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Full text of "The Corpuscle."

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i 



The Corpuscle. 

RUSH MEDICAL COLLEGE, CHICAGO, ILL. 
Medical Department Lake Forest University. 



VOL. VI. SEPTEMBER, 1896. NO. 1. 

TUBERCULOSIS OF BONES AND JOINTS. 

By Edmund F. Burton. / 

(Awarded the L. C. P. Freer Second Prize for 1896.) 
Continued from August. 
SYNOVITIS. 

The principle function of articular synovial membranes 
is to furnish a lubricant for the diarthrodial articulations. 
This viscid secretion, called synovia, resembles in appearance 
the white of egg, and it is chiefly by its peculiar nature that 
the synovial differ from other serous membranes. These mem- 
branes furnish an internal covering for the capsular and other 
ligaments bounding the joint cavity, also enclosing any ten- 
dons which pass through it, but do not extend between the ar- 
ticular sufaces of the bones forming the joint. They are 
likened by Gray to short, wide tubes attached at their open 
ends to the margins of the articular cartilages. Processes are 
sent inward a short distance on the articular surfaces, and 
folds of the membrane, called synovial ligaments, occasionally 
pass across the cavity. The processes, or plicae synovales, 
which project into the cavity, are vascular and are usually cleft 
into fringes at their borders, the larger of the villi thus formed 
containing each the convoluted twig of an artery and gener- 
ally fat cells. The more minute villi are nonvascular. The mem- 
brane is composed of connective tissue fibres and has a smooth, 
shining lining formed partly, according to some authors, of 
epithelial and partly of irregular branched cells. 



2 TUBERCULOSIS OF BONES AND JOINTS: BURTON. 

In joint tuberculosis, whether the infection within the cav- 
ity is primary or secondary, the synovial membrane under- 
goes radical changes due to the proliferation of the bacilli and 
to their ptomaines. As in the case of bone, these results of in- 
fection are various. They may be described under five heads: 
\ 1. Miliary tuberculosis of the synovial membranes. 2. Diffuse 

\ thickening of the synovial membranes. 3 . Tubercular hy- 

\ drops. 4. Tubercular empyema. 5. Tuberous synovitis. 

\ 1. Miliary tuberculosis of the synovial membrane. In this 

\ form there is no change apparent to the naked eye in the sur 

face of the membrane and no symptoms of disease in the joint. 
Post-mortem examination shows miliary tubercles in the sub- 
\ synovial tissue. They may be be simultaneous with an osseous 
\ focus not communicating with the joint, or they may exist 
\ where there is no other infection in the tissues immediately 
surrounding the joint. There may or may not be a slight hy- 
drops. This condition occcurs in acute general tuberculosis 
and'is of only anatomical interest. 

2: v Synovitis Hyperplastica Granulosa. There are naturally 
several .degrees or stages of hyperplastic granulation, all of 
which nrist be included under this head. A condition com 
monly met with, called gelatinous infiltration, is a moderate 
thickening, in which the first changes to be noticed are that 
membrane becomes swollen and opalescent and its surface 
loses its smooth, shining appearance. Later, its inner portion 
forms a layer of soft tissue, at first villous, later covered with 
caseating material. 1 This layer is quite distinct from the outer, 
which is more firm and non-caseous. The soft layer is un- 
evenly distributed, being greatest in amount at the point of re- 
flection of the synovial membrane on to the bone or cartilage, 
or near an osseous deposit. Nor is the ratio between the thick- 
ness of the two layers constant. Sometimes the soft layer is 
is very thin, in other cases it forms almost the whole of the 
thickened portion, and has been seen an inch thick. Serous or 
purulent fluid is sometimes present, but not in large amount. 
Extensive deformity of the joint, flexion, rotation, and possi- 
bly dislocation, may result from and accompany this form. 
One of the early stages is sometimes described as a distinct 
condition, under the name of pannous synovitis, so called 
from the fact that a thin layer of granulation tissue encroaches 
upon the surface of the joint, somewhat as the pannus invades 
the cornea. 

In a second type we find a condition which is gen- 



TUBERCULOSIS OF BONES AND JOINTS: BURTON. 6 

erally the result of a primary infection. The tubercular- 
growth therefore commences in the substance of the membrane 
rather than upon its surface, and there is not the division into 
two layers, but the entire thickening is firm and tough. As 
the disease progresses, the entire membrane becomes involved, 
and there is ultimately a softened condition such as occurs in 
the internal layer described above. Such caseating process 
naturally commences in the first-formed tubercles and there- 
fore there are found, at first, yellow or transparent spots of 
broken-down tuberculosis tissue, scattered irregularly through 
the substance of the membrane, while its surface is still smooth. 

In a third instance, the synovial membrane may be thick- 
ened and yet tubercles be very few in number or entirely ab- 
sent from the membrane itself. In the former case, the bacilli 
have lodged in the fibrous portion of the membrane; in the 
atter, the thickening is found over an osseous deposit which 
has not yet reached the surface or has done so outside the ppint 
•of reflection of the synovial membrane, and has been shut off 
from the joint cavity. In either case, the change in the mem- 
brane is due to the inflammation caused by the proximity of 
the tubercular process. It is not necessary that ther^ should 
be a breaking into the cavity in order that there may be inflam- 
mation in the joint. Volkmann says: "Increase of synovial 
fluid, swelling of periarticular structures, and thick and red 
synovial membranes are present before pus has entered the 
joint." Synovitis does not, however, invariably result from 
tuberculosis in the immediately surrounding tissue. Eugene 
Vincent mentions the case of a child who died of tuberculosis 
meningitis at La Charite, Lyons, where, in the head of the left 
femur, which was apparently perfectly healthy, there was 
a tuberculosis nodule which appeared to be on the point of 
•opening into the joint, the joint being still free from any indi- 
cation of the disease. 

The distinction thus made between the different types of 
•diffuse thickening are of more than merely pathological inter- 
est, since their recognition will accurately indicate to the sur- 
geon his proper mode of procedure in order to remove no tis- 
sues beyond those that are diseased. On the other hand it has 
been shown by A. H. Pelliet that it is equally important for him 
to make sure, by an examination of the bone, cartilage, tendons 
and vessels, that he does not err in the opposite direction and 
fail to remove all source of possible infection. 

3. Tubercular Hydrops results from an altered condition of 



■■■$ 



4 TUBERCULOSIS OP BONES AND JOINTS: BURTON. 

the synovial membrane, or its vessel walls, whereby free 
transudation is permitted, but absorption prevented. There is 
little or no naked eye appearance of tuberculosis in the mem- 
brane, and it is only slightly thickened. There is very slight 
pain and no interference with movement. The swelling is con- 
siderable, due to distension of the walls of the cavity by the 
fluid. Abernathy says "the capsule has in some cases been so 
distended as to reach half way up the thigh." Removal of the 
contents by aspiration causes but temporary reduction of the 
enlargement. In fact, the whole condition represents a slow 
involvement of the joint, which later will show characteristic 
tubercular synovitis. 

4. Tubercular Empyema. This condition is quite similar 
to the preceding, with the exception that the fluid is purulent. 
The synovial secretiou, greatly increased in amount, is changed 
to typical tubercular pus by the caseation and breaking down 
of very fine tubercles in the membrane. It is ordinarily a pri- 
mary synovial affection, occurring in old people. In certain 
cases, uowever, it may follow the opening of an osseous deposit 
into the joint cavity. It is exceedingly difficult to control and 
soon terminates as do other forms. 

5. Tuberous Synovitis is a somewhat rare form of the dis- 
ease, in which there is hypertrophy of the subsynovial tissue, 
and formation, beneath the intima, of nodules of varying size 
and number. There may be a single large mass, or the synov- 
ial surface may be fairly shaggy with fibrous polypi. They 
undergo early degeneration. They also frequently become de- 
tached and are found loose in the cavity, and according to some 
authors this is one of the sources of the rice bodies in joints. 
The lesion is a local one, and early removal of the growth often 
results in permanent cure. 

The changes in the cartilage which arise during the course 
of a tubercular synovitis follow an order slightly different from 
that in the membrane. The hyaline structure is broken up 
into fibres, some of which are detached, and falling into the 
cavity mingle with the detritus and fluids. Others remain and 
give a velvety texture to the floor and edges of the cartilage 
abrasion. Hyperemia is present, causing inflammation of the 
cancellar plates, and the articular lamella disintegrate so that 
the cartilage becomes perforated. This process may involve 
the entire cartilage at the same time, or it may make much 
more rapid progress at one point than another. In the latter 



TUBERCULOSIS OF BONES AND JOINTS: BURTON. 

case, the surrounding portion may come away in flakes of va- 
rying size, or undergo gradual caseation and liquefaction. 

SYMPTOMS. 

The recognition of the true nature of the disease in a well 
advanced case of tuberculosis of joint or bone is not a difficult 
matter where there is opportunity for careful study of history, 
course and symptoms. An early diagnosis, however, is espe- 
cially important for its successful treatment, and in this stage 
the indications are not always such as to lead unerringly to a 
correct appreciation of their significance. 

In children the first early symptoms are often attributed 
to other and minor causes, and the affection is consequently al- 
lowed to develop into a formidable condition. 

Swelling. — This is a most important symptom, being al- 
most invariably present, although in the early stages it may 
be so slight and careful comparison with the sound side is re- 
quired in order to detect any enlargement. Where the hip if, 
the seat of the disease the increase in size may not be readily 
apparent on account of the large amount of tissue covering the 
joint. Swelling is generally absent in caries sicca of the 
shoulder joint, where muscular atrophy frequently causes dim- 
inution in size of the surrounding soft parts. 

Impaired Movement. — This is also a symptom of great value, 
although early in the course of the affection it may be inter- 
mittent. In the lower extremity the lameness is ordinarily 
most noticeable upon rising in the morning or after an unusual 
amount of exercise. In the upper extremity the patient will 
use peculiar movements in lifting objects or in feeding himself. 
The importance of this symptom is an argument against the 
use of an anaesthetic during examination, since the relaxation 
of the muscles would prevent its discovery. 

Muscular Atrophy. — This is rarely if ever absent when the 
disease has become established. Its etiology is a subject of 
considerable discussion. The muscles involved are, as a rule, 
those directly above and connected with the joint involved; for 
instance, in disease of the wrist, the muscles of the forearm 
undergo atrophy; in the knee, the quadriceps extensor is 
chiefly affected. The wasting process is not necessarily con- 
fined to the muscles, however, but all the tissues of the part 
may be affected. 

Pain. — There is always some pain present, although less 
than in an acute suppurative osteitis, the tension produced in 
the latter being much greater than in the former. The loca- 



\ 
\ 



6 TUBERCULOSIS OF BONES AND JOINTS: BURTON. 

tion of the pain does not always coincide with that of the lesion, 
but will likely be found in a part supplied by nerves which 
pass or take their origin near yie seat of the disease. This is 
especially noticeable in spondylitis, children so affected com- 
plaining of pain in the pit of the stomach. ''Night- cries" are 
the result of pain probably caused by the contraction of the 
muscles forcing together diseased articular surfaces of the 
bone. 

Fluctuation. — This symptom may be caused by hydrops, by 
intraarticular abscess or by masses of soft granulation. The 
use of an exploring needle will decide, when there is a question 
as to the cause of fluctuation present. The strictest antiseptic 
measures must be observed in such a case. 

Spasm and Contraction. — Reflex muscular spasm and con- 
\ traction produce different effects in different situations. For 
\ example, in spondylitis, in the cervical region, wry neck re- 
Wilts; in the dorsal region, angular curvature or rigidity of the 
column; in the lumbar region there is slight lordosis. In hip 
disease, dislocation may be caused; when the knee is affected 
the le^ is flexed upon the thigh. The reflexes are ordinarily 
increased. 

TREATMENT. 

The omnipresence of tubercle bacilli in all densely popu 
lated districts has been fully demonstrated by the experiments- 
and researches of many investigators. Its remarkable tenaci- 
ty of life has also been abundantly proven. Heat, cold and 
dessication must be extreme in order to destroy its virulence. 
The dried sputum from phthisical subjects is the prolific 
source from which the bacilli are disseminated in the dust of 
the streets, houses and public conveyances and buildings. 

Cornet showed that dust from the walls and furniture of 
rooms occupied by consumptive patients produced tuberculosis 
in animals inoculated with it. In the course of a lifetime, 
therefore, countless tubercle bacilli are no doubt inhaled by 
every inhabitant of a city or town of any considerable size. 
High as is the mortality from this cause — far exceeding that of 
any other disease — it is evident that the majority who escape 
after such repeated exposures owe their immunity to some 
process within the body whereby the bacilli or their products 
are either expelled or rendered innocuous. To the action of 
the ciliated epithelium of the air passages may be due the ex- 
pulsion of some germs which are thus really prevented from 
gaining further entrance to the body. It is believed by Met- 



TUBERCULOSIS OF BONES AND JOINTS: BURTON. 7 

chnikoff and others, however, that the phagocytic action of 
the leucoc3^tes and multiplying connective tissue cells is the 
patent factor in the prevention of obnoxious effects from the 
bacilli and in arrest of inflammatory processes already begun. 
The leucocytes, by their amoeboid movement, may possibly en- 
compass and destroy the bacilli themselves before they have 
had an opportunity to initiate any inflammatory reaction in the 
tissue cells, and this is thought to be what invariably takes 
place in the vigorous and well nourished healthy body where 
no infection occurs. But in a low state of bodily health, resis- 
tance is diminished; that is, the devouring cells are persumably 
less active and less able to prevent or counteract the toxic 
effect of the products of the microparasite, and there follow 
the inflammatory changes which have been described above. 

Even under these conditions, however, the action of the 
phagocytes does not entirely cease. Granulation tissue may 
be formed about the inflammatory area, and should the condi- 
tions be rendered more favorable by the improvement of the 
general health by better nourishment and the consequent in- 
crease in general resistance, there may follow, as we have 
seen, an arrest of the tuberculous process and healing of the 
focus. Heitler, in a paper published in the Wiener Klinic in 
1879, states that in 16,562 post-mortem examinations, obsolete 
tubercles, or rather calcareo-caseous nodules, were found in the 
lungs of 789 cases, or 4 per cent of the whole number. Other 
observers, from a smaller number of post-mortem examina- 
tions, have placed much higher the percentage of such healed 
tubercle in patients dying of non-tubercular disease. 

This so-called spontaneous healing of tuberculous foci may 
be due to the phagocytic properties of the wandering cells, and 
undoubtedly is partially, at least, the result of such influence. 
It is probably attributable in larger measure, however, to the 
inhibitory influence exerted upon the development of the para- 
sites by the anti-bacterial chemical substances either normally 
present in the human organism or produced after infection has 
taken place. The latter products are thus the indirect result 
of the toxins of the bacilli. Such counter poisons or antitoxins 
may destroy the toxin of the tubercle bacilli, or may combine 
with it to form an innoxious substance. This theory has color 
of probality from its demonstration in acute diseases. Dr. 
Newton suggests that the so-called scrofulo- tuberculous lesions 
are the out break of inherited tuberculosis and owe the com- 
parative mildness of their course, when contrasted with pul - 



\ 



o TUBERCULOSIS OF BONES AND JOINTS: BURTON. 

monary or intestinal phthisis, to the fact that the causative 
bacilli have been a long time in the system, which has ac- 
quired a partial, in some cases probably a complete, immunity 
against them, whereas in the acquired form of phthisis the 
bacilli attack an organism quite unprepared and quickly over- 
whelm the entire system. This view is supported by the fact 
that the number of bacilli in and about a tubercular joint is 
often very small, showing that in the months and years which 
they have had an opportunity to multiply they have increased 
very little in numbers and have been deprived by the phago- 
cytes of much of their virility, and probably numbers of them 
have perished. Syphilis affords an example of similar action. 
The acquired form of the disease is prompt, ostentatious and 
violent. The inherited form is gradual, uncertain and stealthy. 
If it does develop, its site is apt to be the bones or deeper 
structures, and recovery may be spontaneous. 
' \^ The unchecked progress of the tuberculous lesion results, 
as has been shown, in caseation and liquefaction of the degen- 
erated tissues and continued invasion of the surrounding struc- 
tures in the direction of least resistance. Sooner or later the 
surface of the part is reached, with resulting sinuses discharg- 
ing the contents of the abscess. In some cases, under favoring 
circumstances, such escape of the infected and infectious mass 
is followed by the formation of granulation and later cicatricial 
tissues in the wall of the cavity, and consequent healing. 
Haward Marsh says "an abscess often constitutes the last step 
in repair." We may consider this process a final operative 
effort on the part of the system to rid itself of the disease. 

There have thus been indicated the four natural routes of 
escape from thp malign effects of tubercular invasion. The 
imitation and aid of these spontaneous processes, singly or 
combined, constitute the scheme of treatment of the various 
phases of the disease, and we may consider the subject of 
its treatment under the following heads: 1. Constitutional. 
2. Expectant or mechanical. 3. Toxins and antitoxins. 4. 
Operative. 

Constitutional Treatment. — It may be stated as a general rule 
that the most efficient treatment which can be adopted is that 
which tends to general health, and while this statement holds 
good to a great extent in the consideration of any form of dis- 
ease, in the case of tuberculosis it requires no modification 
whatever. This is shown by the fact that increase or diminu- 
tion of body weight is invariably a point of prime interest to 



TUBERCULOSIS OF BONES AND JOINTS: BURTON. y 

clinicians. Nourishing and strengthening food, healthy exer- 
cise, salt water bathing, and above all sunlight and pare air 
in abundance, will endow the tissues with great power of resis- 
tance to parasitic invasion. Even when a tubercular diathesis 
is combined with constant exposure to infection, such meas- 
ures are successful in many cases in preventing the disease 
from gaining a foothold. And not only is an efficient prophy- 
laxis thus exercised, but even where the tuberculous process 
has gained considerable headway, through a lowered state of 
the system from any cause, a restoration of bodily vigor will 
often result in the arrest of the action of the bacilli and de- 
struction of their products. Dr. Sampson believes that tuber- 
culosis has a tendency to die out like other germ diseases when 
placed in unfavorable circumstances. Dr. Gibney says that 
joint tuberculosis is, with nourishing treatment, a self-limited 
disease whose average duration under such circumstances is 
from 3^ to 4 years. Dr. Kestley makes the broad statement 
that "time will kill tuberculosis, unassisted by the surgeon." 

It is evident, therefore, that in the more advanced cases, 1 
where active measures are indicated, such constitutional treat- 
ment will be a most valuable adjunct, and in all the modes of 
treatment about to be referred to, it will be borne in mind that 
in connection with them there are to be neglected no means of 
promoting the constructive metabolism of all the tissues of 
the body. 

Expectant or Mechanical Treatment. — Before the days of an- 
tiseptics in surgery it was a temerous operator who opened a 
strumous joint or bone cavity except as a dernier resort. 
Cupping, blisters and leeches are the measures proposed by 
such authorities as Benjamin Brodie and Sir James Paget. 
Following the discoveries of Sir Joseph Lister the feeling of 
safety from infection led to more freedom in operative proced- 
ure in this as in other surgical lines. Again more recently, 
the adoption of more conservative methods has followed the 
revelation of the true nature of tuberculosis and its mode of 
progression. 

The idea of physiological rest as a cure for joint diseases 
is not a new one. Benjamin Brodie in 1846 said: '-There is one 
kind of treatment applicable to all cases of diseased joints, 
namely, the taking away of the function of the joint and keep- 
ing it in a state of complete immobility, with as much care as 
in case of fracture. 1 ' And again: "This is all the local treat- 
ment which the disease requires if you are called to the patient 



fr* 



10 TUBERCULOSIS OF BONES AND JOINTS: BURTON. 

in the first instance." Still earlier than this we find in the lec- 
tures of Sir Astley Cooper, in 1835, the statement that com- 
plete and prolonged rest is the best curative measure in these 
cases. 

The later day advocates of this treatment, either alone or 
combined with other methods, are so many as to make the ver- 
dict almost unanimous in its favor. Dr. Tayre in thirty years 
prior to 1892 treated by conservative methods 407 cases of hip 
joint disease, exclusive ol exsectiom Of this number only nine 
died from the disease; 301 recovered, 71 with perfect motion, 
142 with good, 83 with limited movement, 5 with ankylosis; in 
78 the result was unknown. In a single instance he thinks, 
that ankylosis was due to prolonged immobilization. 

Verneuil claims, on the other hand, that there does not ex- 
ist a single fact which shows conclusively that fixation, how- 
ever long continued, has ever caused ankylosis. Senn says 
that ankylosis, instead of being caused by immobilization, re- 
sults from incomplete immobilization and poorly fitting splints. 

Dr. Shaffer has had the best results in cases of tubercular 
abscess from non-operative treatment, using continuous me- 
chanical protection and constitutional remedies, keeping the 
patients in bed when the symptoms were acute. He reports 
twenty-seven cases of abscess which remained under his care 
long enough to test the value of such treatment. Of these, six 
underwent complete absorption in from one to three years; fif- 
teen after opening spontaneously closed in periods varying 
from two to twenty-one months; five still presented small dis- 
charging sinuses at the time of report. Howard Marsh lays it 
down as a rule to which there are exceedingly few exceptions 
that when a joint which is the seat of tubercular disease of 
short standing is enclosed in a well fitting splint and kept at 
rest the case gives no further trouble. 

From a careful analysis of seventy -nine cases, which he 
considers typical, treated by rest and no operative measures, 
he draws the following conclusions; 

1. By early immobilization, formation of abscesses may 
be averted in 80 per cent of all cases. 

2. In suppurating cases that recover, 65 per cent have 
good motion in the joint, 35 per cent moderate motion. 

3. In non-suppurating cases, 77 per cent have good and 
23 per cent moderate motion in the joint. 

4. Mortality, 6 per cent. 
Although "the trauma that comes from use is the chief 



TUBERCULOSIS OF BONES AND JOINTS: BURTON. 11 

cause of exacerbations," in most cases of joint disease physi- 
ological unrest is caused not only by voluntary movement, but 
by the tonic contraction of surrounding muscles causing pres- 
sure of the joint surfaces against each other. When the lesion 
is purely synovial and there is no marked rigidity of the mus- 
cles this will not be the case (Cheyne), but the bone surfaces 
will be maintained in apposition by tonic contraction in nearly 
every case of bone tuberculosis. Moreover, the inflammation 
in bone causes such marked increased muscular contraction 
that the condition is regarded as symptomatic, especially in 
the early stages. In pure synovial disease the rigidity is less 
marked. In case of the hip joint, for example, even if move- 
ment is prevented, the pressure of the head of the femur 
against the acetabulum will result in the flattening of the 
former and the enlargement of the latter in an upward and 
backward direction. 

Hugman says: "Gradual extension should be employed 
to overcome the action of the muscles, which add to the inflam- 
matory condition of the part by friction of the head x>f the 
thigh bone upon the ilium.". 

In these cases, therefore, in addition to provision for the 
absolute rest of the part, there must be added sufficient exten- 
sion to prevent the bone surfaces from being pressed together. 
Such is notably the indication in tuberculosis spondylitis, 
where the pressure of the inflamed bones against each other is 
kept up, not only by contraction of the muscles, but also by 
the weight of the upper part of the body. Destruction of the 
cancellous structure is thus greatly hastened and curvature re- 
sults from the absorption of the bodies of the vertebrae. Pres- 
sure upon the chord, compression myelitis and paraplegia are 
the natural sequelae. 

Paralysis may also result from a condition of pachymenin- 
gitis either before or after the occurrence of curvature. In 
these cases the " distractionsmethode " of Volkmann combined 
with complete rest is clearly indicated. Dr. Brackett reported 
several cases of paraplegia in Pott's disease cured hy exten- 
sion and fixation, in one case when the paralysis was of eighteen 
months standing. 

The favorite method of applying both fixation and exten- 
sion is by the employment of a plaster-of-Paris jacket applied 
while the patient is lifted partially or entirely from the floor by 
supports under the chin and axillae. The spinal column is by 
this method fully extended. Such treatment employed early, 



12 TUBERCULOSIS OF BONES AND JOINTS: BURTON. 

combined with the general hygienic measures referred to, and 
the administration of suitable drugs — as iodide of potassium — 
has resulted in the cure of a very large proportion of cases 
without deformity. Where curvature has already occurred, 
the column above and below the gibbosity may be extended 
and strengthened, although the diseased area remains fixed. 
Many devices other than plaster jackets are employed for the 
accomplishment of the same end, modified according to the 
ideas of different surgeons and the requirements of individual 
cases, such as Sayres' corset, Lannelongue's " ceinture pel- 
vienne," la gouttiere of Bonnat, Phelps' box, la claie d'osier 
of St. Germain, jackets of poroplastic felt, leather, bamboo, 
wood, woven wire, paper, etc. Dr. Lovett of Boston (Medical 
Neivs, February 29, 1896), in a report of the result of experi- 
ments both with models and upon the living subject, expresses 
his belief that a plaster-of -Paris jacket is really harmful where 
the patient is allowed to walk about, and is only useful when 
the recumbent position is maintained. The Thomas splints 
for hip, knee and ankle are much used and highly esteemed by 
English surgeons, and in the careful hands of their painstak- 
ing inventor gave most satisfactory results. They consist 
essentially of a rigid iron bar to which the parts on either side 
of the articulation are fixed, and the joint thus immobilized, 
while at the same time the flexion is gradually reduced. A 
high shoe on the foot of the sound side allows the affected limb 
to hang and thus auto-extension is obtained. In these same 
joints extension in bed is accomplished by various arrange- 
ments of weights and pulleys. By many like methods the 
same end is sought- Dr. Phelps says that absolute immobili- 
zation of an inflamed joint until it is perfectly cured, should be 
insisted upon, and that voluntary and passive movement be 
prohibited. Porgue expresses the consensus of opinion on this 
subject when he says: "En somme, le repos est le 
pansement par excellence des vertebres malades de tuber- 
culosa " 

The so-called passive hyperemic method of Bier consists 
in applying a pressure bandage to the affected limb up to the 
seat of the tubercular swelling; above this a constriction band 
is applied and the resulting hyperemia is continued, if possi- 
ble, until all active signs of the disease disappear. Bier has 
reported at different times successful employment of this 
method — in all 180 tuberculosis joints in 155 patients — in cases 
where failure has followed the employment of other means, as 



TUBERCULOSIS OF BONES AND JOINTS: BURTON. 13 

immobilization, injections of iodoform oil and evon opening of 
the abscesses and antiseptic lavage, 

Favorable results from this treatment are not, however, 
invariable. In five cases reported by Dr. Bobrow, live cases 
by Dr. Zerenino and four by Dr. Tourtchaninow, all of Mos- 
cow, there was no benefit derived from its employment. The 
last-named surgeon also experimented with guinea pigs, rab- 
bits and dogs, with negative or adverse results. 

Bier does not propose his treatment as a substitute for ex- 
cisions and amputations, but thinks that among the conserva- 
tive measures it is one of the best. It is not known whether 
the action is directly on the tubercular process by the venous 
hyperemia produced or by accumulation of serum, 

Dr. Zeller of Berlin reports its use in twelve cases, com- 
prising tuberculosis of knee, elbows, tarsus and carpus. In 
one case there was temporary benefit, amputation being re- 
quired later. In two cases the disease was aggravated. The 
other nine cases resulted satisfactorily. His findings are that 
the pain is quickly diminished, but that if this treatment alone 
is followed, abscesses will be likely to form with extension of 
the lesion inside and outside the joint. In combination with 
immobilization and iodoform injections its use is recommended, 
the action of the iodoform being said to be more prompt and 
certain in hyperemic areas. 

Injections. — We now come to the treatment by parenchyma- 
tous and intra- articular injections of various antiseptic sub- 
stances which is ranked by Senn as " one of the important 
achievements of modern surgery. In the somewhat extended 
list of chemical agents which have been used for this purpose, 
with greater or less measure of success, the one which stands 
facile princeps and with which by far the best results have 
been obtained in the greatest number of cases is iodoform. 

The use of iodoform by injection was proposed in 1881 by 
Mikulicz, though but little attention was paid to the subject 
until four years later, when Von Moorhof's "Zur Iodoformfrage" 
appeared. Since this time it has steadily grown in favor for 
the reason lately expressed by Dr. Penger. He says: " The 
marvelous effect of the iodoform emulsion to bring the tuber- 
culosis to an end has not only saved many lives, by the avoid- 
ance of the secondary injection which so often follows incision, 
but has saved all the bone remainiug in the tuberculous joint 
and has given functional results far superior to those follow- 
ing excision. In consequence of this it is only the severest 






14 TUBERCULOSIS OP BONES AND JOINTS: BURTON. 

cases of articular osteo-tuberculosis which do not respond to 
the iodoform emulsion injection." 

" The curative power of iodoform injections has so far been 
most manifest in the treatment of heretofore most hopeless; 
cases of surgical tuberculosis — tubercular abscess in connec- 
tion with an inaccessible osseous focus. Statistics show that 
more than 50 per cent of such cases are amenable to this, 
method of treatment. 

Iodoform.— Experiments made by Troje and Tangl show 
that the effect of iodoform upon tuberculous tissue is due- 
directly to its bactericidal properties. Pure cultures of tuber- 
cle bacilli were exposed to iodoform vapor and powder for 
varying periods, with the result that their virulence was dimin- 
ished in proportion to the length of exposure, fifty days' appli- 
cation of the vapor and three weeks of an excess of the powder 
resulting in death of all bacilli. In this form of treatment of 
tubercular disease of bones and joints the aim is, therefore, 
under strictly aseptic conditions, to bring the iodoform into 
contact with the bacilli and continue this condition for a suffi- 
cient length of time to render them harmless. 

In spondylitis, with occurrence of psoas abscess, the in- 
jection of iodoform emulsion has been followed by the almost 
immediate cessation of pain, the contracture and abnormal gait 
vanish and the vertebral caries is checked, 

The statistics of Dr. Wieland are most interesting and in- 
structive. Since 1891 he has treated 61 cases as follows: 21 
cases of cold abscesses, including many psoas abscesses; of 
these 16 are definitely cured, 4 are improved, 1 showed no im- 
provement. 12 cases of joint tuberculosis, of these 9 are defi- 
nitely cured, 3 are improved; 28 cases treated first operatively 
and afterwards by iodoform injections, of these 25 are cured* 
2 are improved, 1 died. 

De Vos reports 68 cases, with 72 per cent entirely cured, 
with only two cases of recurrence. He is of opinion that no 
massage or passive movement should be used after injection, 
since iodoform intoxication or dissemination of the tubercular 
infection might be thus produced. Many others believe that 
moderate passive movement is needed in order to bring the in- 
jected fluid thoroughly in contact with all parts of the cavity. 

It is, of course, most imperative that the strictest aseptic 
and antiseptic measures be adopted in connection with the 
puncture and introduction of the trocar. The point of en- 
trance must also be carefully chosen in order that the fluid 



TUBERCULOSIS OF BONES AND JOINTS: BURTON. 15 

may be properly placed. Von Bunger, in an article on the 
selection of the point of puncture for injection in tuberculosis 
of the hip joint, asserts that the reason why iodoform, treat- 
ment of the wrist and ankle joints have proven so much more 
successful than in the hip joint is that in the former cases the 
joints are always reached, while in the latter the fluid has 
failed in many cases to enter the cavity. 

Dr. Potts of the Hospital of the University of Pennsyl- 
vania advocates the introduction of iodoform into joints by the 
use of the electrode and galvanic current. In a case of tuber- 
cular synovitis he reports excellent results from thirty appli- 
cations. Iodoform was found in the urine. 

A 10 per cent, emulsion in glycerin or pure olive oil has 
been found to be the best solution. The ethereal' solution 
should not be used, as it is likely to cause necrosis of the tis- 
sues overlying the abscess and iodoform intoxication. There 
is frequently considerable reaction following the injection of 
iodoform, and the toxic symptoms may be quite severe. Ordi- 
narily there is a slight elevation of temperature, some accelera- 
tion of the heart action. Occasionally profound depression, 
headache and vomiting. 

Some objections are made to its use. According to Herb-- 
ing, fibrous and not bony ankylosis with flexion usually results. 
He therefore favors resection both for the reason that a bony 
ankylosis is secured and because time is saved, during which, 
under the iodoform treatment, there is an opportunity for the 
occurrence of metastasis. Dr. Taylor, of Philadelphia, fears 
that the cheesy masses are not all removed by the aspirating 
needle, and therefore prefers arxhrotomy. 

Balsam of Peru. — In the opinion of Senn, Balsam of Peru 
stands next after iodoform in the treatment of tuberculous af- 
fection of bones and joints. It was employed by Sayre more 
than thirty years ago as a pressing after resection, and has 
been recommended more recently by Landerer, and by Buchner 
and Hueter. 

Chloride of Zinc. — Lannelongue, used a 10 per cent solu- 
tion of zinc chloride as an injection in tuberculous joint dis- 
ease in twenty-three cases reported to the Paris Academy of 
Medicine. It is followed by the formation of fibrous tissue 
around the focus. The solution is conveyed not into the de- 
generated part itself, but outside and around it. 

Cinnamic Acid. — This has been used with considerable 
success in the clinic of Dr. Landerer, in whose hands iodoform 



16 TUBERCULOSIS OF BONES AND JOINTS: BURTON. 

has not given great satisfaction. After evacuation and flush- 
ing of the cavity with normal salt solution, five to thirty cubic 
centimeters of a 5 per cent alkaline solution of cinnamic acid 
in glycerin are injected. The action of the acid is not directed 
toward the bacilli, laboratory experiments showing that it is 
not fatal to them outside the body. There is set up, however, 
a vigorous leucocytosis. Observations of Landerer indicate 
that the number of leucocytes was increased two and one-half 
times. 

The superiority claimed for this acid over iodoform emul- 
sion is the absence of the temperature and pain following the 
use of iodoform. Of thirty- eight cases treated in this clinic 
thirty-four are reported cured, with two still under treatment. 

Guaiacol. — A 20 per cent solution of guaiacolin oilis rec- 
ommended by Bonome of Rome as an excelleut injection, both 
peri-articular and intra-articular. He also used the emulsion 
after operative treatment, introducing into the joint or bone 
saturated gauze tampons, which are renewed daily. 

Clove Oil. — Kenasz and Nannotti have had good results 
following fortnightly injections of a 10 per cent solution of 
oil of cloves or essence of cloves in olive oil. 

Copper Phosphate. — Saint-Germain uses a mixture of a 
solution of five parts of sodium phosphate in thirty parts each 
of glycerin and water, with a second solution of one part cop- 
per acetate in twenty parts each of the same liquids. This is 
injected and the puncture sealed with collodion. There fol- 
lows an increase of from two to three degrees in temperature, 
which may last for several days, during which some pain oc- 
curs. The injection may be repeated in two weeks. 

Succinic Acid. — The effects of succinic acid — or acid of 
amber — are said by Caravias to be similar to those of cinnamic 
acid, namely, fibrous encapsulation of the tuberculous focus. 

Picric Acid. — Dr. Spannocchi has used this agent with 
some success, pai ticularly as a dusting powder after curettage 
and removal of sequestra. 

Napthol Camphorated. — This preparation is made by 
fusing together pulverized Beta naphthol and Japan camphor, 
one part of the former to two parts of the latter. It has been 
greatly praised by Reboul. The mixture may be advantage- 
ously combined with 10 per cent ' of iodine. 

Potassium Permanganate. — Dr. Agnew in 1883 advised 
early evacuation by aspiration of the contents of cold ab- 
scesses and-the injection of potassium permanganate or car- 
bolic acid. 

Carbolic acid, arsenic, mercuric chloride, teucrin and 
other antiseptics have been used, and for various reasons 
abandoned, wholly or in part. Carbolic acid, however, has 
an advocate in KOnig who, in quite a large number of cases re- 
ferred to below, found better results following the use of car- 
bolic acid than of iodoform. 

(Concluded in Oct.) 



CURRENT MEDICAL LITERATURE. 

THE NATURE OF EXOPHTHALMIC GOITRE. 

Martius (Berliner Klinik, May, 1896) discusses this subject 
from the clinical point of view. Moebius has come to the con- 
clusion that the disease is a poisoning of the organism by the 
morbid action of the thyroid. To this Buschan has opposed 
his nervous theory, which he holds to afford a better explana- 
tion of the clinical phenomena of the affection. Martius con- 
siders that the large number of conflicting theories is due to 
the cardinal symptoms of the disease being regarded as the 
disease itself, which is in reality an affection more or less of 
every system and organ of the body. The theory which loca- 
lises the lesion in the medulla oblongata is quite unsupported 
by pathological evidence, and the sympathetic theory at once 
breaks down by reason of its failure to explain the tremor, t^e 
disordered impulses originating, which certainly do not pass 
down from the cortex to the muscles along the sympathetic. 
It is too often forgotten that the peripheral nerves are not 
originators but only conductors of impulses. Experimental 
evidence, based upon section or stimulation of their fibres, is 
therefore valueless as an indication of the condition of the 
nerve cells, which is the all-important factor in disease. Oc- 
casionally one or other symptoms of exophthalmic goitre may 
be produced by pressure on or disease of the sympathetic, but 
in the actual disease the chain and ganglia are invariably found 
to be healthy. Martius is therefore forced to the conclusion 
that the congeries of symptoms depends essentially on funct- 
ional disturbance of the central nervous system. Turning to 
the thyroid, however, the researches of Goffroy, Greenfield, 
and others have shown that the enlargement is due not merely 
to vascular dilatation, the result of disordered innervation, 
but to a specific hyperplasia, in the crypts of which colloid 
material is either absent or much changed chemically (Lu- 
barsch). Pathologically, exophthalmic goitre is very sharply 
marked off on the one hand from nervous diseases, having ana- 
tomical basis, and on the other from functional affections such 
as hysteria and neurasthenia. It resembles much more closely 
in its symptomatology chronic intoxications such as mercurial 



18 CURRENT MEDICAL LITERATURE. 

ism and alcoholism, and this resemblance is not diminished by 
the fact that Grave's disease often appears to take origin from 
a fright or some other psychical disturbance. The acute symp- 
toms of alcoholism (delirium tremens) and of plumbism are 
often evoked by the action of apparently slight external 
causes upon systems already impregnated with the poisons, 
and the appearance of symptoms of exophthalmic goitre may 
also date from similar causes in the course of chronic intoxica- 
tion from the disturbed action of the thyroid gland. With 
this may also be compared the onset of uraemia in cases of 
granular contracted kidney. Martius therefore concludes that 
exophthalmic goitre is a chronic poisoning of the whole ner- 
vous system, but that the evidence at present available is in- 
sufficient to settle the question as co whether the diseased thy- 
roid gland produces the poison or inhibits its destruction. — 
British Medical Journal, June 6, 1896. 

OPERATIVE TREATMENT IN EXOPHTHALMIC COITRE. 

Allen Star (Med. News, April 18th, 1896) has collected 190 
cases of exophthalmic goitre in which some form of operation 
had been performed upon the thyroid body. Of these 74 are 
reported as completely cured; many of these had been watched 
two to four years before the result was published, exophthal- 
mos sometimes persisting for a year; 45 are described as im- 
proved, and three as not benefited. Twenty- three cases died 
immediately after the operation, and inasmuch as death was 
not due to haemorrhage or want of aseptic precautions, it is 
best explained as a result of a sudden poisoning of the entire 
system by an excessive absorption of thyroid juice suddenly in- 
duced during the operation. This may be due to the necessary 
handling of the gland during the operation, increased absorption 
by torn vessels, or a hypersecretion due to the ether used for 
anaesthesia. He therefore approves Kocher's suggestion that 
the operation should be under cocaine, and not under ether. 
The symptoms preceding this fatal result are sudden rise of 
temperature to 105° to 107 g , rapid pulse (180 to 200), nervous 
distress, sweating, collapse, and finally cardiac failure. The 
author concludes that cases which fail to react to the rest, 
cure and therapeutic treatment should be treated by extirpa- 
tion of the thyroid gland. (British Med. Journal, June 6, '96.) 

CONCEALED TUBERCULOSIS. 

In the N. Y. Medical Journal, Aug. 10, 1885, Dr. R. K. Rach- 
ford gives the prominent symptoms of glandular or concealed 



CURRENT MEDICAL LITERATURE. 19 

tuberculosis, as it occurs in children or youths to the age of 
twenty. As this affection is curable, and when recovered from 
affords immunity against pulmonary tuberculosis later in life, 
we give the symptoms below. 

1. Family history of tuberculosis. 

2. History of exposure to contagion in infancy or early 
childhood. 

3. Pronounced anaemia without apparent cause. 

•4. Irregularity and early appearance of the menstrual 
function. 

5 A scant and pale menstrual flow, followed by leucor- 
rhceal discharge. 

6. Dyspnoea and pain in the side on slight exercise. 

7. Proneness to catch cold. 

8. Abnormal dwarfishness of the body. 

9. Progressive failure of the health. 

10. Neurotic disease, especially incontinence of urine. 
Sixty per cent, of his clinical cases with incontinence are tu- 
berculous, and 45 per cent, of the neurotic cases are tubercu- 
lous. 

11. Dyspepsia, associated with chronic diarrhoea or con- 
stipation. 

12. Enlargement of external lymphatics, accompanied 
by pronounced and inexplainable anaemia. (N. Y. Med. Times, 
•June, '96. 

SERUM TREATMENT OF SCARLET FEVER. 

