table ; Formula and doses for Hypodermic vledi-
cation ; Poisions and their Antidotes ; Diameters of the Ke-
male Pelvis and Foetal Head ; Obstetrical Table; Diet List
for various Diseases ; Material and Drugs used in Antiseptic
Surgery; Treatment of Asphyxia from Drowning; Table of
Incompatibles ; Eruptive Fevers ; Weights and Measures. Bv
William Powell, M.D., author of “ Essentials of Diseases of
Children.” Sixth edition thoroughly revised. Philadelphia,
W. B. Saunders & Co., 1900. Canadian Agents : J. A. Car-
veth & Co., Toronto. Price, $2.00.

The title of this book, as given above, is its contents boiled
down, and shows that it contains a mass of very vafuable informa¬
tion. Among practitioners in the country there is a continual out¬
cry for formula. The result is that most of the leading medical
periodicals, in each issue, now publish prescriptions recommended
by well-known medical men, and some also who are not generally
known. This is a valuable contribution, so far as it goes, but to
be of ever-ready value they must be cut out and arranged alpha¬
betically as to diseases, or they cannot be readily referred to. In
fact, this is what is done in this book, and prescriptions recommend¬
ed in all the principal diseases can be found instantly. In this lies
its value, and upon the whole the formula are good. Blank leaves
are inserted, on which can be entered formula, which the medcal
man has himself found useful.

F. W. C.

The Physician’s Visiting List (Lindsay & Blakiston) for
1901. Philadelphia, P. Blakiston’s, Son & Co., 1012 Walnut
Street.

We cannot pay a higher compliment to this Visiting List than
by saying that we have used the visiting list continuously for almost

568

publishers’ department.

forty years, and hope to use it so long as we actively follow out
profession. It is published in yearly form or perpetual form or
monthly edition. The price is far below its value.

F. W. C.

PUBLISHERS DEPARTMENT,

“THE LIVING AGE” FOR 1901.

During the fifty-seven years of its existence this sterling weekly maga¬
zine has steadily maintained it* high standard. It is a thoroughly satis
factory compilation of the most valuab'e literature of the day, and as
such is unrivalled. As petiodicals of all sons continue to multiply, this
magazine continues to increase in value, and it has become a necessity to the
American reader. By its aid alone he can, with an economy of time, labor and
money otherwise impracticable, keep well abreast wiih the literary and scientific
progress of the age. and with the work of the ablest living writers. It is the
most comprehensive of magazines, and its prospectus for 1901, which appears
in another column, is well worth the attention of all who are selecting their
reading matter for the new year. Th? Living Age Company, Boston, are
the publishers. The offer to new subscribers is particularly inviting.

“THE SIEGE OK THE LEGATIONS.”

The Living Age will begin in its issue for November 17, and will continue
for several successive numbers, a thrilling account of “The Siege of the Lega¬
tions.” written by Dr. Morrison, the well known correspondent of the London
Times at Peking. . This narrative is of absorbing interest in its descriptions of
the daily life of the besieged legations, and it is noteworthy also as containing
some disclosures reDing to ths inside history of what went on at Peking in those
stirring days, which are altogether new and of the utmost im »ortaoce. The un¬
usual length of Dr. M Prison’s narrative has precluded and probably will pre¬
clude any other publication of it on this side of the Atlantic. In Eogland it
has attracted wide notice.

The London spectator remaiks concerning Dr. Mon ison’s narrative of the
siege:

The Times has at last teceived and publi-hed a full narrative from its cor¬
respondent, Dr. Morrison, of all that prec-ded and accompanied the siege of the
Legations. Gibbon could not havr told the story better. It is obviously im¬
partial, full of detail, yet clear and consistent, and it has been accepted
throughout the Continent of the history of that strange episode in the relations of
Europe with Asia.

THE PREDATORY MOSQUITO.

Every physician who “ keeps tab * on the advances and discoveries of
medical science is now aware that there are two kinds of mosquitoes—the good
and the bad. We pre-ume, however, that some one will dispute this state
ment, and say of this insect, as the average army officer says of the Indian,
“ There’s no good mosquito but a dead mosquito.'’ It's true that they all sting,
but some of them add insult to injury by injecting the malarial virus into her
unsuspecting victim We say h*r t because we believe the male mosquito is a
better behaved insect than his spouse an l does not “ present his little bill 99 at
inconvenient times.

These few remarks are but prefatory to the announcement that the Palisade
Manufacturing Company has prepared and is now mailing to physicians an illus¬
trated folder, showing in sepii the distinctive differences between Culex (the
non malarial) and Anopheles (the m larial) mosquito, with instructions as to
how to detect the good insect i cm the bad. A copy will be mailed to any
physician who has not as yet received one.

Vol. XXVIIi.

D&G&MB&R, 1900

Mo. 12

O' ft %*»*«##*««K***«^********#jMt«HIH»****»*****«**^^ Ji / y\: x

' 'S. ~ * " * ,«!s' ’ "' hi

< \* r y

1 i* f

EST*&t-tSrtb& //w /.

\^y

suBSCRirr :.

•98 K

H

owe doll,a r? a v cds J j -. ,

5 1 >

ANADA

MONTRBAL

A IIcntu.y Journal of Medicine and Cur^:;/

(

J

II |

d 1‘0 f

efl 4 !< •>

^2 V - ?•

! : s *

J - 3 ;U:
1 1 i '>

J :i; | V

<• i >

BDITOB.

V. \VA\ I AXi- CAMPLKLL, M.A., M.D., D.C.L., L UX.I*. I <>s .

C.:A J Li »»*.. L.»iir\t IVlfciJibAi. PriOrt.SSsf'N iff • f fKJ 1 /'.?}

Ji- i

jU
■]!: >

Hi »

- V

>:-m l

J !- I (

1 !'

> | ; -' >
/( : 11

ir.UOaii (XCiUEIVELY F30V CPU!i'

m

jis!

i !>! I r”

J :?:

o: i i

' it

\ I f

;d:v: t:o:v

i«sf. iSf FO' j

t *« *s

u a )

I W i* * ' T; ^ M
l 4 * ri ■ » -/ $ * O t S

r r ;v -f r , v

i ^ V V ^ *. f JuJ

Although niary now Hypno¬
tics and a nal^osu's httvo*’ boon
i« oontly introduced, isKrhN-
'i ti» ('till holds its position as
Tli K Hypnotic and Sedative.

'»'> pr* paro nho <d,V-
rutoLt; or vm .

(«*I j^l» t limeH the single
*t»ent;llij for hypodcrttklc
iojtM I.liill.

••.ilirhMS AN1> PRICKS
Oa An’hidAiln.s

F 80 Cj > •
Nddi-ii

i m . ' *» ^ n *••

IIt:’. Ml 4 J.tm

Si»;K *'ss
C ..

?, rj *. f ;

ais & COMPANY

(s« W. din^ton St. West) Q'f ^ V

m-t

r! &&• &we i#r^ ^^ %>:^^ i\< 'r ijf -f-*?• rb: 4N

r; -

..».a»51 o n J yr j cwri-?e.• - <^ i: <,

£;■/;, r; /V MI/'lEOGAPH.

' liAA I •; f»\ T:ryM d

:n lv.l'Ov M-Mrd tn t .xchantjfil. u

! i '.I > t * i‘" X \ • r .St

MONTREAL

HOLLAND’S IMPROVED

..Instep Arch Sup

wo cast

A POSITIVE RELIEF A NO

l FLAT-FOOT

FOR

V of treated for Rheumatism, Rheumatic Cnut and

C/o ^hewiyiMtc Arthritis of %f\& Ankle Joint are Fiat-foot.

HiS* jh&f* WbrnMif* Tin* :VMaa4-'4 revolution it» tins-

Jk !»•»».i-.t.•;>? ' • ' ; . rt»]tf*tti>g lit U dpi>n■ v-‘io iw.v-ni V ** fit M&ft*? i*W$ #f fiW

//>/,.n/v..'- ; '•'••

Hlr« of ant! tlu- Ttoitwi State* tfre u*ika

tifid to rOiWfcer*, o V trig tadtiv rant bjipifife&xtfiut

cf ihh w*f*»!uitv?d iy ‘k%*.^|| h*(s the Wu’y, nyM, pint'* f-ninH/rly

ww,

SiipfioriW- itwhC* highly fhre'0,iitiu^Jol^4 l>\ phy^teto^ /yr clnhitfin«' who puffer iron*

mabh'ut #ii$£$g&\&&*$$ h;r- xv ^ ii; vm&w**’>&& sutii u» nt*i tu*? tesuHU* hut ftf tiMsy

. ^f.a-Khll'erh^f-^nyu* M'ft-f'M.*

lti\Alipifyiltyf'fvi.'# jetif/r* 4 £&p.JijpK* 6 *ftc^d***

A m o i«i ,vf< irt \ ‘ ju * i9Ml Mt iwn

rf? CO.

'Ag, i en'f£ :; far ';:

■:'•.•:•;•>;;■(:/. : Canatla*

3 RO- 3 S 6 S’ 4 «_ Paul Street*. Morrtmai.

ARE YOU PARTICULAR

By whom your Prescriptions are prepared ?

licenthb

e \i

i ^nch fflore ; a competent clerk always present..

*$ - • _-

. &•
S*

1

phammeists, riothiilg; el«e,

but good ones. .. .

•V T C, ^

We jjjve you what you pi^scribe and charge only » fair pries for it.

Please remember our store* wuen you have. patients in oiu ^erghborhoo^v
You shall both be pleaded to deal with usi,

HENRI LANCTOT, Pharmacist

STORES: |

oao ST. LAWRENCE. Corner PRINCE ARTHUR
a» 9 >i ST. LAWRENCE, Near OE IMONTICNT

ta cotrcspomliog with AdvertJtrrt pica.-* mention Th* CANAfii Mf.dicai, Kr.coiu.

ADVERTISEMENTS.

i

“ PROTOSE”

A Vegetable food, tested under
Medical Supervision in cases of
Defective Nutrition, Diabetes, Dys¬
pepsia, Obesity, etc-, etc., and as an
Exclusive Diet- •*. .*•

GUARANTEED TO CONTAINS -

85 p. c. of Proteid matter, full strength powder $2.50 per jar
45 “ “ half strength powder 1.50 “

30 “ 4 ‘ ihird strength powder 1.00 “

(For rectal injections at half the pi ice.)

In Ottawa: At C. C. CULBERT, Rldeau and Cumberland Sta.

In Toronto: At LLOYD WOOD, Church and Gerard Sts.

In Chicago: At PETER VAN oCHAACK A SONS, 140 Lake St.

The HATCH PROTOSE CO., 10 Richmond Sq.

_ MOIST l'BEAL _

N eurasthenia.

ERVE STARVATION

m Blood Poverty

are the conditions in which Mercauro has produced
desired results, never before secured by me in a
practice covering over twenty years.

A. M. Owen, M. D.

e

Ex Member Judicial Council Amer.Med.Assn.

Bx Pres. Miss. Valley Med. Assn.

Tr^flo- Pan Amer. Med. Congress.

In correspondirg with Advertisers please mention *1hk Canada Medical Riccor.

11

A D VER T1SEMEN 7 S.

“The Patient's
Gibraltar* *

is the manner in which
a physician refers to

in connection with its
use in pneumonia, infec¬
tious fevers generally
and whenever an aseptic
fluid nutrient is indicat¬
ed. Palatable, prompt¬
ly absorbable and nutri¬
tious. A very present
help in time of Typhoid.

Dose—1 to 2 tablespoonfuls,
3 to 6 times a day

When food and antiseptic
are both required, pr e -
scribe LIQUID PEPTO-
NOIDS with CREOSOTE..

Ifu Qolmotcn tfom.'Ga,
lu>, Tl.^.

Canada Branch s R. L. G!bSOn, 83 Wellington St. We*t, Toronto.