In the Jour, de Med., March 10, 1896, Marmorek, of Paris, 
makes a report of the treatment of scarlet fever by injections 
of anti-streptococcus serum. Notwithstanding that we do not 
yet know the specific organism which is the cause of scarlet 
fever, the frequent presence of a streptococcus may be of sdme 
value. It is found in the throat and in the glands, kidneys, 
ear discharge, valvular vegetations, etc. On these grounds, 
Marmorek injected anti-streptococcus serum in ninety-six cases 
of scarlet fever at the Trousseau Hospital. Of these, five 
died — four from diphtheria, and one from pneumonia. The 
most marked effect of the serum was on the swollen glands, 
which subsided so rapidly that there was no suppuration in a 
single case. In the event of albuminuria, one or two injections 
caused its disappearance. Not only did the serum seem to 
prevent grave complications, but it also caused the rapid dis- 
appearance of false membrane from the throat and subsidence 
of delirium. The general state rapidly became better, the 



20 CURRENT MEDICAL LITERATURE. 

pulse slower and stronger. The only bad effects observed 
were transient erythemas. The writer, while admitting that 
the series is too small to warrant any definite conclusion, is 
still of the opinion that the serum treatment was of consider- 
able use in reducing the severity of the attack. — (The Canadian 
Practitioner, June, 1896.) 

SCHLEICH'S METHOD OF LOCAL ANAESTHET1ZATION. 

The skin is first made aseptic, then pinchea up, and the 
sterilized needle of the syringe containing the solut'on, which 
should be cold, is passed obliquely under the epidermis, and a 
few drops are injected until a white elevated wale appears. 
The needle is withdrawn and inserted at the edge of this wale, 
and so on, until an area as large as may be desired is made 
anaesthetic. If the spot to be cut is first cooled by an ether 
or rhigolene spray, if it is the skin, and by a strong solution of 
carbolic acid, if it is the mucous membrane, the prick of the 
needle is not even felt, but in the case of the small needle, 
which should be used, the pain is almost nil, especially when 
the skin is pinched. Wurdemann has used this method in 
operations about the eye and also in abscesses and felons with 
success. Sehleich has even done coeliotomies with it, but 
others might not dare follow this lead. The solution most 
usually employed is a grain and a half of cocaine, one-third of 
a grain of morphine, and three grains of sodium chloride in 
three ounces and three drachms of sterilized water. Two other 
solutions, one containig double the quantity of cocaine and 
and the other one-tenth the amount, are also used. The value 
of this operation is in the technique, and stress is laid on 
the point that the needle must not go beneath the skin. This 
process is capable of development and is worthy of a careful 
trial. — (Maryland Med. Journal.} 

ILLEGITIMACY. 
(From an essay by Dr. H. Hatch, of Quincy, 111., read at the 39th Annual! 
' session of the Medical Assn of the State of Missouri.) 
There are, he said, few who recognize the importance of 
this subject or know of the frequency of its occurrence. Nor 
do physicians as a rule appreciate the fact that much of it 
might be prevented by their counsel and instruction. The 
alarming increase in suicides, infanticides and murders, as well 
as the relative increase in number of public prostitutes must 
be ascribed to the growing evils of illicit intercourse and par- 
ticularly in the rural districts. It is true that a majority of 
girls in country towns who "get into trouble" are now shrewd 



CURRENT MEDICAL LITERATURE. 21 

enough to go to some city to remain until all traces of abortion 
or of natural labor have disappeared, and then return home in 
as good social position as before their secret "fall;" but the 
number of public illegitimate births is rapidly increasing; in 
Europe the ratio is 120 to the 1,000 births — in America (so far 
as recorded) 78 to the 1,000. In the way of public health, il- 
legitimacy heads the line of degeneracy; abortions, alcoholism, 
sexual perversions, generation of criminals, etc., being the di- 
rect result. The causes of the increase are (1) human passions, 
(2) too free mingling of the sexes — especially in the high 
schools, (3) too great liberty during courtship, (4) poverty of 
the masses — preventing marriages which otherwise would take 
place, (5) wrong laws. The remedy is neither education nor 
religion, though both are of some value as preventatives. The 
laws should be changed so that the mother of a bastard shall 
be published as fully as the father — for as things now are the 
man runs away to escape punishment (or marriage) while the 
woman remains as a subject of pity instead of being held equal- 
ly responsible before the law. Further — the law ought to hold 
the parents of minors responsible for the sexual sins of their child- 
ren, for many cases of illegitimacy may be traced to want of 
instruction on the part of parents — many more to want of watch- 
fulness. It is the duty of physicians to instruct mothers and 
even the young men and women and to create public sentiment 
against the unbridled liberty between the sexes so common in 
this country. Still further — it might be well to advocate a 
law which will make castration the punishment of the man con- 
victed of seduction who refuses to marry the woman in- 
jured. 

Dr. I. N. Love, of St. Louis, regarded this as one of the 
most important subjects which can be discussed by medical 
men. It is the duty of every physician to instruct the people 
upon the dangers which beset the young and especially the re- 
sponsibility of maternity upon the minds of young women. * 
Further, every physician owes it to hu- 
manity to protest against the kissing and the hugging which 
are generally regarded as harmless. Kissing is a part of sen- 
suality and should be prohibited so far as its indiscriminate 
practice is concerned; it is entirely too common, particularly 
in the country. Holding parents legally responsible for their 
children under age will certainly do much to check the number 
of illegitimate children. And Protestant ministers might do 
much to check it by adopting the methods of the Catholic 



22 CURRENT MEDICAL LITERATURE. 

clergy in giving instruction upon the duties of maternity, etc. 
— The Medical Fortnightly. 

PROLONGED INTRA-UTERINE RETENTION OF AN OVUM. 

Oloff (Prag. med. Wochenschr., xx. 22, 1895) records the case 
of a pluripara, aged 43, who in November, 1893, five years 
after the birth of her tenth child, suffered from jaundice and 
amenorchoea; in February, 1894, from melaena and hsemateme- 
sis and enlargement of the abdomen; she was tapped three 
times for ascites, and died on November 9th, 1894, from cir- 
rhosis and rupture of a branch of the coronary vein of the 
stomach near the cardia. In the right horn of the uterus were 
the remains of a spherical ovum about 1.5 cm. in diameter, con- 
sisting of the chorion with many calcified, villi; the amnion and 
embryo had apparently escaped through a tear in the lower 
part of the ovum which had no organic connection with the 
uterine wall. Under the microscope the mucosa showed where 
the ovum had been attacned. Oloff estimated the development 
of the ovum at from two to three months, that the retention 
had lasted about a year, and that there had been no uterine 
haemorrhage. Resnikow (Centralbl. f. Gynak,, xix., 9, 1995) re- 
cords the following case: A patient who had been twice con- 
fined (of twins the last time), when again seven months gravid 
had a severe illness with fever, during which labor pains came 
on, but only for a short time. She afterwards had a purulent 
discharge and rigors, followed by amenorrhcea. After four 
years the uterus was dilated, and the bones of a seven months' 
foetus removed, and she recovered her health. Two similar 
cases are quoted. — British Medical Joztrnal per Canadian Prac- 
titioner. 



The Corpuscle. 



EDITORS, 

J. E. LUCKEY, '97, Editor-in-Chief. 

746 West Adams St., Chicago. 
T. R. CROWDER, '97, Sec'y and Treas. 
FRED. BARRETT, '97. E. L. McEWEN, '97. A. F. STEVENSON, '98. 



Communications relative to advertisements and subscription (Subscription price 
$1.00 per annum), should be addressed to the publisher. Remittances should be made 
by money order draft or registered letter payable to "The Corpuscle," and addressed 
to Fred C. Honnold, 402 S. Paulina St. 



Ruby Red and Black: Colors of Lake Forest University. Orange: Color of Rush 

Medical College. 



The Physician's It is not best to measure one's success by his in- 
Duty to society. come . Most of the world's great physicians have 
died poor men. There is a reward of more value than money 
in the sense of having done duty. So what is the difference if 
"Christian science," osteopathy and kindred humbugs seem to 
nourish; it will be but for a comparatively short time. To lift 
up the masses requires a reformer to be on a higher plane. 
There is no sense in waiting for ''the age to call for a higher 
education among medical men." The medical men must make 
the age recognize its need of something better. The physician 
must be the man among men. To do the best for the body is 
to do the best for the mind or soul and so the physician must 
be a practical psychologist. He must Know how to touch 
every department of intricate human nature. 

Ignorance of physiological laws causes neglect which leads 
to pain and great sorrow. The doctor must enlighten his 
patrons on these laws and thus he has a duty to perform as an 
educator. Society is suffering from conditions today that are 
based solely on ignorance of laws clearly patent to the physi- 
cian and it is his duty, so far as in his power, to dispel this ig- 
norance and save the innocent. To neglect to do this is to 
neglect duty. To neglect duty is to fail, even though untold 
riches be the reward of such neglect. 



JAMES B. HERRICK, A. B.. M.D., Editor. 



Membership in the Alumni Association or Rush Medical College is' obtain- 
able at any time by graduates of the College, providing they are in good standing in 
the profession, and shall pay the annual dues, $1.00. This fee includes a subscription 
to The Corpuscle for the current year. This journal is the official organ of the 
Association. 

Dues and all communications relating to the Association should be sent to 

JOHN EDWIN RHODES, M.D., Sec'y and T eas„ 34 Washington St., Chicago 



Clem D. McCoy is at Kenton, Ohio. 

Frank C. Wiser, '91, is surgeon for the B & M. R. R. at 
Rulo, Nebraska. 

F. B. Harmison, '96, is at 3300 State street, Chicago. 

J. F. Gesell is at Richmond, Kansas, and reports that he is 
doing well. 

Dr. E. J. Smith writes from Harlan, Iowa, where he is 
practising, and closes with the sentiment, "Long live Rush." 

We are sorry to record the death of Dr. J. J. Bennett, one 
of our graduates, at Lloyd, Wisconsin. No particulars have 
reached us. 

Dr. Merlin C. Johnston, of last year's class, is at 109 E. 
26th street, Minneapolis. He is well satisfied with the open- 
ing of practice and has been fortunate in securing a position as 
demonstrator of anatomy and instructor in the same branch in 
the College of Physicians and Surgeons in that city. 

From The Irish Times, Dublin, Wednesday, July 15, 1896;. 
Evans and Park — July 7, 1896, at the Methodist church, Ban- 
don, by the father of the bride, Edward Purden Evans, M. D., 
Milwaukee, Wis., U. S. A., to Maida, eldest daughter of Rev. 
John Oliver Park, Bandon. Dr. Evans is a graduate of '94. 

D, M. Finlay, '68, writes from Cascade, Iowa: "Old Rush 
to the front where she stands all over the United States of 
America." 

Dr. S. H. Rabuck, '96, writes from Lyle, Minn., that he 
bought out an old doctor and "jumped right into a practice." 
He says further that his weakest point is in prescribing and 
giving medicines: "It bothers me to make up an elegant and 



ALUMNI DEPARTMENT. 25 

palatable prescription." We wonder if any others of '96 are 
bothered in the same way? 

Dr. Hubenthal, '96, is located and doing well at Belmont, 
Wisconsin. 

Dr. M. A. Cunningham. '96, has located in Jonesville, 
Wisconsin. 

Dr. F. R. Warren, '96, has located in Otis, Indiana. 

A well established practice is for sale in a town of 3500 in- 
habitants — a railroad center. Address for particulars, Lock 
Box 576, Aberdeen, S. D. 

Also a good location for a German speaking doctor. Ad- 
dress Dr. R. G. Sayle, 105 Grand Ave., Milwaukee. 

Dr. T. F. Desmond is located at Webster City, Iowa. He 
is one of the many who plan to be present at Commencement 
next year. The glowing reports of the pleasant and profitable 
Commencement week of '96 have caused large numbers of the 
Alumni to already look forward to the time when they can see 
'97 graduate. 

Dr. J. R, Barnett, of Neenah, Wisconsin, knows when he 
gets a good thing for little money. And he is wide awake to 
the fact that two good things, the Corpuscle and membership 
in the Alumni Association, are purchased with one dollar — 
either gold, silver or greenback. He writes: "It is so seldom 
in this world that we can buy two things at less than the value 
of either." 

There are Rush men in the east as well as in the west, and 
they are loyal, too. Witness the following from W. T. Bishop, 
79: 

Harrisburg, Pa., July 17, 1896. 
John Edwin Rhodes Md., Secy, and Treas. Alumni Rush 
Medical College, Chicago, 111. 

My Dear Doctor: — Please find P. O. order for two dollars. 
Corpuscle 1896-97 $1. To pay debt due Pulse $1. 

Until your kind favor of July 2nd, 1896, I overlooked the 
first request for payment of Corpuscle — it is worth twice, and 
more than that, the price. If every Alumnus of Rush would 
pay $1, the debts due for Pulse could be paid without trouble. 

Whenever published and whatever the price, I want two 
copies. Please accept thanks for your kind interest. Very 
truly, W, T. Bishop, Rush 1879. 

Dr. B. M. Linnell, '93, was married to Miss Grace A Bru- 



26 ALUMNI DEPARTMENT. 

baker, daughter of Mr. and Mrs. Andrew Brubaker. June 30th, 
at Dixon, 111. Their address is 279 Cly bourn Ave., Chicago. 
The Corpuscle wishes the happy couple all joy and a suc- 
cessful life. 



Vincent Lombard Hurlbut, M. D. , died July 24, at his, 
home, 2342 Prairie avenue, Chicago, 111., of Bright's disease. 
Though most of his busy life had been spent in Chicago, Dr. 
Hurlbut was a native of New York State, where he was born 
in the town of West Menton on June 28, 1829. His father was 
Dr. Horatio N. Hurlbut, a descendant of the Puritans. As a 
child he moved with his parents, first to the town of Sparin, 
Crawford County, Pa., and later to Jefferson, Ashtabula 
County, Ohio. Graduating from the Jefferson Academy, he 
studied medicine, first under his father at his home, and later 
in a medical college at Cleveland. In 1851 he came to Chicago 
and entered Rush Medical College, from which he graduated 
the next year. During the same year he began the practice of 
and followed it with unflagging application. 

He soon gained prominence in his profession, and for a gen- 
eration had been one of the leading physicians of the city. In 
1873 he was appointed surgeon of the Woman's Hospital for 
the State of Illinois, and long held that position. He was a 
member of the American Medical Association, of the State 
Medical Society, was Vice-President of the Cook County Med- 
ical Society. Dr. Hurlbut was a thirty-third degree Mason 
and one of the oldest and most widely known members of that 
order in the West. He entered the Blue Lodge in 1860 and 
took the various degrees until he reached the highest, receiv- 
ing the thirty-third in Boston in 1864. From 1863-5 he was 
commander of Apollo Commandery and in 1867 he was made 
Grand Commander of Illinois. In 1871 he was elected Gener- 
alissimo of the order, and in 1877 was chosen Grand Com- 
mander of the order at the triennial conclave at Cleveland, 
Ohio. Notwithstanding his success and honors he was very 
unostentatious in his manner and his acts of charity were 
innumerable, ever ready to alleviate suffering and unhappiness. 
Our genial colleague will also be greatly missed by former 
habitues of the Old Grand Pacific Hotel, to which hostelry he 
was house physician for over twenty years. — Jour. Amer. Med. 
Ass'n., Aug. 1, 1896. 



The Corpuscle. 

RUSH MEDICAL COLLEGE, CHICAGO, ILL. 
Medical Department Lake Forest University. 



VOL. VI. OCTOBER, 1896. NO. 2. 



MEDICAL EDUCATION. 
By Edwin Klebs, M. D. 

PROFESSOR OF PATHOLOGY. 

Opening lecture delivered at Rush Medical College, Chicago, September 

29, 1896 

Ladies and Gentlemen: The wish expressed by my new 
colleagues that I open the lectures of this new year of medical 
instruction by some considerations of our work, laid upon me 
the somewhat difficult task of explaining my opinion, in a foreign 
language, on the organization of schools in this country, with 
which, also, I am not perfectly acquainted. 

You must not ihink that this will be a confession of my ig- 
norance of American history and institutions. On the contrary, 
I have always, from the time of my youth, inspired by the 
treatises of Ralph Waldo Emerson, loved this land. At the 
time of the great civil war I eagerly studied the work done by 
your fathers, who, destitute of everything necessary to carry 
on a successful war, decided to live or die for liberty and hu- 
manity. 

I was astonished at this time to acknowledge the origin of 
a new war-hygiene, later further developed in the great wars 
of the old country. Comparing the great losses in the Crimean 
war, which preceded the great losses in the Crimean war, 
which preceded the American civil war, with those of the 
Franco German war of 1870, you will not fail to see the great 
progress in this new field, principally, as I think, effected by 



28 MEDICAL EDUCATION: KLEBS. 

the distribution of the wounded and sick over vast areas, by 
means of the mighty streams. 

It seems to me that the American people, impelled by ur- 
gent necessity, became more and more inventive, and learned 
more in a few years than it would have learned in centuries 
without that impulse. 

The wonderful development in this land that you all know, 
from your own experience, now followed during the short per- 
iod of twenty to thirty years. All faculties were exalted by 
the confidence in the restored Union; enormous wealth and 
prosperity, such as were never known before in history, were 
arising from the soil of the new land. 

Naturally, then came depression. In the restless strife 
|or improvement many things, without which a people can not 
be happy, were not taken into account. I only mention the 
devastation of woods, threatening a change of clime, unless re- 
planted systematically, an injury not otherwise to be remedied. 

Political and financial influences have more and more in- 
creased the internal difficulties, so that now will come a time 
when the labor of the whole land will be required to sustain 
this prosperity. 

But how will the people endure this change of conditions, 
the irreparable loss of so many facilities? I think that they 
will accept the new position, the harder strife for life, the con- 
ditions of life impaired and narrowed also by the competition 
of the whole world. 

This confidence is based in the first place, on historical 
facts. A people who have surmounted the hardships of a civil 
war will find a method also in this harder time, but in another 
way. 

Not the pioneer and the digger, but the teacher and edu- 
cator will be the leaders in the new course. Science will be 
the aim. 

The educational question now moves the whole world. 
European civilization based wholly on the old classic traditions 
of Rome and Greece, has reached, especially in Germany, a 
standard classic education which seems to be incompatible with 
the claims of modern life. Natural science will more and more 
supplant the ancient literature and the modern philologist finds 
that the modern languages have attained a higher certainty 
and clearness by which to express the modern thoughts than 
the dead languages now occupying nearly the whole time of 
the scholar. 



MEDICAL EDUCATION: KL.EBS. 29 

The reform of higher school education now commencing 
in Germany, will save our country from imitating the so called 
classic studies. Let us till the mind of the child and the youth 
with a broad knowledge of earth and heaven, of living beings 
and dead material, of human life and thought, history and phil- 
osophy, so that they may understand the coming life and be 
able to distinguish the good and the evil, the just and the un- 
just; religion and morals must have a prominent part in this 
system of education. What I wish to say is this, that for the 
young man or woman willing to devote themselves to medical 
science, a non classic education is quite sufficient. But the re- 
quirements of preliminary education necessary for admission 
to our colleges seems to be totally insufficient. Unless certain 
literary colleges have been attended, an examination in writing, 
in the branches of a good English education, including algebra 
as far as equations of tne second degree, the first book of 
geometry, English composition, elementary physics and the 
elements of the Latin language should be substituted; chemis- 
try and physics will be taught in the freshman year. 

I do not find in the program the descriptive natural 
sciences, the natural history of plants and animals, the geology 
and mineralogy, which contain the elements of so many parts 
of the medical science, not to speak of knowledge of human 
history, art and thought. I am quite sure that a great number 
of our pupils have completed their education in these direc- 
tions, but I doubt if that is the case with everyone. 

I do not pretend to propose reformations, but I do hope to 
find the young men better educated than the scanty require- 
ments for admission to the leading medical colleges lead me 
to believe. 

For comparison, I will give a short outline of the require- 
ments in German universities, in natural history only. The 
young men entering the university have learned a great deal of 
natural history at the gymnasiums, but before commencing the 
medical studies they must spend a whole year's course in nat- 
ural sciences, such as botany, zoology, chemistry and physics, 
including practical work in microscopy and the chemic labora- 
tory. 

If we look at the schedule of Rush Medical College we 
will perceive that in the freshman year no more than 745 hours 
are devoted to study, in the following three years from 870 to 
1,036. I think that one could very well dedicate 150 to 200 
hours to the study of botany and zoology in the first year. 



30 MEDICAT, EDUCATION: KLEBS. 

But this, as other practical questions, must be considered at 
another time. Furthermore, I would wish for a certain know- 
ledge of the German and French languages, already required 
by the Johns Hopkins University, also some ability in draw- 
ing. Without knowlege of these modern languages the medi- 
cal student can only make use of the English literature and 
translations from the German and French, but as the greatest 
part of medical literature and the most valuable is published 
in periodicals, the student can not fully understand the medical 
literature of his time without this knowledge of modern lan- 
guages. As the development of science is a very rapid one, 
scientific work is not possible without personal literary.study. 

But we have given enough detail on medical teaching. 
Let us now look at the American students and their qualifica- 
tions for this science. As I have had many opportunities to 
teach Americans in European laboratories, I am prepared to 
speak upon that point with due reservation. First I will say 
something about the ladies studying medicine abroad. The 
greatest number I had in Zurich were Kussian or Slavs, Ger- 
man, Swiss and American. The best prepared for study were 
Swiss, American and German. In diligence they surpassed 
nearly every male student and as far as memory is concerned, 
it was very difficult for our male students to attain better 
marks than the female in the examinations. In the anatomic 
and microscopic work, over which I made personal observa- 
tion I found American ladies among my best workers; in the 
composition of publication there were some differences, how- 
ever, depending more upon the personal character than upon 
mental faculties. One lady whom I highly estimated for her 
assiduity and very clever work, labored somewhat under a too 
much developed pride, declining every help in the composition 
of her paper, which, based upon delicate microscopic researches, 
would have made more impression if the points and the deduc- 
tions had been more thoroughly discussed. I do not know if 
that was a personal propriety, but I can understand that a wo- 
man prides herself on independent work; this pride can be a 
very good support in the hard work awaiting the doctress. I 
shall ever remember another American whom I had the pleas- 
ure to aid in her original work, as the best example of a medi- 
cal student, fitted to do any scientific work. In this direction 
I must give the American ladies the first place and I hope to 
see here the same attainment in practical medicine. 

As to the qualification of American men for scientific med- 



MEDICAL EDUCATION: KLEBS. 31 

ical work, there can be no doubt. From my youth to the pres- 
ent time I have h ad many opportunities to come in contact 
with them as a teacher, and can openly express my opinion, 
that they would not, in any way, remain behind any other 
people, only being handicapped by their preliminary education 
and imperfect knowledge of foreign languages. But these 
slight defects were compensated for by a burning zeal for 
learning. My first experience dates back to the early sixties, 
when I was assistant of Professor Virchow. My first pupil, a 
man as old as I, was a Californian and showed, perhaps, more 
enthusiasm than your eastern people, but I will never forget 
his open-hearted joy, when he understood a difficult matter, 
explained by the inexperienced teacher, in pretty bad English. 
And I have made the same observation, repeatedly, through a 
quarter of a century. All young Americans that came to me 
for study, were brave, joyful, enthusiastic people, but some- 
times a little deficient in school education. They have all been 
my friends. 

You, probably, all know the cause of these characteristics. 
The American life is a practical one, and the arts and sciences, 
here, come in second place. But I am sure this state of things 
will change before long. Deficiency in education is more and 
more improved, and there are many men of the highest and 
most refined education in liberal arts and sciences. One of my 
friends in Germany, a learned man of high standing, a deep 
critic of Go the, stated that he was astonished by American 
visitors, oftentimes finding that they had the most profound 
understanding of German literature and philosophy. That is 
a good understanding of what can be done by your people in 
medical science also. 

In medical practice we can certainly meet any competition, 
but not in medical science. The reason for this is to be found 
in the organization of our medical schools, which I have al- 
ready touched upon. I understand very well that these organ- 
izations resulted from compromises and that under given cir- 
cumstances, for the moment, higher attainments could not be 
demanded without driving a large number of students into the 
hands of so-called medical colleges, which one of my friends 
designated as "paper mills," a shameless scattering of diplo- 
mas for money. 

Regarding these facts I can not find a better remedy than 
to place the higher education in the hands of the federal gov- 
ernment. This would present many difficulties, as I know 



32 MEDICAL EDUCATION: KL.EBS. 

from my experience in Switzerland, and I would not like to in- 
terfere in practical questions. But we can take these matters 
out of the hands of the government and regulate them. By 
"we" I mean all good citizens who find that the prosperity of 
the country depends upon the education of the people. Very 
much is done in this direction. For our prominent scientific 
institutiona are founded by private individuals, by donations, 
often rich men restoring a part of their earnings to the people, 
the well-conducted work of whom has produced these means. 
A political economist in Germany has named that the "inher- 
itance of the people.'' "To give is more blessed than to re- 
ceive," said Jesus, the greatest socialist. Yes, we will bless 
these rich men who will help in the education of the people 
and perhaps prevent the day of wrath. But not alone to the 
rich people should the appeal be made to assist in the educa- 
tional question. Every physician, every patient is interested 
in this work and can afford to promote the higher medical 
education. I am sure the generous American people will favor 
progress in higher scientific education. 

Here arises a very important question: Is the efficiency 
of such institutions for higher learning assured by money 
alone? Can money buy such institutions, as it can buy rail- 
roads and steamships? 

The success in original scientific work depends more upon 
the. worker than upon the external conditions of work. In my 
youth I have seen Helmholtz, the great physicist work out his 
great discoveries in optics with the simplest means, and calcu- 
lating with a child on his lap. The great mathematician 
Gauss, when asked how he had found his new methods enor- 
mously enlarging mathematic conception, replied: "By repeat- 
ed thought over the same matter." So we see that the per- 
sonal conditions for scientific work are given everywhere, if 
there is a quiet place for thinking and men apt for this work. 
An exceptional mental faculty is not necessary for this, as not 
every learned man needs to be a genius. Continuous work is 
sufficient if the right way is laid open. Such indicators 
(Wegweiser) guiding the seekers after knowledge will arise in 
every country where learning is esteemed and supported. 

I have experienced a striking example in my own life. I 
came to a university, in a land where science was not much 
developed, but proud of its great political power in a past time. 
This aristocratic people, with high self -consciousness, resented 
bitterly that so many strangers were called by an intelligent 



MEDICAL EDUCATION: KLEBS. 33 

government to fill the chairs at the university. Some wished 
to injure the intruders, not personally, but by diminishing the 
number for instruction. A politician of high standing was in- 
duced to promote the attack, which would be adverse to the 
development of the university, when one of the professors 
opened the eyes of this political leader, showing the true aim 
of his associates, by saying: "You, as a liberal and reformer 
can not support an action against natural development. Give 
good seed to the soil and you will see good fruit ripen. 
Learned men can not be found everywhere. Take what you 
have and you will see, that in some generation, you will have 
enough support from your own countrymen. " Thereupon the 
good man ceased to support his tempters and the chairs of the 
now, after nearly thirty years, occupied by a great number of 
native teachers, universally acknowledged to be of the highest 
rank, 

What I wish to show by this experience is that higher 
study needs a thorough cultivation, continued for a long time. 
It is the same as with the cultivation of plants. If King 
Probus had not planted the grapes on the borders of the Rhine, 
the Rhine wine would not have won its world-wide celebrity. 
I tasted the California wines some forty years ago and I was 
not pleased with it, but now it is quite a different thing. 

As we can not reform the whole system of higher educa- 
tion at once, we must commence slowly, warming and pro- 
tecting the delicate plant sown in a soil in which, as yet, other 
plants, industry, farming, business of all kinds have grown so 
luxuriantly. If the soil commenced to be exhausted by the 
one fruit, the good farmer will plant another. Science is a 
plant that has borne very good fruit in old Europe, why should 
it not develop here, when a young, fresh people, free from 
many prejudices of the old w x orld, will strive to win the first 
rank in the great problems of the human mind? 

But how shall we promote strong scientific work in our 
department, the medical science? In the first place you must 
change your opinion on the tendencies of the college or uni- 
versity. It does not suffice to have excellent instructors and 
well educated pupils, but we must have the w T ill to give or re- 
ceive more than medical instruction, sufficient for medical 
practice, or only for the examination. That would be the 
office of a high school or a university, in the sense of German 
universities. More than in other countries, -you will find that 



34 MEDICAL EDUCATION: KLEBS. 

these institutions are founded not only for education, but also 
for observation. 

The difference between a school and a university is not al- 
ways comprehended as it should be here, nor in Europe. As a 
young professor, I often spoke with business men about the 
difficult task of a university professor, but they did not under- 
stand me. ''Oh,'' one said, "I think, in the first year, that it 
may be very difficult to lecture so much, but later one learns 
that." This is only too true, many professors learn to repeat 
the same lectures, and very amusing anecdotes are told in Ger- 
many about teachers accustomed to do this. One of these 
learned professors, reading his lecture absent-mindedly, also 
read the foot-note: "Here I like to make a joke." But I can 
assure you that this sort of professors died out, and from that 
time the acknowledged glory of German and other universities 
commenced to fill the world and attract people from every 
country. By these remarks I do not mean to say that German 
universities are perfect. As the devil always sows weeds 
among the wheat, so there the high position of professorship 
has attracted many inferior people who rely more upon pro- 
tection than personal worth, and the egotism of many profess- 
ors goes a little too far. Where there is much light there will 
also be shadow; but at all events we can look to German uni- 
versities as the best examples of our scientific schools. 

The first object of these schools is, and must be to educate 
the pupils to scientific and practical work. We must educate 
them to be independent observers, for a physician must have 
this quality, and without it he will not enjoy his task. He may 
fill his position very well, operate and prescribe, but if he does 
not look at his patient with the eyes of an observer he will 
fail to see many features of the highest importance. To the 
superficial physician not trained to careful observation, one 
case looks like another and he will be astonished if the expect- 
ed effect of a certain remedy does not appear. It is, as with a 
savage people or a flock of cattle to the unexercised eye, they 
seem to be all alike; the observer, however, if he be an exper- 
ienced traveler or a cattle grower, will see the difference. 
Certainly the good physician will learn, in the office and at the 
bedside, what he has not learned at school; but it would be 
better if he would go out into the world wholly instructed and 
experienced. Scientific work, done while a student, will aid 
the practitioner. 

Hoping that you are convinced of the great importance of 



MEDICAL EDUCATION: KEEBS. 35 

this truly dominant question, I will add some suggestions as to 
what should be done in this direction. First, every laboratory 
should be so arranged that a certain number of students and 
also of younger graduates could work, not in learning the ele- 
ments, those must be understood, but for original scientific 
work. The smallest problem which we attempt to solve brings 
with it more elucidation than the reading and memorizing of a 
whole text- book. I fear that in our method of teaching learn- 
ing, memory is too much relied upon, recitations prevail and 
not discussions. With young people, working on problems, 
there must be more discussion than recitation. I prefer a 
student who does not know so many facts, numbers or figures, 
but who understands the connection of facts and how to make 
conclusions from the known to the unknown. 

In the laboratory opened for the work of students, it is not 
necessary to give long lectures but to discuss the matters in a 
conventional manner. 

Whoever is farther advanced in his work, will come and 
expound his results to teacher and his colleagues. From the 
discussion new thoughts will arise not before given by the 
teacher. The scholars can learn without feeling that they are 
being instructed. I hear that such a system has been com- 
menced here in private primary schools; if it is practicable 
with children, why should it not be with thinking men? 

But in this matter another side is to be taken into consid- 
eration. If we have such laboratories who will work in them? 
The student is busy the whole day and the young physician 
must oftentimes attend to making his living. I do not think 
that people are poorer here than in Germany, where all this is 
done, but if so, the means for such work must be found and I 
do not doubt but it will be. In German universities we have 
so-called stipendia, which enable the poorer student to con- 
tinue his studies, and beside that, we do not want to have med- 
ical proletarians (a very good word of Billroth). Whoever un- 
dertakes this noble study should first find the necessary means. 
The poor should not be excluded, but they must show the true 
qualifications. 

For the young graduates, working to perfect their educa- 
tion, I would recommend the two appointments which, in my 
opinion, have made German universities great; first, the doc- 
torate, obtained by scientific work; second, the private uni- 
versity teachers (Private Docenten). 

The title of doctor, historically, means more than that of 



36 MEDICAL EDUCATION: KLEBS, 

physician; it expresses a scientific qualification, shown by or- 
iginal scientific work. For that degree the publication of a 
dissertation is required, that is, a scientific treatise and theses, 
scientific questions which the applicant will defend in free de- 
bate against every one. 

This venerable practice has been, as all human things, 
liable to deterioration, but it has influenced, in a very osten- 
sible manner, the high standing of the profession. Innumerable 
students of medicine have been compelled, by this custom, to 
do original work, or treat clinic observations in a historic and 
critical way. Certainly the dissertations have awakened many 
literary talents which would have slumbered without this in- 
citement. 

Graduation or examination is necessary for the Doctorat; 
the latter is intended to show the qualification for scientific 
work and teaching. It is therefore indispensable for every 
physician teaching in a medical faculty. 

The private lecturer, privat-docent, is a position quite un- 
known in English and American colleges; in France the flro- 
fesseur agrege occupies nearly the same position. The title 
privat-docent is conferred by the faculty, on application, for a 
certain branch of science. He lectures in the same manner as 
the professors, mostly supplying gaps in the regular lectures 
or giving lectures on special parts of the science, elaborated 
by his own work. Many of the private lecturers are assist- 
ants, and are given the opportunity by their chief to deliver 
special courses. Without going into particulars, one will see 
that this institution is highly adapted to the education of pro- 
fessors. 

I wish to submit this institution of private lectures to the 
earnest consideration of leading men in this country. Having 
so far only touched upon the student epoch of medical men, we 
can not make the whole importance of this discussion quite 
clear if we do not explain the standing of our profession and 
science in public and private life. 

The profound change which our science has undergone in 
the last century will be made clear by some historic references. 
In the earliest times medicine was in the hands of the priests 
and based only upon occasional observations such as were made 
by the people. Hippocrates destroyed the secret and put these 
ideas into systematic order. The observation of facts became 
controlled and the work of physicians subjected to general 
rules, governed always by moral laws, highly. appreciated at 



MEDICAL EDUCATION: KL.EBS. 37 

all times by the true physician. Since that' time the work of 
the physician possesses a sacred feature. The patient needs 
to rely, with full confidence, on the knowledge and the truth- 
fulness of his physician. He must know that he can not be de- 
ceived, although errors can not be entirely excluded. If the 
physician has any doubts consultation may be sought. 

The medical profession must be so organized that it will be 
the best for the public. Quackery and evil conduct are more 
contemptible than in any other occupation. Where the gov- 
ernment does not protect the medical profession it must pro- 
tect itself, as is done here by the code of ethics, accepted by 
the American Medical Association. 

This organization, securing the interests of the public as 
well as of the physicians, has sometimes roused distrust rather 
than confidence, but a thinking man will congratulate himself 
for having a medical profession caring for its honor. This 
position of the profession seems to be one of the principal feat- 
ures which attracts the young men to our lecture rooms. The 
practice is not so lucrative as in the old times, when one would 
say "dat Galenus opes." The sense of humanity forms another 
attraction to the medical science; if the physician can help, he 
is loved as a god, and to the incurable he can always bring 
comfort and diminish their suffering. 

In our time, in which the strife for gain seems to reign, 
the people have double interest that our profession preserve 
these feeling, and I hope that the public will support them. It 
will be to the interest of the patient that he follows obediently 
the prescriptions of his physician. I have seen so many pa- 
tients ruined by their feeble, distrustful character, changing 
from one physician to another, thus losing the best time in 
which they could have been saved. But, on the whole, I have 
found the American to be an excellent patient, not excited, not 
nervous, but quietly doing and sustaining whatever is necess- 
ary. I have never elsewhere seen so much courage in endur- 
ing pain. 

But the position of the physician in our time must be 
looked upon from another side. The change in the medical 
principles, effected in the last thirty years, is so enormous that 
weaker minds could not follow. On the whole, one can say 
that the younger generation has fully adopted the new theory 
of the bacterial causes of disease, though not always willing 
to make the necessary deductions. 

How great this change was may be shown by an example. 



38 MEDICAL EDUCATION: KLEBS. 

The two pathologic conditions, which alone nearly governed 
the old pathology, were "fever" and "inflammation." The 
seething of bad humors or juices in humoral pathology, the 
struggle of the soul, the Archaus of Stahl, through many cen- 
turies formed personifications of disease, very apt to be at- 
tacked by the zealous physician, who mistook the signs or 
symptoms of the disease for the disease itself. Under this de- 
lusion such things as "essential fever/' or fever in itself were 
spoken of. Later, under the auspices of a more developed 
physiology, one tried to explain these phenomena by the doc- 
trine of irritation. Albrecht von Haller has shown that irrita- 
bility is the general property of all living substance, a proper- 
ty consisting in the outbreak of the genuine activity of the or- 
gan, after an external influence has acted as an irritant. So 
the muscle will contract if acted upon by mechanical, electric 
or chemic influences in the same manner as it does when irrit- 
ated by its nerves through the action of the brain or by an 
electric current. The action producing the irritation can be of 
a very different nature, the effect produced upon the body is 
always the same. You will understand this if you think of the 
works of a clock moving in the same manner, whether its 
spring or pendulum be put in action by the hand, by an earth- 
quake, or by removing a hindrance. 

This theory seems to best explain the two symptoms gov- 
erning, or of disease itself. From Broussais to Virchow this 
explanation prevailed, giving very good indications for thera- 
peutics. If the irritability of an organ or the whole body is 
increased, one has recourse to remedies of a soothing, mitigat- 
ing action; if the irritability is deficient, one must irritate; if 
the two processes do not help, according to the doctrine there 
only remained the counter-irritation (contra- stimulus). If, for 
example, an inflammation of a knee-joint was treated without 
good result first with cold, later with warm poultices, there re- 
mained only a counter-irritant, the burning. The consequence 
was that old country women, shepherds, etc., sometimes had 
greater success than learned physicians. 

This inadequate doctrine was destroyed by pathologic an- 
atomy, which, frem the end of the last century, was more and 
more developed in Europe, first in France and England then in 
Germany. After many great predecessors, Rudolph Virchow 
developed a new doctrine which seemed, at first, to cover every 
Jogical desire, namely, the cellular pathology. 

This doctrine showed the composition of the body to con- 



MEDICAL EDUCATION: KLEBS. 39 

sist of a great many living organisms, the so-called cells, bound 
together by the common action of vessels and nerves. This 
theory disclosed manifold processes in disease, in their minut- 
est details; it enriched our knowledge, but it did not advance 
our therapeutics; to the action of cells was confined the regu- 
lation of irritation. • So the cellular pathology was thought to 
have found in the action of the cells, the whole essence of dis- 
ease, and the question, "Why do the cells act in an abnormal 
manner? " was asked no more. 

For Virchow and for many of his pupils and followers, the 
question of cause did not exist. He declined to go farther, 
with the oracular answer of a sovereign, "We. can not know all 
things." 

I admire R. Virchow very much, having been for a long 
time his pupil and assistant, having learned from him the finer 
distinctions of pathologic processes. I acknowledge that he 
has enriched pathology more than any one else before him, but 
he did not have the right to command a stop to all other pro- 
gress in our science. The word "why" must always be used, 
if the knowledge does not cover the whole truth and does not 
explain the cause of action. 

Already a new dawn announced the bright day of our pre- 
sent knowledge. Medical historians and geographers remem- 
bering the spread of the great plagues, and enlightened think- 
ers, as Henle, had, contemporaneously with Virchow's cellular 
pathology, proclaimed the theory of the external origin of con- 
tagious diseases, from living matter, the germ theory hinted at 
in oldest popular medicine. The microcosmos was opposed 
by the macrocosmos in pathology. 

In our time the investigations in this direction had com- 
menced, first without regard to pathology. Pasteur had de- 
tected the origin of fermentation due to the microbes, destroy- 
ing the physical con tact- theory of Justus von Liebig. But 
Pasteur declared, fearing to oppose the dominating school of 
pathology, that these discoveries had nothing to do with pa- 
thology. When later, in the seventies, he transferred the 
germ theory to pathologic questions, he had to suffer many 
persecutions, as I know from his own month. 

Already many years before Pasteur recognized his error, 
the parasite of anthrax was found by two German observers 
(Pollender and Brauell), but were, by all the leading men, 
declared as inorganized, or if bacterial nature was conceded, as 



40 MEDICAL EDUCATION: KLEBS. 

consequent to the disease or organisms developed in the dying 
animal. 

A sort of madness seemed to have controlled the defenders 
of the old doctrine, so that even the excellent experiments of 
Davaine did not change the minds of stubborn doctrinaires. 
Davaine isolated these organisms and showed that a single one 
was sufficient to infect and kill an animal. The development 
being first local, at the place of implantation, and the general 
infection could be prevented by destroying or extirpating the 
infected part. 

Lister developed the same idea, the external infection in 
wounds, and commenced a reform in surgery, which was more 
and more refined and perfected later. 