ADVERTISEMENTS,

iii

VAN NESS-COOPER’S

LACTOLITHIATED

STRONTIUM COMPOUND

(Van Ness Formula)

— FOR THE TREATMENT OF —

BRIGHT’S DISEASE

T HE Salta of Strontium used in our preparation are entirely free from Barium, neutral,
reliable and palatable. The Lithium is well washed in Alcohol, neutralized and dried.
These salts, when combined, in the treatment of Bright's Disease, and in conditions associated
with Albuminuria, give results which are so rapid that, in 24 hours after dispensing, the Albu¬
men excreted will be diminished one-half, and in ten days almost entirely disappears.

DOSE—l to 2 teaspoonfuls after each meal.

Dr. Davids. Bright, surgcou General of Turkey, stationed at Constantinople, says there
are more cases of Bright's Disease in Turkey than in any other country in the world, and that
the disease is < arable by Lacto-Lhhiated Strontium Compound, made by the Van Ness-Cooper
Co., N.Y.C. Dr. Bright is a direct descendant of Richard Bright, M.D., for whom the dlse&se
was named.

Dr. Addison C. Fox, Baltimore, says,— 41 I am curing my cases," and that he has had most
wonderful results from its use.

Dr. W. if. Williams, Dale, ind., writes.— 41 1 have used Urge quantities of Strontium Com¬
pound and have had results from it 1 could not obtain from any other preparation, and I have
exhausted almost everything else to give relief to my patients.

Dr. W. A. Brown, Ath i, Mass , says.—“ 1 am curing my cases."

Dr. David Coleman, Richmond Borough, Greater New York, has had several very obstinate
cases of Bright's Disease, and they have all recovered from it.

And many others, whom we will put fu direct communication with Physicians on request.

PRICE PER PINT, 92.00

VAN I}ESS-C00PER’S

ECZEMA LOTION

(VAN NESS FORMULA)

NITRO GLYCERINE IN SOLUTION

POISON.—For External Use Only, in Syphilitic Eruptions, Indolent
Ulcers, Eczema, Tetter and itch.

A non-alcooolic combination of Bichloride Merc., Acid Hydrocyanic
(Dil.), Acid Nitric (Dil.), Aoid Pyroligneous (Crude),

Tuligo Ligni, oynocardia Odorata. Qlyoerine.

DIRECTIONS FOR USE.—Apply with sponge or hand three or four times daily. Itching
oeases at once, and results can be relied upon in every case.

I N regard to above preparation we are prepared to pat Physicians (on request) indirect com¬
munication with at least (2<VMU) Physicians (specialists in skin diseases) who are using it and

f mrchase from us direct. They do uot hesitate to say it is the only preparation that gives them
mmedlate, and permanent results. We never fail to receive duplicate orders and testi¬
monials without end. without any solicitation on our part. The action of Nitro-Glycerine in
folution, when combined with the other ingredients, is distinctly different from any preparation
for a like purpose to date. We will refer you to some physiciau who is near you, as our sales
cover the eoiire North America.

PRICE PER PINT, 92.80.

MADE OSLY BY

VAN NESS-COOPER CO. (Inc), New York City-

MONTREAL REPOT. 28 St. Antoine St. -. Tel. Main 1420

Catalogue of all our productions sent on application.

In corresponding with Advertisers please mention The Canada Mkdical Record.

A a VE RT'IS EMEaV 7 S

T. E. HUOT

-aed'S ST. CATHERINE ST..
NEAR ST, „M \IUv ST«j

Lrtte.of Ni>. Violent* Sf*.

HDfspenaing Chemist

ATeJiare miuh i».« notify iug

jwurotis tlutt tve hnvvr ■re*Jv*v«**i V} the
mid commodious |»r&i«ihy&, - No, 2693 St,
Catherine St. hum we baye tow *v choice
uinl varied fu^ortuifani of the finest lines i»

1934 St. Catherine

Cor. St* Charted BorromseV

MENS,
LADIES* and
CHILDREN’S

MONTREAL

In whtfUoy Uj -vMtHi urfcjijirjtnss to cofctiiiuo

as i.g rue Rant to iafce orjJcr<* H&

PRESCRIPTIONS CAREFULLY DISPENSED 1

Only purest Drugs used.

WITH

MALTINE with CREOSOTE

i* th</ mft'U eligible anil {iKhtiabio for.ni in which * T^osexe can he i.

The vchtcle^vtairicir* Ranic.nkffit WW H >*£r

lood ..Arid dig*M*v»i value, to ail eoudifk'iis Ui wfilv.U. tfr aalfWWMf.[

•unpi-jiyed,

ub [*eml z*inpk-'pit This tjYZp&raiiQV Ui

88 Wellington St., West
TORONTO

THE MALTINE CO

In corresponding with Advertisers pic^a^ mention The CAnAda M»meAl, Kfccoau

advertisements .

IV

■ ■•FOR* ■•

Spring Time

Carden Tools, Rub¬
ber Hose, Reels and
Nozzles, Lawn
Mowers, Washing
Machines and
Wringers.

CUTLERY : - Table and
Pocke Knives. New
Razors, etc. Prepared
Paints, etc.

L. J- fl. SUflVEYER

6 ST. LAWRENCE MAIN ST.,

. . . MONTREAL

No Student
° r Professor

Of Bishop's College

Should Buy
tljeir Supplies

Without firat Calling on the
TRADERS who ADVERTISE
in the -

UUDI MEDICAL BECORD.

Wheeler’s Tissue P isphates.

Wheeler’s Compottxd Elixir ok Phosphates
and Caltsaya. A nerve food and nutritive tonic for
the treatment of consumption, bronchitis, scrofula-
and all forms of nervous debility. This elegant pre
paratlon combines In an agreeable aromatic cordial
acceptable to the inost irritablc conditions of the
s tomac h: Bone Calcium Phosphate Ca a ‘JP0 4 . Sodium
Phosphate Na 2 HP0 4 . Ferrous Phosphates 1-V 3 ‘JP0 4 .
Trthvdrogan Phosphate 1I 3 Po 4 . and the active
principles of Calisuyu and Wild Cherry.

Special indications. Spinal Affections, Carles,
Necrosis, Ununited Fractures, Marasmus, Poorly
Developed Children, Retarded Dentition, Alcohol,
Opium, Tobacco Habits, Gestation and dictation, to
promote Development, etc., and as a physiological
res torative in Sexual Debility.

Notable Properties. As reliable in Dyspepsia as
Quinine in Ague. Secures the largest per c» nt. of
Benefit in Consumption and all Wasting Diseases,
b y determining the perfect digestion and assi mil at ion
of food. When using it, Cod-Liver OH may be Taken
Without repugnance. It renders success possible in
treating chronic diseases of Women and Children,
who take it for pleasure for long periods, a factor
essential to maintain the good will of the patient.

phosphates being a Natural Food Product , no
substitute will do their work] ~ ~ *

Dose— For an Adult, one tablesjwxmfiil . three
!imes a day, after eating; from seven to„ twelve
years of age, one dessertspoonful; from two to seven
one teasjioonful. For infants, from five to twenty
drops, according to age. ;

Prepared at the Chemical Laboratory of T. B,
WHKKLKH, M I)., Montreal, P.Q. ((

To prevent substitution, put up in ponnd bottles
only, and sold by all Druggists at One Dollar.

-THE-

Uptown Family ButcDer

HANDLES

“Goods, of quality only the best

At prices which will siand the test.”

THERfcFORE^W-

FOR ALL KINDS OF

Fresh Meats, Poultry, Fish,Vege¬
tables) Eggs, Butter, Corned
Beef, Ox Tongues* Canned
Goods, Bacon, Ham, Sausages,
etc.,

You cannot do better tf\an go to

C. R, WESTIiAIE k CO.’S

MARKET,

128 PARK AVENUE.

Telephone Up 1066.

In conre^Donding with Advertisers please irention 'Ire Canada Medical Record

ADVt 111 JSliMHfiZS

GENITOURINARY DISEASES

A Vitalizing Tonic to the Reproductive Systemic

SPECIAUV VALUABLE IN

®ROSTAT|C TROUBLES OF OLD MEN—!WRITABLE" S^tlOfcR-
CYSTiTiS—URETHRITIS^PRE-SENILITV.

OO CHEW. CO.; NEW YORK

DOse:—O ne Tsaenaonfu) four Time* a Oaf,

CANADA TRUSS FACTORY

^ktore F;?t.Ktaiilied I HAG M e *J
nalng uaiu^

Ip F. GROSS

■ft $\, : 7 1 2 tm. A IQ ST. ■ : : 0

J A n MONTREAL .

lj\ [It . Niami-f •

AVjM W ctjotinned under new manage* ;
pient.

Pftysictatta* arfeseH&^Iofua |
carafXiUy ct!*penaed- .}

T■ H llohinson

1 n*trijuxi«mt* , £«»r ** Ivy^SCHf liefiM-uilUc**.
lircww’H Pi*t«??»Y Ajrtifljcl»at Mmb* r (ifiwa’A
Cbe*tKxpim<H'>K \% m<o*,

Syringes «H kimls of i* nbin»r itiiuwiii,

THE PEAF MAWB T<7 HEAR

Send U>r Pfic** inu

SELLING OFF : -

Surgical andY^r'iiiar* la'iiriijaciils

A1 A-Oti'KAt UhJH iv'Ji'.VN
ASi>H>;t.ow cos'i' mfut:

736 SHERBROOKE ST.

TH* VM Q4Z Slsht ttcil

GEORGE m BARK

PHONE UPS 49

KUU

l>4PA At EPICAL RECORD.

LOT* Ll/8 MONTHKA L TUJMlSK^ef
*■« MUf; AVl» 1 »I A icy:

MONTREAt BCaiKEgfe
BlRfcfcTOtty,

ANpy, W. TEBKITOKY
Pll<K€TOHV\
irntaipiff? pliucctoh?;

W & M HT IilCHOLAfl ST.,

MONTREAL*

281 BLEURV ST

Correct P^pgnsigg;

in ending; wish. At^em^rv, r hast' mention 'The Ca#apa’ Msdical Record.

AD VER TISRMENTS.

J. E. TREMBLE

DISPENSING CHEMIST

Cor. St. Catherine and Mountain Sts

MONTREAL

•PHONE, UP 910

Sunday Attendance

OPEN ALL DAY . . .

9 30 a m. to 0 30 p-m-

ALWAYS RECOMMEND THE BEST.

L»aui*entian Soda Water

An absolutely Pure and Natural Soda Water. Sold In Bottles and Syphons. Read the Analysis
by Prof. J. T. Donald, Bishop’s College.

-ANALYSIS :-

Grains per
Imp. Gallon,

Chloride of Sodium ...5.40

Chloride of Potassium.... 77

Sulphate <»f Sodium. 0.30

Bicarbonate of Sodium.32.37

Bicarbonate of Magnesium. . 1.72

Bicarbonate of Litne. 1 08

Silica. 43

51.97

For the Sick Room, the Best is none too good.

LAURENTIAN SPRINC WATER COT

209 ST. ANDRE STREET

C. ROBILLtARD «fe CO. - - Sole Agents.

Trow *.
Abdominal Supporters
Elas tic Mins

Prescriptions Carefully Prepared.

P. IgCOMACK & GO.

Oo*. MoO/ll a Not** DAms fra.
Cor • Park Av. a Primok Arthur St.

Robert’s Pharmacy

Prescriptions carefully compounded

Kissengeri RaKoczy

MINERAL WATER.