At the same time I demonstrated the propagation of cer- 
tain bacteria in the internal organs of the body after they had 
found entrance through natural openings or through wounds. 
The abundant material of the Franco- German war of 1870 gave 
me the opportunity to show that these organisms, while spread- 
ing in the organs, always precede the cellular derangements. 
Cultures and infections of animals in these other cases of infec- 
tious diseases showed the causal nature of, probably, all con- 
tagious diseases. By separating the bacteria from fluids, in 
the cultures, by filtration, we could demonstrate that only the 
bacteria produced the disease. It was shown by Tiegel, my 
assistant, and later in Tokio, that the fluid had only toxic in- 
fluences (1871 to 1873). 

I also was very vigorously attacked from all points, espec- 
ially from the medical side, whereas other learned people, such 
as Tyndall, were convinced of the importance of the new de- 
velopment in pathology. Certainly many imperfections, un- 
avoidable in a new research, may have given some reason for 
criticism. The later researches of Robert Koch and others de- 
cided the battle on the fundamental principle in pathology. 
This can be pronounced in the following thesis: Disease is the 
struggle of two organisms, the one invading the other. 

If I have explained my opinion clearly enough you will see 
what can be done for scientific medical education. By my lec- 
tures, which I will give in this college, I will attempt to inspire 
the student to do original work, which is the only way to pro- 
mote the scientific standard. 



MEDICAL STUDENTS OP EUROPE. 

A letter written by Prof. Norman Bridge to "The Editors of The 
Corpuscle," from Dresden, Aug. 1, 1896. 

There has been for some time a good deal of dissatisfac- 
tion, on the part of the faculties of the medical departments of 
German universities, with the way medical students pursue 
their studies and pass their examinations. At present a student 
may enter his name in the regular way, pay his fees and ap- 
pear perhaps once or twice at the lectures and clinics, and not 
go near them again during the semester and receives full credit 
for attendance upon the course. No effort is made to know 
whether he attends or not; he can attend if he likes. He does 
his practical work in much the same way; omits most of it r 
perhaps, and does not suffer in consequence provided he can 
pass his final examination at the end of five years from t^e 
time he began his medical studies. And in his finals, too, he 
has many opportunities to exercise his finesse. For example, 
he may be required as a part of the examination to examine a 
patient in the hospital, take notes of the case and later present 
a critical written report of it — but this report he may write in 
his room alone, or with company. In other directions the op- 
portunities for indolence and deception are nearly or quite as 
great, so I am told by some of the teachers. 

As a result of this system there attend the most attractive 
and valuable clinics often not more than ten to twenty per cent 
of the students registered to attend them. 

A movement is on foot to change this order of things, and 
a council of representatives from the different universities has 
just been in session and perfected a scheme that has been sub- 
mitted for discussion and possible amendment and that, it is ex- 
pected, will be adopted and go into effect in three years. 

The scheme requires that by the end of their second year 
in the medical department students shall have passed all their 
examinations in general science, including inorganic chemistry 
and that at least one year before their final examination in 
medicine they shall pass their examination in anatomy and 
physiology, (now included with all the practical branches in 
the last,- or final examination) ; also, that after passing success- 



42 MEDICAL STUDENTS OF EUROPE: BRIDGE. 

fully his. final the student shall not he permitted to go out to 
practice, but that he shall first spend a sixth or practical 
year, either in an accepted clinic, or policlinic, or with an ac- 
cepted private practitioner having a large practice, from which 
or whom he shall be certified as having been diligent and satis- 
factory in his work. The scheme also requires, what appears 
to be somewhat novel here, that no sort or part of .any exam- 
ination shall be taken by any student except in the presence of 
a censor of some kind, either a professor or some one appointed 
for the purpose. That this point is put so strongly gives me a 
sense of assurance that Rush College has not been so very 
wicked in her examination regulations the past few years. The 
weakness of tolerably good human nature must, it seems, be 
acknowledged in all lands and times as one of the verities 
eternal. 

I have only attempted to give a few items of this elaborate 
scheme. If it goes into effect in its present form, it will pro- 
duce something of a revolution in medical study, for it makes 
the time of study and apprenticeship six years instead of five, 
which latter is certainly long enough with the thorough prep- 
aration required in this country, before the study of medicine 
is undertaken, provided even fairly good use of his time is made 
by the student. It will, moreover, open the eyes of any medi- 
cal student who shall have had experience with existing meth- 
ods. From the discussions of the subject I have heard by 
members of some of the faculties as well as by practitioners at 
large, it looks very much as though the scheme would be 
adopted in its present form or with such modifications as will 
not seriously weaken it in its drastic requirements. 

That some of the innovations proposed bear a strong re- 
semblance to certain regulations of the best schools in America 
is evident at a glance, and it will be interesting to see if they 
are adopted in this conservative old country. 

The German medical students differ from some of their 
brothers in America, and it is interesting to inquire why. 
Thy enter a lecture-room as quietly and noiselessly as though 
it were a church; there is no whispering or play among them 
while in the room, indeed, they pay little or no attention to 
each other, and such a thing as applause on their part is al- 
most unknown. I have attended many lectures of all sorts 
here and have not witnessed it once during the regular courses. 
When called down to assist at the examination of a case they 



MEDICAL STUDENTS OF EUROPE: BRIDGE. 43 

are frequently as much scared as American students are or 
even more so. 

This may be due in part to the profound deference they 
usually pay to the professor — the awe with which they regard 
him, for the respect paid here to authority of any and all kinds 
is surprising. But then the politeness and deference paid in 
general by men to each other is vastly greater than we ever see 
it at home, indeed the politeness that men show to each other 
is in some quarters distinctly more apparent than that which 
they show to women. 

History seems to indicate that with marked public polite- 
ness among men there is likely to go correspondingly severe 
measures when men differ, or violate the laws, statutory or 
social. The duelling propensities of the French and of the 
first families of our own South aforetime, illustrate the fact. 
Can the student duelling in the universities here rest on similar 
grounds? Fully twenty per cent of the medical students — 
possibly twenty-five — show by the scars on the left side of the 
face and head and top of the latter, their experience in this line. 
But then many of the duels here are rather friendly than other- 
wise and not the result of insult or even anger, but apparently 
are brought about by a desire to follow a fashion or to show 
their courage or to have in their lives afterward the satisfac- 
tion of feeling that their faces advertise and announce con- 
stantly their relations with a certain environment in a certain 
early experience* There are few things the self-assertion of 
the genus homo more insists on than in being catalogued aright, 
and who knows what a satisfaction it must be to a man that he 
bears on his face the ineradicable proof that he has studied at 
a university and what is more, that he has belonged to the 
choicest set there! With us the creation in the larger cities of 
university clubs and the American Academy of Medicine is 
about the only means we have had so far of accomplishing this 
end. Our poverty is almost palpable. The club does not 
count for much; not one in twenty of one's acquaintances knows 
that he belongs to it. How much more effective if we could 
have some mark or brand on the face, not on the arm above 
the elbow as some of the Harvard men bring away with them, 
but where every one could see at a glance that the bearer has 
not only been in a regular course at some university but has 
actually "made" some of the best societies! It would minister 
to the happiness of the individual constantly, as wearing good 
clothes does, and in the same manner; but it would do more, it 



44 MEDICAL STUDENTS OP EUROPE: BRIDGE. 

would create envy on the part of others and so popularize the 
university course — if indeed this is desirable. But if such a 
work is adopted it ought to consist of a brand making a scar of 
a definite size and be put on such a part of the physiognomy 
as would not seriously injure the comeliness of the individual. 
A few of the students here are scarred to positive repulsive - 
ness, which seems unnecessary. One surprising thing about 
this fashion is that a man should be prouder of the cuts the 
other fellow gives him than of those he himself gives; the 
latter show his skill and strength relatively, the former his in- 
feriority. If one receives only a few trifling cuts that would 
not, if quickly healed, make noticeable scars, they are kept 
open or irritated till scars are assured, and so the highly prized 
life-long label. The entire body, except the face and head, is 
protected against injury and the face and head are protected 
as far as possible against any wound that could disfigure the 
individual more than a few scars can. But the better class of 
the students are, as they are everywhere, magnificent fellows, 
and they do good work, and as they fight their so-called duels 
they must make a thrilling spectacle, if one can judge by their 
practice on each other under all the conditions except that the 
head and face are covered by a sort of armor. 

In Italy, or in the University of Rome certainly, six years 
of medical study is required. Formerly men were graduated 
in surgery in four years, and in internal medicine in six, but 
now all must take the six years' course and the distinction be- 
tween physicians and surgeons is abolished. By the end of the 
fourth year of medical study satisfactory evidence must be 
presented of a good literary education — it is not required on 
admission to the medical course, and there is no medical exam- 
ination until the final one. Students, even more perhaps than 
in Germany, study as they like; only when they at last ask for 
the honors of the university do they experience any severity. 

There are a thousand students of medicine at this univers- 
ity, and a lecture in a practical branch or a clinic, is frequent- 
ly attended by only sixty to eighty persons. The pecuniary 
demands are very modest, one hundred dollars covering all the 
charges of the university for the six years. 

It sounded curiously to my ears to be told by a professor 
in this school, in explanation of the ingenuity and tact of 
American surgeons, that: "You see you are a very young and 
rapidly developing country, while we are a very old one." 



TUBERCULOSIS OF BONES AND JOINTS. 

By Edmund F. Burton. 

(Awarded the L. C. P. Freer Second Prize for 1896.) 

Concluded from September. 

TREATMENT. 

Toxins and Antitoxins: — The theory of the production, by 
the presence of the toxins of bacteria in the body, of antibac- 
terial chemical substances is the basis of treatment by tuber- 
culin introduced by Koch in 1890. Tuberculin is the product 
extracted from pure cultures of tubercle bacilli. Its subcuta- 
neous injection in human subjects produces a febril reaction, 
pain, coughing, fatigue and sometimes nausea. Its advent was 
hailed with the greatest enthusiasm ; it was accepted at once as 
a specific for the disease, and was adopted in all parts of the 
world. It has not, however, fulfilled the extravagant promises 
made for it by its overzealous friends, whose claims for its 
value, based solely upon the results of laboratory experiments, 
were far beyond the representations made by Koch. The nat- 
ural reaction has therefore caused its use to be almost entirely 
abandoned except for diagnostic purposes in cattle, since the 
febril reaction resulting from its injection into a tuberculous 
animal is conclusive as to the presence of the disease. 

The fact remains undisputable, however, that whatever 
therapeutic value future investigation may show it to possess, 
it production was the first step toward the discovery of an an- 
titoxin for tuberculosis. 

Klebs has produced from tuberculin, by precipitation by 
alcohol and purification, a substance which he calls tuberculo- 
cidin, or antiphthisin, and which he claims possesses the vir- 
tues of tuberculin, with none of its perniciousness. 

Dr. Barbour, Tennessee, has used it in several 
cases with markedly satisfactory results, but further trial is 
necessary before any definite statement can be made as to its 
value. The treatment of tuberculosis by substances obtained 
from the blood of animals inoculated with tubercle bacilli or 
their toxins is, at the best, still in its infancy. Indeed, the pos- 



46 TUBERCULOSIS OF BONES AND JOINTS: BURTON, 

sibility of the successful treatment by this method of any 
chronic disease has yet to be demonstrated. 

Dr. Paquin, of St. Louis, claims that the serum from horses 
rendered more than normally immune by the injection of toxins 
for three months will arrest pulmonary phthisis in its first 
stage in from three to four months, and in its second stage in 
from four to six months. He bases his belief upon forty cases 
treated in the six months prior to July, 1895. 

Babes of Budapest in 1863 reported the use of serum from 
immunized dogs, followed by amelioration of the condition of 
the patients. Subsequent experiments made upon various ani- 
mals led him to the following conclusions, among others. The 
serum of animals treated first with tuberculin and then with 
dead bacilli appears to be more efficacious than that of animals 
treated with tuberculin alone; that with such serum tubercu- 
losis can be certainly cured if so treated in its early stages, but 
that the doses of serum must be somewhat large, small doses 
appearing to aggravate the infection. 

There is today, however, no definite and certain knowledge 
derived from clinical experience in regard to this subject of the 
treatment of tuberculosis by toxins or antitoxins. Yet labora- 
tory experiments upon pure cultures of the bacilli and upon in- 
fected animals strongly indicate the probability of its value, 
though until further developments such treatment will be but 
tentative. 

OPERATIVE TREATMENT. 

The subject of the operative treatment of tuberculosis of 
bones and joints is, for two reasons, an exceedingly complex 
one; first, because of the lack of unanimity of opinion among 
the masters of the art as to the advisability of radical surgical 
measures in this disease, and second, because of the varied 
character of the operations adopted. It is, therefore, impos- 
sible in this space to do more than outline in the briefest 
manner the procedures most commonly followed, together with 
the opinions of a few authorities as to when such measures are 
indicated. 

The situation of the lesion is often the main factor in de- 
termining whether or not operation is advisable. In tubercu- 
lar spondylitis, for example, operative interference is nearly 
always contraindicated, although laminectomy has been per- 
formed many times for the relief of the paraplegia of Pott's 
disease. It was revived by McEwan who reported four recov- 
eries out of twelve cases. 



TUBERCULOSIS OF BONES AND JOINTS: BURTON. 47 

Calot presents a careful and detailed report of ninety la- 
minectomies, in above fifty per cent of which death occurred 
as the immediate result of the operation, and only nineteen 
were benefitted. His own experience of the uniformly benefi- 
cent effect of rest and immobilization in similar cases lead him 
to make a strong plea for orthopedic measures and for the 
abandonment of radical surgical treatment. He quotes in his 
support from Pott, Boyer, Bouvier, Ricord, Charcot, Michaud, 
Lannelongue, Chepault, and others. 

Dr. Menard failed to obtain any therapeutic effect in two 
cases in which he performed laminectomy. A third case, 
where, in the course of the operation, a tuberculous abscess 
was opened incidentally, made a rapid recovery. In six other 
cases abscesses were opened and drained, resulting in marked 
and immediate improvement, with permanent good result. 

Dr. Parkin has had more favorable results from the opera- 
tion. He reports six cases, with recovery and disappearance 
of the paralysis in every instance. Jn three of these cases the 
paraplegia was caused by accumulations of tubercular pus, and 
the recovery may have been due, as in Menard's cases, to the 
evacuation of this fluid rather than to the removal of bone. 
On the whole, the history of the operation is far from encour- 
aging, and especially since such favorable results have been 
obtained from the use of iodoform injections, a resort to lamin- 
ectomy is justifiable only in extreme cases, where the disease 
continues to progress in spite of all other appropriate treat- 
ment. Willard sums up the objections as follows: 

It endangers life. 

It is uncertain in its relief. 

It weakens support of head and shoulders. 

The weakening process throws more strain upon both 
muscles and diseased bone, thus increasing the likelihood of 
sharp flexion, and deformity of the column. 

No statement involving accurate percentages would be 
warrantable without consideration of the technique of the dif- 
ferent operations and the history and stage of the disease, 
which is beyond the scope of this paper. 

The operative measures available in joints of the extrem- 
ities are the following: 

1. Arthrotomy . The joint is here freely opened by incision 
for exploration, or evacuation of fluid contents, or both. This 
is ordinarily followed by the injection of an antiseptic solution 
or packing of the cavity with antiseptic gauze. 



48 TUBERCULOSIS OF BONES AND JOINTS: BURTON. 

In tubercular disease of the knee joint, when both arthrec- 
tomy and resection are contraindicated, Drobnik advocates the 
free exposure of the cavity and long-continued plugging of the 
cavity with iodoform gauze. He thinks the seat of the disease 
should be kept open to allow for the rejection of the tissues al- 
ready destroyed or undergoing necrosis. In this respect he 
differs from the majority. A very reasonable objection to 
incision in cases of abscess is that advanced by Shaffer 
that it is almost impossible to keep sterile an open sinus for 
any long period of time. If drainage is to be provided for, 
the incision should, of course, be placed at the dependant por- 
tion of the joint to facilitate the egress of fluid from the 
cavity. 

Some authorities favor arthrectomy in all cases of joint 
tuberculosis accompanied by abscess, and especially instead of 
aspiration where tubercular pus is to be evacuated before in- 
jection, in order to remove thoroughly the particles which may 
not be able to pass through a trocar. 

2. Arthrectomy or Evasion. — This consists in the opening 
of the joint and removal of diseased tissue with least possible 
damage to neighboring healthy parts. It is an operation of 
somewhat recent introduction, being first practiced in 1887 by 
Wright and Collier as a substitute for excision, though its 
present general use is due to its advocacy by Volkmann. The 
removal of tuberculous tissue from the articular ends of bones 
is accomplished ordinarily by the sharp spoon, so much of the 
membrane, capsule and cartilage as are diseased being cut away 
with knife or scissors. Billroth says: "I prefer the scaping 
off of the diseased portion of bone with a sharp spoon to all 
other modes of proceeding," 

The technique described by Neuber, Kiel, is as follows: 
After removal of diseased tissue and any sequesta found, the 
cavity is washed with sterilized water or an antiseptic solution, 
then filled with iodoform emulsion and the wound closed with 
buried sutures, without drainage. Fourteen cases were thus 
treated by him, of which eight healed by primary union, four 
by granulation, and two after slight suppuration. , 

The advantage of arthrectomy over excision is that by the 
former method it is frequently possible to retain or restore the 
function of the joint and avoid shortening of the limb, the epi- 
physial cartilages remaining intact. The value of this result 
before maturity is evident. Nevertheless, it is claimed by 
some that a movable joint will only be obtained in circum- 



TUCERCULOSIS OF BONES AND JOINTS: BURTON. 49 

stances under which the same or a better result could have 
been had by immobilization. 

Jeannel of Toulouse, combines arthrectomy and the use of 
hot water instead of iodoform emulsion. After opening or emp- 
tying the cavity he either pours into it boiling salt water, re- 
peating the application several times, or the water is poured 
in, then brought to the boiling point by the thermocautery. 
Suppuration rarely follows, and generally primary union and 
cicatrization occur, with very little pain after the first day. 

There is the same objection to the use of drainage tubes as 
mentioned above. Where the abscess is of considerable size, 
as in the hip, so that it is not always certain that curettage has 
reached every part, it may be necessary to leave a tube for a 
short time, perhaps twenty-four hours. Senn secures capill- 
ary drainage by a tampon of iodoform gauze. 

Partial arthrectomy has sometimes been practiced, and a 
portion only of the diseased part removed, the regenerative 
processes excited by operation and injections being depended 
upon to complete the work, but such a proceeding has not 
given satisfaction, and at present the removal of all the in- 
fected tissue is considered essential to permanent success. 
Following arthrectomy, immobilization by the application of a 
plaster cast or splint is generally advocated. 

Excision or Resection. — In the history of resection the ten- 
dency toward conservatism is again illustrated. Formerly a 
removal of both articular surfaces was always meant by this 
term. This is now called a complete or typical resection and 
is practiced less often than the partial or atypical resection, 
which consists in removing only the portion diseased. Thus, 
while excision has largely replaced amputation, it, in its turn, 
is giving way to more conservative measures. It is especially 
valuable when the patients are adults, where the chances of 
favorable results by conservative methods are less than in 
children and the danger of metastatic infection greater. Time 
is ordinarily also a factor which urges in favor of the shorter 
treatment in these circumstances, and the element of shorten- 
ing of the limb is eliminated. Dr. Eve advises amputation af- 
ter the age of thirty, although his reasons for the opinion are 
not quite clear. After excision of the joint of a child, the 
strength of the union between the bones seems not to keep 
pace with that of the rest of the bone, and it is apt to gradu- 
ally yield. Deformity occurs from imperfect bony union and 
the patient becomes seriously crippled. 



50 TUBERCULOSIS OF BONES AND JOINTS: BURTON. 

There is a great diversity of opinion among surgeons in 
regard to the usefulness of this operation and as to when it is 
indicated. Some regard the removal of the local leison as a 
sure preventive of the spread of the disease, and, therefore, 
advocate early operation. Others are opposed to any opera- 
tive treatment and employ only conservative measures. Ver- 
neuil says: "Les m^dicins n'avaient pas de plus mauvaises 
r^sultats que les chirurgiens. " Others pursue a middle course, 
granting the necessity for such interference, but only as a last 
resort. We can find, therefore, authority in abundance for 
either course of treatment. 

The quotations given below indicate the views of a few 
writers on the subject. The first is taken from the report of a 
committee of the Clinical Society of London on the indications 
for resorting to excision of the hip joint. 

1. Necrosis and separation of the entire head of femur 
and its conversion into a loose sequestrum. 

2. The presence of firm sequestra, either in the head or 
neck of the femur, or in the acetabulum. 

3. Extreme caries of the femur, or of the pelvis, leading 
to prolonged suppuration and the formation of sinuses. 

4. Intra-pelvic abscesses following disease of the acetab- 
ulum. 

5. Extensive and old-standing synovial disease and ulcer- 
ation of the articular cartilages, with persistent suppuration. 

6. Displacement of the head of the femur on the dorsum 
ilii, with chronic sinuses and deformity. 

The next is from a paper read by Dr. Croft before the 
Clinical Society: 

When Excision Should be performed. — I. When there is 
fluid in the joint, incision, under strict aseptic precautions, 
should be made, as if the surgeon intended to excise, and he 
should only desist on finding the articular structures in a con- 
dition from which they could rapidly recover and yield a mov- 
able joint. 

2. When pus is known to be present, even if the surgeon 
is uncertain as to the condition of the joint, he should excise. 

3. If the surgeon is certain that necrosis has occurred ex- 
cision should be practiced. 

Wright: "Treatment short of excision, when once suppur- 
ation occurs, is useful only as a palliative or a means of tem- 
zing." 
Ashhurst: "The operation (excision of hip joint). is such 



TUBERCULOSIS OF BONES AND JOINTS: BURTON. 51 

a grave one under any circumstances that I do not consider a 
resort to it justifiable in any case in which it is not evident that 
life will be imperiled by longer persistence in expectant meas- 
ures.'' 

Billroth says: "Modern surgery is justly proud of the de- 
velopment of resections of the joints." But in another place: 
"I do not see that we are justified in performing excision 
early in children with hip joint disease, for by timely treatment 
many more recoveries follow and a straight ankylosed hip is 
better for a patient than an excised joint." 

Townsend says: "The more one operates, the more con- 
servative he becomes." On the other hand, 

Barker says: "Why waste so much time? Why not re- 
move the disease, and let the joint stiffen soundly in a couple 
of months, instead of subjecting the patient to as many, or 
perhaps double the number, of years of irksome treatment for 
perhaps no better result?" 

Gibney expresses the opinion that when surgeons become 
more thoroughly acquainted with the best technique of modern 
aseptic surgery they will more fequently resort to excision, 
removing the bone, the real source of supply for the abscess. 

Senn: In adults excision offers the best results. It is not 
necessary to wait for the appearance of an abscess. As soon 
as the diagnosis is established, operate." Again, "If the syn- 
ovial tuberculosis has destroyed the articular cartilage and has 
involved the articular extremities of the bones, the prospects 
of recovery under expectant treatment are reduced to a mini- 
mum, and if operative interference is decided upon, a typical 
or atypical resection becomes an unavoidable necessity." 
"Resection of a tubercular joint is indicated when a primary 
osseus focus or foci cannot be reached by an extra- articular 
operation, when the joint has become invaded secondarily and 
when a primary synovial tuberculosis has extended to the ar- 
ticular surfaces of the bones and the disease has proved refrac- 
tory to less heroic measures." 

Sherman, of the Children's Hospital, San Francisco. — 
(Transactions Amer. Orthop. Assn., VI-122.) Given a child 
with tuberculosis of hip and abscess, his chances for recovery 
and possession of a limb equally if not more useful than can 
be obtained in any other way are all subserved by the earli- 
est possible operation. Given a case of tuberculosis of the hip 
and no abscess in a child with feeble powers of resistance, but 
who is plainly staggering under his load of infection, that 



52 TUBERCULOSIS OP BONES AND JOINTS; BURTON. 

child's best chance for recovery lies in the resection of the 
tubercular bone." 

Moore, Minneapolis. — (Transactions Amer. Orthop. Assn. 
Vol. VI- 344.) Reports six cases of excision. "I have never 
found it necessary to excise the joint when rest has been em- 
ployed early and systematically, but have been obliged to am- 
putate in many cases when the treatment had begun too late 
or where it had not been properly carried out." 

Albertin, Lyons: In a case of tuberculosis of the knee, the 
following methods may be employed, singly or combined, the 
choice being influenced by the age of the patient. 
For children — 

1. Simple arthrectomy. 

2. Arthrectomy and removal of diseased bone. 
For adults — 

1. Intra-epiphyseal resection. 

2. Epiphyseal resection — typical resection. 
Townsend advises resection in tuberculosis of the shoulder 

joint, since ankylosis is the almost invariable result of any 
treatment, and this is secured by early operation, while at the 
same time further infection is prevented and much time saved. 
The lesion is a very rare one in this location, however, Dr. 
Townsend having seen but twenty-one cases among 3,244 cases 
of bone and joint tuberculosis. 

Konig reported to the Twenty -fourth Congress of Sur- 
geons, 1895,740 cases of bone and joint tuberculosis with treat- 
ment and results: 

191 cases were treated by immobilization and other con 
servative methods. Of these 63 were cured, of which 40, or 
about 21 per cent, obtained movable joints. 

63 cases, injections of carbolic acid were used, with 36 re- 
coveries; 57 per cent. 

40 cases received injections of iodoform, 13 cures; 33 per 
cent. 

150, arthrectomy was performed, with 106 recoveries (only 
one with movable joint), 22 deaths, 11 still under treatment, and 
11 unknown results; 70 per cent recoveries. 

296 resections gave 186 recoveries, all with ankylosis; 63 
per cent. 

Schltiter reports 100 cases of excision of the knee joint in 
patients from 20 to 60 years of age: 44 cases healed and re- 
mained perfectly cured; in 5 of these fistulae formed, but healed 
later; 32 died, 15 of these from tuberculosis; in 3 there was no 



TUBERCULOSIS OP BONES AND JOINTS: BURTON. 53 

benefit; in 11 amputation was required subsequently; in 10 the 
final result was unknown. 

McArdle reports 41 cases, of which 10 were tubercular 
teno-synovitis, 20 were intra-articular and 11 were peri artic u 
lar tuberculosis. Of these, permanent recovery occurred in 37 
cases. 

Gibney reports 499 cases of knee joint tuberculosis. Ex- 
pectant treatment resulted in recovery with motion in 60 per 
cent of cases; with partial immobilization and extension 77 per 
cent recovered with motion; with complete immobilization and 
continued application of apparatus 95 per cent recovered with 
motion. 

4. Ampitation. While amputation is the most radical 
treatment for a tuberculous bone or joint, yet it is not always 
the most dangerous or exhausting. In cases where there is 
also pulmonary phthisis the patient, emaciated and anaemic 
from the combination of disease, may rally after an amputation 
and be greatly benefited in general health. It is ordinarily in- 
dicated rather than resection in the large joints if the patient 
is pronouncedly anaemic, also where a tubercular abscess has 
perforated the capsule and the surrounding tissues have be- 
come infiltrated. If healthy lissue is used for the flaps, the 
wounds will heal as quickly as when the amputation is for 
other indications. 

The conclusions with which Rydygier, of Vienna sums up 
the evidence presented in a monograph upon this subject can- 
not easily be improved upon. They seem to represent the best 
modern methods, and are therefore here given in full. 

1. Conservative orthopaedic treatment is not to be consid- 
ered as in competition with operative measures, but one sup- 
plements the other. 

2. The particular method to be employed in a given case 
depends upon different circumstances, the means of the patient, 
the age and general condition, local findings and the joint af- 
fected. 

3. The better the conservative orthopaedic measures em- 
ployed the fewer will be the operations required. 

4.. If the joint contains pus in spite of conservetive treat- 
ment, and if there is a tendency to further destruction of the 
joint, operation is needed. 

5. The best method of conservative treatment is that which 
allows the patient to exercise in the open air without irritating 
the joint. 



54 TUBERCULOSIS OF BONES AND JOINTS: BURTON. 

6. The best operative procedure is that which permits a 
free and complete entrance into the joint so as to be able to re- 
move accurately all diseased tissue without undue regard for 
the future function of the joint. In some cases it is desirable 
to excise completely to secure ankylosis. 

7. In the after-treatment of resected joints the patient 
should get about as soon as possible. 

8. Operation too long postponed is not to the advantage of 
the patient, but if done too early may make the patient a 
cripple. The proper selection of cases should be made on an 
anatomico-pathological basis. 

9. General treatment should not-be neglected, especially 
sea and other baths. 



DISSECTING INSTRUMENTS. 
By C. A. Parker, M. D. 

Several years experience with students in the dissecting 
room has lead the writer to regard the subject of dissecting in- 
struments as quite important. To some advice in this direc- 
tion may appear superfluous, since every student seems intuit- 
ively to know that he needs a "dissecting case," and regards 
one as about the same as another, any increase in price being 
due to additional knives or other instruments. The writer does 
not wish to add a new case to the many kinds already on the 
market, but rather to speak of the quality and kind of tools 
found in these cases ordinarily. 

Very little attention appears to be given to the kind of in- 
struments needed by the student. The answer to inquires: 
"Oh, any good case will do," is very commonly heard, and is 
about as helpful as the admonition to patients to "diet" them- 
selves, without specific instructions. They are about as wise 
as before. A number of students come to college already 
equipped with a case that their father or some relative used 
before them and which usually bears the ear-marks of an- 
tiquity. Being supplied it is seldom necessary to discard the 
old and purchase new. But to the student who must buy new 
instruments a few words of advice, specifically given, will not 
come amiss. 

Looking into a case picked up at random we generally find 
as contents: a pair of scissors, forceps, two or more knives, a 
chain with hooks, and frequently a blow pipe. The essentials. 



DISSECTING INSTRUMENTS: PARKER. 55 

are the knife, forceps, and scissors, named in order of their im- 
portance. 

After a blow pipe has been in the dissecting room a few 
days touching the lips to it is disgusting; moreover at Rush a 
blow pipe is useless, since the syringe and aspirator needles 
does its work more quickly and effectually. As for chains one 
is seldom found in the ordinary case that will stand vigorous 
service. The links open and the chain parts at an inopportune 
time. 

Of the essential tools, the scissors are generally good in all 
cases. They cut to the point, and remain reasonably sharp 
during a dissection, not being used as much as the knives. 

Not all cases have good knives. The cartilage knife, found 
in practically all cases, is used but two or three times in a dis- 
section, and its quality is not so important. But great care 
should be exercised in the selection of the work knives. Their 
shape and size vary greatly in the different cases, and in qual- 
ity they are good, bad and indifferent. Do not take a wooden 
handled knife. It is very hard to clean them, they can never 
be used for any other purpose, and they are very apt to become 
loose in the handle. Wooden handles are not to be thought 
of. A metal handled knife can be made thoroughly aseptic 
after use in dissecting and therefore is not debarred from use 
in surgery later. The handle, be it grooved, fluted, or rough 
ground, is not so important as the blade. The finest dissecting 
is done with the small knife, and most of the careful work with 
the first eighth of an inch from the point. For removing in- 
tegument and superficial fascia more of the cutting edge will 
be used, but such work forms but a small proportion in a dis- 
section, the tracing of minute vessels and nerves being far 
more important and requiring the best of tools for satisfactory 
results. 

It is very commonly stated that one should use the same 
kind of a knife as in surgical work, in order to become accus- 
tomed to the instrument. This at first thought, seems to be 
just right; but the surgeon changes his knive according to his 
work, and surgery and dissecting are somewhat different in 
their pupose. In surgery one may cut away many of what are 
termed ''minor" structures to accomplish some particular ob- 
ject in view; while in dissecting there is but one opportunity 
for seeing all the various structures of the human body and a 
very different plan must be followed to get the most out 
of the material at hand. So it is the writer's opinion that the 



56 DISSECTING INSTRUMENTS: PARKER. 

one kn ife with which most of the work should be done should 
have a narrow blade, not more than one-fourth inch wide, nor 
more than one and one-half inches long, tapered rather acutely 
to the point so that the blade will not obscure the view of the 
finer structures. One thing more about selecting a knife: the 
readiness with which a sharp edge may be kept must be con- 
sidered. It will hardly be practicable to determine the temper 
of the blade before buying; that will have to be taken for 
granted. But as regards shape a choice can be made. A knife 
is a wedge; the back is the broad part and the cutting edge 
the narrow part, and one should be selected that is very thin 
even at the thickest part, as that will give a blade which is 
most easily sharpened. Of course it must be thick enough to 
stand ordinary strain. By examining a number of knives the 
point referred to will be noticed. 

Forceps give more trouble than any other instrument ♦ 
Knives are commonly good, forceps commonly — almost invar- 
iably — bad. 

The springs of the forceps vary from those that are too 
weak to separate the blades when caught in the tissues to those 
that tire the thumb and fingers in holding them. Examine 
a number of forceps and pick out one with a comparatively 
easy spring. But more important than the spring is the grasp 
of the blades, and it is safe to say that fully seventy -five per 
cent, of the forceps in dissecting cases are faulty in this particu- 
lar. The blades should meet squarely, and should be sufficiently 
stiff so that pressure does not make them glide sidewise. 
They should be narrow enough at their points not to hide the 
structures one is seeking to grasp. They should fit accurately 
to the tips, and should be of exactly the same length. They 
must not separate at the tips on hard pressure while the blades 
are in opposition further back. Examine a number of forceps 
by holding them to the light: press the blades quite firmly and 
it will be noticed in the majority of those examined that the 
extreme points separate as the pressure is increased. In dis- 
secting this is the most exasperating condition one has to con- 
tend with; just as a little hard pressure is applied to hold some 
tough but thin tissue the forceps promptly open at the points 
and seem to grin at the student's futile efforts. This is such a 
serious objection to so many forceps that lately the writer has 
advised the "mouse-tooth" variety. It is a grfeat relief to find 
one of this sort in the dissecting room after trying half a dozen 
of the ever-slip kind. The forceps should be between four and 



DISSECTING INSTRUMENTS: PARKER. 57 

and five inches in length. The best have two teeth in one 
blade and three in the other. 

To sum up: choose a knife with metal handle, narrow, 
thin blade, tapered rather acutely to the point; a pair of 
mouse -toothed forceps, preferably two and three toothed; and 
a pair of scissors, sharp pointed and cutting- to the point. 
These instruments should be bought at the instrument stores, 
and not in dissecting cases. Each instrument should be ex- 
amined as to its particular qualities. A case for them is not 
necessary, and gets foul easily in the dissecting room. Wrap 
the tools in a piece of cloth which may be thrown away when 
dirty. The three instruments mentioned above will cost from 
11.50 to 12.00 for the set. 



SCHEDULE OF FOOT BALL GAMES. 

It-is the duty of every loyal Rush man interested in athlet- 
ics to be present at these games scheduled below and give as 
much encouragement as possible to our boys. 

Oct. 10. — Purdue at LaFayette, Indiana. 

Oct. 23 — Lake Forest University at Lake Forest. 

Oct. 26 — Grmnell College at Chicago. 

Oct. 30.— Y. M. C. A. Des Moines at Des Moines, la. 

Oct. 31. — Grinnell College at Grinnell, Iowa. 

Nov. 2. — State University Iowa at Iowa City, Iowa. 

Nov. 11. — Armor Institute, at bet. 35th St, and Wentworth. 

Nov. 14.— P. and S. of Chicago. 

Nov. 17. — Lake Forest at Chicago, 

Nov. 21.— 111. Cycling Club at Chicago. 

Nov. 26. — Thanksgiving Game with Beloit College at 
Rockford. 



The Corpuscle. 



EDITORS, 

J. E. LUCKEY, '97, Editor-in-Chief. 

746 West Adams St., Chicago. 
T. R. CROWDER, '97, Sec'y and Treas. 
FRED. BARRETT/97. E. L. McEWEN, '97. A. F. STEVENSON, 



Communications relative to advertisements and subscription (Subscription price 
$1.00 per annum), should be addressed to the publisher. Remittances should be made 
by money order draft or registered letter payable to "The Corpuscle," and addressed 
to Fred C. Honnold, 402 S. Paulina St, 



Ruby Red and Black: Colors of Lake Forest University. Orange: Color of Rush 

Medical College. 



Rush opens her fifty-fourth annual course of lec- 
' tures with the brighest prospects. The opening 
exercises were attended by the usual large audience testing 
the standing capacity of the Upper Lecture Room. Dr. Edwin 
Klebs, the renowned pathologist, lately added to Rush's Fac- 
ulty, gave the address of the evening printed elsewhere. Dr. 
Lyman presided in the absence of President Holmes. Dr. 
Bridge presented to the Faculty on behalf of friends the pic- 
ture of Dr. D. D. Bishop, whose death last spring robbed the 
College of one of its most efficient instructors. The picture 
will probably hang in the histological laboratory where Dr, 
Bishop did his work, In a few choice words Dr. Lyman ac- 
cepted the gift for the Faculty. We are indebted to the Jour- 
nal of the American Medical Association for the advance proofs 
of Dr. Kleb's address. 

The new student is in evidence. He may be the 
self-possessed man of experience, familiar with col- 
lege ways; or the stranger to city life, unused to the work and 
routine of the course he has entered upon. We are not posing 
as a diseminator of advice, gratis, but for such of the new men 
as need them we have a few words of kindly suggestion which 
may prove of some value. 



EDITORIALS. 59 

Attend all exercises scheduled for your year religiously. 
Do not miss a single one until you have your work well under 
control, and then not one unless absolutely necessary. The 
importance of being present at lectures during the early part 
of the year, to get the foundation of a subject well laid, and to 
hear correctly the many announcements made during that time 
cannot be estimated. 

Endeavor to get a good start in each subject you take up. 
Many a man has failed at the end of the year simply because he 
did not grasp the fundamental principles. The first month's 
instruction is the most important of the year's. Get every 
word of it thoroughly. 

Reserve your judgement regarding your professors when 
things do not go to suit your notion. It is impossible to con- 
sult individual wishes in so large a school. They are only hu- 
man, have feelings just as other men, and are working for the 
true interests of the students. Accord them respect and it will 
be returned. Some are sensitive to their treatment by the 
students. Show them the deference that is their due and they 
will command your admiration and good will. 

If you have difficulty with a subject do not hesitate to seek 
information of the quiz-masters. You will find them gladly 
willing to assist you. 

Do not allow the strangeness of the surroundings to euchre 
you out of making good recitations. If you aie called upon, 
speak out boldly. Many men are timid and say "don't know" 
when they really do know. But do not try to run a "bluff." 
The quiz-master will soon discover your method of making 
something out of nothing, and while you may cause consider- 
able laughter among your class mates, they will quietly put 
you on the list as doubtful. 

Lastly, if you are getting through on a small amount of 
money, do not err by making your board bill sustain the bur- 
den of economy. There is a large amount of work to be done 
before you get your degree, and body nutrition should be kept 
up to a high standard. Economize in every other way if you 
will but do not stint your stomach with two meals per day, 
nor wear it out on two-dollar-a-week boarding house hash. 
Doing so will cost you dearly in the end. Take plenty of ex- 
ercise and sieep your full quota of hours regularly. By ob- 
serving this rule of "three" you cannot fail to do good mental 
work. 



60 EDITORIALS. 

The student We are proud to note that Rush is steadily forg- 

spirit. j n g a head. Nor is her advancement temporary 
or uncertain. Each year is marked for a constant and regular 
progress; there are no footsteps backward. The returning 
student finds the buildings improved and beautified, the labor- 
atory facilities increased, the standard of admission raised, 
the curriculum amplified, and brilliant additions made to the 
corps of professors. He very properly congratulates himself 
on his choice of school knowing that such a spirit of improve- 
ment points to ultimate uncontested leadership. 

A progressing whole implies progressing parts. Every 
department of the college is contributing to the general ad- 
vancement. Certain conditions — inevitable accompaniments 
of college life — which at one time were detrimental are chang- 
ing and now are lending a most potent aid in placing the stan- 
dard of Rush beyond the reach of contestants. In no case is 
this more strikingly illustrated than in the student spirit. 

The time was — and not very long ago — when the prevail- 
ing spirit among our students was not the best. There was a 
lack of an earnest disposition to do conscientious work, and 
an excess of a desire to have a hilariously good time. The 
good-natured exuberance of animal spirit is not to be con- 
demned; it is rather a saving element in the physician's 
life since he must encounter so much that is depressing. But 
the medical student is in college for business. He is prepar- 
ing to enter a profession that necessitates broad technical 
knowledge, and entails great lesponsibilities. ' Justice de- 
mands that boisterous manifestations of vigorous life should 
not interfere with the individual's work, nor with the per- 
sonal comfort of others and their right to do thorough work 
themselves. 

We say that at one time there was too much of this hilari- 
ous spirit for the good either of the student or the school. 
But happily a change is on. The spirit of work, of endeavor 
for proficiency, of desire to be well equipped for professional 
life, is growing among the students. It is a part of the gen- 
eral progress, and reciprocally is doing much to make further 
advancement easier. It is an improvement that money has 
not purchased — indeed, it lies beyond the power of wealth to 
secure; yet the benefit to Rush that w T ill ensue from the 
grounding of a thoroughly studious spirit among its matricu- 
lates will be priceless, For the student, the true man is 
brought more into prominence. The quieter traits of charac- 



EDITORIALS. 61 

ter, those that command the respect of others, and determine 
a man's real worth, find freer expression. The sober and re- 
tiring student is discovered to be a prince of good fellows, and 
the leader in the scrimmage proves not one-tenth as bad as he 
seemed. General acquaintanceship is enlarged; good fellow- 
ship extends its circle beyond isolated groups until whole 
classes are included. Recitations are better; instructors are 
inspired to new efforts for the students' interests; professors 
are encouraged and a long step is taken towards the realization 
of that great desideratum: personal acquaintanceship between 
the members of the faculty and the students. 