Cor. CRAIG and ST. LAWRENCE

In corresponding with Advertisers please mention The Canada Medical Record

FACULTY OF MEOICINE, MONTREAL

TUii rtietlv Session* i <00-1901

K. AV -Ih-.xfiK? »t, h'-t'..

F W. Fa # M»rix ; i>l. 1>., .Oewii <*f J. B- *U:Fonn&li., .M.»„ Viet?-] >**.11 of ■»,*' .

rfiar'e&B-Crmu

f*. W. f.AMi'iii u.,.. 31 A., >f |i„ JjJ<AMv*h>«wt„ \W.U< Dealt, Professor of T'nnri ,Hm

Paw^i.6i{viif Afe*tioine*itd

•J. B, MKJox!*fthb. Pff«?U*ifo of Mtittidii*' «ml !S«u-

rrvFgy, Profe.^i.r ««/<')n*ica( NTt'»1^v?o

Jams# PBkim-iiv, A.M.. V.»».. MJU.YtS Ko-, of

A, L. SxiTift* W,A« t M i>„ W.R.C.S. Khg, > Professor of PljufeAl GvnichofegV

H, L. IU-.no\\ B.A.. M.Ife L.K.C.S.k;., L.fc.tf.P. ItftfdU IWeaior* ot UbtfofrW;

*!. T. I>kyamvAI.A_. F.C.S., ProfcftiNjr *r0U«iii?«try*

Geo, Tiu.F.rm: Ildafe, Ai.Ife 04., Profhaadr of Laryngologyandrcio vu»logy •, wtoi. Kc«fl*lr.tr.to
the Ftoenlty.

»Jr:«KB8E, F.O.S., fedftwsinr of CheinUtfV.

W,■G;tt.ASfi‘STp;w J JC«T, T*~V.., M h , <;M., Professor Pb*V»‘v<Vt)iHgife*i?_

Aatswvx BrtoKKfc. Nf.If K»h»i., Professor of Phyal'dngv Mirtij I.U/tfcjor

LaWfntery, Koyfel Vivtorui Hop pita ’

W*. H fH*0WMV»>;p, A M Prof^or of Mwlical Jiimnniiiwu,«c.'
asv>ujw MACiprtA.tt.,.BVAU M.K> AUU'.S, Kug., UJfo&P hotvi., Pro)>^f of

fogy and fiactork>loj?v. •

UPC TiJftERS

Knti,or;Awi4<Et.t,v;3f ,« i^riuvcf ."Avi. .

A. if; O.M. t M.li . Lec t urer on liyj%:»*«vt> A<v»i IfewouM.r-itov of ti;>cfer>o]t>g7,

C^A HfcUBAKT, li.K.OJ*. !.oni. r Kim, UecfurVr pD A 3g&to)tiy v'

1). if»"NA* \ffA, H.D., Lvecup^i on ^gr^ry.

INSTRUCTOR ANO DCMOti St'#*?®**'

■ UKKHfAir TaTLSv/C,JI., M .D., L.Xt.O.I\ >u.d S. !• .tin., 1> F.i* »tid 3. Glasgow; (listrVFiot in

ttl.r.mwu .

Gte*& Fi*K v O.M., MAh. Demonstrafei: of Aohtnpay, iTjiitiwibr■ Vii Siirga'vah add A'w»t; kVglrtU*r.
^EdAUlt,. At.lL> O.M., L;R,0 5 X'.: K ; mf S f4\u < Ut*>Y *ud Vfi.f^orv.. tv^

J{ fto|fj»gjy.

f v^tnoinsti^i.-r 4 f

vt> ui-i.<r ivi Vnas-t!»*■ tie*

‘ ' Y„ I>. ,|g'V-*' li^v--vVV? ^‘•

Xtf four of

^SN 5 S®w 3 Wl(J^||*>t tfm^ofXtr'j-i' ,r»«.r»Ujf ^••U.

Tlic ldcturf.» w,ofdvim»rj?.{.rfiiir>o« jh Annual Ct*urs« amgl?^ Jnrlng a period\>fxitflA
J’tjgioujng { .i> October.

Valy'OT^ )s compulsory (in the third yeery. bttt ^h h? Fealty Htroogiy

f<5eOri>mcnd «ll rtvul^nth \x b«> c tn tu uifend'alao the aunnner Pes^ibus* Aprmg their ai*d

PiodleA) fcvltica*ioh, Jt* f/tV.UUWior doing so are in many roeipyeLs lUHV^uaHcd irfCauudA.

Itt <ui*mi*>n (<♦ the regular cmirc^o of diiht/rlic iccrurop, students have thwjul^mtago of oxt«Fn#i\e
£ni\ rnt.^i hoj»pit*j privilege*.

Tt(^ U*nferal jioshttal, Ihoral Victoria. Wfeftorn IK^pUad- r>itm Hyapita'i ^4

I Ittti\nndXirii) J n ffr.rfi irft. Vir u nf <>«ia i \ J I t/» yAa' i % \3f'Mt t • t 11 • T*

i>is

in

spenAurhia afford e>ofy <t}ij>ortimfcY Urstwbintz ^of th'« CoVzgi' V* receive- ejjmCaJ IhtPtfwtloo
Medicine and Srdrgwfy.. At ihe : wvm*nis Hi>itbSt#d ef/ecia) ad v>int Hgt# a horded ivr Uif

prafiiimil f«tudy of

The aniiual CuUhge few average ^MX). ^hat; * special •Me^aht ii’ m flowed wbmi tJUrK*i«f
y^ara* course If paid for on eDwrani^.

Pot luformaitoiuaiid copies of Apnitai AtiiVounotfipetir, Addro**

9<4 &a f tGK'£sref9 Srxcrr.

Cto. T. foss. M,0.. Roe *UBT.

ADVERTISEMENTS.

IX

WHEN THE
STOMACH REFUSES

food and nourishment, when intestinal or gastric inflammation
render the stomach entirely unavailable, or inadequate, try

BOVININE

per rectum. It will nourish and support, and aid any form of
medication.

When collapse calls for instantaneous blood supply—
try it by sub-cutaneous injection of one part to two of neutral
salt solution, and note the prompt response, a response so much
more efficient and powerful than that from blood dilution. If
you are interested a postal will bring our scientific treatise on
topical and internal administration, and reports of hundreds of
clinical cases.

THE BOVININE CO.,

75 West Houston St., New York.

LEEMING MILES & CO., MONTREAL Sole Agents for the Dominion of Canada.