But it is not necessary to enumerate advantages; they are 
easily seen. We hold the change in the student spirit to be an 
invaluable improvement for both college and matriculates; 
one whose beneficient effects are far reaching and not 
merely confined to the present. 



JAMES B. HERRICK, A. B.. M.D., Editor. 



Membership in the Alumni Association of Rush Medical College is obtain- 
able at any time by graduates of the College, providing they are in good standing in 
the profession, and shall pay the annual dues, $1.00. This fee includes a subscription 
to The Corpuscle for the current year. This journal is the official organ cf the 
Association. 

Dues and all communications relating to the Association should be sent to 

JOHN EDWIN RHODES, M.D., Sec'y and T eas„ 34 Washington St., Chicago 

The numerous friends of President Holmes will be happy 
to learn that he will be in his office at 821 Marshall Field 
Building, after October 12th. 

Prof. John B. Hamilton will not leave "Rush" and Chica- 
go, other reports to the contrary. His numerous friends will 
be pleased to learn that they are not to lose him from their 
midst. We are pleased to report that the doctor is recovering 
from a recent illness. 

Dr. D. A. Angus, '96, is doing nicely at 1228 Milwaukee 
Avenue, Chicago. 

Dr. M. A. Weiskopf, '96, has located at 608 Blue Island 
Avenue, Chicago. He has been appointed surgeon to the United 
Hebrew Charities Free Dispensary. 

Dr. R. C. Fullenweider, '96, has found a pleasant and very 
profitable location -at the S. W. Cor. Ashland Boulevard and 
Madison Street, Chicago. 

Dr. W. D. Calvin, '95, reports a good practice at Riverside, 
111. 

Dr. Clem D. McCoy, '90, is located at Kenton, O. 
Dr. B. F. Strong, '96, is located in the flourishing little 
city of Howard, Kas. He is enjoying a good practice and has 
lately been elected County Physician of Elk County, of which 
Howard is the county seat. 

Dr. Fred C. Honnold, '96, is located at 940 W. Madison 

Street, Chicago. He is enjoying a rapidly growing practice. 

H. N. Boshill, '95, called. He is engaged in practice at 

Melvin, 111., where he is doing very well. Was married in 

March of the present year. 



ALUMNI DEPARTMENT. 63 

Dr. Esser, '91, was recently in the city. He is located at 
Peterson, Iowa, and says that in spite of hard times he is 
doing well. 

Dr. T. J. Dunn, '81, writes that at Elliottstown, Illinois, 
there prevails a severe epidemic of diphtheria. "The like was 
never known here before." 

Geo. G. Barnett, '84, is at Ishpeming, Michigan, and one 
of the staff of the Ishpeming Hospital. 

Dr. G. Ranniger, '89, has just returned to Naperville, Illi- 
nois, from a four months sojourn in Europe. The doctor has 
just received an appointment to the staff of a newly organized 
hospital in Aurora. 

Dr. J. M. Furnas, 71, of Lisbon, Iowa, has been visiting 
his son-in-law, Dr. J. R. Hamill, '87, who is at 382 S. Kedzie 
Avenue. Dr. Furnas has been enjoying the clinics and speaks 
in praise of the advanced work he sees going on and of the 
progress made in the last twenty- five years. 

Dr. C. D. Center, who was formerly one of the Editors of 
this journal was recently married. The doctor is doing nicely 
afcQuincv, Illinois. 

The editor of this department while on his way to Wiscon- 
sin last month, met on the train Dr. and Mrs. Joseph B. Noble, 
'86. The doctor was full of reminiscences of the days of '85 
and '86. He is located at Tower, Minnesota ; and is doing well. 
He was married, September the ninth, to Miss Isabella Rice of 
that town. The Corpuscle extends Congratulations and best 
wishes. 

Mason City, Nebraska, September 28th. 1896. 
JohnE. Rhodes M. D., Chicago, 111. 

Dear Doctor: — Enclosed find One Dollar for my dues the 
coming year. I frequently meet Dr. Fletcher, of St. Paul 
Nebraska, who was a classmate of Prof. Etheridge, 72 or 73 
I believe. There are no other Rush men around this part of 
the country. Yours truly, A. E. Robertson. 

North Prescott, Mass. 
Dear Doctor: — My only excuse for not answering before is 
that I am busy and the country roads are rough. With the 
best of wishes to yourself and Old Rush. 

Walter A. Clark. '85. 

Eleva, Wis., Sept. 28, 1896. 
Dear Doctor: — 

Herewith find enclosed blank filled and one dollar. The 



64 ALUMNI DEPARTMENT. 

Corpuscle is a source of intellectual comfort and is looked for 
regularly. Business is fairly good. Times here among the 
people are hard indeed. Yours fraternally, 

C. H. Elkinton, M. D. 
Fayette. Iowa, Sept. 22, 1896. 
Dear Doctor Rhodes. 

I had entirely overlooked the within until the non-appear- 
ance of The Corpuscle restarted my thinking machine. 
Please forward The Corpuscle; I have no inclination to drop 
it. Yours for Old Rush. 

J. W. McLean, '69. 
Camanche, Ia., Sept. 24. '96. 
Editors of The Corpuscle. 

Gentlemen: — Old Rush is well represented here in Eastern 
Iowa, and her sons are in the advance guard. I have a nice 
business and am a surgeon on the B. C. R. & N. Ry. Among 
my journals The Corpuscle is a most welcome visitor to my 
table, and the reports of clinics I delight in, as they bring me 
back to the good old days gone by. I hope to be with you 
next commencement. I am a loyal son. 

William H. Cook, '94, 

Hoopeston, III., Sept. 24th, 1896. 
Dr. John Edwin Rhodes, Chicago, 111. 

My Dear Doctor: — I have been very negligent in paying 
my Alumni dues and one reason is that my mail has been sent 
to Good wine, 111., instead of Hoopeston, 111. Inclosed you will 
please find one dollar to pay my dues and send, from this on, 
my mail to the above address, that is Hoopeston, 111. With 
best wishes for old Rush I am, 

Yours fraternally, 

Lemuel Baxley Russell, Class of '94. 



My Dear Doctor: — That there existed much disappoint- 
ment among Rush Alumni and students because of the non- 
publication of a '96 Pulse, is well known. 

The Pulse of '94 was the first of its kind, and its character 
and import were by a very large percentage of the students 
then attending Rush, not understood until the book was pre- 
sented to the public. A favorable verdict as to its success was 
immediately rendered. 

The Pulse of '95 was also a pronounced success as a liter- 
ary production and compilation of college incidents, well illus- 




DR. TMEODOR A. EDWIH KI1E1"BS. 
Professor of Pathology Hush Medical College. 



The Corpuscle. 

RUSH MEDICAL COLLEGE, CHICAGO, ILL. 
Medical Department Lake Forest University. 



VOL. VI. NOVEMBER, 1896. NO. 3. 

CASES PROM PROP. SENN'S CLINIC. 
Reported by H, J. Brugge. 

Case I. Case of Appendicitis. Patient has had two pre- 
vious attacks. Has had a preparatory diet anticipating opera- 
tion, for two days. An initial incision of the external oblique 
muscle is made and on separating the wound the internal 
oblique is disclosed, covered by fascia. This muscle is slight- 
ly incised and further enlargement of the opening is accom- 
plished by tearing and stretching. The anterior longitudinal 
band of the caecum is followed down to the appendix which is 
found to be surrounded by adhesions with its apex directed up- 
ward behind the caecum and firmly bound down by adhesions. 
There is a shorb mesoappendix. Three enlarged lymphatic 
glands present themselves close to the appendix, one of which 
is removed for microscopical examination. They are the seat 
of a plastic adenitis. Small abscesses should now be looked 
for as liable to be present. 

With difficulty the appendix is freed from the adhesions 
which firmly bind it down, and a small perforation is discov- 
ered at its very apex, from which exudes on pressure, a thick 
dark reddish liquid. The caecum is covered by sponges. 

The meso appendix is now tied and cut, freeing the appen- 
dix. The appendix is now removed by subserous resection, a 
circular incision being made around the appendix, including 
only its perUoneal coat. The proximal segment is stripped 
back toward the caecum for half an inch and the appendix cut 
off close up to the cuff. The mucous membrane of the appen- 



66 CASES FROM PROF. SENN'S CLINIC. 

dix stump is cauterized after ligation and the cuff of peritoneum 
sewed in place with fine catgut sutures. Pads have been 
placed closely around the appendix during the operation. 

Five days later case shown and remarked upon. Omentum 
exhibits an instinctive tendency to guard the life of a patient 
with slight perforation of the appendix by sealing the perfora- 
tion, which might otherwise cause a fatal peritonitis. When 
making enucleation of an appendix bound down with adhesions, 
press the separating finger in a direction away from the appen- 
dix so as to avoid rupturing it. 

Case II. Epithelioma of Tongue involving the left side 
of the base. It is impossible in this case to make a successful 
operation through the mouth because it is necessary to remove 
the infected glands. 

The regular Billroth operation would be defective on ac- 
count of removing anterior anchorage of tongue. Langenbeck 
made an operation cutting from the angle of the mouth across 
the inferior maxilla and sawing the lower jaw laterally; or the 
jaw may be sawed and divided in the median line. But these 
operations are defective in that union of the bone is sometimes 
late and causes inconvenience. Kocher's operation is the best 
under partial anaesthesia. 

Better let the patient suffer some pain than run chances of 
asphyxia. Kocher's incision is made and- the flap reflected. 

The facial artery will probably have to be ligated during 
removal of the infected glands. Palpation now discovers in 
the submental space, glands of almost cartilaginous consisten- 
cy which will have to be removed as the first step in the opera- 
tion- Every one of the submental glands should be removed, 
which after division of the platysma myoides is accomplished. 
Next the facial artery is tied after the application of two 
haemostatic forceps, between which the incision is made. The 
submaxillary gland is now drawn away from the jaw and 
search made for enlarged lymphatics behind it. Another small 
carcinomatous gland is found on the anterior belly of the di- 
gastric. Submaxillary is removed and a small gland discov- 
ered in its capsule. The jaws are here separated by a gag and 
the tongue drawn out and transfixed near its tip with a stout 
needle armed with a strong ligature. 

A finger is introduced into the mouth to guide in incising 
the mucous membrane sufficiently to admit four fingers. Full 
exposure of the tongue base is secured. With a haemostatic 
forceps the tongue is perforated just above the glottis, and an 



CASES FROM PROF. SENN'S CLINIC 67 

elastic cord drawn through. The constrictor is tied about an 
inch from the carcinoma and just above the pharynx. The op- 
posite side of the tongue is not diseased. 

A wedge-shaped piece is removed on the affected side and 
the lingual artery thereby cut. An assistant should always be 
roady to catch it in case the ligature shouldn't hold. The lig- 
ature here is accidently cut, but the artery is seized with 
forceps. Search is made for existence of other deposits with 
negative results. The lingual artery is tied and the wound 
approximated and sutured with heavy catgut. Of course the 
tongue is one-sided. The mucous membrane is united with 
separate sutures, the facial artery ligated and the skin is 
sutured and wound drained at the two lower angles. The 
ligature through the tongue is left to aid in withdrawing the 
tongue, should it fall back. 

Two days later the patient is shown in clinic in good condi- 
tion with full control of tongue which however deviates toward 
the left. In a few weeks the patient will gain perfect control 
of it. Thus far he has taken nourishment through a stomach 
tube in order to allow the the tongue rest. 

Case III. Malignant Tumor of Orbit. — Probably a perios- 
teal sarcoma of spindle -celled variety. An incision through 
the skin in the line of the eye-brow is made, both for cosmetic 
purposes and and to permit easy access to the orbit. No ex- 
ophthalmus. As the supra orbital nerve is already destroyed 
by the tumor it is ignored and attention directed to isolation 
of the tumor from the bone, care being taken to avoid inflicting 
any injury on the eye_ It is now evident that the tumor is 
derived from near the nerve. The periosteum is reflected, 
small instruments being employed. As undoubtedly the tumor 
is a sarcoma, the supra-orbital notch containing the nerve is 
cut out with the a chisel. The tumor is in such close connec- 
tion with the conjunctiva that there is danger of cutting 
through it. The tumor appears to follow the nerve very 
closely, in fact, seems to have originated in the nerve sheath; 
therefore removal of as much of the nerve as possible is indi- 
cated. The retro-bulbar adipose tissue is now encountered, and 
the limits of the tumor on this (right) side have been reached. 
The lachrymal apparatus is not affected. Having traced 
the nerve back to the spheno-maxillary fossa, it is seized with 
a haemostatic forceps and extraction performed by twisting it 
off; a piece at least an inch and a half beyond the forceps is 
secured. The tumor is now removed and the wound sutured. 



68 CASES FROM PROF. SENN'S CLINIC. 

Case IV. Fracture of spine in a man injured on a mining 
car. He has no control of his legs. The car in which he was 
riding, while running very rapidly, met an obstruction and re- 
bounded, causing the injury with present symptoms, instantly. 
There is kyphosis in the dorsal region, and the reflexes in 
the lower limbs are absent. The sartorious muscle on both 
side is greatly hypertrophied. Bluish spots are seen over the 
metatarso-phalangeal joint of the great toe and also on other 
parts of the foot. Anaesthesia of the part and impairment of 
muscular movement are apparent. The bladder was paralyzed 
for five weeks following the accident and constant use of the 
catheter required. There is no sensation in the bladder, though 
he can micturate by compression of the bladder with the ab- 
dominal muscles. Mucus which formerly was present in the 
urine has now disappeared. There is paraplegic paresis. 
The curvature of the spine involves the last two dorsal and the 
first lumbar vertebrae, the latter of which is the seat of the 
fracture which was caused by hyper-flexion of the spine. 

The usual line of fracture, extending diagonally across 
the body of the vertebrae is probably present here. 

Treatment will consist of extension upon Rauchf uss' sling, 
and if at the end of six weeks, no improvement is noted, a lam- 
inectomy will be performed. 



RUSH'S MANDOLIN CLUB. 

The Rush Medical College Mandolin Club has organized 
for the college year with the following officers: 

President and financial manager, E. J. Jones; director, 
Eugene Allen. 

The club has every prospect of success, having been 
strengthened by the addition of several new men. The mem- 
bers are: First mandolin: — Eugene Allen, E. F. Jones, Henry 
Fehr, F. Skinner, William Cooling. Second mandolins: — F. 
H. Senn, Henry Durrin. Guitars: — F. L. Hodgus, H. Gue, S. 
Brown, R. Whittly. Flute: — Ochsner, Danniels. Harp: — B, 
S. Curren 



A CASE OF CARCINOMA OP THE PROSTATE GLAND 

WITH SECONDARY ASCENDING 

PYELONEPHRITIS. 

Reported By J. D. Freeman, B. S. 

The clinical history is briefly as follows: 

A. H. O.j male; American; age 72 years; occupation, real 
estate dealer; was admitted to the Presbyterian Hospital, ser- 
vice of Dr. Graham, Feb. 29, 1896. The family history was 
negative. He had always enjoyed excellent health until the 
year 1888, in April of which he had a hemorrhage from the 
lungs. In May 1894 he had an attack of what was called pro- 
statitis, since which time he has been subject to increasing 
pain in the region of the prostate and increasing difficulty of 
urination. He can not void urine voluntarily and small 
amounts in the bladder give rise to intense pain so that he has 
to be catheterized every two hours. The urine is alkaline, 
contains pus, mucus, shreds of tissue and is very offensive. 
Occassionally the obstruction of the urethra becomes complete 
and examination shows this to depend upon a mass at the en- 
trance to the bladder. Frequent diarrhoeal passages and in- 
voluntary bowel movements supervened. A few days before 
death urine passed per rectum. 

Died, May 14, 1896. Post mortem examination, May 15, 
1896. The Autopsy shows the body to be that of a man weigh- 
ing 135 lbs., hair white, eyes blue, pupils equal, neck thin, 
chest flat, abdomen sunken, greatly emaciated, rigor weak. 

Internal Examination : Peritoneal cavity contains no fluid; 
omentum shrunken and devoid of fat; visceral and parietal 
layers of peritoneum smooth and shiny; lumbar and sacral 
lymphatic glands enlarged and nodular, as felt through the 
peritoneum. 

Pleural Cavities: Contain large amounts of murky yellow- 
ish fluid; in that of the right cavity float numerous small floc- 
culi of plastic lymph. Pleura of left cavity, smooth through- 
out. Right cavity, posterior wall covered by yellowish fibrino- 
purulant exudate. 

Pericardial Cavity: Small amount of clear yellow fluid 
present; layers of pericardium show no change. 



70 A CASE OF CARCINOMA OF THE PROSTATE GLAND. 

Heart: Considerably larger than owners fist; moderate 
amount of red clotted blood in all cavities; endocardium neither 
thickened nor opaque with the exception of a few small yel- 
lowish raised areas seen on the body of the mitral valves. 

Aorta: at the commencement — diffusely dilated to slight 
extent; numerous large and small yellowish plaques scattered 
upon the intima. 

Coronary Arteries show same yellowish areas in their walls. 

Myocardium somewhat softened and pale — red on section. 

Lungs: left lung — pleura smooth; lung heavy; non crepi- 
tating; on section, a large amount of dirty grayish fluid can be 
expressed from substance; entire lung filled with frothy fluid 
of like character. Right lung — corresponds in description to 
the left, save the presence of a thick layer of fibrinous exudate 
upon its posterior pleural covering. 

Liver: Capsule smooth; brownish red in color; a few 
round, yellowish white, umbilicated hard nodules varying in 
size from pin head to hazel nut are seen projecting from sur- 
face. On section the liver contains a small amount of blood; 
lobules fairly distinct. 

Spleen: Capsule wrinkled, purple in color. On section, 
pulp is dark red, considerable increase in connective tissue 
noticeable, vessels stand out prominently. 

Kidneys: Left — upper third of kidney occupied by a large 
cyst containing a murky amber fluid; numerous smaller cysts 
scattered over surface of kidney; capsule strips readily leaving 
a pale red uneven surface; pelvis dilated and filled with pus; 
on section cortical markings fairly distinct. Relation of cor- 
tex: medulla :: 1 : 3. Right kidney — pelvis distended with 
clear fluid. Substance of both kidneys occupied everywhere 
by innumerable small cavities and areas containing yellowish 
green pus. In the medullary portion grayish yellow streaks 
extend upward toward the cortex in a more or less radiating 
manner. Both ureters are dilated and thickened; walls cov- 
ered with muco-pus. 

Bladder and Prostate: Bladder distended with murky urine 
in which float numerous necrotic shreds of tissue and flocculi 
of pus; mucus membrane black in color and undermined in 
places; walls greatly thickened and of boggy texture. At base 
of bladder is seen a raised crescenticmassof soft tissue spring- 
ing from the prostate projecting into bladder cavity. The 
base and surrounding tissues are infiltrated and hard as well 
as the regional lymphatic glands. An irregular necrotic per- 



A CASE OF CARCINOMA OF THE PROSTATE CLAND. 71 

f oration of the bladder wall in the trigone, 2 c. m. in diameter, 
connects the lumen of bladder with a large abscess cavity 
located beneath its floor and posterior wall. The anterior wall 
of the rectum having a similar perforation allows free com- 
munication between the bladder and rectum. 

Pancreas, Negative. 

Stomach and Intestines show no changes . 

Anatomic Diagnosis: — carcinoma of prostate — carcinoma 
of regional lymphatic glands and of the liver — ascending sup- 
purative cysto-ureteropyelo-nephritis — perforation of urinary 
bladder — retro- vesical abscess perforation into rectum — sero- 
fibrinous pleuritis — oedema of lungs. 

The microscopic sections show a typical gland celled carci- 
noma of the prostate, of the retroperitoneal lymphatic glands 
and of the liver. 

Remarks-- The clinical symptoms of this case are sufficiently 
ly well explained by the presence of the carcinoma prostate in 
consequence of which there resulted urinary obstruction as well 
as metastatic carcinoma of the regional lymphatic glands and of 
the liver. In the course of the diseases the stagnated con- 
tents of the urinary bladder become infected either on account 
of the catheterization or due to invasion of bacteria from the 
rectum or from without; and this infection led to the develop- 
ment of a suppurative cysto-ureteropyelo-nephritis. The sup- 
purative inflammation traveling upwards along the urinary tract 
by continuity of tissues. On account of the suppurative cysti- 
tis and urinary retention there resulted a necrosis and perfora- 
tion of the wall of the urinary bladder, this leading to the for- 
mation of a retro-versical abcess which subsequently ruptured 
into the rectum. 

From either of these quite extensive, but nevertheless 
local suppurative processes there resulted shortly before death 
a more general infection, which is evidenced by the serofibrin- 
ous -pleuritis. 

This case is very instructive in that it illustrates — 

1. A rarer form of carcinoma, namely of the prostate, 

2. The development of an ascending inflammation of the 
urinary tract and the kidney, in consequence of the obstruction 
to the outflow of urine by the tumor and, 

3. The perforation of wall of bladder by a suppurative 
process, with the formation of an abcess behind it. 



DOUBLE OVARIAN MULTILOCULAR TUMORS. 
By W. H. Lane, M. D., Angola, Ind. 

My main object and endeavor in offering this report will 
be to avoid all technicality and scientific discussion that is so 
interesting and so necessary to the comprehension of so impor- 
tant a subject as ovarian neoplasms. 

The question of Dovarian tumors has been so much written 
of and discussed that one feels like apologizing for presenting 
so common a subject, but as it is yet vital in some measure I 
will offer that, as my excuse in presenting this brief report. 

It is not my intention here to add a single thought that 
will aid in revealing anything startling, but only to report 
briefly an interesting case of double ovarian multilocular tumor. 
However, it may be laid down as an axiom at once, in all cases 
of benign and malignant tumors of the uterine appendages 
that their removal should be attempted as soon as their diag- 
nosis is established, except as in the presence of such contra- 
indications as would determine non-interference in any sur- 
gical operation, such as extreme exhaustion, advanced disease 
of the kidneys, heart, etc. Reference is here directed to ovarian 
cystomata which grow slowly but persistently, at first occupy- 
ing the pelvic cavity, then becoming so large that the pelvis 
will not hold them, they rise up into the abdominal cavity, 
where by reason of their large size they interfere with the ab- 
dominal organs, with respiration and the heart action by 
crowding upon the diaphragm; thus the general nutrition be- 
gins to suffer. The tendency is towards destruction of the indi- 
vidual by literally crowding them out of existence. 

In the latter part of January, 1896, I was called to see 
Mrs. H., married, age forty-five, and the mother of four chil- 
dren, the youngest of whom was nineteen years. Pound her 
confined to her bed since sometime in December, 1895. Her 
family history was good. Some nine years ago gave birth to 
a post-mature child which was dead and much decomposed, re- 
sulting from infection from sources not known, and after many 
months of pelvic inflammation and septicaemia she made a 
complete recovery. 

In August, 1895, after a hard day's work she was ap- 



DOUBLE OVARIAN MULTILOCULAR TUMORS: LANE. 73 

parently overcome by the intense heat and a few hours later 
there developed a local peritonitis followed by a " bunch" in 
the left iliac region which has since that time steadily en- 
larged, crowding up and out of the way the abdominal vis- 
cera. During this time she has been up and doing, with con- 
siderable pain and tenderness over the abdomen, having every 
few days or weeks an attack of local peritonitis which would 
soon subside by rest in bed and hot applications. During her 
life the menstrual periods have been normal, occasionally 
slightly prolonged. The enlargement steadily increased in 
size until the patient was completely exhausted and was con- 
fined to her bed. When seen, was suffering much pain and 
tenderness over a greatly enlarged and distended abdomen, 
which presented a rough and irregular tumor occupying the 
whole of the cavity, with fluctuations confined to the right of 
the medium line only, hard and irregular over the remainder 
of the surface. Temperature slightly above normal; respira- 
tion markedly interfered with; pulse rapid and weak, 120 to 
130: constipation of bowels, moving only when relieved by 
enemas: urine scanty and high colored. The prominence of 
the bulging was at the umbilicus and below; resonance over 
the stomach and bladder only; decidedly flat over, the enlarge- 
ment. This condition continued the same for a few days until 
consent was obtained for an operation. 

On February 16th the patient was carefully prepared for 
operation in the usual manner. After making the medium line 
incision, and coming in contact with the tumor, found exten- 
sive adhesions, very firm, to the parietal walls, more slightly 
to the intestines, stomach and underside of the liver, which re 
quired much painstaking care to separate them without vio- 
lence. After emptying the tumor of part of the fluid, there 
remained mostly small cysts and solid tissue, " some fifteen 
pounds '' was removed from the abdomen by extending the in- 
cision upward, there practically being no pedicle, the fallopian 
tube and broad ligament was clasped short to the body of the 
uterus, there transfixed by a heavy ligature of braided silk and 
removed; examination revealed the left ovary considerably en- 
larged with three cysts and bound down with adhesions which 
was treated in like manner and removed. The abdominal cavity 
was thoroughly cleansed and dried. There being no oozing of 
blood of any importance, the wound was closed without drain- 
age, and the incision was closed with two buried sutures of 
silk worm gut about one and a half inches apart including the 



74 DISEASE AND ITS CURE: SALISBURY. 

peritoneum, deep fasciae and muscular tissue to insure against 
hernia. The external deep sutures, which included all the tis- 
sues, were of braided silk with a superficial stitch placed be- 
tween each deep one, These were removed on the tenth day. 
Before and at the close of the operation the patient wi3S heavily- 
stimulated by hypodermic injections of brandy and strychnia, 
placed in bed with warm flannels and hot water bottles. She 
responded well considering the low condition in which she en- 
tered the operation and the following shock. She urinated 
freely in ten hours and her bowels were moved by gentle saline 
laxatives on the third day. The temperature at the end of 
thirty hours rose to 100 T V degree F. when it dropped to nor- 
mal and remained there, the patient making an uninterrupted 
and uneventful recovery. 






DISEASE AND ITS CURE. 
Prof. J. H. Salisbury, A. M., M. D. 

Among the noxious influences that tend to destroy or im- 
pair the functions of the various organs of the body, the first 
rank must be given to those soluble chemical substances known 
as poisons. We may therefore define disease as a process of 
poisoning by poisons either mineral or vegetable, or the pro- 
duct of minute organisms or the result of the action of the 
organism itself. The primary effect of poison is to kill or to impair 
function; but this effect is to a great extent counterbalanced by 
the fact that the poison arouses the activity of Certain organs 
or of the system generally to a struggle against the poison. If 
this reaction is powerful and the poison is present in small 
quantity we have the appearance of stimulation as in the first 
stage of alcoholic intoxication or opium poisoning. If on the 
other hand we have a large dose of the poison or a feeble re- 
sistance on the part of the system on account of exhaustion or 
previous enfeeblement of the organism, we have the symptoms 
of paralysis which at length, reaching the vital centers, ter- 
minate in death. 

The action of the system against poison seems to be main- 
ly in three directions: First, Removal by elimination, as by 
vomiting , diarrhoea, diuresis, or diaphoresis. Second, Storing 
up in various organs (a sort of internal elimination) as deposits 
in the liver spleen or connective tissue. Examples of this are 
the fatty degeneration of the liver and deposition of arsenic in 
this organ in arsenic poisoning, collection of worn out blood 



DISEASE AND ITS CUKE: SALISBURY. 75 

corpuscles and dead bacteria in the spleen, dropsy in renal 
disease etc. Third, Destruction by various antidotes or anti- 
toxins. Thus phosphorus when oxidized to phosphoric acid is 
practically harmless; acids are neutralized and unless they 
have already produced caustic effects they are then harmless. 

Passing- to the poisons produced by microorganisms we 
see a great similarity between their effects and those of the 
well known mineral and vegetable poisons. Almost the iden 
tical lesions are produced by arsenic and Asiatic cholera. It 
is known that the cholera microbe does not enter the blood and 
its effects must therefore be due to a poison absorbed into the 
blood. Mercury produces an almost typical dy sentry and the 
pathological histology of the kidney in mercurial poisoning is 
very similar to the lesions in those forms of poisoning by un- 
known agents which we call Brignt's disease. 

Our conception of disease may be embodied in the follow- 
ing proposition. Disease is a form of poisoning and consists 
of two intermingled sets of phenomena viz: The debilitating, 
degenerating and sometimes fatal action of the poison, and the 
antitoxic and eliminating reaction of the system. 

When the disease is infectious we have a veritable war be- 
tween organisms. The greater organism is an interdependent 
collection of cells aggregated into organs which have assigned 
to them their various functions, These functions are not fully 
exhibited by the normal system for the reason that the re- 
serve powers of the system are only called into play in the 
moment of danger. To assume that an action of an organ dif- 
fering from that usual in a state of health is detrimental to the 
system would be a grave mistake. 

The bowels should normally move only once a day; but 
under the influence of certain poisons they move several times 
an hour. The latter action is as essentially normal under the 
changed circumstances as the daily movement under ordinary 
circumstances. The stomach irritated by arsenic reacts by 
vomiting. This is as it should be and instead of quieting the 
stomach by some other poison the physician aids the removal 
of the poison by large draughts of water or by the stomach 
pump. We should look upon these new actions of the organs 
as connected with some general purpose and called forth by 
the new danger that threatens the organism. 

Among the organs or parts of the body which play their 
part in destroying parasites and the poisons they produce we 
must reckon the blood and especially the leucocytes. These 



76 DISEASE AND ITS CURE: SALISBURY. 

wandering cells seem to act as a body of police for the whole 
body. 

That they act by their own powers of digestion and ab- 
sorption to remove foreign matters is well established and that 
they exert this action upon bacteria is very probable. That 
the serum of the blood has a bactericide action is well known. 
This seems to be due to the action of nuclein which is produced 
by leucocytes. 

Besides the blood other organs have especial functions in 
connection with the poisons of disease. When the poison en- 
ters from the alimentary canal it must of necessity first pass 
through the liver. The liver seems to stand at the gateway of 
the circulation to separate noxious substances — entering 
through the alimentary canal. These it destroys to a certain 
extent — others it stores temporarily in its substance as in the 
case of arsenic. 

Some poisons it eliminates by the bile. The importance 
of the liver as a defense against poisoning is insufficiently ap- 
preciated. The action of the liver in infectious diseases is 
doubtless of the same sort which explains the increase in size 
of this organ in many cases of such diseases. 

The germicidal action of the acid of the gastric juice is a 
somewhat feeble but real protection against the invasion of the 
system by microorganisms; and it is probable that similar pro- 
tective properties belong to the intestinal fluids. 

Our knowledge of the methods by which the system resists 
invasion by microorganisms and cures infectious diseases 
should furnish us with a safe guide for treatment. In general 
we may address our efforts for the cure of disease to the ac- 
complishment of the following purposes: 

1st; The removal of the cause. This can not always be 
effected but when it can it furnishes the first indication to be 
fulfilled. 

2nd; Eliminate. 

3rd; Sustain the nutrition of the system as thereby the 
system is enabled more effectually to manufacture the anti- 
toxin. 

4th; Stimulate those organs especially connected with 
combating the poison of the disease. 



MALARIA. 
By Ellsworth D. Whiting, A.B. 

(The L. C. P. Freer Prize Essay, Rush Medical College, 1896.) 
Reprint from The Journal of the A. M. A. 

Malaria, or paludism, is a non- contagious, infectious dis- 
ease, characterized by typical paroxysms, the principal patho- 
logic changes being in the blood, liver and spleen. Its etiolcgic 
factor is a specific protozoon, the Plasmodium malarias of Lav- 
eran, which can generally be demonstrated in the red blood 
corpuscle. 

Malaria may be considered a primitive disease, that is, 
one found in newly settled countries. It attacks the settler 
when he turns the soil for the first time, when there is no 
drainage for and when the shallow wells fill from the surface. 
As soon as the swamps are drained and the wells freed from 
surface water the " chills and fever" disappear. 

As to the geographic distribution of malaria, it is quite 
extensive, being found in tropical, subtropical and temperate 
zones. In the northern part of Africa malaria is epidemic. It 
was there that Laveran made his first discoveries. In Europe, 
southern Russia and Italy are the common seats of the disease 
though it is found to some extent in England, France and Ger- 
many. On our own continent malaria is endemic in the South, 
Mexico, Texas, Arkansas, Louisiana and Missouri, and more 
common in the North than was formerly supposed. In the 
West Indies it exists in its most malignant forms. 

As to the manner in which the parasite affects entrance 
into the human body medical opinions differ. Until a few 
years ago there was a consension of opinion that malaria was 
an air- borne disease, the lungs being the only infection atrium. 
Those who upheld this theory based their opinions upon the 
fact that malaria was common among people living in low, 
marshy regions abounding in vegetable growth. These men 
claimed that the organism had its habitat in the soil, from 
whence, under favorable conditions, it was disseminated 
through the atmosphere and thus readily reached the air pass- 
ages and circulation of the human organism. They claimed 
also that while moisture was not necessary to the development 
and spread of the disease it greatly aided it in its growth. 



to malaria: whiting. 

They maintained for this reason that night air was much more 
heavily charged with malarial organisms than the air during 
the day. 

Within the last few years other investigators have gone so 
far as to state that malaria is not an air- borne disease in any 
sense of the word. After extensive investigations these gen- 
tlemen have proven to their own satisfaction that this disease 
is purely of water borne origin. To maintain their position 
they have brought to bear very strong evidence. They cite 
numerous instances where gangs of laborers working in the 
same malarial districts were dissimilarly affected, those drink- 
ing from the surface water suffering from the disease, while 
those drinking boiled water, or that obtained from deep wells, 
were unaffected. These men all breathed the same air both 
night and day. 

This is a strong argument in favor of the water- 
borne theory. It may be argued that the vitality of those 
drinking the pure water was sufficient to resist the action of 
the organism, even had it gained entrance into the body 
through the air passages, while the vitality of those drinking 
the surface water was naturally lower. This objection would 
hold good were only one case cited, but it must necessarily fail 
when hundreds of similar cases are given. Another proof of 
the probability of the water-borne infection is demonstrated by 
the fact that here, in the midst of Chicago, in the heart of win- 
ter, when there is no building and excavating, malaria is pres- 
ent in almost every hospital in the city. The writer has dem- 
onstrated the presence of the organism in the blood of Cook 
County Hospital patients this winter who have not been away 
from the city in many years. The air-borne theory does not 
explain clearly these midwinter infections while the water- 
borne theory does. Many streams flow into Lake Michigan 
from the flats of Illinois and Indiana. These streams teem 
with malarial organisms. They empty their polluted waters 
into the lake and the currents flowing northward find their way 
into the cribs and thence to the dwellings of the citizens of 
Chicago. It is a noteworthy fact that not only is malaria found 
in the wards of Cook County Hospital but also among families 
living on the finest boulevards. Taking into consideration the 
array of testimony on either side, the writer is inclined to lean 
toward the water-borne theory, yet granting that in some cases 
infection by air seems highly probable. 

Formerly many held that the organism gained entrance 



MALARIA: whiting. 79 

into the body through the stings of insects. This theory is 
upheld by but few to-day. 

As a rule malaria is most prevalent in the spring and fall, 
yet tne disease is present to some extent during all seasons of 
the year. 

Under like conditions malaria is no respecter of persons as 
to sex. It is, however, more common among men than women, 
because of their manner of life, as they are more exposed to 
its etiologic factor. Children under one year of age rarely 
have the disease. 

There can be but little doubt as regards the difference in 
degree of personal receptivity. All persons of lowered vital- 
ity are readily susceptible to the disease, nevertheless in men 
full of health there is great difference in the degree of im- 
munity. This immunity may be natural or acquired. Persons 
going into a malaria district seem to acquire immunity after a 
lapse of years, while those born in the malarial atmosphere 
are often never affected by the disease. The negro is much 
less affected than the white man, the ratio being as three is to 
one. 

The histojy of the discovery of the Plasmodium malarise 
and the various theories set forth by the different observers as 
to its character furnish interesting matter for study aud in- 
vestigation. 

Note — Here follows the history of literature and experi- 
ment on the subject. See Journal of American Medical Society, 
July 18 to 25, 1896: 

Before entering upon a systematic study of the organism, 
a description of the manner in which specimens are obtained 
may be of advantage. 

The technique of obtaining specimens for a fresh examina- 
tion, though simple in theory, presents many slight, but an- 
noying, difficulties in actual practice. The main points ever to 
be kept in mind are cleanliness, quickness and skill of hand 
and eye. The instruments necessary are a small lancet, two 
pairs of blood forceps, slides and cover slips. The site of 
puncture should be thoroughly cleansed, first with soap and 
water to remove dirt, secondly with alcohol to remove oily 
materials, and then allowed to dry. 

Blood for examination may be taken from any part of the 
body. In adults the finger tips or lobe of the ear is most satis- 
factory. The writer has had most success in taking specifi- 
mens from the lobe of the ear. Here there is practically no 



80 MALARIA: WHITING. 

pain; a very minute puncture only is required to obtain the 
necessary amount of blood; it is out of the sight of the patient; 
immobility is easily obtained and infection is not liable to fol- 
low. The puncture of the finger tip is painful; being in the 
sight of the patient much annoyance is caused in children and 
hysteric subjects and there is more danger of infection. In 
infants the most desirable site is the inner surf-ece of the heel. 

Great cleanliness should also be observed in the prepara- 
tion of the slide and cover slip. Both should be thoroughly 
cleansed immediately before using. In preparing the cover 
glass it should first be allowed to stand in 25 per cent, sul- 
phuric acid for one-half hour. It should then be washed in 
alcohol and finally dried with a perfectly clean and dry silk or 
linen handkerchief. In the preparation of the slide such pre- 
cautions are not necessary as cleanliness can be secured by 
brisk rubbing. 

If it is convenient it is of great advantage to have the 
slide as near body temperature as possible. This may be ob- 
tained by the judicious use of Xhe alcohol lamp or by friction 
at the hands of an assistant. 

The site of operation and the necessary articles being in 
readiness, a slight puncture, directed upward, is made in low- 
est point of the lobe of the ear. The lobe is then turned up- 
ward and the blood allowed to flow without pressure. The 
first few drops are wiped away when a cover glass held in 
blood forceps is touched to the summit of the following drop 
as it emerges from the opening. The slip is then quickly 
transferred to the slide. In order to guide and steady the 
hand that the cover may not touch the skin, the following pro- 
cedure may be followed: Let the left hand, which is holding 
the lobe of the ear, rest against the neck of the patient, then 
by placing the fingers of the right hand, in which the cover 
slip is held, lightly upon the left hand, steadiness and accuracy 
of tactile sense may be acquired to a remarkable degree. It 
is also of advantage to hold the forceps as near the cover slip 
as possible. 

If the cover slip and slide have been perfectly cleaned; if 
the operation has not taken too long and the cover glass has 
not touched the skin nor the drop been too large, the blood on 
touching the slide will immediately spread out between the 
slide and cover, No pressure should be applied. On micro- 
scopic the corpuscles will be seen to lie separate and dis- 
tinct side by side and unaltered in the surrounding plasma. 



MALARIA: WHITING. 81 

Often in spite of the most careful preparations the drop of 
blood will not spread, a condition which the uninitiated will be 
at a loss to explain. This may be explained in four ways at 
least: 

1. After immersing in sulphuric acid, the acid may not 
Lave been entirely washed away. Especially does this occur 
when a number of slips are washed at the same time. Long 
cleansing in water is necessary to thoroughly remove the acid. 
When the acid can not be tasted it will do no harm in the 
spreading, fixing and staining processes. 

2. A raveling may be found lodged in between the slide 
and cover slip, which prevents the hugging of the slide by the 
cover glass. 

3. The surface of the slide may be uneven. 

4. The slip may be warped. 

Blood prepared in this manner will keep from one and one- 
half to two hcurs without crenating and may be kept longer 
by annointing the edges of the cover slip with vaselin or 
glycerin. In the examination of blood for the organism of 
malaria a one-twelfth oil immersion objective with ocular num- 
ber five is recommended. These high magnifications are not 
absolutely necessary. Laveran made his first observations 
with dry lenses of low powers. 

The preceding methods are the simplest and most prac- 
tical for clinical work. Some observers use methods much 
more complex. Hayem's slide is used to some extent. This 
consists af a hollowed out slide. The drop is placed in the de- 
pression and protected by a cover slip. Plehn describes a 
most elaborate method by which he keeps microscope, slide 
and specimen at body temperature. He mounts his specimens 
in parafin and thus keeps them intact for three hours. 

In the preparation of dried specimens for future staining 
the technique is the same except that instead of placing the 
drop collected on the slip upon the slide, it is placed upon a 
second slip, held likewise w 7 ith blood forceps. The slips are 
left in contact from one to two seconds when they are drawn 
apart being continually held by forceps and the lines of force 
kept parallel. They are then set aside to dry with the clean 
side down. The drying process takes but a few moments, 

When it is necessary to take dried specimens without aid, 
the Operator is compelled to fall back upon devises which may 
best suit the circumstances. The writer has been very suc- 
cessful in the pursuance of the following plan: One cover 



82 MALARIA: WHITING. 

slip is placed upon a clean piece of paper at the very edge of a 
table while the second cover when the drop of blood is col- 
lected is plaoed upon the first. As the blood cements the slips 
togethor both are raised by lifting the one in the grasp of the 
forceps when they may easily be separated. 