For Literature app'y direct >o the Bovinine Co., N. Y.

TBH PHONE EAST 27S.

T. D. MqLE/SH

Dispensing and Pharmaceutical Chemist

469 St. Lawrence Main StMONTREAL

N.B.—Physicians’ Prescriptions carefully dispensed
with pure Drugs only.

NO SUBSTITUTION.

In corresponding with advertisers please mention The Canada Medical Record.

A O V&Xt 1 SEM&NJS.

C. Ashford ifijSSgi Montreal,

Medical and Burgled* Bscrk*.

T»xt Hnok«,: iir<u3 Uitii MuiilU *tpi! V<

f fttfcflbti j t\g St titffent*

•'.Vi : '.

Catalogues with prices oh application. ;

Students' fHoto Books at lowest prices.

Publisher oa— -——

The Montreal General Hospital Pharmacopoeia

35 CENTS, POST PAID

National Pharmacy

• Edrn, Giroux, jr.

216 St. Lawrence St.,

MONTREAL.

* * *

Prescriptions Carefully Compounded.

ALWA.tS.A

I* EH FURIES *,n *toek

ESTASUSMtft m fitlt TEUPHQHE 1305

.WRAY,

UNDERTAKER

AND

PRACTICAL - EMBALMER

123 St. Dominique St„ MQNTBEAL,

fnftkotft. Com tie Anil F!r»t*l2»* H**?*h*
Every l«?r*on»1 supervision Mentor-

uttt charged *

Ambulance Htmdquarteesu

ggk thfcwvie* fa

W *u\ch $urg*oi ip md IT^d<*t*f»*
gB^M aMw Are . hii*rssi©<i wUl iW th*
' qj^BSB Siral for.nro prompt a heft-

.thm *tui t»&r* Br

wm ■■ Ui& Ui« 5**rv?oe yf. v)oft «Arofc?i-
foneo, ‘ivlaon clreUauBAuriv»Ur*
tttatut »ueh A convovnnt^, .van. will n&lijre.

2s Bv- 8p«?<iAi aiii^Titiuft ip Aifto gfyptt to
cenioy »V al vAUon t a to I«suue X*}) UJuaV

in wiwspDiiwirng with Mvrrnvttt- jjlea** mention The t. ASATn MEDICAL f*BOOED ~

W^k

891

H, A. COURLAY

Prescription Cheriifft

Lei. till ynu

2613 St« Catherine 8 tiH& 5 £

T*l t Up to?. Cur. Cuy,

3'h« tisft flf orir Appmt ti?. f*Tr‘

V'; , *;•

PJWE* to. PHYSICIANS.

Iir^eripiiona.

27 St. Maurice Street,

yiur^ OhvScietUtfii

wu.]t fip|

I'i ' MM|>i:»jvw. .. ' . . . ,

k trial m&m£n

"■ **'. '‘,v I*?/"'*fc■' .*r- J vv v '-^''

hbasvtibuj* t

»u till it# vMijtm?. Mt*v>ches.

A. l-A V;ALLjt£fc

■■ : <ie*«*rl|»4l»vn.

A t'oaj^J«5Vi i K^ortmoot ,ihr>m vn liavi/1
liepakst>f uli >hi *Uoct notice.

- ' and ATtifefs Violins-nimiiin

itfiKNf Pus Tim «jatEUrt4T^x* mvasssr
£. HP SON A Cu.; LojKton.Eiiit.,

PELISSON. (UONmT 4 i'0.,tyijtt| Pruin:,
OEKOMP TU/IHEAt VIU E LA^tV. 1

rraoite.

: sasi/sr^Th* Uik of thiti

JiQ* P**>»uiry.« H* ou; l)! 1 £*vyrt

Jfi without ir, i;*o reij. To

■» h#M ail thuTfipttf W!‘oi+*ai* :
■jr 2f» Seue d« tl&Aronne, P*r<* - £isnf In*; *}r
?to? WCffo? 7 Tr.

35 St. Lambert Hill,

MONTREAL,

1*.c«}(7c?'pOfviiiig vyiti> Advertiscii mem nr r.

H*« CAis at;a WittiteAu KkEonn

XII

AD VRR71SEMENTS

WYETHS’^—^s^

Granular Effervescing

Kissingen -
Vichy Salts

-FOB THE TREATMENT OF-

OVER-FATNESS.

In the current number of this publication will be found Dr. Cathell's inter¬
esting essay on the treatment of Obesity. Acting on Dr. Cathell’s suggestions
Messrs. John Wyeth 6° Bro., of Philadelphia, have added to their »ist of
gianular effervescing Salts a Kissingen Salt which embodies all the constituents
of the natural Kissengen Water but in a much more concentrated form, and is
peculiarly adapted for the treatment of Obesity, as suggested by Dr. Cat hell.
This Salt, we are satisfied, is decidedly more convenient for all concerned as it
is not always practicable to obtain artificial or natural Carbonated Waters.

Wyeth's Granular Effervescing Salts of Vichy are also more economical,
and what is more important, they will be found to possess greater activity than
any of the medicated waters, as generally found in the market.

Vichy and Kissingen Salts yield, in moderately cold water, a most refreshing
and palatable effervescing draught, which will cenainly be relished and appre¬
ciated as a daily stomachic by the most ex ctmg patient.

The well known and valuable therapeutic properties of the Vichy Water
are strictly and carefully imitated, following the French government’s official
analysis. The most popular of the three springs is the one selected, namely
the Grande Grille.

These Salts may now be obtained from any retail druggist.

Granular Effervescing Vichy per 4 oz. bottle .. 60c

“ “ “ “16“ “ . 1.40

•* *• Kissengen per. 4 oz. bottle.. 60

“ “ “ “ 16 oz *' . 1.70

r\/\Qr __ Of both Kissengen and Vichy Salts is a desseit spoonful in a
LMJOL tumbler of moderately cold water and equals the same quantity
of the natural waters.

As a specific lor Obesity, Granular Effervescing Vichy should be taken
alternating daily with Granular Effervescing Kissengen.