Before specimens can be stained they must be fixed. Fix- 
ation consists in bringing about some molecular change in the 
corpuscles in which condition certain elements take certain 
stains. The nature of this process is not known. Some say 
that the change is that of coagulation of the albumin, but this 
can hardly be true as carbolic acid does not fix blood. Fixa 
tlon is probably simply a process of dehydration. 

There are many methods by which blood is fixed. This 
may be accomplished by passing through a flame, heating at 
120 C, immersing slips in picric acid, mercuric chlorid, abso- 
lute alcohol, osmic and glacial acetic acid or alcohol and ether, 
equal parts. The writer has been most successful in the use 
of the latter method. He generally leaves the specimens in 
the fixing agent for twelve hours but good results have been 
obtained after one-half hour's' fixing. Unsuccessful attempts 
at fixing with alcohol and ether often arise from the fact that 
the alcohol is not absolute or contains enough acid to destain 
the specimen. Commercial alcohol is rarely pure. The rea- 
gents used in the fixing of blood should be distilled for the 
purpose and kept in an air-tight container. 

Results obtained from heating on the graduated bar are 
variable, due to the fact that it is exceedingly difficult to keep 
the bar at an even temperature. In this method of fixing, an 
ordinary one-burner oil stove is used. Across the top of the 
stove is placed a copper bar two feet in length, four inches in 
width and one -eighth of an inch in thickness. After the bar 
has attained a stationary degree of temperature, the boiling 
point is determined. This is accomplished by dropping water 
upon the bar and noting the point at which it boils. At this 
point a line is drawn across the bar and a row of slips, smear 
side down, are placed one inch within this line. The speci- 
mens are permitted to remain at this temperature from one to 
three hours. Although simple of description this method is 
open to many criticisms. The apparatus must be continually 
watched, as a rise of temperature ruins the specimens. It is 
best to protect the bar as much as possible from drafts and to 
determine the temperature every few moments with water. 
Many investigators have used an oven in which the tern- 



MALARIA: WHITING. 83 

perature may be accurately regulated. By means of this de- 
vice good results have been obtained. 

The parasite of malaria takes the stain of all basic anilin 
dyes. It is unaffected by the acid dyes except when they are 
of great strength and left in contact with the organism a long 
time. These facts have given rise to a host of methods of 
staining, a description of all of whioh would be futile; there- 
fore a few of the more important ones will be described. 

An exceedingly interesting and ingenius method is given 
by Celli and Guarnieri, who succeeded in staining the parasite 
while alive. For this purpose they employed aseptic ascitic 
transudation in which methylene blue was dissolved. They 
placed this solution over the site of the puncture, allowing the 
blood to flow with the fluid, which was quickly transferred to 
the slide. It was then kept in a warm moist chamber for three 
hours, when the organisms were seen to be well stained. This 
method, however, does not procure permanent specimens. 

Chenzinsky succesfully stained specimens which had been 
previously fixed and dried by placing them for five minutes in 
a mixture composed of a 50 per cent, aqueous solution of 
methylene blue, and an equal amount of 5 per cent, of eosin, 
in 60 per cent, alcohol. 

A cumbersome yet ingenious plan has been devised by 
Feletti. After allowing a 25 per cent, alcoholic solution of 
methyle blue to dry upon a slide he places upon it a cover slip 
upon which a drop of blood has been collected. He then sur- 
rounds the cover slip with parafin. The serum of the blood 
dissolves the methylene blue, w T hich stains the organisms. 

Mannaberg, after fixing the specimens in alcohol and 
ether, equal parts, for half an hour, stains them in a concen- 
trated aqueous solution of methylene blue for an equal length 
of time. After having been washed and dried in water, the 
specimens are left for thirty minutes in a 2 per cent, solution 
of eosin in 60 per cent, alcohol. They are then washed, dried 
and mounted in balsam. 

The method described by Romanowsky is effective yet im- 
practicable for routine work. Immediately before using, he 
makes a fresh solution composed of one part of a filtered, sat- 
urated, aqueous solution of methylene blue, to two parts of a 
1 per cent, watery solution of eosin. The specimens fixed by 
heat, are floated smear side down upon this mixture, contained 
in a watch glass. The specimen is covered by an inverted 
glass and the whole enclosed in a moistened beaker. The 
specimens are allowed to remain in this solution from one-half 
hour to three hours. By this method Romanowsky claims 
that he stains the red corpuscles red, the parasites blue and 
the nuclear chromatin violet. 

(To be Continued.) 



SOME ANATOMICAL MNEMONICS. 
By Charles A. Parker, M. D. 

The story is told of a dull student who one day surprised 
his teacher by giving correctly though after much studious de- 
liberation, the date of the battle of Waterloo, which so aroused 
the master's curiosity that he asked him how he remembered 
the date, and this is the wonderful method he gave: "First I 
remembered that the Declaration of Independence was signed 
the 4th of July, 1776; now four times four subtracted from the 
4th of July gives the 18th of June, month and day, and to get 
the year I added 1776 to 1492, divided the sum by four, then 
added the age of Methuselah and subtracted the number of 
years the children of Israel were in the wilderness and in- 
creased the result by 61, which gave me the year 18] 5. ; ' 

Such heavy mental gymnastics were worthy of a better 
cause; it was like killing a mosquito with a Krupp gun, but he 
remembered the date. 

I once asked a bright student, after he had given correctly 
some rather perplexing anatomical data, what aids or rules he 
used to remember what he had just given, and his answer was 
that he "had no time to learn rules." .But we all use association 
so much in everyday affairs to hold the memory and so it must 
have seme place also in anatomy. 

Systems of mnemonics were in use in ancient Greece and 
the history of the subject through the centuries is interesting, 
but we are at present concerned with its application to anatomy. 

This article does not presume to be complete but simply 
reduces to writing some of the various aids which I have be- 
come acquainted with in my associations with students and 
teachers, and which I have happened to pick up in medical 
literature on the subject. 

Many anatomical mnemonics that I have seen appear to be 
more complicated than the facts to be remembered; but it is a 
matter of personal judgment which are advantageous and 
which are not. 

To facilitate the work I shall follow the order in Gray and 
will begin with the bones 

Superior Maxilla. — Regarding-the positions of the foramina 



ANATOMICAL MNEMONICS: PARKER. 85 

of Scarpa and Stenson, and the structures they transmit: 
change the pronounciation of nerves to narves; that gives 
Scarpa and narves similar sounds and thereby easily associated. 
A and I, letters in the first half of the alphabet, help us re- 
member, anterior left; and p and r, in the last half fix posterior, 
right. The nerves being settled, there is nothing perplexing 
about structures passing through Stenson foramina. 

Scapula. — The relations of the origins of the major and 
minor of the Teres and Rhomboid muscles may be remembered 
as the minor above in either case; and so also are arranged the 
origins of the Zygomatic muscles on the malar bone, especially 
if the head be tilted slightly backward. 

Suprascapular notch: notch-nerve; both words begin with 
the same letter. The artery then does not pass through the 
notch. 

LONG BONES. 

Direction of Nutrient Artery. — Sit in a chair with the chin 
resting on the hands and the knees drawn up to the body; then 
will the nutrient artries of all the long bones of the limbs run 
downward; in the humerus, ulna and radius toward the de- 
pressed elbow; and in the femur, tibia and fibula away from 
the elevated knee. I do not know who is responsible for this 
very good rule, though I think I first heard it at Rush. The 
other fact in this connection, that the epiphysis toward which 
the nutrient artery is directed is the first to unite with the 
shaft, is commonly noted in the text-books. 

Bones of Carpus— The bones of the carpus come in for 
their share of mnemonics and there are numerous familiar ones. 
The following may suffice, though I have heard many varia- 
tions, some of which were hardly to be commended as gems of 
literature: 

" Sailing swiftly cooking peas. 
Traveling toward my ulna." 

Ad the Woman's College I heard: "Some ladies can't pray; 
teach them, O uncle." 

Os Innominatum. — A small point that has shaken my faith 
more than once is the relation of the facet of origin common 
to the Biceps and Semitendinosus to the origin of the Semi- 
membranosus. The friceps is frelow. Again on the inner sur- 
face of the tibia the attachments of the Gracilis and Semi- 
tendinosus, surrounded by the Sartorious may be remembered 
thus: g for Gracilis is above t for Tendinosus in alphabetical 
order and so on the bone. I have never heard any mnemonics 



86 ANATOMICAL MNEMONICS: PARKER. 

for the bones of the foot; that is probably because they are so 
large and distinct in function that we must learn more than 
their names, and so get familiar with them in other ways. 

ARTICULATIONS. 

Knee Joint. — It is a careful student indeed who can 
readily describe the crucial ligaments, and many of 
the rules given are about as badly twisted as the ligaments 
themselves, and need another key to explain them. 

One rule that I heard in class, and which I have to study 
out each time I want to give it, is to place the middle finger of 
the left hand across the back of the index finger of the same 
member, and then put the hand, palm downward, on the knee 
of the same side; and now by a little study we will see that 
the middle finger is in the position of the anterior crucial liga- 
ment, the lower end or tip of the finger representing the at- 
tachment to the tibia in front of the posterior; and the direc- 
tion of the proximal end of the finger upward and outward 
from there the course of the ligament to the external condyle. 
The index finger would then represent the course of the pos- 
terior crucial ligament. 

A much easier way is to say the vowels as we used to do 
in school, a,e,i,o,u, etc., and use the first part for our purpose; 
as anterior, external; the anterior being secured, the posterior 
is not difficult. 

When I was a student of Rush, Prof. Chas. T. Parkes was 
the surgeon, so some one used his name in connection with the 
structures behind the internal malleolus something in this 
manner: "Parkes does vex all very nervous people," in which 
p stands for posticus (tibialis posticus); does digitorum (flexor long 
dig.); vex all very, vein, artery, vein, (venal comites); people, 
pollicis (flex. long, pol.) 

The last muscle is changed to hallucis in the last Gray, but 
that was quickly remedied by one of the freshmen at the Wo- 
man's College who was heard to say sotto voce, "hens," 

After all, it is about as difficult to remember the rule as it 
is the structures, and I have had occasion in the dissecting 
room to reconstruct the forgotten charm from the relation of 
the structures. 

I presume there are mnemonics for the structures in the 
posterior annular ligament of the wrist, but I have heard none. 

MUSCLES. 

Eye. — The Superior and Inferior Oblique muscles botn pass 
under their corresponding recti muscles in their course over 



ANATOMICAL MNEMONICS: PARKER. 87 

the globe, although the Inferior is in deep relation also with 
the External Rectus. 

Abdominal Muscles. — The relative proportions of the attach- 
ment of the three abdominal muscles to Poupart's ligament 
and the crest of the ilium may possibly be recalled more 
easily by remembering that the first muscle, beginning super- 
ficially, is attached the ivhole length of Poupart; the second to 
one-half (the outer half ) ; and the third to one-third (the outer 
third) of the ligament. Or the relation may be expressed, 1, 
i, i. On the crest of the ilium, beginning superficially, the 
first extends one- half, the second two- thirds, and the third, 
three fourths, the length of the crest from the anterior super- 
ior spine; or, shorter, we have i, f, f. 

ARTERIES. 

Axillary Artery. — One day a careful student called my at- 
tention to the startling discovery that the branches of this ar- 
tery when represented by the first letter of each, placed in 
proper order, spelled the talismanic work salasap; but when he 
learned that it had been heard for years among anatomical 
students, much of the enthusiasm was taken out of the discov- 
ery. Probably many a student has thought he was the origin- 
ator of the magic word until he compared notes and found that 
others knew it before him. It is a good key. I have seen 
clumsy keys for the branches of the abdominal aorta, internal 
maxillary and other arteries, but none that were much easier 
to remember than the branches themselves. 

A very interesting region is the one in the neighborhood 
of Poupart's ligament, Scarpa's triangle and Hunter's canal 
and even extending down into the popliteal space 

The vein, artery and nerve under Poupart's spell the word 
van, but if the van happens to go the wrong way we may have 
the vein external and the nerve internal. All doubt can easily 
be dispelled by using vane instead, and the e will always be for 
external. 

The relation of the artery and vein to each other in their 
spiral course down the thigh may be remembered by imagining 
a ribbon, say an inch wide, lying flat against the surface of the 
thigh extending from the middle of Poupart's ligament down- 
ward, in front, and then with an easy curve to the inner side 
of the limb, and finally into the popliteal space. Letting the 
inner margin of the ribbon at Poupart's represent the 
vein and the outer the artery, then in the middle of the thigh 



b8 ANATOMICAL MNEMONCIS: PARKER. 

will the vein become posterior to the artery, and in the poplit- 
eal space posterior and external. 

Although on the same principle, a simpler method is to 
use two fingers instead of the ribbon, one for the vein and the 
other for the artery, starting at Poupart's as before and passing 
the two fingers side by side down around the inner side into the 
popliteal space; the finger toward the inner side, for the vein, 
will become first posterior and then external. 

In connection with the arteries at the knee may be men- 
tioned the commonly known rule that in a cross -section at the 
knee joint there is one large artery, the popliteal; at two inches 
below the knee, two arteries — anterior and posterior tibials; 
and at three inches below, three arteries— anterior and poster- 
ior tibials and peroneal. This rule is only approximately 
correct. 

NERVOUS SYSTEM. 

Functions of Spinal Nerve Roots. — It may be easy for most 
students to remember that the anterior is motor and the pos- 
terior is sensory, yet at a crucial test often the faith weakens 
and in the language of the vernacular he is "balled up," 

There is a little story, which, by the way, is often a dark 
chapter in the "old, old story," that will fix the facts quite 
permanently, I think. 

A young man was under the painful necessity of rather 
precipitate flight on account of the unexpected appearance of 
her irate father, and as the vis a tergo of a No. 10 Walkenphast 
somewhat accelerated his descent of the front steps it was very 
apparent that it was posterior, sensory and anterior, motor. 

In one of the journals I noticed a very good rule for re- 
membering the afferent and efferent roots by use of the word 
same — sensory, afferent; motor, efferent. 

CRANIAL NERVES. 

''On old Melindy's pointed tops 
A Finn and German picked some hops," 

Almost every student recognizes an old friend in the 
above; at least he recognizes the form though he is often wont 
to put more variety into the features. 

Relations of Nerves and Arteries in the Limbs. — In the fore- 
arm the ulnar nerve is to the ulnar side of the ulnar artery, 
and the radial nerve to the radial side of the radial artery; 
while in the leg the anterior and posterior tibial nerves are to 
the fibular side of their accompanying arteries. 



ANATOMICAL MNEMONICS: PAKKER. 89 

VISCERA. 

Common Bile Duct — The relations of the common duct, the 
portal vein and hepatic artery as they lie together in the right 
border of the lesser omentum are often very indistinct in the 
student's mind, whether the artery or the duct is to the right; 
though he more commonly knows that the vein is behind and 
between. Associate the sounds of ductus and rectus right — the 
duct to the right — and the difficulty disappears. 

Semilunar Valves of the Heart. — According to Gray the 
valves in the pulmonary artery present three flaps, two in 
front and one behind; and tne aorta has also three, but with 
one flap in front and two behind. Which has the single valve 
in front and in which it is posterior can be remembered by the 
trademark, A No. 1, that is, aortic, anterior, one, and we know 
that the pulmonary valves are just the opposite. 



OFFICERS OF CLASS OF '97. 

Elected October 29, 1896: 
Prasident, William Stokes. 
Vice-presidents, (to be elected by sections.) 
Recording Secretary, C. F. Clayton. 
Corresponding Secretary, M. U. Cheshire. 
Treasurer, W. G. Hatch. 
Historian, Edward Johnson, B. S. 
Valedictorian, W. H. Maley, B. S. 
Essayist, S. E. Findley, A. B. 
Chaplain, W, H. Folsom. 
Poet, G. L. McDermott. 
Chorister, C. C. Cummings. 
Sergt.-at-Arms, W. W. Grove. 



MEDICAL PRACTICE ACT OP ILLINOIS. 
Resolutions adopted by the Illinois State Board of Health, Oct. 6, '96. 

Whereas, the wise and progressive enforcement by our 
predecessors of the Act to Regulate the Practice of Medicine 
in the State of Illinois passed July 1, 1877, has resulted in gen- 
eral, but not uniform improvement of the methods of medical 
education throughout the United States and a material eleva- 
tion of professional attainments and ability necessary to obtain 
the legal right to practice medicine in many states, thereby 
securing in many states a better equipped, more competent, 
and more scientific body of medical men to the gain and advan- 
tage of the people thereof; and 

Whereas, this latter result has been attained to the fullest 
extent in those states where the college diploma is not recog- 
nized as final, but only as a qualification for examination by a 
board whose members are not connected with, or interested in 
any college or teaching institution; be it 

Resolved, By the present members of the Illinois State 
Board of Health, with the fullest appreciation of the invalua- 
ble work of their predecessors that Medical Education and the 
status of the Doctor in Medicine have outgrown the limitations 
of the Medical Practice Act of 1877; now, therefore be it 

Resolved, That said act should be so amended as to require, 
first that all applicants for the right to practice medicine and 
surgery or any of their branches in the State of Illinois, shall 
demonstrate their fitness for such practice through an exam- 
ination by a board of impartial, competent and practical exam- 
iners, skilled in the various branches of medicine and surgery, 
and no member of which board shall be connected or affiliated 
with or interested in any diploma-granting college or teach- 
ing institution. Second, that no applicant shall be eligible to 
such examination unless the legal possessor of a diploma of 
graduation from a medical college in good standing; 

Resolved, That this Board earnestly invite the cooperation 
and assistance of kindred boards throughout the United States, 
to the end that uniformity of practice may ultimately obtain in 
the recognition of medical practitioner in all parts of the coun- 
try; of all reputable medical colleges whose dignity and use- 
fulness will thereby be promoted; of the medical profession of 
the State, as represented in the various medical societies with 
the view of excluding the incompetent and unworthy from its 
ranks; and of the members of the forthcoming general assem- 
bly in this effort to protect the health and lives of citizens of 
the State.— J. W. Scott, Secretary Illinois State Board of 
Health. 



EXAMINATIONS. 

This is a subject which appeals to every student, and to 
the student no more than the educator. It is impossible to 
secure absolute justice in examinations, simply because all men 
are liable to mistakes and examiners are no exceptions. That 
there is a better method than now in use, all will agree but as 
to what is that "better method," there is some difference of 
opinion. 

Examinations are to enable both teacher and pupil to gain 
some adequate conception of the latter's advancement. It is 
generally acknowledged that the present system does not ac- 
complish this. There are to be found instructors who find de- 
light in flaunting the examination as a whip lash to impel to 
greater effort, or to act as a sort of punitive ordeal for past 
offenses. At times classes are confronted with sets of ques- 
tions that are anything but practical, questions born of painful 
narrowness and absolutely worthless in the determination of a 
student's knowledge. 

Jonathan Hutchinson. F. R. S., P. R. C. S.,in a late intro- 
ductory address before Owens College, England, urged that it 
is the examiners and not the teachers who set the pace and 
determine the scope of education. He insisted that examina- 
tions ought to proceed on more settled and uniform lines than 
at present and that far less ought to be left to the predilections, 
or it may be the caprice of individual examiners. In referring 
to this subject as treated in one of his former addresses he said. 

"With the design of yet more completely eliminating the 
more personal element in the examiner, it was suggested that 
he should not even be asked to devise the questions which 
would be put, but should be permitted only to make his selec- 
tion from lists of such questions carefully-worded and deliber- 
ately approved by others. The one of my proposals which 
was received with least favor by my critics was that these lists 
of questions should be published and should be accessible to 
students before their examinations. It has been said — not, I 
think, without a certain savor of sacred simplicity — that this 
publication would enable students to get up the answers to the 
questions before presenting themselves; as if the examiner had 
some sort of vague interest in catching the candidate napping 



92 EXAMINATIONS. 

or in finding out by a chance some subject to which he had 
given only imperfect attention; as if an examination had for its 
sole object the detection of ignorance and not also the promo- 
tion of knowledge. The lists of examination questions ought, 
of course, to be reasonably exhaustive, and a considerable pro- 
portion of them ought to be objective, and then, if a student 
got them up and prepared his answers he would simply have 
done what is wanted, he would have got up his subject. Nothing 
would be easier than to prepare questions which should baffle 
the "crammer' and make a real practical acquaintance with the 
subject in hand essential to success. It is surely needless to 
point out how valuable such published lists of questions would 
be to the student in guiding his course of worR and preventing 
him from inadvertently omitting important topics nor how 
directly they would contribute to that invaluable part of edu- 
cation in which pupils become instructors one of another. 

"The plan of printing lists of all questions allowed to be 
proposed is one which I would extend to written examinations 
on all subjects, It is by no means exclusively applicable to 
those for medicine. Every examination, whether special or 
general, should have its own list. They would serve as guides 
to the student in his work, and in many instances to his teach- 
ers also, and would, I feel confident, give an impetus to educa- 
tion in general. They would put an end forever to the too 
prevalent evils of an examiner taking his own book as his text 
and regarding as alone important subjects on which he looks 
upon himself as an authority. They would make examinations 
at different places and by different boards more uniform, would 
place the alumni of provincial schools on a more just position 
as regards metropolitan examiners. 

"Another of the proposals which I thought valuable, and 
which I feel confident must sooner or later be adopted, was 
that examinations should be subdivided— specialised, in fact. 
Something has been done in this direction already, but much 
remains to be accomplished, and the sooner it is attended to 
the better. By "cramming" as distinguished from the honest 
acquisition of durable knowledge, we mean, I suppose, the 
hurried obtaining of crude and, for the most part, merely ver- 
bal information, with a view to its immediate use at an exami- 
nation, and with little or no thought of any other object. Now 
it is obviously the business of the examiner to frustrate the 
efforts of the crammer, and to accept only such knowledge as 
the memory is likely in some fair measure to retain. In saying 



EXAMINATIONS. 93 

this it is at the same time to be freely admitted that we must 
of necessity all of us forget much; nor is it at all the fact that 
all forgotten knowledge has been useless to us. Of much 
which, for question purposes, we have forgotten, our minds 
still retain impressions which yet are very valuable to us. 
Our attainments are the result of what we have once known 
quite as much as of what we now know. Our minds have been 
nourished and built up by our past studies, and they retain 
their growth. We are like evergreen trees which are constant- 
ly shedding their leaves, but which keep the wood which those 
leaves have helped them to make, and are constantly produc- 
ing by its agency new buds. I cannot believe that the mind 
ever wholly loses the results of knowledge and insight which 
have been once its full possession. The problem is then how 
can the examiner ensure most effectually that his candidates 
shall take worthy methods in the acquisition of the knowledge 
which he exacts? It may be admitted that it is a plausible 
supposition that greater security is afforded, that the tablets 
of memory have been deeply indented if a man is able to dis- 
play at one and the same time a good knowledge of various 
subjects. This assumption must not, however, be pushed too 
far. There are those who can cram many thinks at once, and 
having regard, on the other hand, to the many who cannot, 
and to the admitted impossibility of simultaneous retention by 
the minds of most men of a detailed knowledge of a great va- 
riety of subjects, the final result is invariably a lowering of 
the standard of examination. In the few instances in which 
this condescension to humanity has been refused, the result 
has been the maintenance of a standard to which but very few 
can attain, and those rather distinguished by memory than 
judgment." 

In considering the matter of increasing the number of lec- 
tures and decreasing the number of examinations he said: "I 
would increase the number of examinations and would leave 
the student to seek the necessary knowledge where he" could 
best find it. It might be from a book, it might be in converse 
with fellow students, it might be in the hospital wards, in the 
museum, the dissecting, or, possibly, the class room. In any 
and all of these let him learn as best he might, only make sure 
in the end, by a well-arranged examination, that he got the 
knowledge. ***** A clear memory of the utter 
uselessness of many of the lectures which on compulsion I did 
attend makes me entertain no very vivid compunction as 



94 EXAMINATIONS. 

regards the many I missed. It is not every professor who pos- 
sesses a most meritorious knowledge of his subject who pos- 
sesses also the art of making his lecture afford instruction to 
his class. Let us have free trade in this matter and give the 
student leave to buy at the shop where that is sold which he 
wants." 

To illustrate questions that are unsuitable the following 
had been given: "What are meant by the terms 'abulia' and 
'hyperbulia,' and what class of mental diseases come under 
each heading?" "Give the symptoms and pathology of 'syrin- 
gomyelia'." While Mr. Hutchinson joined with others in think- 
ing that such questions ought not to be sprung as surprises on 
an unhappy candidate, he alleged that had these questions been 
published with an exhaustive list, the student would take care 
to make himself acquainted with them and the knowledge 
gained would have been of interest and value; and the ques- 
tions in such circumstances would be suitable. 

The suggestion of Mr. Hutchinson may be open to criti- 
cism just as any human's plan would be. However, on careful 
thought it seems that the publication of an exhaustive list of 
questions on the various subjects of a medical course would 
save the student a very great deal of time and energy and 
would not permit the amount of "cramming" at present in 
vogue. The mastery of such lists of questions would mean the 
mastery of the subjects and no longer could ignorance of a 
point be attributed to a "catch question." 

After a question is answered the diversity of opinion 
among the judges of the manuscript causes much dissatisfac- 
tion. In a science that is not exact, it is ridiculous to attempt 
the expression of scholarship in mathematical terms. Hence, 
it is best to avoid strife among students by simply marking the 
mistakes on the papers. Afterwards return them in all cases 
that the student may profit by noting their blunders. 



ARSENIC EATING IN STYRIA. 

The following observations among the arsenic habitues of 
Styria, taken from an exchange, will be of interest to the stu- 
dent of Materia Medica. 

"Efforts to find out the truth regarding the practice of ar- 
senic eating in that country have always been attended with 
great difficulty. The laws regulating the sale of the drug are 
stringent, and those addicted to it have to observe great secre- 
sy. The habit probably originated among the employers of 
the numerous arsenic works in Tyrol. It was discovered that 
by taking internally gradually increasing doses of arsenic they 
were better able to withstand the poisonous effects of the 
fumes incidental to their labor. From them the practices 
spread through the lower classes. Pure arsenic, the red sul- 
phide, and the yellow sulphide are the forms most frequently 
used. The dose is small at first — about the size of a pin head. 
It is gradually increased until an amount equal to the size of a 
pea is taken. The habit generally begins aq. about the age of 
fifteen, and may be continued up to the age of seventy -five. If, 
however, the user does not commence to discontinue the drug 
at fifty he invariably dies a sudden death. Fatal cases of 
poisoning are found occasionalty among the Styrians, so they 
are not invincible to the deadly effects of the drug. Enormous 
doses are taken with impunity by some. A case was reported 
in which twenty -three grains were ingested daily. Singularly 
this man began with a three grain dose, an amount ordinarily 
considered decidedly dangerous. Efforts towards abstinence 
only made him ill; sn resuming his regular allowance health 
was always restored. It seems hardly probable that the cus- 
tom exists because of the power of arsenic to enhance personal 
beauty, for the drug is taken by both sexes alike. The peas- 
ants themselves say it makes them strong and healthy, which 
qualities they use in a marked degree." 



BUILDING FOR THE FUTURE. 
By Walter J. Brown, A. B, 

For months recently the national intellect has floundered 
about over the honey-combed surface of pending disaster, little 
effort seems to have been made by the masses to grapple with 
real issues; instead, prejudice has been arrayed against preju- 
dice and faction against faction. Political bias, party enthu- 
siasm and questionable zeal, culminating in demonstrations and 
babble void of intelligent economic considerations, have been 
largely called into play to settle by ballot for the future, ques- 
tions which involve the very life and destiny of the nation. 
The economic production, distribution and consumption of the 
nation's wealth does not depend fundamentally upon the medi- 
um of exchange; questions of party and politics are unimportant 
compared with the question of principle involved. History 
teaches us that nations have proven as inevitably mortal as the 
individuals which composed them; yet a nation must commit 
suicide in order not to live forever. This country spends for 
intoxicating liquors, in a given year, more than the entire value 
of its wheat, corn, oat, rye, barley and potato crops; its great 
cities are centers of corruption and vice, which are the most 
expensive, the most inefficient and the worst governed in 
Christendom. The peril of the republic is great, a crisis is 
imminent, for 

"The sword of heaven is not in haste to smite, 
Nor yet doth linger." 

The problem of the age is the conduct, character and en- 
vironment of the individual man. He is the unit of value of 
the nation. A policy which permits 260,000 such units to be 
slaughtered annually by one single traffic, to say nothing of 
indirect results, will soon eat the very vitals out of our nation- 
al life and character. One half of the present voting force is 
composed of young men, yet instead of protecting the rights 
and fastening the moral character of this great army by mak- 
ing vice difficult and dangerous, every facility is afforded for 
corrupting its life and raping its vitality. The professions of 
medicine, law and dentistry, though limited numerically, prac- 
tically control the great family and business interests of the 



BUILDING FOR THE FUTURE; BROWN. \)( 

Commonwealth and are composed mostly of young men. 
Thousands of students enter these professions yearly, most of 
whom we admit immediately into the inmost privacy of our 
private lives and place in their trust our material or physical 
welfare. Yet of all classes they are the most neglected and 
most difficult to reach, spiritually. A degree from a literary 
college does not make a gentleman, neither does a degree from 
a college of medicine make a physician, much less a man. Ed- 
ucation, mental discipline and culture are indispensable to any 
great undertaking, they form the intellectual basis of power by 
bringing out the man; by setting free his faculties; by making 
him possessor of himself; by giving him horizon; by filling him 
with resources, and by making him twice the man he would be 
without it. But, a true man is not all intellect, his physical, 
social and spiritual nature require attention and demand de- 
velopment. 

It was Goethe who said that, ' 'The destiny of any nation 
at a given time depends on the opinions of the young men who 
are under twenty five years of age." A little reflection will 
convince us of the truthfulness of his statement, will convince 
us that if we hope to build a nation for the future it is our duty 
ultimately, from whatever basis we may consider it, to save 
the young man, and save him body, mind and soul. The pur- 
pose of the great Christian movement among the colleges of 
our land is to do that very thing. In this city the influence, 
enterprise and integrity of the Young Men's Christian Associ- 
ation is becoming more and more a factor in the lives of our 
college men. As it brings them in tomch with the many valu- 
able physical, social, intellectual and devotional privileges in 
the splendid buildings placed at their disposal they come to 
feel that there is a fraternal bond of sympathy and love that 
unites them; they feel that it means something to be a man, their 
ideals and conceptions are raised; their ambitions are stimu- 
lated. They come to realize that the standard of a man is not 
measured in gold, but in growth; not in position, but in person- 
al power; not in capital, but in character. "He who would 
grasp the key to power must be greater than his calling, and 
resist the vulgar prosperity that retrogrades toward barbar- 
ism; there is something greater than wealth, grander than 
fame; character is success, and there is no other." 



The Corpuscle. 



EDITORS, 

J. E. LUCKEY, '97, Editor-in-Chief. 

746 West Adams St., Chicago. 
T. R. CROWDER, '97, Sec'y and Treas. 
FRED. BARRETT,'97. E. L. McEWEN, '97. A. F. STEVENSON, '98. 



Communications relative to advertisements and subscription (Subscription price 
$1.00 per annum), should be addressed to the publisher. Remittances should be made 
by money order draft or registered letter payable to "The Corpuscle," and addressed 
to Fred C. Honnold, 402 S. Paulina St, 



Ruby Red and Black: Colors of Lake Forest University. Orange: Color of Rush 

Medical College. 



Brief Biography Rush Medical College has numbered among her 
of Dr. Kiebs. Faculty one of the most renowned men of the 
world — Prof. Theodor A. Edwin Klebs, to whom as much as 
any living man, the science of pathology is indebted. The 
following brief biography may be of interest to many. Dr. 
Klebs was born in Konigsberg, Prussia, Feb. 6, 1834; entered 
the University of Konigsberg in 1852, and afterwards studied 
in Wtlrzburg, Jena, and Berlin, graduating with the degree of 
M. D. in 1857. In 1859 he was assistant in the Konigsberg 
Physiological Laboratory; in 1861 assistant to Virchow. He 
became Professor of Pathological Anatomy in Berne in 1866, 
subsequently taking the same Chair in the University of Wtirz- 
berg (1871). In 1873 he went to the University of Prague and 
in 1882 accepted the same chair in Zurich. 

Dr. Klebs participated in the Franco- German war (1870) 
during which he had an excellent opportunity to make extens- 
ive observations on the pathology of gunshot wounds (Vide; 
Beitrage zur pathologischen Anatomie der Schusswunden," Leipzig 
1872-4). 

In 1884, he discovered the diphtheria bacillus, one year 
before Loemer. 

In consideration of his valuable contributions to science, 



EDITORIALS. 99 

he has been honored by the most exclusive scientific societies 
and academies of Europe and America. 

In 1894 Dr. Klebs came to America where already his 
eldest son had settled in the practice of medicine. Through 
a happy combination of circumstances Rush was enabled to 
secure his services as Professor of Pathology and he entered 
on the duties of the office at the opening of this school year. 
His broad scholarship and cheerful, genial disposition have 
already won the admiration, respect and love of his students. 

The Corpuscle (July 1896; pg. 464) contains a list of the 
titles of some of his most important works. "His contributions 
to the knowledge of pathology have been numerous and 
valuable." 

During the past decade there have been great 
changes in medical education. Recitations, labor- 
atory-practice and clinics have largely taken the place of the 
old time didactic lectures. The change is both pleasing and 
profitable to the student. 

We have heard the "recitation-method" criticised lately. 
There is no doubt of there being weak points in the system 
but that it is a great improvement over the didactic lecture is 
generally acknowledged. A recitation properly conducted is 
of much more value to the student than listening to lectures 
the content of which he can find quite as clearly defined in his 
text-book. There are, however, subjects demanding presenta- 
tion in lectures and to these the above remark does not per- 
tain. 

The popular idea that the recitation is a contrivance for 
securing "a mark," a grade, is certainly disastrous to the 
attainment of the best results. It is a means, or ought to be, 
of obtaining a clearer knowledge of the subject in hand. The 
grading should be considered an incidental of secondary impor- 
tance. There are, however, a great number who are unwilling 
to ask legitimate questions for fear that a display of ignor- 
ance to their instructor will prejudice him into giving them 
poor "marks." There are also those who consume the valu- 
able time of a class by seeking to give the impression of 
knowledge they do not possess — by running a "bluff." It is 
the duty of an instructor to aid the sincere inquirer after truth 
and to squelch the "bluffer." 

It will take time to attain the best results from the late 
reconstruction in medical education. The future will see great 



100 EDITORIALS. 

improvements. Men particularly qualified and educated for 
the work will occupy the chair of the instructor. It is not our 
intention to criticise our present excellent corps of instructors, 
but we hold that a teacher of medicine is a specialist — a speci- 
alist because his work demands special adaptation and prepa- 
ration. The principles of pedagogics are broad enough to in- 
clude all phases of education and a man ignorant of these prin- 
ciples has no right to occupy the instructor's chair before an 
intelligent class of students. 

The efficient teacher knows how to enthuse a class, to- 
make obscure points plain, to point out important facts, to 
make the hours spent in recitation the most profitable of the 
course. 

There are students to whom is largely attributable the 
failure of many recitations. It is certainly to the interest of 
every one concerned that honest effort be made in the prepar- 
ation and presentation of the lessons. Gentlemanly demeanor 
will foster habits of great value to the physician. Quiet, un- 
obtrusive conduct is a mark of the deepest intellects. The 
mistake is sometimes made of attributing failure to the in- 
structor when the whole blame rests upon the student to whose 
neglect or lack of preparation it is entirely due. 



^lumr^i Depapfcir^i 

JAMES B. HERRICK, A. B., M. D., Editor. 



Membership in the Alumni Association of Rush Medical College is obtain- 
able at any time by graduates of the College, providing they are in good standing in 
the profession, and shall pay the annual dues, $1.00. This fee includes a subscription 
to The Corpuscle for the current year. This journal is the official i rgan ( f the 
Association. 

Dues and all communications relating to the Association should be sent to 

JOHN EDWIN RHODES, M.D., Secy and T eas„ 34 Washington St., Chicago 



Dr. James P. Gregory, died Oct. 16, '96, of diphtheria, at 
the age of 34 years. He was for seven years superintendent 
of the hospital at Kucheng, China, and later in the hospitals of 
New York. Recently he had commenced practice at Maquoketa, 
Iowa, near the place of his birth. 

Dr. Burton Clark, '94, is at Oshkosh, Wis. He is doing 
nicely. He reports that Rush is represented in Oshkosh by 
eleven men. Truly a good showing. 

Frank Howard Payne, '94, is Professor of Physiology and 
Hygiene in the College of Physicians and Surgeons, San 
Francisco. 

Dr. C. Francis Dennan, '88, is now located at Hot Springs, 
Ark., also at Birmingham, Ala. 

Dr. C. E. Hemingway, was recently married to Miss Grace 
Hall, of Oak Park, 111. Dr. Hemingway has made a good start 
in his own town and gives every indication of making a success. 

Cards have been received announcing the marriage of 
Chas. Bolsta, '95, to Miss Emily Clayton, of Appleton, Minn. 
They will make Ortonville, Minn., their permanent home. 

A sad tradgedy was the suicide of Dr.CarlNitz, a graduate 
of Rush, and a resident of Chicago. With his mind deranged 
by numerous reverses and by family dissensions, he first took 
his wife's life and then his own. The details of the shocking 
affair, as published in the daily papers, leave little doubt as to 
the mental irresponsibility of the unfortunate man. 

From Ogden Utah comes the following: 

Dr. R. S. Joyce, '91, is physician and surgeon for the 



102 ALUMNI DEPARTMENT. 

Pioneer Electric & Power Co. of this city, also Division Sur- 
geon of Rio Grand Western Ry. 

Dr. A. C. Behle, '94, is still house physician at St. Marks' 
Hospital in Salt Lake City, of which Dr. F. S. Bascom is 
Medical Director. 

Dr. G. W. Baker, '94, has recently received the appoint- 
ment of attending physician of the State Institute for Deaf, 
Dumb and Blind, located at this place. 

Dr. T. F. Conroy, Class Poet of '96, was appointed, last 
July, interne at St. Joseph's Hospital, 360 Garfield Avenue, 
Chicago. Please note change of address. 

Dr. W. L. Brown, '96, writes from Unionville, Mo., and 
sends the report of a case he has had the good fortune to 
attend. He expects to be on hand to enter Dec. 1st as interne 
in Cook County Hospital. 



The Corpuscle. 

RUSH MEDICAL COLLEGE, CHICAGO, ILL. 
Medical Department Lake Forest University. 



Vol. VI. DECEMBER, 1896. No. 4. 

♦REGENERATION AND METAPLASIA OF THE CON- 
NECTIVE TISSUES. 

BY L. HEKTOEN, A. B. , M. D. 

The connective tissues — ordinary connective or fibrous tissue, 
periosteum, bone, cartilage, myxomatous and fatty tissue — are all 
made up of embryologically equivalent mesoblastic cells, the marked 
variations in the structure of the mature tissues depending essen- 
tially upon differences in the matrix, the intercellular substance. 
The regeneration of these tissues consequently begins with the 
production of an indifferent embryonal or formative tissue from 
which the definitive tissue is produced by the construction of pe- 
culiar intercellular substances. These tissues are also able to change 
from one to the others without the intervention of an embryonal 
stage by a change of the intercellular substances only — metaplasia. 
Thus cartilage may change into bone, and fibrous connective tissue 
into cartilage, etc., by a transformation of the matrix in each case. 
In the case of fat tissue the conditions are somewhat different, inas- 
much as the tissue is produced by the deposition of fat in the inte- 
rior of either embryonal or mature mesoblastic cells, but metaplasia 
occurs here also. 

The mature connective tissues possess different degrees of 
regenerative power. The regenerative power is most marked in 
the ordinary fibrous connective tissue, in periosteum and the medul- 
lary tissue of bone, whereas cartilage and bone substance proper 
possess but little ability to form new tissue, so that in them larger 
defects are either repaired by proliferation of periosteum (perichon- 

*Portion of a lecture to the Sophomore class. 



104 Regeneration of the Connective Tissues: Hektoen. 

drium) or ordinary connective tissue with subsequent differentia- 
tion of the matrix, or the defects are filled with scar tissue. 

At the present time it is regarded as settled that white blood cor- 
puscles cannot become changed into connective tissue cells, and this 
is taken as granted for the purposes of the present discussion; but the 
question is referred to again in connection with the healing of 
wounds. The theory of Shakespeare, and more particularly of Graw- 
itz and his scholars, that the intercellular substances of many tissues, 
as the tendon, for instance, contain invisible, slumbering cells that 
are roused into active proliferation by the influence of regenerative 
and other stimuli, is not supported by any facts that would war- 
rant its discussion at the present time. Regeneration of the con- 
nective tissues begins, therefore, with mitotic division of pre-ex- 
isting mature cells that are situated in fibrous connective tissue, 
periosteum, or cartilage, etc., as the case may be. Usually and 
essentially it concerns, as already indicated, either ordinary con- 
nective tissue or periosteum. If defects of any extent are to be 
repaired the proliferation continues actively until there is formed 
a layer or mass of young cells, the embryonal or formative, or gran- 
ulation tissue. Simultaneously new capillaries are formed by 
budding processes from the old. It is quite likely that the capillary 
endothelial cells also give rise to formative cells, as already described. 
The embryonal cells are always larger than the small, mature cells 
of the connective tissues; the form of the cells varies, depending 
apparently much upon mutual compression and upon the age of 
the cells — round, oval, spindle-shaped and branching cells are ob- 
served; the nuclei are large, often vesicular, and there may be 
cells with two or many nuclei — giant cells. These embryonal or 
formative cells, granulation cells, are now given various names, de- 
pending upon the kind of mature tissue they are destined to form 
in the process of further differentiation — if fibrous tissue, fibroblasts, 
if cartilage, chondroblasts, and if bone, osteoblasts — and from this 
point the successive changes present well marked distinctions. 

Fibrous Tissue. — When fibrous tissue is reproduced, as oc- 
curs with such great frequency in the healing of wounds and in 
the filling of all kinds of defects in the organs and tissues of the 
body, the fibroblasts form in part a homogeneous, in part a fibril- 
lated intercellular substance or matrix. Concerning the manner 
of formation of the intercellular substance, the investigators express 
different opinions. Some claim that the fibroblasts produce a 
homogeneous intercellular substance which subsequently becomes 
more or less finely fibrillated; others that the protoplasm of the 
cells first forms fibrillar in its peripheral layer which are subsequently 



Re^eneiation of the Connective Tissues: Jlektoen. 105 

deposited between the cells; the direction in which these fibrillae 
come to run is determined undoubtedly by the mechanical tension 
of the tissue. As the intercellular substance is formed the fibro- 
blasts become smaller and flattened and lie as fibrous connective 
tissue corpuscles in small spaces in the matrix. When a wound 
or a defect becomes filled up with a finely fibrillated connective 
tissue produced in this manner, a scar, or cicatrix, is said to have 
formed. Scar tissue, or cicatricial tissue, is the result of the differ- 
entiation of fibroblasts. 

Cartilage. — Formative tissue composed of chondroblasts may 
be produced to a limited extent by existing cartilage cells, but 
originates generally from mitotic division of cells in the periosteum 
or perichondrium, the medulla of bone, and sometimes in connective 
tissue. The chondroblasts produce a hyaline intercellular substance 
which gradually increases in amount, while the cells become smaller 
and lie as cartilage cells in small round cavities around which the. 
matrix becomes more dense, so as to form a sort of capsule for the 
cells. New cartilage is also frequently produced by metaplasia. 
This occurs, for example, in the perichondrium of growing car- 
tilage by a gradual change of its fibrillated intercellular substance 
into the homogeneous hyaline material of cartilage, while the con- 
nective tissue cells assume the form of cartilage cells. Cartilage 
can be formed in the same manner in connective tissue septa in 
connection with the growth of enchondroma, and also from the 
medullary tissue of bone. Hyaline cartilage may change into fibro- 
cartilage by the formation of fibrillae in the hyaline matrix. In sim- 
ilar manner cartilage may by metaplasia change into the other 
connective tissues. 

Bone. — The formative tissue arises principally from the cells 
of the periosteum, the perichondrium, and the bone marrow, but 
it may be produced by fibrous connective tissue. The osteoblasts 
become separated by a homogeneous or densely fibrillated ground 
substance which subsequently becomes impregnated with lime 
salts, while the osteoblasts change into small, irregular cells that 
come to lie in small cavities as the bone cells of the mature bone. 
In more extensive bone production the ground substance is pro- 
duced in certain districts only of the formative tissue, and before 
calcification takes place these homogeneous districts are known 
as osteoid tissue; in the meantime the formative tissue, between 
the areas of osteoid tissue, changes into the structure of bone mar- 
row; the cells send out processes which unite with those from other 
cells at the same time as a fluid, sparsely fibrillated, intercellular 
substance is formed, and in this substance the cells charac- 



106 Regeneration of the Connective Tissues: Hektoen. 

teristic of bone marrow are subsequently deposited. When the 
osteoid tissue has become infiltrated with lime salts the osseous 
structure has been completed. 

Usually, however, this purely neoplastic process of bone forma- 
tion is associated with metaplastic changes. Thus the formative 
tissue may first produce hyaline cartilage which subsequently be- 
come vascularized and then by metaplasia changes in osteoid tis- 
sue, which becomes impregnated with lime salts, while the carti- 
lage cells become bone cells. The osteoid tissue is then distin- 
guished from osseous tissue by the absence of lime salts and from 
cartilage by the irregular outline of the cells and the greater den- 
sity of the intercellular substance. Simultaneously this part 
of the cartilage immediately adjacent to the vessels changes into 
the structure of bone marrow. These various processes are 
described with more completeness of detail in connection with the 
healing of fractures. Connective tissue, as well as pre-existing 
cartilage may also change into bone directly according to the prin- 
ciples of metaplasia. 

Fat Tissue. — New fat tissue may arise by the deposition of 
fat in the cells of formative tissue, myxomatous or fibrous con- 
nective tissue. When myxomatous tissue changes into fat tissue, 
the star-shaped cells become globular fat cells, while the inter- 
cellular mucoid material vanishes. The medullary tissue of bone 
may become changed into, fat tissue — fatty marrow — in the same 
manner. 

Myxomatous Tissue. — Myxomatous tissue may be produced 
by formative tissue by the appearance between the formative cells 
of a homogeneous, jelly-like intercellular substance, which contains 
mucin, while the cells send out processes that form a network. 
Myxomatous tissue can also arise by metaplasia from any of the 
other connective tissues. When fibrous tissue changes into mucoid 
tissue the fibrillated intercellular substance disappears and in its 
place appears the mucoid material, while the fibrous connective tis- 
sue corpuscles change into cells with interlacing processes. In a 
similar manner — mutatis mutandis — cartilage, bone, medullary 
tissue and fat tissue may become transformed into* myxomatous 
tissue. 



GASTROSTOMY BY A CIRCULAR VALVE METHOD. 

BY EMANUEL J. SENN, M. D. 

Gastrostomy, since it was first suggested by Egeberg in 1837 
and performed by Sedillot in 1849, nas undergone many transforma- 
tions in the evolution of technique. The primitive operations as 
done by Sedillot, Fenger, Foster, Durham, Langenbeck, Kronlein 
and Verneuil consisted simply in making the external incision 
through the abdominal wall and fastening the stomach in the 
wound with sutures or steel needles as a support and then incis- 
ing it. There naturally was no resistance to the stomach contents, 
the great obstacle to gastrostomy. The operation fell into ill re- 
pute and practically lay dormant until the present decade, when it 
was revived and received an impetus in the modern methods of 
Von Hacker, Hahn, Witzel, Ssabanajew and Frank, in the hope 
of rectifying the disagreeable features which are inevitable in a con- 
tinual leakage of a gastric fistula. It is rather strange, when we 
compare the. great mortality attendant upon gastrostomy with that 
of colostomy, which is the identical operation lower down the 
alimentary canal, and entails little risk to life under corresponding 
conditions. The mortality varies according to different observers. 
Of 207 cases collected by Gross, 167 were for cancer and 40 for 
cicatricial stenosis, with a death rate of 29.47 per cent, from the 
operation itself. Dr. N. Senn estimates it at 25 per cent.; while 
Zesas is more radical than either of the other observers, and places 
the mortality at 60 per cent, for cicatricial stenosis and 84 per cent, 
for malignant cases. This great mortality is probably due in a 
great measure to the extreme emaciation which patients undergo 
before they will submit to operation. In stenosis of the rectum, 
both benign and malignant, we meet with the same conditions, 
but without such a frightful mortality. I am of the opinion that 
the great shock which so often follows gastrostomy is in a great 
degree due to the tension exerted on the rich plexuses of the sym- 
pathetic system which have such an intimate relation with the 
stomach. This is especially the case when there is considerable 
contraction of the stomach. Before dwelling on the subject of 
this paper, it will be in order to review the muscular structures 
of the stomach in a concise manner. The muscular coat, which 
here is exceedingly well developed, consists of three layers: 1, lon- 

107 



108 



Gastrostomy by a Circular Valve Method: Senn. 



gitudinal, the most superficial; 2, circular or transverse; 3, oblique, 
the deepest layer. The uses of the muscular fibers are: 1, adapta- 
tion of the stomach to the quantity of the food; 2, to keep the stomach 
closed until the food is digested; 3, peristaltic movements. The 
contractile power of the walls in the pyloric region is the most 
energetic, as here more force is necessary to overcome the resist- 
ance of the pylorus. Nevertheless the stomach throughout its con- 
tinuity is a powerful muscular organ and its walls tend to contract 
when stimulated. This phenomenon was beautifully demonstrated 
in the case of St. Martin, where the bulb of the thermometer was 
tightly grasped when placed in a gastric fistula. This natural 
adaptation of the stomach to its contents in the old-fashioned gas- 
trostomy is interfered with to a certain extent by the adhesions 
which form between the parietal peritoneum and the stomach. 




Fig. 1.— Puckering strings in situ. 1, skin; 2, muscle; 3, peritoneum; S, stomach. 

It is in this area, surrounded by adhesions, that the fistula is made, 
being a straight incision into the stomach with no pretense of 
making a valve, or of devising an oblique or circuitous route. 
The strong adhesions to the parietal wall prevented the muscular 
structures around the fistula to contract or dilate in conformity 
with the rest of the stomach, and consequently the fistula remained 
patent. It has been my purpose to plan a logical method of gas- 
trostomy to meet the following indications: 

i. To prevent leakage by making a valve of the stomach 
wall itself, instead of utilizing extrinsic structures to that end, 
and also for the same purpose to provide a constriction in imitation 
of a sphincter. 

2. To minimize shock by putting the least possible strain 
on the stomach. 

3. To have a fistula which remains closed during digestion 
and can be opened ad libitum for the ingestion of food. 



Gastrostomy by a Circular Valve Method: Senn. 



100 



In search of an ideal mechanism I found a prototype in the 
valves of veins. These valves are, as a rule, semilunar, and allow 
the blood to flow in one direction; but when there is resistance 
they are set into action and are infallible to regurgitation. I mod- 
ified the principle by making a circular valve. The operation con- 
sists of an abdominal incision of about four inches in length, and 
which can be made in any location deemed advisable, as no abdom- 
inal muscular structures are required for sphincter action. How- 
ever, Fenger's incision, which is parallel to the left costal border 
left of the rectus muscle, is preferable. The stomach is seized 
as near the great curvature as possible and a cone is formed by 
an assistant, who holds the apex with his fingers or a tissue for- 
ceps. Two puckering strings of heavy chromicized catgut are 
placed parallel to each other about two and one-half inches below 




■^-^"z, r-fc^VgrC-i 



Fig. 2.— Puckering strings tied, forming a constriction. 



the apex of the cone. These sutures include the serous and mus- 
cular coats of the stomach (see Fig. i). These sutures are next 
drawn taut and tied, forming a constriction or neck (see Fig. 2). 
This end may also be accomplished by folding the stomach with 
Lembert sutures, but requires more time. Next, a portion of the 
gastro-colic omentum is brought up and a cuff is sutured with 
fine silk over the constriction (see Fig. 3). The stomach is noW 
ready to be fastened into the parietal wound. This is done with 
interrupted silk sutures which include the upper portion of the 
omental cuff, the peritoneal and muscular coats of the stomach, 
and all of the abdominal wall except the skin. The rest of the 
abdominal wound is now closed with silkworm sutures, leaving 
only that portion of the stomach visible which is to form the 
valve. This concludes the first stage of the operation. 

The second stage can be done at this time or can be deferred 
for forty-eight hours until adhesions have formed. This consists 
of an incision about one-half inch in length in the center of the 



110 



Gastrostomy by a Circular Valve Method: Senn. 



portion of the stomach exposed. A rubber tube is inserted through 
this opening into the stomach. The stomach wall is now inverted, 
forming a circular valve. The inversion is secured by Lembert 
sutures of silk (see Fig. 4). The tube is now withdrawn and the 
operation is completed. If properly performed, the valve should 
be below the level of the external integument. The retraction is 
greatly favored by subsequent contraction of the wound. 




Fig. 3. — Omental cuff covering constriction and stomach sutured to abdominal wall. 

This method of gastrostomy entirely obviates the possibility 
of regurgitation of ingesta. There are two barriers against this 
mishap, the constriction and the circular valve. The tendency of 
the constriction, or neck, is to remain contracted on account of 
the omento-peritoneal adhesions which surround it. It is also 
under the inherent control of the muscular walls of the stomach 
itself, as the adhesions to the abdominal wall are above this point. 
This constriction, in all probability, would be sufficient to control 
regurgitation; but as an additional safeguard, stress is laid on the 
value of the circular valve, which is invincible to all passage of 
fluids from the stomach externally. The importance of the omen- 
tal cuff is twofold, in that it aids the maintenance of the neck 
and acts as a plastic substance to fill in the spaces between the 
folds formed by the puckering strings, making a continuous sur- 
face for suture to the abdominal wall. 

Following is the report of a case in which the circular valve 
method was used with most excellent results: 

Mr. M. R. consulted me August 26, 1896, for stenosis of the 
esophagus. Age 48 years, married; family history negative. He 
first became aware of difficult deglutition some six months before. 
This gradually became more marked until he had to subsist en- 
tirely upon liquid diet. Fifteen days before the patient came into 
my hands, the stenosis became complete. The patient was ema- 
ciated almost to a skeleton, and presented that cachexia so pathog- 



Gastrostomy by a Circular Valve Method: Senn. 



Ill 



nomonic of malignant disease. He lost approximately sixty pounds 
in weight. Upon examination of the esophagus I found the patho- 
logic lesion at the cardiac end of the stomach. With careful manip- 
ulation I was enabled to pass the smallest-sized olive-pointed bougie 
into the stomach. There were apparently two points of stenosis 
about an inch apart. The bougie would become engaged in the 
upper one, then become free, and finally pass through the lower 
one into the stomach. After exploration there was no bleeding 
whatever; nor did the patient ever have any hemorrhage. The 
diagnosis was conclusive of carcinoma of the cardiac end of the 
stomach, especially with the aid of the clinical history. I sug- 
gested gastrostomy as a palliative measure, and after consultation 
with his family and friends an operation was agreed upon and the 
patient sent to St. Joseph's Hospital. The man was so weak, the 
pulse being only 46, that an operation at this time would most 
certainly have been fatal. He was given 1-30 grain of strychnin 
hypodermically every three hours and enemata of milk, beaten 
eggs and whisky, until August 31, at which time he became some- 
what stronger. 




Fig. 4.— Inversion of stomach above constriction and sutured with Lernbert sutures, 
forming a circular valve. 

Operation: Before taken to the operating room patient was 
given an enema of black coffee, also a hypodermic of 1-30 grain of 
strychnin. Pulse 56. Anesthetic, ether, which was sparingly given 
and was administered with great care by Dr. Homer Thomas. 

Fenger's incision was made. The abdominal wall was unusu- 
ally thin. Immediately after opening the abdomen the stomach 
presented itself, which I found very much contracted. I passed 
my hand along the great curvature up to the cardiac end, where 
I felt a hard nodulated mass, which confirmed the diagnosis. The 
point selected for the gastrostomy was at the greater curvature, 
and as near the cardiac end as possible without putting tension 
on the organ. The first stage of the operation was completed 



112 Gastrostomy by a Circular Valve Method: Senn. 

in the manner I described before. During the operation, which 
took twenty minutes, the patient gave evidences of shock and the 
pulse became almost imperceptible; but he was revived with hypo- 
dermics of whisky and external heat. I decided to defer the sec- 
ond stage of the operation, that of making the fistula, for thirty^ 
six hours, until firm adhesions had formed. After reaching his 
bed the patient rallied. Temperature 99.2; pulse 82. The patient 
did well until the evening of September 2, when the temperature 
rose to 101.8; pulse 120. He also coughed considerably. Upon 
examination of the chest, I found that lobular pneumonia was 
present, a complication which is very frequent after gastrostomy. 
I concluded that procrastination in doing the second stage of the 
operation would be dangerous. The patient was so debilitated 
that no anesthetic could be given, nor was it deemed advisable 
to remove the patient to the operating room; so I completed the 
operation upon the patient in his bed. Four ounces of peptonized 
milk were then introduced through the tube. This was continued, 
with the addition of one ounce of whisky, every three hours. The 
pneumonia gradually left and the patient grew stronger. Ten 
days after the operation he was able to sit up, and he left the hos- 
pital after three weeks, although the disease was pursuing its re- 
lentless course. 

Remarks. — After each feeding the tube was removed, and at 
no time was there the least leakage from the fistula. The valve 
was easily opened with slight pressure of the tube, as was also 
the constriction. Upon withdrawal o-f the tube, the valve would 
close with the precision of a trap-door. I put the valve to the 
crucial test, by filling the stomach with milk and having the patient 
cough violently, and shifted him in every possible position to favor 
leakage; but the valve remained true to its purpose and there was 
not a vestige of regurgitation, a positive clinical demonstration. 
The wound contracted so that the mouth of the fistula was the only 
portion of the stomach exposed. 

Note. — Since the preparation of this paper I find in the New 
York Medical Journal of November 7, 1896, that Dr. Willy Meyer 
describes a modification of Witzel's operation devised by Dr. Bronis- 
law Kader, assistant in the surgical clinic of Professor Mikulicz 
of Breslau. In this operation the stomach is inverted in the man- 
ner I describe, except that the inversion is carried to a greater 
degree by making two rows of Lembert sutures instead of one; 
the principle being to form a canal of serous tissue. The rectus 
muscle is bluntly divided as in the Von Hacker operation, in order 
to be utilized for sphincter action. — Journal of the American Medical 
Association. 



PHYSIOLOGY OF THE FALLOPIAN TUBES. 

TRANSLATED BY E. L. McEWEN, PH. B. 
[From '• Krankheiten der Eileiter," edited by P. Wendeler, Leipzig.] 

The theories as to function of the Fallopian tubes must deal 
almost exclusively with those processes which are intimately re- 
lated to sexual reproduction. The oviducts have three different 
offices of great importance to perform: First, they receive the 
ovule, newly liberated from the follicle, and convey it to the uterus, 
thus functionating as excretory ducts for the ovary; second, they 
serve as canals through which spermatozoa, present in the uterus 
after intercourse, reach the fimbriated infundibulum; and, lastly, 
we must admit that they are organs in which impregnation of the 
ovule normally occurs. 

The movement of the cilia, which are always to be found 
upon the cylindrical epithelium of the oviducts at the end of 
foetal life, constitutes an important element in all theories regard- 
ing the passage of the ovule into' and through the tubes, however 
diverse they may be. Thus ciliary movement, directed from 
within outward, was first observed by Valentine and Purkinjie in rab- 
bits ; later, by the same investigators, in other mammals, in birds and 
in amphibians. Meyer's discovery of the existence of ciliated epi- 
thelium upon the peritoneum of the frog led Joh. Muller to ascribe 
to that form of epithelial cells in mammals an important part in 
the reception of the ovule into the tube. O. Becker was the 
first to explain definitely the mechanism of this process. He 
pointed out that from birth onward the ciliary movement in the 
oviducts causes a constant current to' flow from the abdominal to 
the uterine end of the tubes, by which a like current in the serous 
fluid upon the peritoneal surface of the ovary is produced; this 
later serves to direct the liberated ovule toward ostium abdom- 
inale. Kiwesch and Kussmaul accepted this theory. The latter 
also showed that the force of the ciliary stream, as well as the 
amount of capillary fluid between the intestinal folds within the 
pelvic cavity, must be increased beneficially by the congestion coin- 
cident with menstruation and by the bursting of a Graafian follicle. 

Wholly ignorant of the earlier observation of Meyer mentioned 
above, Thiry found upon the peritoneum of the female frog, shortly 
before the period of heat, ciliated epithelium arranged in rows 

113 



114 Physiology of the Fallopian Ttibes: McEwen. 

converging toward the openings of the oviducts, with cilia mov- 
ing in a like direction. This condition could not be found in 
males or undeveloped females. Pigment which Thiry placed upon 
these rows of cilia was carried toward the tubal orifices and then 
into the oviducts. 

Henle, who accepted the theory of the influence of ciliary 
motion and the conclusions to be drawn therefrom, showed, regard- 
ing the fimbriae of the tube and their anatomical relation as facili- 
tating the entrance of the ovule, that the infundibulum, not only 
at the time of heat or menstruation, but always, approaches the 
ovary or in part covers it. 

Later, Pinier, by systematic experimental investigation, sought 
to solve the problem of the entrance of the ovule into the tube. 
He injected into the abdomen of a rabbit about 40 c.c. of a solution 
of common salt in which india ink and pus corpuscles were sus- 
pended, and found the same in the vagina after two and a half to 
three hours. Upon the strength of this experiment he attributed 
the entrance of the ovule to the operation of the same agencies 
as did O. Becker, mentioned above. Pinier endeavored to prove 
that the movement of the cilia was sufficient to carry the cor- 
puscular particles onward through the tubes without the help of 
a fluid current. Preliminary to an experiment like that just 
described he ligated the uterine horn -J c.c. from the opening 
of the tube. He found thereafter a large number of pus cor- 
puscles, which he had injected, above the point of ligature, and 
the lumen of the tube greatly swollen with serous contents. 

One can much more readily conclude from a very interesting 
observation by Henson that the movements of the cilia alone, 
when a current through the tube could not exist, is sufficient to 
cause the ovum to enter the infundibulum and pass down the 
oviduct. This investigator found about 100 unimpregnated ovules 
in a rabbit's tube, the uterine extremity of which was imperforate. 
Heil followed Pinier in experimental investigation of the ques- 
tion whether the passage of the ovule through the oviducts could 
result from ciliary motion. He succeeded poorly, as did Kehrer 
before him, in his efforts to study the movement of the ovule 
through ciliary motion in excised portions of mucous membrane 
under the microscope. He criticised Pinier for his neglect to 
take into consideration the movements of the intestines, the force 
of gravity, the respiratory movements, capillary attraction, and 
the general capricious movements of the animal experimented upon. 
He likewise called attention to a source of error in the increase 
in the intra-abdominal fluid from the large injection, and to the 



Physiology of the Fallopian Tubes; McEwen. 115 

significance of the great difference in size between ovules and the 
particles injected by Pinier. Heil himself instituted a series of 
animal experiments, from the results of which he teaches that we 
are not in a position as yet to give an unobjectionable explanation 
of the passage of the ovule into the tube. He believes emphatically 
that the hypothesis of the efficiency of the ciliary current, especially 
of its power of distant action, cannot be maintained from previous 
experiments, and that it must be substantially altered. 

Lode, in his researches, heeded the criticism justly made of 
Pinier's experiment by Heil, regarding the increase of fluid in 
the abdomen and the too diminutive size of the injected particles, 
the advancement of which by means of ciliary motion and fluid 
currents could not be identical with that of the much larger ovules. 
He injected into rabbits the ova of ascaris lumbricoides, which are 
one-half as large as those of the rabbit. After ten hours he found 
many ova in the tubes, while they were wanting in the abdomen. 
After thirty-six hours the ova had nearly reached the uterine 
horn. At the end of seven days many were found in the tube 
and one in the cornu. Lode often observed two or more ovules, 
once as many as eight, adhered together. He is of the opinion that 
this aggregation of the ovules is not effected in the tubes, but before 
their entrance therein. He regards ciliary motion as the impelling 
force and expresses the view that sexual excitement had an accel- 
erating influence upon the rapidity of this motion. His experi- 
ments with sexually immature animals were negative; a result 
which he attributes to the absence or imperfect development of 
the cilia. Before completing his injection experiments Lode in- 
vestigated the efficiency of ciliated epithelium in excised por- 
tions of mucous membrane under the microscope. Contrary to 
Kehrer and Heil, he saw a vigorous onward movement of the 
ovule both from the ciliary motion and the serous current. 

There can be no doubt that the splendid experiments of Lode 
have substantially added to our understanding of the manner of 
passage of the ovule through the tube; yet it seems to me they 
have not made clear all the details of the obscure process. In this 
connection there comes to mind the question of peristaltic or anti- 
peristaltic motion in the oviducts; regarding which we do not pos- 
sess satisfactory knowledge, but which certainly could exercise a 
powerful influence upon the tubal contents. 

Lode has discussed this question admirably. He thinks, 
rightly, too, that peristaltic movement cannot drive the ovule for- 
ward directly, but at best indirectly, since it sets in motion the 
fluid present in the tube by means of which the ovule is carried 



116 [Physiology of the Fallopian Tubes: McEwen. 

onward. He agrees, however, with Kiwisch that the lumen of 
the tube is widest at the abdominal end and narrowest at the uter- 
ine end; therefore, a force originating" anywhere in the oviduct 
might turn the fluid contents toward the abdominal end. Hence, 
the advance of the ovule toward the uterine end could not be ef- 
fected by peristaltic action. 

To this I would oppose the fact that the wide abdominal end 
up to the capillary clefts is completely filled by longitudinal folds 
of the lining membrane, especially at the time of congestive hyper- 
emia; while a cross section of the uterine end shows an open star- 
shaped lumen. It appears probable, therefore, contrary to the 
view of Lode, that the uterine end would permit an escape of fluid, 
from a peristaltic wave passing from the pavilion to the uterus, more 
readily than would the abdominal end, and thus a current would 
be created. It is possible that a circular contraction of oviduct 
walls in the region of the ampulla could close entirely the cleft- 
like tubal openings between the soft vascular folds of the mucous 
membrane, and that this contraction passing on toward the uterus 
would cause the contents to move in that direction; one could 
almost say, to be pressed out of the uterine end. The greater 
rapidity, so frequently observed, of the movement of the ovule 
in the abdominal portion of the tube in comparison with that in 
the uterine portion would be easily explained by this view. I am 
therefore of the opinion that the experiments of Lode have not 
shown that the passage of the ovule is accomplished exclusively 
by ciliary motion and the fluid current created thereby. 

I regard the above mentioned observation of Henson of the 
presence of many unimpregnated ovules in the imperforate tube 
of a rabbit as the only reliable demonstration of the possibility 
of an onward movement of the ovule through ciliary motion alone. 
But it is not sufficient to warrant a denial that under normal con- 
ditions peristaltic motion and the current it creates can produce 
greater effects, and is therefore a more important factor in the 
movements of the ovule. 

A striking assertion is made by Morau, who claims to have 
seen under the microscope in animals, and in one case in woman, 
rows of ciliated epithelium upon the lig. infund. ovar, which were 
developed at the period of menstruation. At other times the liga- 
ment was covered with simple pavement epithelium. Between 
these rows of cilia, the movements of which directed the ovule 
toward the ostium abdominale, the flat epithelium remained un- 
changed. 

The oldest hypothesis as to the entrance of the ovule into 



Physiology of the Fallopian Tubes: McEwen. 117 

the tube assumes that during ovulation the oviduct become erect 
and with outspread fimbriae surrounds the follicle, so that the 
ovule, when it bursts forth, must fall into the end of the tube. 

This theory, shown by Heules to depend upon the vessel-injec- 
tion experiments of Von Hallers and Walters for support, was 
refuted on good grounds and practically abandoned. Yet recently 
it appears to find advocates when slightly modified. Robinson 
claims to have seen frequently in vivisections, and in animals killed 
during the period of heat, the movement of erectile tubes, the out- 
spreading of the fimbriae and their application to the ovary. On 
the basis of his interesting observations he has built up a new 
theory as to the process of menstruation. The movement of the 
ovule through the duct he attributes to peristaltic action. 

Milroy also regards the tubes as erectile organs. He believes 
that the fimbriae lie upon the ovary at the time of ovulation. His 
description of glands upon the fimbriae, the secretion of which 
surrounds the ovule and prevents its falling into the abdominal 
cavity, will probably be received with doubt. 

In my opinion it is entirely wrong to, look upon the tubes or 
their fimbriae as erectile organs. Although the mucous membrane 
of both the infundibulum and ampulla is characterized by an un- 
usual development of blood vessels, these organs are wanting in 
all other anatomical features of erectile tissue. In fact, I have 
seen an entirely different condition of the pavilion in marked 
hyperaemia when I expected to find the so-called "erection." The 
opportunity has been mine repeatedly to examine the tubes in 
the first stage of acute inflammation. I observed the mucous mem- 
brane of the fimbriae to be greatly swollen, glistening and dark 
red. The vessels were dilated and completely filled. The swell- 
ing of the mucous membrane had produced a complete eversion 
of the pavilion. In place of a funnel-shaped cavity, presenting at 
its bottom the ostium abdominale, I found a conical projection, at 
the apex of which this opening was to be sought. The everted 
mucous membrane made up the superficial covering of this cone. 

If menstrual congestion produces a similar unfolding of the 
infundibulum — which is not improbable — then this eversion of the 
mucous membrane would greatly increase the number of waving 
cilia in the abdominal cavity; a circumstance which would favor- 
ably influence the eventual seizure of a liberated ovule by the cil- 
iary current. 

A very interesting observation regarding the movement of the 
fimbriae — which seem to be concerned in the seizure of the ovule — 
was made by Henson in two porpoises. He saw the fimbriae in 



118 Physiology of the Fallopian Tubes: McEwen. 

active motion, gliding to and fro upon the ovulating ovary, the 
motion being produced by involuntary muscle fibers. The gran- 
ular cells of the ovule from the bursted follicle caused the former 
to adhere to the fimbriae, by which it was carried over the smooth 
surface of the ovary. Kehrer also saw similar movements of the 
fimbriae. Apparently upon the basis of these observations Ahlfield 
assumes in the most recent addition of his work, "Lehrbuch der 
Geburtshuelfe," that the fimbriae constitute an apparatus the pur- 
pose of which is to surround the ovary and to grasp the ovule. I 
believe it was these appearances reported by Henson and Kehrer, 
as well as the "Wiederhinaufkriechen" of the fimbriae, mentioned 
by various reliable authors, that first gave rise to the erroneous 
idea of the "erection" of the infundibulum, and of the embracing 
of the ovary. The musculature of the fimbriae and, perhaps, to a 
slight extent, the ciliated epithelium of the pavilion, are responsible 
for these movements. 

From observations similar to Henson's, Rouget announced the 
presence of appreciable bundles of smooth muscle fibers in the 
meso-salpinx. He was of the opinion that these fasciculi, stimu- 
lated reflexly during ovulation, caused the infundibulum to be 
approximated to the ovary, and enabled the fimbriae to move over 
the most distant portion of that organ, in order to grasp the ovule 
when liberated. The same investigator ascribes a distinct role 
to the simultaneously occurring erection of the tube. Hasse goes 
still further. He wrapped the tube, with its mesentery, around 
the ovary, making a pocket shut off from the abdomen. In the 
capillary cavity thus formed he claimed the cilia, by their move- 
ments, established a fluid current which bore the contained ovule 
toward the ostium abdominale, in communication with the pocket. 

Leuckart advanced another theory. He regarded the Graafian 
follicle as a "projectile apparatus," and believed that when a fol- 
licle burst, its contents, including the ovule, were projected with 
some force, so that it would reach the pavilion without much diffi- 
culty. 

Kehrer, and, more recently, Heil — both of whom, as mentioned 
above, did not believe ciliary motion and the current thereby cre- 
ated to be adequate to carry the ovule into the infundibulum — 
sought the aid of this "ejaculation" theory. Kiwisch criticised 
Leuckart justly in that the point of rupture of the follicle is con- 
tinually displaced by pressure of intra-abdominal organs, so that 
the discharge of the contents cannot be represented other than as 
a gentle outpouring. The experiment of Henson, also, who caused 
a follicle to burst on the slightest pressure with a needle, seemd 



Physiology of the Fallopian Tubes: McEwen. 119 

to me significant as refuting the ejaculation theory. As the fol- 
icle ruptured a drop of fluid was projected, but the ovule with its 
adherent layer of granule cells was emptied upon the peritoneum 
of the ovary. 

Lastly, there remains to be mentioned the theory of Panksch. 
This author found in a suicide supposed to have experienced coition 
five or six days previously, new connective tissue membranes be- 
tween the tube and ovary, which he presumed to be intended physi- 
ologically to assist in guiding" the ovule to the oviaucf. A num- 
ber of similar observations in mature women, made later, strength- 
ened his belief. 

As Kehrer has shown, and as is to-day acknowledged by all 
without exception, this fibrous structure of Panksch is a patho- 
logical product of chronic circumscribed peritonitis, and has noth- 
ing to do in guiding the ovule. 

The large number of the theories referred to and their varying 
character show clearly that the process by which the ovule is con- 
veyed from the follicle to the tube yet awaits a certain, complete 
and unimpeachable explanation. 

Looking back upon the pertinent researches of so many in- 
vestigators, I may outline the process as I could accept it, in agree- 
ment with nearly all contemporaneous observers, as follows : When 
a ripe follicle bursts its fluid contents, with the ovule covered 
with granule cells, is gently poured forth from the point of rup- 
ture upon the peritoneal covering of the ovary, and thereupon 
occupies the capillary, cleft-like space between the ovary and the 
adjacent organs. As to its further progress, two possibilities are 
to be considered. 

First, the relations would be such that the ovule, on exit from 
the follicle or soon thereafter, would fall without the range of 
action of the fimbriae, and at no time afterward would come within 
their reach. It would finally be destroyed in the vast capillary 
crevices of the abdominal cavity. I believe this happens very sel- 
dom in the normal genital apparatus. A few authors claim in this 
a possibility of primary tubo-abdominal pregnancy, which is denied 
by others. 

The second possibility is that the ovule, immediately on reach- 
ing the ovarian peritoneum, or subsequently, comes within the 
domain of influence exerted by the infundibulum. In this case 
the process is most simple if the ovule has immediately come id 
direct contact with the mucous membrane of the pavilion — which 
is found upon the tip and outer side of the individual arms. Under 
such circumstances the direct influence of the ciliary movements, 



120 Physiology of the Fallopian Tubes: McEwen. 

together with the fluid current thereby created in the capillary 
crevice of which the ciliated epithelium constitutes one wall, would 
convey the ovule immediately to the abdominal end of the tube. 
As we have seen above, the possibility of an influence upon this 
current by peristaltic action cannot, with our present knowledge, 
be asserted. If the ovule does not come immediately in contact 
with the mucous membrane of the infundibulum, the next possi- 
bility arises, viz. : That the ovule by the movements which the fim- 
briae manifest, as observed by Henson, especially at the time of 
menstruation or during the sexual orgasm in women and prob- 
ably to a slight extent at other times, reaches a fimbria, from which 
point it is immediately carried onward as shown above. Further, 
we must assume that the fluid currents, which at the period of 
menstruation extend in wider circles about the tubal entrance, are 
strong enough to forward an ovule which comes within their reach 
into the pavilion. Lastly, it is conceivable that an ovule, failing 
of the assistance of these currents, might be brought opportunely 
within their influence by movements of the intestinal folds. 

It may be accepted that the slight increase of the capillary 
fluid by the liquor folliculi would favorably influence the advance- 
ment of the ovule, while an abolition of capillarity by ascites would 
hinder such advancement. 

That the congestive hyperemia during menstruation, as well 
as the excitation of the organs during coition — which would cer- 
tainly exercise an accelerating influence upon the ciliary move- 
ments — operates to favor the seizure of the ovule by increasing 
the action of the fimbriae and also the peristaltic motion, is exceed- 
ingly probable. I deem it probable that the muscle fasciculi, dis- 
covered by Rouget in the tubal ligaments, serve more to main- 
tain the tone of the ligamentous apparatus and to prevent exhaus- 
tion and relaxation from the continued force exerted upon it, than 
to functionate as a distinct organ for assisting the ovule to enter 
the tube. 

Two mechanisms are described by the different authors for 
conveying the ovule, which may have been so fortunate to enter 
through the tube. Some claim it is carried forward slowly by the 
motion of the cilia and the currents so produced (Henson, Hyrtl, 
Henle, Von Winckel, et al.). Others believe that the ovule, after 
its entrance, is forwarded by muscular action (O. Becker, Hening, 
Robinson, et al.). A third class of investigators think that both 
elements share in moving the ovule onward (Bruecke, Schroeder, 
et al.). 

If the conditions which obtain in birds are considered, whose 



Physiology of the Fallopian Tubes: McEwen. 121 

large ovules can be forwarded by muscular action only, one is sat- 
isfied to ascribe the chief office to peristaltic motion; on the other 
hand, the observations on frogs and rabbits teach that ciliary motion 
alone is sufficient. From the contradictory opinions of the authors 
it may well be concluded that the manner in which the ovule is 
conveyed through the tube in man and mammals is not yet es- 
tablished. 

Our knowledge, too, of the course of peristalsis in the tubes, 
and its influence upon the contents, is not yet satisfactory. Hyrtl 
speaks of vermicular movements toward the ostium abdominale, 
and Gruenhagen-Funke mentions the same direction. Ludwig's 
statement is interesting. He describes the movement as always 
progressive, and believes it may pass from the ovary to the uterus 
or in the opposite direction. Similarly Leuckart asserts that in 
many cases the diffusion of spermatozoa is facilitated by a sort of 
anti-peristalsis of the conducting organ. It would seem to me the 
possibility that at the moment of orgasm in coition a change from 
peristalsis to anti-peristalsis occurs (as we have many times ob- 
served in the intestines on marked irritation) cannot at present be 
confidently assumed. That a decided movement of the internal 
generative organs, especially of the tubes, occurs in women at the 
moment of highest sexual excitation is well evidenced by their 
description of the pleasurable sensations attending a satisfactory 
intercourse. 

Since having directed more attention to the conditions shown 
in microscopical preparations of the normal tube I have noticed that 
in women who have borne many children, and of whom, there- 
fore, one could premise a full and active sexual life (if they have 
not yet reached the menopause), there exists an extraordinarily 
strong development of the longitudinal muscle fibers of the ovi- 
ducts; while in persons of the same age, whose sexual condition 
betokened virginity — or a very sparing use of the genital organs — 
the layer of longitudinal fibers is very scant. If these appearances 
can be confirmed by a greater number of observations, and a pos- 
sible subinvolution after pregnancy be excluded, the view that in 
woman satisfaction of sexual passion is attended by powerful move- 
ments in the tubes is made certain. The interesting question would 
remain, however, whether peristalsis or anti-peristalsis was con- 
cerned. 

As to the time required in animals for the passage of the ovule 
through the tubes, many positive statements have been made based 
upon the results of systematic research. Bischoff, Hyrtl and others 
call especial attention to the slowness of the progress of the 



122 Physiology of the Fallopian Tubes: MeEwen. 

ovule. Ludwig asserts that it is not known what causes the move- 
ment to be so slow, and that if the ovule followed the impulse of 
the ciliary stream or of the peristalsis, it would travel much more 
rapidly. Bischoff found that the ovule lingered in the tube three 
days in the rabbit, four to five days in ruminants, and eight to ten 
days in dogs. In agreement with this, Henson claimed that the 
ovule in rabbits reached the uterus after about seventy hours. 
In woman only one authentic observation of an unimpregnated 
ovule in the tube has been made, and that by Hyrtl. According 
to Bischoff, who has described the case in detail upon statements 
by Hyrtl, the ovule required five days from beginning of menstru- 
ation to reach the uterine end of the tube where it was found. As 
we know, through Leopold and Mironho-ff, that the Graafian fol- 
licle in woman may burst as well at the beginning of menstrua- 
tion as during its height or at its close, and that menstruation may 
pass without the emptying of the follicle, we cannot deduce from 
this case, so well authenticated and described, an absolute figure 
for the duration and passage of the human ovule in the oviduct. 
It would seem that the assumption that the ovule required about 
one week's time for passage through the entire duct is not far from 
truth. 



*MALARIA. 

BY ELLSWORTH D. WHITING, A. B. 
[The L. C. P. Freer Prize Essay, Rush Medical College, 1896.J 

Mannaberg has devised a method by which he brings out in 
great clearness the finer structure of the parasite. At first the 
dried specimens are floated a few moments upon distilled water, 
and after being dried are bathed in dilute acetic acid until there 
is a complete disappearance of the hemoglobin. The specimens 
are then permitted to float for two hours upon the following fixing 
solution: 

Concentrated aqueous picric acid 20 c.cm. 

Distilled water 30 c.cm. 

Glacial acetic acid 1 c.cm. 

The specimens are next placed in absolute alcohol for twenty- 
four hours. After this they are stained from twelve to twenty-four 
hours in a solution consisting of one part of hematoxylin (hema- 
toxylin grams 10 to ioo c.c. acid alcohol) to two parts of a .5 per cent, 
ammonia alum solution. The specimens are destained in acid al- 
cohol (hydrochloric acid 25 per cent., alcohol 75 per cent.) and 
ammonia alcohol (three drops of ammonia to 10 c.cm. 75 per 
cent, alcohol). They are then washed in 8 per cent, alcohol and 
mounted in balsam. By this method the parasite and leucocytes 
are stained blue, the red corpuscles being colorless. 

The preceding methods and numerous others have been used 
since the discovery of the organism by Laveran and the staining 
methods set forth by him. Moreover, the method advised by him, 
although the simplest and oldest, is most practical and efficient 
for ordinary use. Laveran fixes blood in alcohol and ether equal 
parts. He first places the specimen, for thirty seconds, in concen- 
trated aqueous eosin, and after washing and drying, stains for 
thirty seconds in concentrated aqueous methylene blue. 