Children should be given from one-quarter to one tea spoonful.

To insure against substitution of inferior salts of questionable therapeutic
value, physicians and pharmacists should insist that their prescriptions and order
be filled with none but 44 Wyeth’s ” product in original packages.

DAVIS & LAWRtNCE CO.. Ltd.

_WnHTRVAT

Manufacturing Chemists

SOLE AGENTS IN OaNADA FOR

John Wyeth At Bro., Ino.

A D VERTlSEMh.fi/lS.

xiii

®—CONTENTS —®

ORIGINAL COMMUNICATIONS.

Odds and Ends in Ordinary Practice. .*521

Notes from The Clinic of Dr. F. \V. Camp¬
bell . 524

SELECTED ARTICLES.

A Clinical Lecture on the Prevention of

Valvular Disease of the Heart in Cases

of Acute Rheumatism . 527

The Treatment of the Breasts and Nip¬
ples during Pregnancy and the l*uer-

periuni...532

Typhlitis ; Extreme Case of Blood cured . 537

MEDICINE AND NECROLOGY.

'Hie Prevention of Tuberculosis .530

Rational Treatment of Neurasthenia...... 540

The Influenza Heart . ..5H

The Chemical Diagnosis of Gastric
Diseases ...,..54 ■>

Continuous Us© of Digitalis in Heart

Trouble ..544

Hot Air in Chronic Rheumatism ... .544

The Rational Treatment of Pneumonia. . 545

The Ehrlich Diazo Reaction.547

Fecal Impaction .549

Neuralgic Pain . 550

Chorea . 550

SURGERY

Spinal Cocaine Anestheeia. 551

Ingrowing Toe-Nail . 552

A Note of the Safest Method of Removal

of the Appendix.552

Therapeutic Notes f .553

Jottings.. 550

EDITORIAL.

Unnecessary Death .501

Personal ... .503

Book Reviews. 504

Publishers* Department..

Fellows’ Hypophosphites!

Specific Effects and Instructions for Use.

To Stimulate the Ai-pktitk— Take half the Tonic Dose, as directed, In yery cold (not
iced) water, fifteen minutes before eating. J v 1

To Stimulate Digestion and Assim i lation. —Take the remaining half of the Tonic
Dose, during meal time, in water.

To 1 v« rkask Rapidly is Weigh r.-Tuke the Tonic Dose, as directed, and adopt the free
use of new milk in addition to the regular food. F

To Sustain Mental Exertion.—M ix two teaspoonfuls in a tumblerful of cold water, and
drink sm ill quantities occasionally during the hours of intellectual work.

To give Power to tub Vocal Chords.— Take the Tonic Dose fifteen minutes before sim?
lug or lecturing. K

Where ininous rrperforation is difficult, the Tonic Dose repeated every two hours will effect
its rern >/ai with very little effort.

To Prevent Recurrence of Night Sweats. —Take the Tonic Dose at each meal and at
bed time. The contractile power is imparted to the nerves, which are connected with the sweat
glands.

To Prevent Sweating Hands ani> Feet. —Take the Tonic Dose as directed, avoid undue
excitement, and occupy the muni with pleasant unwearying pursuits.

Kou Convalescence from Typhoid ami other low‘ Fevers, and Debility from residence in
hot or malarial localities, employ the Tonic Dose.

To Strengthen and Develop Nursing Infants.— Let the mother take the Tonic Dore
as directed with the food.

lo Promote Sleep, lake the Tonic Dose before eating. This applies parlicularlv to
sufferers from shortness of breath. J

NOTICESCAUTION.

The success of Fellows’ Syrup of Hypophosphites has tempted certain persons to offer imi¬
tations of it for sale. Mr. Fellows, who has examined samples of severil of these, finds that
no TWO OF THEM ark IDENTICAL, and that all of them differ from theoriginal in composition
in freedom from acid reaction, in susceptibility to the effects of oxygen, when exposed to lhrht
or heat, in the property of retaining the strychnine in solution, and in the medicinal
effects.

As these cheap and inefficient substitutes are frequently dispensed Instead of the genuine
preparation, physicians are earnestly requested, when prescribing, to write “Syr. Hypophos
Fifil.LOWS.”

As a further precaution, it is advisable that the Syrup should be ordered in the original
bottles: the distinguishing marks which the bottles land the wrappers surrounding them)
year can then be examined, and the genuineness—or otherwise—of the contents thereby
proved. *

DAVIS Sl LAWRENCE CO. Ltd. y Wholesale Agents v Montreal.

XIV

A D V EH 7 2SEMEN 7 S.

Founded byC. LI TTELLin 1844 44 Made up of every creature's beet ”

THE LIVING AGE

A. Werlcly Ma&azlna of Contemporary Literature and Tbo*»g*hf,

FREE FOR
THREE MONTHS

Cntll the edition is exhausted
there will be sent to each new
subscriber for 1901 on request
the numbers of THE LIVING
AGE, from October 1st to De¬
cember 31st, 1900. Tli-se num¬
bers will contain The Siege of
the Legations, Heinrich
Seidel’s attractive serial, The
Treasure, aud the opening
chapters of A Parisian
Household, by Paul Bourget.
These serials are copy¬
righted by THK LIVING
aGK and will appear only
lathis magazine.

Publitljed Weekly at
$6.00 per Year.
Single fiun\bers, 15 cts.

A XElEXSlTY TO EVERT HEADER OF IITELLIDEACR AID LITERARI TASTE.

Eact| Weekly Humber Contains Sixty-Four Pages

In which are given, without abridgment, the most inter¬
esting and important contributions to the periodicals of
I Great Britain and the Continent, from the weighty articles
| in the quarterlies to the light literary and social essays of
| the weekly literary and political journals. Science. Poli¬
tics, Hlography, Art, Tiavel, Public Affairs, Literary
Criticism and all other departments of knowledge and dis¬
cussion which interest intelligent readers are represented in
its pAges.

The Siege of ihe Legations.