In his experimentation with staining the malarial organism the 
writer, although he has used the methods of Laveran to consider- 
able advantage, has been most successful in the use of methylene 
blue alone. He finds that as the organism is endoglobular, its 

* Continued from November number. 

123 



124 Malaria. 

outline is blurred to some extent by the eosin. Specimens stained 
in aqueous solutions are more easily decolorized by washing in 
water than those stained in alcoholic solutions. 

No definite limit can be given to the length of time and strength 
of dye required to properly stain a specimen, even when the strength 
of the staining reagent is known. These points can be accurately 
estimated for normal blood, but as it is a rare occurrence for two 
pathologic specimens to be physiologically the same, their stain- 
ing is necessarily a subject of great variance. To procure a prop- 
erly stained specimen it is necessary to obtain its stain-absorbing 
qualities by making a test specimen. This is accomplished by 
applying a stain of known strength for a certain noted time. 
Using this as a guide, a good specimen may be obtained by vary- 
ing the strength of the stain and length of the time of its applica- 
tion, A good standard for comparison may be found in the leuco- 
cytes. When the small lymphocytes take a deep blue stain and the 
large polynuclear neutrophils a faint blue, the methylene blue is 
of proper strength. When the leucocytes are thus colored the 
malarial organism will be distinctly stained and therefore recog- 
nizable. The eosin should but faintly color the red corpuscles. 

Wlien the staining is completed previous errors, if they exist, 
are brought to light. If acid is present, specimens refuse to stain. 
If the specimen is thick, individual corpuscles are not distinguish- 
able. If the blood has been allowed to dry before separation of 
the slips the corpuscles are not arranged evenly, but in concentric 
circles and rows. If the blood was forced from puncture there 
will be a large amount of plasma present which will obscure the 
field. If fixing material has not been pure, the specimen will not 
stain. If the heating apparatus has become overheated, the cor- 
puscles will be ruptured, charred and disintegrated. 

In the examination of blood for the "plasmodium malarise" 
most satisfactory results are obtained by examining fresh sped- 
mens. The great advantage of this method lies in the fact that the 
ameboid movements of the organism may be observed. 

The organism must be differentiated from, i, blood plaques; 
2, vacuoles; 3, discs of red corpuscles; 4, crenated corpuscles; 5, 
oil globules (?). 

1. The blood plaques are colorless, extra-corpuscular and 
might be readily mistaken for hyalin forms of the organism, were 
the ameboid movement not considered. The plaques are more 
translucent, their outlines more clearly marked and irregular than 
hyalin bodies. There is a tendency toward the grouping of the 
plaques in grape-like clusters. On staining they take the rnethy- 



Malaria. 125 

lene blue, as does the organism, and must be differentiated by 
position and contour. 

2. The vacuoles are lighter in color, translucent, outlines dis- 
tinctly marked, are non-motile and always spherical in form. 

3. Discs of red blood corpuscles are spherical and when pres- 
ent are usually found in large numbers and situated in the center 
of the corpuscle, except in cases of poikilocytosis. These discs 
are of indistinct outline, non-motile, and when present in small 
numbers they can only be differentiated from resting hyalin bodies 
by staining methods. 

4. Crenated corpuscles appear as coarsely spiculated balls. 
These spicula are caused by the irregular contraction of the cell 
wall of the red corpuscle (?). Although colorless these spicula 
appear black when viewed through reflected light, and on this 
account are often mistaken for pigmented organisms. 

5. It is scarcely necessary to differentiate hyalin bodies from 
minute, spherical, translucent, rapidly moving bodies which are 
frequently seen in the blood of malarial patients. These particles 
are found in normal blood and their nature is unknown, but they 
probably are of oil globules from sebaceous glands, commingled 
with the blood in its exit from the puncture. 

It is of vast importance in the differentiation of the hyalin 
bodies from the foregoing bodies to note the kinds of motion visible 
under the microscope. In the field can be seen distinct currents, 
probably produced by heat radiation. These currents give to the 
corpuscles a vibratory, oscillating and rotary motion, which is in 
turn transmitted to the contents of the corpuscle. These move- 
ments are possessed by all of the previously described bodies, 
plaques, vacuoles, discs, crenated corpuscles, and oil globules, and 
must not be confounded with the ameboid movements of the mala- 
rial organism, which is entirely independent of currents, is slow 
and characterized by a change in form of the parasite. 

Through the opportunities afforded by the medical clinics of 
Rush Medical College and the medical wards of Presbyterian and 
Cook County hospitals the writer has been able to observe and 
study the blood changes in many malarial patients. The classifi- 
tion proposed by Thayer and Hewetson will be adopted in the 
following description. 

In describing the tertian parasite the writer will make use 
of a series of specimens taken from a patient in Cook County 
Hospital, exhibiting tertian paroxysms. Specimens were taken 
every four hours, day and night, for forty-eight hours. In this 
manner a complete cycle of the life of the organism was obtained. 



126 Malaria. 

By a microscopic examination of these specimens stained with 
methylene blue the entire development of the organism was traced 
with remarkable accuracy. Fresh specimens were examined as 
far as possible. The patient's history is taken from history sheets 
of the hospital, and the temperature recorded by the writer at the 
time the specimens were taken. The blood count was made after 
the series was completed. 

James W., admitted February 2, 1896; aged 31; born in Scot- 
land; single; carpenter by trade. Family history: father had 
stroke of paralysis some years ago, but is still living; otherwise 
negative. Personal history: has been in Chicago eighteen months; 
drinks occasionally, smokes, habits regular, no venereal history; has 
been working of late in Brighton Park. Previous illness: measles 
and whooping cough. Present illness: had first chill last April, 
which was followed by chills every other day. These disappeared 
upon the administration of quinin, but reappeared late in Septem- 
ber, occurring every other day. The attacks were again stopped 
by quinin. The last attack began February 1 and patient has 
had a chill every other day since. Chills occur between six and eight 
o'clock in the morning. During the chill the patient complains 
of great pain in the back, head, left side and shoulder; the chills! 
are followed by high, burning fever, profuse perspiration and great 
prostration. Appetite poor and bowels regular. 

Physical Examination. — Body well nourished; mind, clear; eyes 
and pupils, normal; tongue, clean; pulse ,full and strong; thorax, 
well devolepd; heart, negative; lungs, negative. Abdomen: liver, 
normal; spleen (palpable) is situated in mammary line from sixth 
rib to one inch below costal arch. Limbs, negative; no adenopathy. 
Hemoglobin, 67^ per cent.; red corpuscles, 4,500,000; white cor- 
puscles, 5,000. 

In this description of a serial examination the writer shall at- 
tempt to follow out the development of the organism, commencing 
with the group of hyalin bodies present in the first specimen. 
However, he wishes it distinctly understood that he does not for 
an instant intimate that the separate stages of the parasite described 
include all the organisms present in the blood at the stated times. 
As a matter of fact, in every slide examined adult, intermediate 
and hyaline bodies were demonstrable, although these latter forms 
in some instances were present in small numbers. In the great 
majority of cases of malaria examined by the writer he has been able 
to demonstrate every form of the organism at any time during 
the course of the disease. This fact has therefore led him to con- 



Mil In rid. 



127 



elude that pure forms rarely or never exist. The symptoms are 
caused by larger groups of organisms. 

The first specimen (Plate IX, Fig. i) was taken February 24 
at ten o'clock in the forenoon, one hour after the chill, the tem- 
perature being 104 degrees F. 

On examination of fresh specimens, many organisms were 





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PLATE IX.— THE PAKASITE OF TERTIAN FEVER. 

Explanatory.— 1, 2, 3, Hyaline Forms; 4, 5, Beginning Pigmentation and Appearance 
of Nucleus; 6, Appearance of Nucleolus; 7,8,9, Further Development of Organisms; 10, 
Full-grown Organism; 11, 12, Segmenting Forms. Magnification— Zeiss, Obj. 1-12 oil 
immer., Oc. 5. From James W., C. C. H., W. 4. 



present in various stages of development, the hyaline forms, how- 
ever, being in the greatest numbers. These consisted of small, 
round, endoglobular motile bodies. The ameboid movement at 
this stage was marked, a complete change of shape taking place 
in a few moments. These forms have been described as colorless, 
but this is probably not strictly true, as they seem to possess a 
very faint shade of color similar to that of the red corpuscle. The 



128 Malaria. 

borders were indistinct, the blending thus produced often making 
it difficult to distinguish the point where organism ended and 
corpuscle began. Although there were organisms within and out- 
side the corpuscles, none were seen in the act of entering, a cir- 
cumstance which has never been observed. At this stage no 
nucleus could be demonstrated in the fresh specimen. 

Specimens were also stained with methylene blue. The 
periphery of the organisms took a greenish-blue stain, fading toward 
the center into a lighter shade of the same color, indicating the 
embryonic nucleus. In this specimen, beside the adult and hyaline 
bodies, many degenerate forms of the organism, together with 
degenerate red corpuscles and free pigment granules, were present. 

The second specimen (Plate IX, Fig. 2), taken the same day 
at 2 p. m., the temperature having fallen to 100.4 F-> showed a 
large number of hyaline forms somewhat larger than those ob- 
served in the first specimen. These possessed the same activity 
no pigmentation was demonstrable. A marked decrease in the 
number of adult organisms was noticed, also the absence of free 
pigment. 

The third specimen (Plate IX, Fig. 3), taken the same day at 
6 p. m., the temperature being 99.4 F., showed the same charac- 
teristics as the foregoing, except that the hyaline bodies were 
larger and a more clearly defined nucleus was present. This nucleus 
nearly filled the organism. In most instances it was round, regu- 
lar and distinctly outlined. On staining with methylene blue, while 
the surrounding protoplasm took a deep greenish-blue color, the 
refractive nucleus showed a faint blue. No nucleolus was demon- 
strable. 

Specimen four (Plate IX, Fig. 4), taken the same evening at 
10 o'clock, temperature 97 F., showed that the organisms had in- 
creased in size, and for the first time an increase in size of the 
red corpuscles was noted. Slight pigmentation was also observed 
in the periphery and pseudopodia. This pigmentation consisted of 
small brownish granules or rods, closely resembling bacilli. These 
were in rapid motion. This motion was not brownian in charac- 
ter, as the granules appeared to pass from one portion of the 
organism to another. The nucleus was well marked. By careful 
focusing, a small area at the side of the nucleus, encroaching upon 
the cell body, was observed in stained specimens. This area, which 
is composed of chromative filaments, stains with methylene blue 
and corresponds to the nucleolus of Mannaberg, Feletti and Grassi, 
and was demonstrated in only a few instances. At this stage the 
peculiar forms which the parasite assumes were very apparent. 



Malaria. 129 

At times the organism would lengthen out into a long, curved, 
crescented shape. Again it would assume a spherical contour, or 
the form of a cross. 

The fifth specimen (Plate IX, Fig. 5) showed a progressive 
growth in both size of organism and number of granules. There 
was also present a pronounced increase in the size of the cor- 
puscle, with a noticeable decrease in its coloring matter. How- 
ever, the most marked new feature was the decided prominence 
of the nucleolus, which, though scarcely perceptible in the former 
specimens, could be easily seen in this one. The chromatin fibers 
in one instance filled up fully one-eighth of the nucleus, while a 
few could be traced to the nuclear membrane. 

Specimens six, seven and eight (Plate IX, Figs. 6, 7, 8) showed 
a decrease in the number of organisms present. However, in those 
present there was noted an increase in pigmentation, size of organ- 
ism and corpuscle. 

On examination of specimen nine (Plate IX, Fig. 9) several 
startling facts were brought to light. As if by magic the field 
teemed with organisms, in numerous instances as many as ten 
organisms being present in the same field at the same time. The 
explanation of this phenomenon, that is, the great difference in the 
number of organisms present in so short a time, probably is that the 
parasites were collected in the internal organs when specimens 
six, seven and eight were obtained. These organisms showed 
especially a great growth of nucleus and nucleolus. In many cases 
the ectoplasm, or portion surrounding the nucleus, staining deeply 
and containing the pigment, formed but a narrow band around 
the nucleus. The nucleus often seemed to be double, consisting 
of two equal or unequal portions. On close observation and care- 
ful focusing it was possible to distinguish narrow bands of ectoplasm 
stretching over the nucleus or endoplasm, but not through it. Some 
organisms of normal size and appearance were present which ap- 
peared to possess no nucleus, but here again very often careful 
focusing showed that we were probably looking upon that portion 
of the ectoplasm which covers the endoplasm. In some instances 
organisms of this description showed no nucleus whatever. There 
were, moreover, many large extra corpuscular, irregular, granular, 
pigmented bodies having no nuclei, which were probably degen- 
erated organisms. These bodies were often filled with vacuoles. 

In specimens ten, eleven and twelve (Plate IX, Figs. 10, 11, 12) 
were found many adult forms which in size equaled that of red cor- 
puscles. These were endoglobular or free in the plasma. When 
intra-corpuscular the corpuscle was greatly enlarged and decolor- 



1 30 Malaria. 

ized, the cell wall showing as a thin film. The pigment granules 
were motionless. 

In specimens eleven and twelve (Plate IX, Figs. II, 12) 
segmentation was observed in two forms. In the first a very large 
nucleus was observed, in which, and partially filling it, could be 
made out faintly staining, sporelike bodies, numbering from fifteen 
to thirty. The second form showed the organism diffusely and 
faintly stained throughout, in which pigment granules and spore- 
like bodies were scattered. This second form was probably a 
later stage of the first described, and resulted from the rupture of 
the nuclear membrane, setting free the sporelike bodies or daughter- 
nucleoli into the ectoplasm. These bodies seemed to contain distinct 
nuclei, and though non-motile while in the organism, appeared to 
acquire motion on reaching the plasma of the blood. In no in- 
stances was fragmentation observed, nor Golgi's rosette forms. 

Thus we have followed the tertian organism through the cycle 
of its existence, and have once more arrived at the hyaline forms. 

As regards the function and mode of reproduction of the 
elementary parts of the organism there is to-day a difference of 
opinion. Grassi and Feletti are of the opinion that the process 
of reproduction originates in the nucleolus. This, on dividing, is 
at first surrounded by the nuclear juice, a semi-fluid substance, 
which, together with the fibrils running from the nucleolus to the 
nuclear membrane, forms the nucleus. In a short time these 
daughter nucleoli receive membranes and constitute the spores. 
The pigment is developed and retained in the surrounding ecto- 
plasm. These pigment granules, he supposes, are formed from the 
hemoglobin of the corpuscle, but do not react to tests for iron. 

Romanowsky goes so far as to say that by the use of eosin and 
methylene blue he has been able to distinguish karyokinesis during 
segmentation. 

Mannaberg in speaking of the development of pigment, agrees 
that it is first seen at the periphery of the organism in the outer 
plasm or ectoplasm. His theory of reproduction is unique. He 
holds that the nucleolus shortly before segmentation entirely dis- 
appears, withdrawing from the nuclear portion of the organism 
into the ectoplasm. It soon reappears in the nucleus and seg- 
mentation progresses as described by Grassi and Feletti. Investi- 
gators agree that reproduction is in all probability accomplished 
in the same manner in the parasites of tertian and quartan fever, 
but in the estivo-autumnal type no nucleus has as yet been demon- 
strated. 



Malaria. 131 

There is to-day, as there was at first, a difference of opinion 
in regard to the nature of the flagellate bodies. The two theories 
still exist, Laveran and his associates contending that these forms 
are reproductive in their functions, while Golgi and his followers 
insist that they are degenerate. The theory that they are produced 
by thermic influences has been generally abandoned. 

In describing the quartan parasite the writer will use as a 
clinical illustration a patient who came under his personal obser- 
vation. 

January 15, 1896, there appeared before Prof. H. M. Lyman's 
medical clinic a case of malaria. Judging the case of more than 
ordinary interest the writer made special investigations, obtained 
a full history, made as many blood preparations as possible, and 
•through the courtesy of Prof. James B. Herrick obtained a thorough 
physical examination. 

Peter A., age 34 years; born in Germany. Came to America 
fifteen years ago. Lived in Pittsburg five years. Since then has 
lived continually in Chicago with the exception of short visits to 
Jamaica, W. I., and Memphis. Single; locomotive fireman by oc- 
cupation. 

Family history: Father and mother dead. Cause unknown. 
Brother and sister died from a lingering disease. Personal history : 
regular in habits of eating and sleeping. Drinks whisky, tea and 
coffee moderately. Previous illness: when twelve years of age had 
typhoid fever. Twelve years ago had severe cold and spit some 
blood with great quantity of slimy mucus. Seven years ago while 
in Memphis had malaria, which easily succumbed to quinin. Two 
years ago had gonorrhea with swollen testicle. Fourteen months 
ago had hard chancre followed by adenopathy. No- eruption or 
falling out of hair. Had rheumatism to slight extent. 

Present illness: July 4, 1895, while working on a railroad tun- 
nel in Jamaica, was stricken down with severe chill, which lasted 
one and one-half hours. This chill was followed by a burning fever, 
profuse perspiration and great prostration. Patient was confined 
to the bed for one week and had a chill every fourth day during 
July and August. During September and October about once a 
week chill would occur every other day. These chills increased in 
frequency until, when he presented himself before the clinic, he 
was suffering from quotidian paroxysms. During the paroxysms 
patient complains of frontal headaches, dizziness, ringing in the 
ears, spots before eyes and pain in the back and limbs. He is weak 
and complains of dyspnea on exertion. Has taken some quinin, 
which has had no effect upon the disease. 






132 Malaria , 

Physical examination: January 17, 1895, 4 p. m. I. Height 
6 feet. 2. Weight 165 pounds. 3. Body well nourished, very mus- 
cular, large boned and well developed. 4. Mind clear. 5. Skin — 
face, arms, neck and back tanned; says back is tanned from bath- 
ing. 6. Eyes — pupil moderately dilated; react, to light; move- 
ments and retina normal ; sclera slightly yellow (examination of the 
eye was made by Dr. Hinde). 7. Tongue moist and slightly coated, 
mucous membrane red. 8. Ears normal. 9. Thorax — heart, rela- 
tive dullness begins at third rib, apex beat one inch inside nipple 
line in fifth interspace. In full inspiration these limits are lowered 
per minute. Very slight systolic murmur over mitral area and 
pulmonic area. No accentuation of aortic or pulmonic tones. 10. 
Abdomen — liver slightly enlarged. Relative dullness begins in 
right border sternum at fifth rib. Flatness begins in mammary 
line in fifth interspace. I nfull inspiration these limits are lowered 
one and one-half inches. In mammary line there is flatness to 
costal arch. On deep inspiration sharp edge of liver can be felt. 
In paracostal line flatness extends two fingers below costal arch. 
11. Spleen — readily palpable. Dullness begins at seventh inter- 
space. 12. Legs — on right shin is large pigmented scar, said to 
have been produced by a red hot iron. Three pale parchment- 
like scars higher up upon same leg. On outer aspect of same leg 
is a linear non-pigmented scar caused by a scythe. 13. Genitals — 
a nodule the size of a hazelnut is found in left epididymis. 14. 
Reflexes — normal, no ankle clonos. 15. Sensation normal. 16. 
Temperature 98.8 F. 

Upon microscopic examination of the blood of this patient a very 
interesting phenomenon was disclosed. Although in small num- 
bers, quartan parasites were present, associated with many tertian 
forms. This condition illustrates and corroborates the experiments 
made by Di Mattei, who substituted one type of malaria for another. 
There is probably little doubt, as this patient was an intelligent man 
whose word may be relied upon, but that this fever was primarily 
quartan and that subsequent to the first a second infection was in- 
curred with a group of tertian organisms. The latter parasites, upon 
development, cause the gradual extinction of the quartan forms pro- 
ducing paroxysms peculiar to their type. 

In the case cited by Di Mattei the extinction of the original type 
was accomplished in a much shorter time than in this instance. 

These two types of the parasite, in some cases lying side by side, 
furnished excellent opportunity for studying their points of differ- 
ence. 

As the tertian organism has been previously described, a descrip- 



Malaria. 133 

tion of the quartan will be given by comparing and contrasting the 
latter with the former. 

In the hyalin forms these types cannot be differentiated, though 
the quartan is more refractive and more sluggish in its movements. 
These appear during and after the paroxysm, as in the tertian. — 
Journal of the American Medical Association. 

[Concluded in January number.] 



The Corpuscle. 



EDITOES. 

J. E. LUCKEY, '97, Editor-in-Chief, 

746 West Adams St., Chicago. 

T. R. CROWDER, '97, Secy and Treas. 

FRED. BARRETT, '97. E. L. McEWEN, '97. A. F. STEVENSON, 



Communications relative to advertisements and subscription (Subscription price 
$1.00 per annum) should be addressed to the publisher. Remittances should be made 
by money order, draft or registered letter, payable to "The Corpuscle," and addressed 
to H. G. Cutler, Unity Building, Chicago. 



Ruby Red and Black: Colors of Lake Forest University. Orange: Color of Rush 

Medical College. 



WIDAL'S METHOD FOR DIAGNOSIS OF TYPHOID FEVER. 

Widal's method for the diagnosis of typhoid fever promises to 
be of very great assistance in deciding doubtful cases. The serum 
diagnosis is simply an application of Pfeiffer's "specific immunity- 
reaction" test of the typhoid bacillus. Issaeff and Ivanoff demon- 
strated that this reaction takes place in a test tube as well as in an 
animal's living body. Gruber applied it to the typhoid bacilli, show- 
ing that the addition of blood serum from an immunized animal, or 
a person recently recovered from typhoid fever, to a fresh bouillon 
culture of typhoid bacilli would stop the motility of the bacilli, caus- 
ing them to become agglutinated into small clumps, which ultimately 
fall to the bottom, leaving a clear supernatent fluid. 

But to Widal belongs the honor of having applied this specific 
reaction test in the diagnosis of typhoid fever. The treatment of a 
small amount of the pure culture of motile bacilli, under a cover 
glass, with a very slight amount of the serum from a typhoid patient, 
readily destroys their motility and causes the charactertistic clump- 
ing. Dried blood, when again moistened, still produces this diag- 
nostic change in the typhoid culture; hence, by drying with proper 
technique a few drops of blood upon a clean piece of paper and 
sending it to a laboratory, diagnosis may be made. The New York 
Health Department has already made use of this method. 

134 



Editorials. 13<) 

The reaction has been found to vary from the fifth to the eighth 
day of the disease. Widal found it in two cases from three to seven 
years after the disease. 

Much is to be expected from the future of this diagnostic 
method. Careful observations and study may add greatly to its 
value. 

BEDSIDE STUDY FOR RUSH'S STUDENTS. 

The broadest preparation for any profession necessitates a thor- 
ough acquaintance with the theories and facts upon which the prin- 
ciples and practice of the profession are based. The best modern 
schools of medicine are endeavoring to better equip their graduates 
by sending them forth armed, not alone with theory, but with 
knowledge gained by observation and practice in the laboratory and 
clinic. 

It is the custom in some of the "old country" schools of medi- 
cine to detail students in classes of two or three to study at the bed- 
side of a patient, taking the history and observing carefully the 
symptoms, complications, treatment, convalescence and sequelae. 
Each student is required to make a full and accurate report of the 
case under his observation. This study of a disease and how to treat 
it in all of its phases is worth more than knowledge culled from books 
based solely on the observations of others. Knowledge gained with- 
out an adequate conception of how to apply it is useless. 

Rush has a wonderful wealth of clinical material, which is grow- 
ing with the renown of her illustrious faculty. Her great hospital 
could readily accommodate, in its various wards, a class of twenty or 
thirty students without any great inconvenience to the management 
or patients. By this we mean that the students should not run in 
crowds helter-skelter through the hospital wards, boisterously seek- 
ing to amuse themselves any and every place at the expense of the 
comfort of patients and attendants; they should not appear in dirty 
clothes with soiled hands and worse manners; but, after passing a 
very careful inspection as to their personal fitness for the work, they 
might be admitted to the hospital and appointed in classes of two or 
three to each patient accessible for study. Each man should 
be required to make a most careful study during the whole course of 
the disease and then report in full to the head of the department. 

The habits of closer observation and attention to decorum and 
personal appearance, which such a system would encourage, would 
certainly be of immense advantage, not alone to the students, but 
also to the college, which would thereby add another point of great 
advantage over other institutions of less fame seeking to make capital 



136 Editorials. 

out of their advertisement of so-called systems of bedside instruc- 
tion. 

It might be possible to institute, with excellent results, an out- 
side clinic. There are hundreds of poor patients who would be 
grateful for medical attendance from even "a young doctor." The 
"young doctor'' — the student — could be practicing within the limits 
of the law under the instruction of supervisors of the outside clinics. 
Full and careful reports should also be required of these cases. 

We believe in Rush. Her rapid strides in the direction of prog- 
ress assure us that the near future will see greater improvements in 
all lines than "The Corpuscle" has ever dreamed of suggesting. 

RUSH SUMMER SCHOOL. 

In accordance with the usual custom, there will be given next 
Spring, in the Pathological Laboratory of Rush College, special 
courses for physicians and advanced students in Pathological Anat- 
omy and Histology, Clinical Microscopy and Bacteriology. They 
will begin on the first of May next and continue for four weeks, oc- 
cupying four hours daily, but the laboratory will be open all day 
for the accommodation of participants. The work planned in 
these courses will include matters of an essentially practical value, 
and opportunities will be given to make special arrangements for 
the continuance of the work as long as is desired after the first of 
June. The courses will be under the direction of the Professor of 
Morbid Anatomy (Dr. Hektoen), and conducted by the assistants 
in the laboratory (Drs. Le Count, Weaver and Olney). The fees 
for any single course are $20; for the three courses, $50. These 
fees include all material and apparatus, except slides, cover-glasses 
and minor instruments. Prospective applicants should address the 
College Clerk early, in order that suitable arrangements can be made 
in a satisfactory manner. 



Prof. Hektoen will go to Indianapolis, December 18, to attend 
the opening of a Pathological Department in connection with the 
Central Asylum for the Insane at that city. The event is to be one 
of considerable celebrity, and Dr. Hektoen is listed among the 
speakers of the evening. 



The Rush Medical College Glee Club has fully organized and is 
meeting regularly for practice. Mr. J. F. Clark is president of the 
club. There is a great plenty of fine voices in the college this year, 
and membership is therefore restricted. It is the intention of the 



Editorials. 137 

management to give a concert at the college in the near future. This 
will be of a high grade and merit the attendance of all loyal, music- 
loving students. 



Judging from a letter sent from its correspondence department 
at iooi West Congress street, Chicago, the "Wisconsin Eclectic 
Medical College" of Milwaukee is a veritable "diploma mill." It 
offers diplomas to pharmacists at the rate of $10 per diploma. Such 
institutions are a disgrace to the country and a menace to the pro- 
fession. 



rllumm Department. 

JAMES B. HERRICK, A. B., M, D., Editor. 



Membebship in the Alumni Association of Rush Medical College is obtainable 
at any time by graduates of the College, providing they are in good standing in the 
profession, and shall pay the annual dues, $1.00. This fee includes a subscription to 
The Cobpuscle for the current year. This journal is the official organ of the Association. 

Dues and all communications relating to the Association should be sent to 

JOHN EDWIN RHODES, M. D., Sec'y and Treas., 34 Washington St., Chicago. 



DEATH OF Dr. W. H. HAYMAN, '86. 

We quote the following from one of the Chicago dailies : "Dr. 
W. H. Hayman died yesterday afternoon (December 2) at the 
residence of his brother, Dr. L. B. Hayman, 167 Oakwood Boule- 
vard, of consumption. His death was hastened, probably, by be- 
ing caught in a blizzard last week in North Dakota. 

"Dr. Hayman was born in Chicago forty years ago. He grad- 
uated from Rush Medical College in the class of '86. On the 
West Side, where he practiced his profession, he was well and 
favorably known. He devoted a great part of his time to the 
treatment of charity patients, and in doing this work he under- 
mined his constitution. 

"Two months ago Dr. Hayman, accompanied by his wife and 
child, went to Montana for his health. The change did him no 
good and he realized that death was not far distant. Wishing 
to die among friends and childhood scenes he undertook the trip 
back to Chicago. The train was snowbound for two days at 
Devil's Lake, N. D., and in his weak condition Dr. Hayman suf- 
fered greatly. His only hope was that he would live to see Chi- 
cago once more. He arrived here at 11 o'clock Monday night, 
very much exhausted. He was taken to the home of his brother, 
in Oakwood Boulevard, where he soon lapsed into unconsciousness." 

THE SHOOTING OF Dr. WINTERMUTE. 

The death of Dr. J. S. Wintermute, Rush, '83, at the hands 
of an insane patient, has brought to light, according to the daily 
press, a strange evidence of the odd workings of fate. We quote 
from two of our Chicago papers : 

138 



Alumni Department. 139 

"Bismarck, N. D., Nov. 12. — (Special.) — There is a peculiarly 
tragic coincidence in the shooting of Dr. J. S. Wintermute of 
Tacoma, formerly of Chicago. He was the son of P. P. Winter- 
mute, formerly of Yankton, who shot and killed Gen. E. S. 
McCook, Secretary of Dakota Territory, in September, 1873. 

"Between him and McCook there was a long-standing feud 
over political matters, and this was aggravated by a dispute over 
bonds of the Dakota Southern Railway in Yankton County. Both 
were interested, upon opposite sides. 

"Wintermute used insulting language toward McCook, who 
attacked and severely beat him. A few hours afterward Winter- 
mute approached McCook and shot him "dead. Wintermute was 
sentenced to ten years' imprisonment, but got a new trial and 
was afterward acquitted. He died within a year afterward." 

"Dr. Wintermute was killed by Samuel S. Tucker, an insane 
patient, who at once committed suicide. The physician was com- 
ing from a mining assayer's office when he was confronted by 
the man and shot in the abdomen. He died after a few hours. 
Dr. Wintermute was 36 years old and graduated from Rush Med- 
ical College about ten years ago." 



Dr. Frank B. Hills, '91, writes from Cahoka, Missouri, that 
practice is good. He expresses the deepest interest in the wel- 
fare of the Alumni Association and its organ, The Corpuscle. 



Dr. G. Wallace Nott, '96, is now at Racine, Wisconsin. He 
reports practice as good. Dr. Nott has the appointment as 
Demonstrator of Pathology in the Wisconsin College of Physi- 
cians and Surgeons, Milwaukee. 



Dr. Bertram W. Sippy, class of '90, has returned from a year's 
study in Vienna. He expects to locate in Chicago, and his many 
friends will extend to him a warm welcome. 



Edwin M. Northcott, M. D., class of '77, has been appointed 
medical director of the Union Mutual Life Insurance Company, to 
succeed the late Thomas A. Foster, M. D. Six years ago Dr. 
Northcott first became connected with the company as medical 
examiner at the Chicago agency. Since June, 1895, he has served 
the Union Mutual Life Insurance Company as assistant medical 



140 Alumui Department. 

director at the home office in Portland, which has enabled him 
to acquire thorough familarity with the important duties which 
devolve upon the medical department. We bespeak for him suc- 
cess in his new position of responsibility. 



The following is self-explanatory: 

Madison, Wis., Dec. 5, 1896. 

My Dear Dr. Rhodes : — Pardon me for not answering promptly, 
but I'm very busy, as I presume most "Rush lights" are, espe- 
cially the Charley Parkes, Fletcher Ingals, Henrotin, etc., class, in 
which I had the honor of being. Find inclosed the Mighty Dollar. 

Yours for "Old Rush," 

A. R. LAW, '68. 




J E. LUCKEY, M. S. 

Retiring Editor of "Corpuscle. 



The Corpuscle. 

RUSH MEDICAL COLLEGE, CHICAGO, ILL. 
Medical Department Lake Forest University. 



Vol. VI. JANUARY, 1897. No. 5. 

MEDICAL CLINIC: NEPHRITIS.* 

BY DR. JAMES B. HERRICK, COOK COUNTY HOSPITAL, DECEMBER l6, 1896. 

I present to-day four cases of Bright's disease, illustrating differ- 
ent phases of parenchymatous inflammation of the kidney. I shall 
not show you any typical cases of the so-called interstitial nephritis, 
or contracted kidney. While the pathologists leave us somewhat in 
confusion as to a definite classification of the various forms of 
nephritis, clinically, we recognize three forms, acute nephritis, 
chronic parenchymatous nephritis and chronic interstitial nephritis. 

CASE NO. 1 (Acute Parenchymatous Nephritis). — The man is 
an American by birth, a painter by occupation. He is thirty-seven 
years of age. Has not used alcohol to excess. He enjoyed good 
health up to four weeks ago, when he thought he took cold. He 
developed a cough, became a little hoarse, suffered from some lassi- 
tude, became sleepy and drowsy. There was derangement of appe- 
tite, but no nausea. He noticed that his feet and legs were swelling. 
He became somewhat pallid. A few days later his face was puffy and 
his hands also. Soon all parts of the body were swollen. He evi- 
dently had Universal GEdema. He did not notice any changes in the 
urine. Since his entry to the hospital, four days ago, he has not 
had any temperature beyond 99.2 degrees F. He complains to-day 
somewhat of headache. Last night he slept poorly on account of 
headache. There has been a little vomiting, but no diarrhoea. 

This is a very short history and would attract little attention in 
many people, but for the fact of the oedema. 

You notice he is pallid. His hands, face and mucous mem- 



Reported by C. C. Cummings, '97. 

141 



142 Medical Clinic: Nephritis: Herrick. 

branes show evidences of anaemia. There is a puffiness of the face, 
which has a pasty appearance. His tongue is moist and but slightly 
coated. Much of the oedema, as of the scrotum, has disappeared. 
There is a little pitting on pressure over the tibia. Exami- 
nation of the pulse shows it to be beating just now about ioo to the 
minute, which is more rapid than it has been. This is perhaps caused 
by a little nervous excitement. I notice the pulse is of moderately 
high tension. It is a litte harder than usual, but the blood vessel is 
not thickened. There is no arterio-sclerosis here. The heart by 
percussion does not show any increase in the cardiac area. On aus- 
cultation, I find a faint systolic murmur, best heard over the pul- 
monary artery, but also heard over the mitral area; this is without 
exaggeration of the second sound, without cardiac enlargement, and 
is therefore a so-called anaemic or functional murmur. There is a 
little exaggeration of the aortic second sound. This conforms with 
what we found in the pulse, namely, a little increase in systemic ar- 
terial tension. 

Examining the urine we find the specific gravity 1026. It is 
acid in reaction and contains a large amount of albumin. I made an 
examination a few 7 moments ago and show you this reaction for albu- 
min — the nitric acid test. Under the miscroscope you can see, as you 
pass down, an abundance of hyaline, epithelial, granular and blood 
casts, with numerous loose corpuscles and renal epithelial cells. 

This case I take to be one of Acute Nephritis. We do not see 
him at the stage when we get the suppression of urine; nor do we see 
him at the stage when there is a large amount of blood in the urine. 
Had we had the privilege of examining the patient four weeks ago we 
should have found the urine turbid, perhaps smoky, or even a reddish 
color from the blood it contained. Even to-day there is an abundance 
of blood cells in the urine and blood casts are present. 

These cases of acute nephritis arise from various causes, among 
which is exposure to cold, which seems to be the cause in this case. 
The acute infectious diseases, as scarlet fever, pneumonia, diphtheria, 
can produce acute parenchymatous nephritis. Drugs, as turpentine 
and carbolic acid, may also produce a nephritis of this nature. It 
may occur during pregnancy, and it also occurs, so it is said, in con- 
nection with certain skin diseases. A recent observer in Germany 
has reported that in the examination of several children he believed 
he could trace a distinct connection between eczema and acute 
nephritis. 

The diagnosis of a typical case presents little or no difficulty, 
provided we examine the urine. Subjective symptoms may be head- 
ache, gastro-intestinal disturbances (such as vomiting or diarrhoea), 



Medical Clinic: Nephritis: Her rick. L43 

no chill, slight elevation of temperature, lassitude, malaise. Fever is 
commonly absent in adults. (Edema is usually present, particu- 
larly in scarlatinal nephritis. Cases of acute nephritis may run a 
course, even to a fatal issue, without the presence of oedema. The 
oedema in acute nephritis is a little peculiar in that it frequently 
changes its location, as, to the legs in the day and to the face in the 
morning. Chronic parenchymatous nephritis presents in general a 
more diffuse and permanent oedema. Changes in the circulatory 
system, which you are taught furnish most valuable evidence, are 
not pronounced in acute nephritis. There is not time for the heart to 
hypertrophy. There is, however, an increase in tension indicated 
by the second sound of the heart. Some cases rapidly develop car- 
diac hypertrophy. This is not present in this case. 

Uraemia may or may not be pronounced. Convulsions and 
coma may come on early or late. The headache that is complained 
of by this patient, and that has kept him awake, as well as the vomit- 
ing, may justly be attributed to uraemic poisoning.* 

CASE NO. 2 (Chronic Parenchymatous Nephritis). — Patient: 
Male, thirty-two years old. Good family history. He is a teamster 
by occupation. Denies syphilitic infection and excessive use of alco- 
hol. He had rheumatism one year ago. He felt reasonably well up 
to two weeks ago, when his face and feet began to swell. He was not 
very sick, but quit work at this time because he felt weak. There 
was headache, which came on him three weeks ago. He had also 
some pain in the loins and some difficulty in breathing. Closer ques- 
tioning brings out the fact that there has been a little shortness of 
breath for three or four months. He could not see much change in 
his appetite. He has noticed that he was a little weaker than visual 
for three months; has felt tired on slight exertion. Every day or two 
he would suffer from headache. 

Now, he probably had nephritis of a chronic or subacute charac- 
ter for three or four months before the acute swelling of the face and 
extremities. He is pallid; lips show anaemia. There is moderate 
oedema present now, though when he entered the hospital there was 
well marked oedema of the lower extremities, face, hands and 
scrotum. Pulse slow and of a moderately high tension. I can make 
out a slight increase in the cardiac area to the left, and upon ausculta- 
tion I get an exaggerated first sound, with a slight murmur and 
trifling changes in the pulmonic and aortic second sound. 

Urine: Specific gravity 1022; acid; large amount of albumin. 

* The morning after the clinic, after another sleepless night, with unabated head- 
ache, the patient had a severe uraemic convulsion. No other has developed up to the 
time of revising these notes, January 4, 1897. 



144 Medical Clinic: Nephritis: Herrick. 

Two of your number have examined the urine from this case 
microscopically and report that they have no trouble in finding very 
many casts. These they describe correctly as hyaline, granular, with 
many casts having- oil globules upon them. Blood corpuscles are 
rare. No sedimentation of the urine was necessary. A drop taken 
from the bottom of the bottle, that has been standing for a few min- 
utes only, has revealed these casts in great abundance. This is, you 
understand, in striking contrast to the number of casts in chronic in- 
terstitial nephritis. 

This case I regard as Chronic Parenchymatous Nephritis. To 
draw a line between some cases of acute nephritis and chronic paren- 
chymatous nephritis is very difficult. We find, too, that occasionally 
cases of chronic parenchymatous nephritis pass very gradually into 
the condition known clinically as chronic interstitial nephritis; in 
other words, secondary contracted kidney. This case appears to be 
on the dividing line between the acute and the chronic parenchyma- 
tous nephritis. 

CASE NO. 3 (Exacerbation of Chronic Interstitial Nephritis). — 
This case illustrates again a point I wish to impress by this array 
of cases, viz., that of the mixture or the association of the various 
forms of nephritis. 

This man has been sick for about one and one-half years. He 
has gone through several attacks of general oedema, 
dyspnoea, anaemia and gastro-intestinal disturbances; has had nearly 
complete blindness on two occasions. This blindness has now im- 
proved, but he still has well-marked albuminuric retinitis. About 
the macula, particularly, can be seen, running off in radiating lines, 
clear, glistening patches characteristic of albuminuric retinitis. 

The history lasts about one and one-half years, and yet, if we were 
to see the patient in one of his attacks, with oedema, dyspnoea, head- 
ache, gastro-intestinal disturbances, urine rich in albumin and casts, 
we might call the case one of acute nephritis, when really it is but an 
acute process engrafted upon an old chronic process. There is dis- 
tinct hypertrophy of the left heart, as I demonstrate to you by 
percussion. The apex beat, far to the left, is quite forcible and heav- 
ing; the aortic second tone is very distinctly exaggerated. These 
findings in the heart are borne out by the pulse, which I find is 
of high tension, but still rather small. 

Length of history; decided change in the heart; left ventricular 
hypertrophy; increase in tension; albuminuric retinitis; increased 
amount of urine; the knowledge gained from observation of the case 
for several weeks that there are times when the albumin is but a trace, 
and the number of casts very small, make a case of Chronic Nephritis 



Medical Clinic: Nephritis: Her rick. 145 

— probably of the interstitial or the diffuse variety, but with acute ex- 
acerbations. 

Sometimes a definite cause can be found for the exacerbation 
— typhoid fever, for instance, would in all probability cause a chronic 
nephritis to take on an acute process, or any other of the infectious 
diseases might cause acute symptoms. So, too, could alcohol or 
exposure to cold. 

CASE NO. 4 (Chronic Parenchymatous Nephritis — Miliary 
Tuberculosis). 