THE LIVING AGE will begin ill its issue for November
17 , and will continue for several successive numbers, a thrill*
ing account of The Siege of the Legation-, written by Dr
Morrison, the well known correspondent of The London
Time* at Peking. This narrative Is of absorbing interest in
Its descriptions of the daily life of the besieged legationers,

| and it is noteworthy also as containing some disclosures relat-
I ing to the inside history of what went on at Peking in those
stirring days, which are altogether new and of utmost im¬
portance. The unusual length of I>r. Morrisou’s narrative
has precluded and probably will pre« ludo any ocher pub-
I Ileal Ion of it on this side of the Atlantic. In England
it has attracted wide notice.

The Living Age Company, P.0. Box 5206, Boston

^|e Print

’-j || EVERYTHING—from the largest Book to the
smallest Business Card. ... We Bind Account
J I Books for Merchants, Banks and Railway Com¬
panies, and Law Books and Part Books, in the
j most Expensive and the Cheapest Styles. No
order is too large or too small.

John Lovell & Son

23 TO 31 ST. NICHOLAS ST.

MONTREAL

In corresponding with Advertisers please mention The Canada Medical Record.

.4 OVERri'S£i#£KT* :

UNSURPASSED IN PURITY

Empress of Natural Table Waters,

f*A O NO *? $f*5UN At K 1 * li %'!, i4i iM> s>fe }<f Or* i■■4 r fjtm *\s£*fe *oi\fw>*

. :m# am*/a. titviiro pfyii#} <'i*>;' : *;♦v--v.* M ‘a t^^*•

^na:i 1 . 1 .' |i'i!ft.|'i<;; Ii.iVTmI rf I •.-;*•> f.U * r.v'j-'.-. ;•: 5 ; •"''<; | .; .;. vS,< :u; ,'rt <K •» * ^. • 11 < 1 ! -!>;*•.,! r. I -f f rf_. ..»? Mu.

■I .li. A7orritiV;iy>i%0> &m.,i>iTi , k ; tfV i iu*r jpt'% tV

analysis or RAtH^R spn^nc w at zn

Uf X T. TtrjXAiiv: '&,&%■. erof <vf Aij*£mt?yr$v' ■$&&&%-t^vili : y<

Cfe&atrttJhg lAiemtet aa4 Ateby#*-- •"., ^ -■’v'• - ; -

16^tef»> otfrtify i^uUt f

■'V(4np&ii%\ ii^u ,liV»4 'ifcifMty&ii lY '«?*

i.ty&tiify &1 SMuw . U t :&£ tiirsful*#* in ^ .

ClljWtih' Qif l’oVft<sj\nK> , ; ,, . ,. VI i *»f '■, ;v.

^ti! jMutp at Atfdinm. ^. ,*£&■$■ ■ p £r8*>W# W£f h\ til *. < A; £

5ai mi . ......., i .#%- 'gtoWtfim,ot Tr<Vfc i/i -v>-v;-y

" acini wii sKatf* tU it lAity nr;

tii* valiufilH i»t huvIi ;

li# A^nUf* »\ui nr+Kj&h: i»4«fy t«S*

\r.vfifr*i ioim>rf,*ut. Amt U i tetter MO* :<h- £4£s?|M:*V-?&$»:' • *ty*. i.imfohr•$

U^rtu^ii w*o?ts a$m«*l, ^jetsu m n miY&da-My <% ?i*irjUy }& iU* itAO

tm TR^fcE M£PK

The Only Emulsion of Cod
Liver Oil and Iron fi -

f«i foil Medidivri!■ dosesv
i 4 /)W btrn\g

effects of LaGrippe, aho in ';

nf,ed by Pht*H'&n< fp;.ot atier

• i • r*'.■ •'* . ■ a, ■ ■ » 1 " (*_•■■ (•'. .■• .. *.

Anaeimc imi Patm^Tiary-

Send For Samples

LIMITED

Iu coixespODOing wn h Ady please ix»cnizO(j Toe Ca>^iva 5 \t£Cf>9p

• r

am

TYPEWRITERS

No Ribbons
No Expense

AMERICAN PRICES

THE BUCKENSOENFER

o Your Own

•• .

Vvii.iiUtt-aisVol >\ SfcmftpttptNr

\ •/ V^nurifcro;>Uy

■Y fir' '■. . : '. -.'• V •*#'/*,'

CREtLWAN BROS. Typewriter Co.

iiipnijrii >». 5,

& 4 i

\ '‘/'♦Vrkt Up

f -|ffc*> r ; ^V. •*.-*'# Z
VM M v.y* */.;*.** .•;»,! v«Vff ivi.MVjj

- u * Hi # #"*'** 1

r r'^Hir r^V'v' «;«ti**x,K^pnu. c >, ivc^, f vp

...

£' >'ovV» A' «*, ifi *. tflttVl iV <yV: ’*«y ».»rj&tV*4*V

SpH lm

ThV* flMtli !Yd. 7 ^ >0 .VO

• .

V ( - '.,*> 1 " , ■.'.

ytrtY

%-m VEARS’

;

•,rt ( n: •'■; "’a v

LE MALTO-LABATTINE

lonbqn.

j mm l$B'Y CERTIFY that I htxi an*
h ■•- i • ' '-3 1 >-.LTii'lcf <*f I.F M:lT.. rO
- a i,.: r - r ^ r LaBaftr -*fld,\;

Lilly pure > on centra tfci
“**' iir. Tiiajgiaie

•r/ri::

igped i

•Sn.tTpx. R. H^sv<-y i>iyA-:S6^McO.*iu

'"; ’*>';-?■»•. , v>-'.Vt': ? v

v ■ :.« iYi

MONTREAL AGENCY

127 Delorimia? Avenue ~127

BUQUININB

VALIDOL

EUNATROL

tAl!

Sole Agents

for Canada

Rooms 333,

aT 9 ACHAMENT STREET

MONTREAL

literature and samples supplied by addressing

THE ABOVE,

■

|b ®*rr««|KadiSS **l

:lCKV>tf At* K*CO*».