The history in this case is a little indefinite. Patient is thirty- 
eight years of age, a machinist by occupation. Seven or eight 
months ago he noticed his face and feet were a little swollen. He 
did not quit work, as he did not feel sick at the time. He has had 
asthma for twenty years, more or less. He has had decided dysp- 
noea for three months. Eleven weeks ago he noticed that his face 
was swollen in the morning and his feet at night. Then the swell- 
ing became more marked over the upper parts of the body, includ- 
ing the scrotum, abdomen and back. He had more or less pain in 
the back and there were dyspncea and cough. He entered the hos- 
pital November 16, 1896. He has had slight elevation of tempera- 
ture since that time, ranging between 98 and 102J degrees F. Pulse 
persistently rather rapid. Numerous rales over the chest were found 
at almost every examination. No appreciable dullness. There has 
constantly been present in the urine large amounts of albumin, hya- 
line, epithelial and granular and oily casts. 

The patient's general oedema has partly disappeared, but he still 
retains some oedema of the scrotum, back and legs. The abdomen is 
very prominent, and there is no trouble in eliciting the ordinary phy- 
sical signs of ascites, — resonance above, flatness below, fluctuation, 
bulging of the flanks and with change in position change in the line 
of flatness. There is dyspnoea and he breathes a good deal as an 
emphysematous patient breathes, but more rapidly; the muscles of the 
neck do not stand out, yet there is distinct retraction of the lower 
intercostal spaces. He is somewhat cyanotic. Percussion over 
the chest shows a tympanitic note and resonance, where we should 
ordinarily expect to find dullness. Thus we cannot easily outline 
cardiac dullness here, and it has seemed to me on examination that 
there was hyper-resonance and a little diminution in the cardiac 
area, perhaps due to the spreading of the lung over the heart. This 
could be due to true emphysema, which occurs so frequently with 
asthma, which he has had for twenty years. It might be a compen- 
satory emphysema, because the fluid has pushed up on the diaphragm 
and every inch of air space is now put to the best use, forcing the 



146 Medical Clinic: Nephritis: Herrick. 

vesicles to be distended. Or in the same manner a destruction of a 
portion of the pulmonary tissue would result in compensatory em- 
physema of the remaining vesicles, as occurs in pneumonia and tuber- 
culosis. 

Diagnosis: Chronic Nephritis, as shown by the universal 
oedema and the urinary findings. But there is something more in 
the patient's case besides nephritis, but just what this is is difficult 
to tell without first aspirating the abdomen. We shall do this for 
the sake of diagnosis, so as to make better palpation of the liver and 
other abdominal organs, and also to remove the element of pressure 
as a cause of the cyanosis and dyspnoea. Besides, it is indicated 
therapeutically. We can test the fluid obtained, for specific gravity 
and richness in albumin, and determine whether it is purely a transu- 
date occurring in the course of the nephritis, or whether an inflam- 
matory process is going on in the peritoneum. 

The little operation of paracentesis needs no words of explana- 
tion. The principal thing is to be sure there is fluid present. A 
distended bladder, solid tumors and intestines filled with fluid, have 
all been aspirated by mistake. The operation should be made in the 
median line, midway between the umbilicus and the symphysis pubis. 
The patient should be placed in such a position that the fluid will 
occupy the lower part of the abdomen. Paracentesis can be made, 
however, in the flanks. There is practically little danger of infecting 
the abdominal cavity. The trocar, in passing through the abdomi- 
nal wall, has any uncleanness wiped off by the skin, and the moment 
the trocar enters, the fluid rushing out washes out all the septic ma- 
terial. But we should always, as here, disinfect skin, hands, instru- 
ments, as for a surgical operation. How much fluid should 
be withdrawn? It is very rare you see a case of ascites from which 
you cannot withdraw all the fluid that will run. This is very different 
from tapping the chest of a patient for pleurisy with effusion. There 
you have to observe the rule to stop when severe pain, syncope or 
cough occur. In examining the fluid obtained we should note 
specific gravity and make rough quantitative estimate of the albumin. 
It may be necessary to examine microscopically and bacteriologic- 
ally. 

In inflammation there will be a high specific gravity and richness 
in albumin. In a simple transudate, the specific gravity will be low — 
under ioio or 1012, and the fluid comparatively poor in albumin. 
If we suspect tuberculosis we can examine for the tubercle bacilli by 
microscope, culture or, best of all, inoculation of animals. If a 
milky chylous fluid be present, we likely have an obstruction in the 
lymphatic channels. The fluid may have a chylous appearance, the 



Medical Clinic: Nephritis: Her rick. 117 

result of broken down cellular elements, as in tubercular peritonitis. 
Bloody fluid speaks in favor of carcinomatous and tubercular effusion 
of the peritoneum. 

You notice that the fluid is very clear and pale at first, but as the 
quantity increases it assumes a faintly milky appearance, suggesting a 
slight degree of chylous or chyliform ascites; specific gravity is 1009. 
A specific gravity below 1012 or 1014 is usually regarded as charac- 
teristic of a transudate. 

As the hour is up I will defer the further examination, and will 
show the patient at the next clinic, when we shall try to solve the 
problem as to what other ailment besides nephritis is present, to ac- 
count for the dyspnoea, rapid respiration, cyanosis and temperature.* 



* This was shown post-mortem (Dr. Hektoen) to be miliary tuberculosis, with 
diffuse pulmonary infiltration, and tubercular peritonitis. Large white kidney was 
found, corresponding, therefore, with the urinary finding. The peritoneal fluid was 
a mixture of a transudate (nephritis) and a chyliform exudate (tubercular peritonitis). 
There was little if any relief to the dyspncea following the tapping. The temperature 
continued. The abdomen refilled quite rapidly. The patient died about five days 
after the paracentesis. 



METHODICAL DIAGNOSIS IN DISEASES OF THE SKIN. 

BY FRANK H. MONTGOMERY, M. D. 

A definite method and the habit of thinking are two essentials to 
good work that save their possessor an immense amount of time and 
energy and enable him to obtain the best results in everything he un- 
dertakes. 

Such habits are of special importance to the medical student 
who usually has a limited time to devote to a large number of sub- 
jects, and who is in consequence tempted merely to cram into his 
memory what he thinks will serve his immediate purpose in the com- 
ing recitation or examination. The cramming* habit, it is needless 
to say, it a most pernicious one, which weakens and destroys the 
power for good mental work, and which in the end fails in the pur- 
pose for which it was cultivated. For the teacher who requires more 
from his students than a mere repetition of the statements of the 
text-book, it is not difficult to discover the thinkers in his class. 
In preparing a lesson of ten, fifteen, or twenty pages in an ordinary 
medical text-book, the man who thinks and employs method in his 
work will select and give most time to the important points, about 
which he will group the minor ones. He will consider conditions 
and facts in reference to their relative importance, their relations or 
interdependence, determining which are causes and which are results, 
which are primary and which secondary, which are essential and con- 
stant, and which are minor, accidental, or unimportant. He will 
thus obtain a true perception or a clear mental picture of the subject 
of his study that he can retain easily, and, further, he has not only 
added to his stock of knowledge, but also has increased his mental 
strength and capacity. Such thoughtful reading requires time until 
the habit is well acquired, but the student who by persistent effort has 
obtained possession of this habit will read easily and with permanent 
profit twenty pages, while his unthinking and undiseriminating fel- 
low who gives an equal amount of time to each line will read five or 
ten pages with no lasting benefit. 

One of the greatest aids to rapid and intelligent reading — or 
work of any kind — is a definite object for which one is searching or 
toward which one is working. One may walk down a business street 
with the intention of seeing all there is to be seen without noticing 
several banks or other offices which he could easily have located 

148 



Methodical Diagnosis in Diseases of the Shin: Montgomery. 149 

accurately had he started out with that purpose. Similarly, in read- 
ing a lesson or in examining a patient, in doing new work of any 
kind to know what to look for is of the greatest aid. 

The following outline is presented with the view of giving the 
student or practitioner something definite to look for in his reading 
of dermatology and in his examination of patients with skin diseases. 
It is put in the form of a methodical examination of a patient, as in 
this form it will probably be of most value to both student and prac- 
titioner. In preparing such an outline, the question at once arises: 
How full shall it be and how much detail shall it include? If too 
brief, it probably will not be understood by many and will be insuffi- 
cient for many unusual cases. On the other hand, if too long and 
complicated, few will have the courage or patience to try to use it. 
An endeavor has been made to present an outline with sufficient de- 
tails so that a careful investigation of all the questions suggested in 
it should furnish material for a correct diagnosis in all but ex- 
ceptional cases. In making this attempt much has been introduced, 
especially under the head of history, that is unessential in the average 
case, but if the outline serves its purpose and encourages the habit 
of thinking on the part of the student, the details of value in each 
case will be readily recognized and made use of without wasting time 
on the rest. 

The second division of the outline devoted to the consideration 
of the objective symptoms can be used to advantage in almost every 
case of skin disease, and if intelligently applied will give information 
sufficient for a diagnosis in the majority of cases. If in reading the 
description of a skin disease the student will look for answers to the 
questions suggested in this section, he will in most instances pre- 
pare himself with the important points in diagnosis. 

The first attempts to follow such a scheme as the one presented, 
either in reading or in the examination of a patient, are necessarily 
slow and therefore often discouraging, but one patient thus carefully 
examined, or one chapter thus carefully read, is of greater educational 
value than an aimless and indefinite examination of a dozen patients 
or a similar reading of as many chapters, and the student who is in- 
clined to be discouraged after his first effort may be once more re- 
minded that methodical work is the most rapid in the end. 

Before the student can do intelligent work in the study of der- 
matology, he must have a definite and exact knowledge of the pri- 
mary and consecutive lesions of the skin. He must not only know 
the definition of the words macule, papule, vesicle, etc., but he must 
be able to recognize each when he sees it. Further than this, he 
should be so familiar with these lesions that when he reads the 



350 Methodical Diagnosis in Diseases of the Skin: Montgomery. 

description, for example, of a group of papules, of a certain size, shape 
and color, he will be able to form a definite mental picture of the con- 
dition described. To obtain a clear idea of the elementary lesions, 
the student must first know and understand the definitions as given 
in his text-books, and then familiarize himself with the lesions them- 
selves as they appear in the patients, or in plates. In the first few 
cases he examines he should study individual lesions rather than 
the particular disease in which they occur. It is in failing to thus 
analyze an eruption on the skin that most students make mistakes, 
for it is a much easier mental process to simply view the eruption as 
a whole, and to associate the general impression thus acquired with 
some name, than it is to make the more minute and careful examina- 
tion. By attending clinics the student can get a good idea of the 
general appearance of most types of skin diseases, but his opportu- 
nities for more minute examination are less frequent and should 
never be neglected. 

To illustrate the necessity for such minute study reference may 
be made, for example, to lichen planus, which appears in a number 
of clinical forms, some of which are so pronounced in character that 
anyone after seeing a number of cases should be able to make a 
diagnosis in a case presenting the same general features of cases 
already seen, though he is not prepared to recognize the disease 
when it appears in some unfamiliar form. To see many cases in this 
easy and indefinite manner, is the easy way to study dermatology, 
and is a most tempting method, particularly where material is 
abundant. On the other hand, one case of lichen planus carefully 
studied and analyzed teaches the student that the essential lesion 
in this disease is a papule of peculiar shape, size, color and character, 
and that the papules occur in characteristic groups. This knowledge 
enables him to recognize the disease, not only when he again en- 
counters it in the general form in which he has once seen it, but also 
when its general features are wholly different from those of his first 
case. These remarks regarding the study of lichen planus apply 
equally well to the study of most cutaneous affections. It is difficult 
for the beginner to understand that a few cases, exhaustively studied, 
are worth far more to him. than many cases hastily examined. 

To read dermatology intelligently, the student must not only 
know thoroughly the elementary and consecutive lesions of the 
skin, but he should be familiar with the terms commonly employed 
in describing their special features, methods of grouping, etc. For 
this purpose he should read carefully, in some good text-book, the 
chapters devoted to diagnosis and general symptoms. Those who 
have carefully studied such chapters will find little that is new in 



Methodical Diagnosis in Diseases of the Skin: Montgomery. 151 

the explanatory paragraphs following the outline, as this matter is 
added merely to illustrate the working of the outline, and is neces- 
sarily limited in amount and incomplete. 



I. 
II. 

Ill 



IV. 
V. 

VI. 



VII. 
VIII. 



IX. 



THE PATIENTS HISTORY. 
Age. 
Sex. 

Married or unmarried. 
i. Children. 

a. Living. 

b. Dead. 

2. Abortions or Miscarriages. 
Family history. 

Individual history, including that of previous skin diseases. 
Occupation. 

i. Active or Sedentary. 
Habits, of eating, drinking, bathing, tobacco using, etc. 
Present state of health. 

Note the condition of the digestive, respiratory, circulatory, geni to-urinary 
and nervous systems. 
History of present skin disease. 



B. 



Cause — if known. 
Appearance at first. 
Sites affected in order. 
Mode of extension. 
Manner of progressing. 

a. Slow or rapid. 

b. Steady or irregular 

c. With exacerbations and remissions. 

d. With periods of entire freedom from symptoms. 
Changes in character. 

Subjective sensations. 

Duration. 

Effect of temperature and seasons. 

Treatment up to date. 



OBJECTIVE SYMPTOMS. 

Accidental Complications due to 

scratching, treatment, etc. 
Site. 

i. Universal. 

2. Generalized. 

3. Diffuse. 



4. Local. {Note influence of clothing, 
occupation, etc.) 

C. Symmetry, or asymmetry. 

D. Acuteness, or chronicity. 

E. Moisture, or absence of. 

F. Lesions. 

1. Elementary {macule, papule, wheal, 

tubercle, tumor, vesicle, pustule, 
or bleb), 

2. Consecutive {scale, crust, excoria- 

tion, fissure, ulcer, or scar.) 

I. Uniformity, or multiformity. 



II. Arrangement. 

1. Isolated. 

2. Grouped. 

3. Discrete. 

4. Coalescing. 

5. Irregular. 



III. Definition. {Sharp, fair, poor, or 

none.) 

IV. Elevation, or depression. 

V. Color. 

1. Under pressure. 

VI. Size. 

1. Superficial. 

2, Deep. 



VII. Shape. 



Apex. 
Base. 



152 Methodical Diagnosis in Diseases of the Skin: Montgomery. 



VIII. 


Consistence. 


XII. Career. 




i. Firm. 


1. Transitory, 




2. Soft. 


2. Persistent. 

3. Type. 


IX. 


Anatomical site. 


a. Simple. 


X. 


Base. 


b. Changing 

c. Modified. 




i. Color. 


XIII. Involution. 




2. Infiltration. 


1. Resorption. 


XI. 


Evolution. 


2. Exfoliation. 




i. From sound skin. 


3. Ulceration. 




2. From other lesions. 


4. Atrophy, etc. 
XIV. Sequelae. 

1. Stains. 

2. Scars. 




SPECIAL FEATURES OF CERTAIN LESIONS, 


A. Vesicles, Pustules, or Blebs. 


V. Attachment. 


I. 


Roof. 


VI. Thickness. 




i. Tense. 


VII. Consistence. 




2. Flaccid. 






3. Easily ruptured. 


VIII. Surface beneath. 


II. 


Contents. 






1. Serous. 


D. Excoriations. 




2. Purulent. 


I. Distribution. 




3. Hemorrhagic. 


II. Shape. 


III. 


Surface beneath. 


III. Arrangement. 


IV. 


Areola. 


IV. Relation to other le 


V. 


Involution. 

1. Desiccation. 


V. Exudation. 




2. Rupture. 


E. Fissures. 




3. Crusts. 




B. Scales. 


I. Distribution. 


I. 


Size. 


II. Size. 


II. 


Color. 


1. Length. 


III. 


Quantity. 


2. Depth. 


IV. 


Consistence. 


III. Pain. 




1. Dry. 


IV. Moisture. 




a. Fatty. 






3. Friable. 






4. Tough. 


F. Ulcers. 


V. 


Attachment. 


I. Size. 


VI. 


1. Firm. 

2. Slight. 
Surface beneath. 


II. Shape. 
III. Depth. 




1. Color. 


IV. Base. 




2. Dry. 


1. Soft. 




3. Greasy. 


2. Infiltrated. 




4. Hemorrhagic. 


3. Indurated. 


C. Crusts. 


V. Floor. 


I. 


Size. 


1. Smooth. 


II. 


Shape. 


2. Uneven. 

3. Clean. 


III. 


Color. 


4. Pus covered. 


IV. 


Composition. 


5. Granular. 




1. Serum. 


6. Sloughing. 




2. Pus. 


7. Hemorrhagic. 




3. Blood. 


8. Glazed. 



Methodical Diagnosis in Diseases of the Skin: Montgomery. 153 



VI. 


Edges. 








G. Scars. 




I. Sloping. 








I. 


Size. 




2. Perpendicular. 














3. Punched. 








II. 


Shape. 




4. Ragged. 








Ill 


Color. 




5. Everted. 














6. Undermined. 








IV. 


Depression, or elevation. 




7. Soft. 








V. r 


texture. 




8. Indurated. 










1. Soft, pliable. 


VII. 


Secretion. 

1. Scanty. 

2. Profuse. 

3. Serous. 

4. Purulent. 

5. Hemorrhagic. 

6. Odor. 








VI. 


2. Hard, indurated. 

3. Thin. 

4. Thick. 

5. Smooth. 

6. Rough, corded . 

Attachment. 


VIII. 


Pain. 








VII. 


Deformity. 


IX. 


Crust. 








VIII. 


Subjective sensation. 


X. 


Evolution. 








IX. 


Absence or presence of 


XI. 


Duration. 










glands and papilla?. 


XII. 


Involution. 














Note carefully the 1 


lumber 


and lo- 








cation of ulcers, 


the age 


of 


the 








patient, and the character 


of 








scars if present. 













hairs , 



I. Consideration of the age of a patient is often of value in 
determining the diagnosis; thus lupus vulgaris usually begins in 
early life, syphilis in early adult life, while carcinoma is unusual be- 
fore the forty-fifth year. Acne vulgaris appears at the age of puberty, 
but rosacea usually first manifests itself after the thirty-fifth year. 
In the delicate skins of children inflammatory processes are more 
acute and appear more frequently in the moist forms than in the skins 
of adults. 

II. Most cutaneous diseases affect the sexes alike, though there 
are some noted exceptions to the rule, as rosacea and lupus erythema- 
tosus, which are found most frequently in women, and the alopecias 
(except alopecia areata), which are unusual in women, but common 
in men. 

Ill and IV. In married people a history of contagion or in- 
fection is usually obtained when such has occurred. The family his- 
tory is often of value in cases of tuberculosis, scrofula, syphilis, neu- 
rotic affections, malformations (as ichthyosis) and some rare diseases. 
Just what part heredity plays in the etiology of cutaneous affections 
is not known, but it is probable that few — aside from syphilis — can 
be inherited directly. The history of a series of abortions, miscar- 
riages or still births should always suggest syphilis. In women 
suffering from late manifestations of this disease it frequently happens 
that no other specific history is obtainable. 

V. A history of the previous illnesses of the patient may be of 



154 Methodical Diagnosis in Diseases of the Skin: Montgomery. 

value in excluding- diseases such as zoster, syphilis and the exanthe- 
mata, from which an individual suffers but once in a lifetime, or it 
may give a knowledge of previous attacks or of other stages of an 
eruption under observation. 

VI and VII. The occupation and habits of an individual are 
usually of importance, chiefly as they affect the functional activities 
of the various organs of the body. Those who lead sedentary lives 
are much more liable to acne, rosacea, some forms of eczema, and 
to reflex phenomena due to impaired digestion. Certain occupa- 
tions, however, expose the individual to external influences which 
excite in the skin various types of erythema, dermatitis or eczema. 
Thus sailors, policemen and others much exposed to wind and 
weather are specially subject to erythematous eczema and rosacea 
of the face. Workers in chemicals, dye-stuffs, or other irritating 
materials, as well as washer-women, bartenders and others whose 
hands are often in water and, while still wet, exposed to the wind 
or the cold, are frequently sufferers from both acute and chronic 
forms of dermatitis, usually known as the trade eczemas. When 
certain lesions persist in unusual places, or in spite of treatment that 
is usually successful, careful questioning may disclose some habit or 
frequently repeated act of the patient that is responsible for the 
entire trouble. An excellent illustration of the many mistakes made 
in this direction is furnished by a man who had been under treat- 
ment much of the time for several years by three or four physicians, 
for a small patch of chronic dermatitis on the back of his thumb. 
The condition would improve for a time under some of the treatment, 
but refused to get well. None of these physicians had discovered the 
fact that the man used a pair of shears, for several hours each day, in 
cutting newspaper clippings. The simple substitution of the knife 
for the shears secured a prompt disappearance of the lesion. It is in 
the atypical, irregularly behaving and puzzling eruptions that an in- 
vestigation into the patient's habits and occupation will most fre- 
quently furnish valuable information. 

VIII. Many skin diseases are found in individuals who are 
otherwise in apparently excellent health. In many other instances, 
in which the individual is also the subject of a systemic affection, the 
latter seemingly has no direct relation to the skin phenomena, except 
as it influences the nutrition of the skin and possibly lessens the lat- 
ter's powers of resistance or of recuperation. However, in a very 
large number of cases, the skin lesions are mere manifestations of a 
general systemic disease, are secondary to disorders of other or- 
gans, or are in part dependent on other affections present. In this 
last class of cases the skill of the general diagnostician must be called 



Methodical Diagnosis in Diseases of the Skin: Montgomery. 155 

into play. A simple urticaria may be due to some article of food or 
other substance taken into the stomach, or to some mental or moral 
disturbance. Chronic and persistent urticaria may be one symptom of 
deep-seated disease in one of several organs, as the kidneys, the brain 
or the spinal cord. Derangement of the nervous system may give 
rise to a large variety of disorders of the skin, such as herpes, pruritus, 
erythema, eczema, pemphigus, dermatitis herpetiformis, etc. Dis- 
orders of other organs of the body are not infrequently accompanied 
by cutaneous manifestations. When the cutaneous symptoms are 
secondary to other disorders, of course it is the primary trouble that 
must be sought for and removed. 

IX. A history of the skin disease under examination should 
be secured briefly, and in detail when necessary to make a diagnosis, 
due allowance always being made for inaccurate and misleading state- 
ments of the prejudiced or ignorant. The cause of an acute dermati- 
tis due to ivy poisoning, to an antiseptic dressing of a cut, or to other 
external influences, can often be determined from the statements of 
the patient. 

Frequently an exanthem is greatly modified by treatment or 
by other accidental influences, and the exact nature of the original 
disorder can be determined only by later examinations, or from the 
statements of an intelligent patient. 

The order in which different surfaces of the body are affected is 
often of aid in the diagnosis. Thus an acute dermatitis affecting 
consecutively the hands, face and genitals in men, or the hands, face 
and breast in women, is almost invariably due to an external irri- 
tant (for example poison ivy) with which the hands have come in 
contact. Certain cutaneous affections usually appear first on certain 
regions, from which the lesions extend to other portions of the body, 
as in eczema seborrho'icum, which almost invariably affects the scalp 
for some time before extending to other parts. An exanthem that 
from the beginning is symmetrically disposed over a considerable 
portion of the body usually has an internal origin. 

The secondary involvement of larger areas occurs in various 
ways. The adjacent surfaces may be involved by peripheral exten- 
sion, with or without coincident involution and clearing of the center, 
or the exanthem may appear on parts distant from its original site 
without involving the intervening surface. An area may enlarge by 
the increase in size of the original lesion, or new lesions may form 
about the borders of the patch and later unite with it. 

The character and type of lesion remains the same throughout 
the entire course of some diseases, and any change in type at once 
indicates some accidental complication (often due to treatment). In 
other diseases more or less frequent change in type is the rule. 



156 Methodical Diagnosis in Diseases of the Skin: Montgomery. 

The subjective sensations caused by cutaneous diseases are those 
of itching, burning - , stinging, pricking and formication. There may 
be hyperesthesia or anesthesia. Itching is the most frequent of these 
symptoms, but varies greatly in intensity in different diseases, and in 
different stages and grades of the same disease. It is usually most 
severe in the chronic, dry inflammatory disorders, such as the papular 
and squamous eczemas. 

The influence of temperature and of seasons on many of tlie 
inflammatory affections of the skin is very marked. Most cases of 
psoriasis and chronic eczema are worse in winter and better in sum- 
mer, though the reverse is sometimes true. Simple pruritus, as well 
as the itching, present in many disorders, is greatly aggravated by 
sudden changes in temperature. 

In many cases presenting atypical and complicated lesions, a 
history of previous treatment will confirm the examiner's suspicions 
that a medicamentous exanthem of some sort has been added to the 
original disorder, or possibly that all the cutaneous phenomena are 
due to treatment. 

[To be continued.] 



MALARIA.* 

BY ELLSWORTH D. WHITING, A. B. 
(The L. C. P. Freer Prize Essay, Rush Medical College, 1896.J 

As the tertian organism has been previously described, a descrip- 
tion of the quartan will be given by comparing and contrasting the 
latter with the former. 

In the hyalin forms these types cannot be differentiated, though 
the quartan is more refractive and more sluggish in its movements. 
These appear during and after the paroxysm, as in the tertian. 

As the organism grows and pigment develops, marked differ- 
ences are seen. In the quartan the pigment granules are exceedingly 
large and few in number. They are of a brown, almost black, color 
and possessed of a slow motion. In fact, the movement of the 
organism as a whole is much slower than that of the tertian parasite 
as shown by the length of time required in changing its shape. 

As the parasite continues to grow the condition of the enclosing 
corpuscle differs greatly from that seen in the case of the tertian 
organism. Instead of becoming swollen the corpuscle either re- 
mains of a normal size or slightly shrinks and instead of becoming 
decolorized takes on, in some instances, a deeper color or a greenish 
yellow or brassy hue. The difference in degree of refractive power 
is more noticeable as the organism increases in size. 

The quartan parasite reaches its full development in about sixty- 
four hours or eight hours before segmentation. It is then round, 
slightly smaller than the corpuscle, and contains a few granules of 
pigment, arranged in the periphery of the organism. There is but 
a thin layer of the body of the corpuscle apparent, which may be 
overlooked on a casual examination. 

A short time after the organism has attained the adult form, the 
pigment becomes motionless and signs of segmentation appear. 
The manner of segmentation may be similar to that described in the 
case of the tertian organism. In the segmentation of the quartan 
organism the rosette forms of Golgi are more often observed. The 
pigment granules form in a block-like mass in the center of the organ- 
ism while radiating fibrils of differentiated protoplasm run from the 
center to the periphery, dividing the parasite into from eight to twelve 
segments. The segments acquire nuclei and constitute the spores. 



* Continued from December number. 

157 



158 Malaria: Whiting. 

In the case in question many extra-corpuscular forms were pres- 
ent. These were probably degenerate bodies. They were granular, 
at times crystalline, exceedingly irregular in shape, and contained 
blocks of pigment, and were often filled with vacuoles. 

The flagellate forms found in quartan fever show similar charac- 
teristics as those in the tertian and estivo-autumnal types with the 
exception of greater sluggishness of movement. 

Fragmentation was observed in this case. A pseudopodium was 
observed to be thrust out from the parasite, filled with slowly rotating 
pigment. Gradually this portion of the organism was cut away, when 
it assumed a spherical form, the pigment continuing its motion and 
seeking the periphery. 

In quartan ague the length of the life cycle is seventy-two hours, 
and the paroxysms generally appear every fourth day. This rule 
is not without exceptions, as the paroxysms may be caused by differ- 
ent groups of parasites having the same abode, but segmenting at 
different times. When two groups segment on successive days there 
is produced paroxysms for two successive days with one day of 
apyrexia. This is termed double quartan fever. When three groups 
segment on successive days, a quotidian invasion results which is 
called "triple" quartan fever. This may be easily mistaken for the 
ordinary quotidian type when viewed purely from a clinical stand- 
point. 

In his study of the organism of estivo-autumnal fever the writer 
has been fortunate in procuring specimens from a patient suffering 
from this disease in Cook County Hospital. The following history 
was obtained from the records of the hospital : 

Charlie F., aged 15 years, born in Chicago, where he has lived 
all his life. School boy, admitted September 30, 1895. Family his- 
tory negative. Personal history — does not drink, smokes many 
cigarettes. Previous history — malaria, no venereal disease. Pres- 
ent history — has been sick three days. Had a chill, headache and 
diarrhoea with anorexia and pain in abdomen. 

Physical examination — 1. Body — well developed. 2. Skin — 
face flushed. 3. Eyes and ears — normal. 4. Tongue — dry and 
coated. 5. Thorax — lungs, resonance imperfect over right lung 
posteriorly; no rales. Heart — rapid, second beat accentuated, no 
murmurs. 5. Abdomen — walls rigid, very slight tympany; pain 
in left iliac region and both hypochondriacal zones ; is covered with 
brawny, mascular eruption; no rose spots. Spleen — not palpable. 
Liver — normal. 6. Limbs — negative. 7. Reflexes — normal. 8. 
Glands — axillary enlarged. 9. Genitalia — negative. 10. Urine — 
negative. 



Malaria: Whiting. 159 

Estivo-autumnal ague is exceedingly rare in this portion of the 
United States, there having been but a few cases in Cook County 
Hospital in many years. 

In this case under observation but few of the hyalin forms could 
be demonstrated. These forms, however, are more refractive and 
smaller than those found in the tertiary and quartan forms. They 
possess ameboid movements and assume at times a peculiar character- 
istic ring-like shape. This appearance is probably caused by the 
thinning out of the central portion of the organism, the corpuscle 
showing through. Then again, the parasites appear to have con- 
tracted into spheres. The shading disappears from the center, ap- 
pearing at the periphery. In other respects they closely resemble 
the tertian and quartan types, except that they are not as active as 
the tertian, but more so than the quartan. 

As the organisms increase in size minute granules of pigment 
appear in the periphery. These granules are few in number and slug- 
gish in movement. In some instances pigment does not appear dur- 
ing the course of the development of the organism. This type is 
characterized by its small size, even in the adult stage. In this stage 
it rarely is more than one-half the size of the containing red cor- 
puscle, which remains normal in size and often changes to the brassy 
hue observed in quartan fever. The corpuscle eventually becomes 
crenated and ruptures, setting free the organism. Segmentation 
may consist in an irregular breaking up of the organism into from 
ten to twenty segments, similar to that described as taking place in 
the tertian organism, or the pigment may collect in the center, the 
process occurring after the formation of the marguerite forms of 
Golgi. Segmentation takes place most freely in the internal organs, 
but it may be observed in the circulating blood. 

The writer was also able to observe in this specimen larger 
spherical forms with pigment granules collected in a block-like mass 
in the center. The bodies of these organisms stained faintly with 
methylene blue. Thayer and Hewetson state that they have often 
found these organisms from two to four hours before paroxysms, and 
have denominated them "pre-segmenting forms." 

Later in the course of the disease larger, spherical, ovoid and 
crescentic bodies appear in the red corpuscles and free in the blood. 
These forms were especially abundant in this specimen. They were 
as large or even larger than red corpuscles, the spherical forms com- 
pletely filling the corpuscle, while the ovoid and crescentic expanded 
one side of the corpuscle, the remnant projecting as a small segment 
of a circle from the concavity of the organisms. In many cases 
ovoid and crescentic forms are identical. This ma)' be proven by 



1 60 Malaria ; Whiting. 

rolling the corpuscles upon the slide, when the ovoid bodies may 
be seen to assume a crescentic form. In the colored specimens the 
corpuscle stained faintly with eosin, the body of the parasite faintly 
with methylene blue, while the periphery showed a deeper color, thus 
giving evidence of a double contour. In many instances the peri- 
phery of the corpuscle was entirely decolorized, while that portion 
next the organism still retained some coloring matter. The pigment 
was generally collected in the form of a wreath in the center of the 
organism, encircling a light clear space and surrounded by a yellow 
or golden halo. The granules were very coarse and at times rod- 
like. These forms have decided ameboid movements. They have 
been seen to send out pseudopodia which are often cut off and 
separated from the organism. 

(Here follows the pathologic anatomy of the internal organs, clinical mani- 
festation, diagnosis, prognosis and treatment. We regret our inability to print the 
many valuable original plates. For omitted facts see Journal of the American Med- 
ical Association, August I and 8, 1896.) 

BIBLIOGRAPHY. 

Malarial Fevers of Baltimore. Thayer and Hewetson. 

Osier's Practice of Medicine. 

Lyman's Practice of Medicine. 

American Text-Book of Medicine. 

A Study of Some Fatal Cases of Malaria. L. F. Barker, M.B., 
Tor. 

Centralblatt fur Bakteriologie and Parasitenkunde. 

Grundriss einer Klinischen Pathologic 

The Leucocytes in Malarial Fever. John S. Billings. 

The Malarial Disorders of Large Cities with Special Reference 
to Chicago. Wm. E. Quine, M. D. 

Malaria as a Water-borne Disease. W. H..Daly, M. D. 

Medical Diagnosis. J. B. Herrick, M. D. 



EXAMINATION QUESTIONS.* 

BY JOHN M. DODSON, A. M. , M. D. 

Editor of the Corpuscle: — The suggestion made in the article 
entitled "Examinations" in your November number, and credited to 
Jonathan Hutchinson, that examination questions should be pub- 
lished to the students in advance, commends itself to me very 
strongly. I am persuaded that a carefully selected set of questions 
on any subject, this presented to the student, may be of decided 
advantage in suggesting and emphasizing the most important por- 
tions of the subject to which his attention should be especially given, 
and he will thus be prompted to make inquiry as to matters which 
are not made clear to him in the lectures and recitations. Incident- 
ally, such a plan must remove the possibility of questions being asked 
in the written examinations which might appear to him to be "catch" 
questions. There can be no excuse for obscurity or unfairness con- 
cerning questions which have been presented to him in advance of the 
examination. 

I propose, therefore, to publish in the Corpuscle a series of ques- 
tions, covering both years of physiology. The questions pro- 
pounded in the future written quizzes and in the final examinations 
for this year will be taken from this list. I present herewith the first 
installment of these questions: 

FRESHMAN PHYSIOLOGY. 

1. (a) What is physiology? (b) What are some of the views 
held in regard to the nature of life? 

2. What phenomena are manifested by living beings only? 

3. What are the principal differences between plants and ani- 
mals? 

4. Define direct and indirect cell-division; karyokinesis. 

5. What is the microscopical appearance of protoplasm under 
low and high powers? 

6. Define spongioplasm; hyaloplasm; nucleus; chromatin; 
achromatin; nuclear matrix; centrosome. 

7. Describe the process of karyokinesis. 

8. (a) In what respects do cells differ from each other? 
(b) Define a tissue; an organ; a system (e. g., the circulatory system). 

* Other questions will follow next month. 

161 



162 Examination Questions: Dodson. 

9. (a) How are the tissues of the body classified in general? 
(b) What are the principal distinguishing features of epithelium as a 
tissue? 

10. (a) How is epithelium classified? (b) Briefly describe each 
variety and mention a situation where it is found, (c) From what 
layers of the blastoderm does epithelium originate? 

11. (a) How are the connective tissues classified? (b) What are 
the chief distinguishing features of the connective tissues? 

12. (a) Describe white fibrous tissue; elastic tissue; embryonal 
tissue; mucoid tissue, (b) Mention a situation where each is found. 

13. Describe adipose tissue; cartilage, with its varieties. 

14. Describe the microscopic appearance of bone. 

15. What is the chemical composition of bone? 

16. What are the two methods of osteogenesis (bone develop- 
ment)? Describe each. 

17. Give the formula of the (a) temporary and (b) permanent 
set of teeth. 

18. Describe the histology of the teeth. 

19. (a) Describe the histology of unstriped muscular tissue, 
(b) Where is it found? 

20. Describe the histology of striated muscular tissue. 

21. Describe the histology of cardiac muscle. 

22. Define epimysium ; perimysium ; endomy sium ; sarcolemna ; 
sarcomere; sarcostyles; sarcoplasm; Dobie's line or Krause's mem- 
brane; Henson's disc. 

23. (a) What are the components of nervous tissue in the cen- 
tral nervous system? (b) Define neuron; neuroglia; nerve fibrils; 
neuraxon; dendron. 

24. (a) What varieties of nerve fibers may we have as to micro- 
scopical structure? (b) Describe the highest type of nerve fiber. 

25. What are the principal varieties of nerve cells? Describe 
each or illustrate by drawing. 

26. (a) Describe the neuroglia, (b) What tissue does it resem- 
ble in structure and function? (c) From what layer of the blasto- 
derm is it derived? 

27. (a) What are the chemical elements found in the body? 
(b) What is a proximate principle? 

28. How do we classify the proximate principles of the body? 
Give examples of each class. 

29. (a) How do we classify the proteids? (b) What are the 
reactions common to all proteids? 

30. (a) What is an albuminoid? (b) What are the chief albumi- 
noids found in the body? 



Examination Questions: Dodson. 163 

31. (a) How do we classify the carbohydrates? (b) What are 
the principal carbohydrates found in the body? 

32. (a) What is the chemical nature of fat? (b) What are the 
chief fatty constituents of the body? 

33. What are the uses of water in the body? 

34. What are the chief inorganic salts found in the body? 

35. What are the principal gases found in the body, and where 
are they found? 

36. (a) What is a ferment? (b) What is an organized ferment? 
(c) What is an unorganized ferment or enzyme? (d) What are the 
principals enzymes found in the. body? 

37. (a) What are the uses of blood? (b) What are its physical 
properties — color, odor, taste, reaction, transmissibility to light, spe- 
cific gravity? (c) What is the usual quantity in the body in propor- 
tion to the body weight, and how is this determined? 

38. (a) Define plasma; serum; clot, (b) What are the essential 
factors in the process of coagulation of the blood? 

39. W r hat conditions favor and what conditions retard or pre- 
vent the coagulation of the blood? 

40. (a) What is the source of fibrin-ferment or thrombin? (b) 
What are the proofs of this? 

41. What are the chemical constituents of blood plasma? 

42. Describe the microscopical appearance of the red-blood 
corpuscle, giving the average size, number per cubic millimeter and 
specific gravity. 

43. (a) What is structure of the red blood corpuscle and what is 
the chief chemical constituent? (b) What is the effect on the red cor- 
puscle of water; dilute acetic acid; dilute alkalis, tank acid, elec- 
tricity? 

44. Describe the microscopical appearance of the white blood 
corpuscles, giving the average size, number in relation to red and 
the principal varieties? 

45. Describe the blood platelets. 

46. What instrument is used to enumerate the blood cor- 
puscles? Describe it. 

47. How are the red blood corpuscles developed (a) in the 
embryo and (b) in adult life? 

48. What is the chemical composition of the red corpuscles? 

49. (a) What is haemoglobin; oxyhemoglobin? (b) How may 
crystals of haemoglobin be obtained and from the blood of what ani- 
mals is it most readily obtained? 

50. What is hsematin; hgemochromogen ; hsematoidin ; carbon- 
monoxide-haemoglobin ? 



164 Examination Questions: Dodson. 

51. (a) What is hsemin? (b) How is it obtained? (c) What 
can you say of its medico-legal importance? 

52. (a) Describe, briefly, the spectroscope, (b) What is the 
spectrum of oxyhemoglobin and of reduced haemoglobin? 

53. What are the principal tests for blood? 

54. (a) Of what does the circulatory system consist? (b) De- 
scribe the microscopical appearance of a capillary. 

55. What are the position, dimensions, weight, shape and struc- 
ture of the human heart? 

56. Describe, briefly, the chambers of the heart, and the valves 
found in them. 

57. Describe the course of the circulation. 

58. Describe the structure of an artery. 

59. Describe the structure of a vein. 

60. In what arteries do we find muscular tissue, and in what 
arteries elastic tissue most abundant? 

61. In what veins do we find no valves? 

62. Describe the cardiac cycle. 

63. Describe the action of the valves of the heart. 

64. What are the causes of the first and second sounds of the 
heart? 

65. What events in the cardiac cycle accompany the first, and 
what the second sound of the heart? 

66. Of what does the cardiograph consist and how is it used 
to study the heart's action? 

6y. W T hat is the maximum pressure in the right auricle and in 
each of the ventricles of the heart? 

68. (a) What is the normal frequency of the heart's action? 
(b) What circumstances modify it, and how? 

69. (a) What is the total amount of work done by the heart in 
twenty-four hours? (b) How is it ascertained? 

70. (a) What nerves connect the central nervous system with 
the heart ? (b) What ganglia are found in the heart muscle ? 

71. What is the effect on the heart's action of (a) division of 
one vagus nerve; (b) of both vagi ; (c) division of both cardiac sympa- 
thetic nerves? 

72. What is the effect on the heart's action of stimulation of the 

(a) central end of the cut vagus; (b) of the peripheral end; (c) of the 
central end of the cut sympathetic; (d) of the peripheral end? 

73. What is the anatomical course of the (a) vagus ; (b) sympa- 
thetic? 

74. What is the effect upon the heart's action of (a) atropine; 

(b) muscarine? 



Examination Questions: Dodson. 165 

75. What is meant by reflex inhibition of the heart? 

76. (a) How is the velocity of the blood-flow estimated? (b) 
What is the velocity of the carotid of the dog; in the capillaries? 
(c) What is the total time of the circulation as a whole? 

yj. What is the use of the elasticity of the vessel walls? 

78. (a) What is the pulse? (b) Describe the sphygmograph. 

79. Describe the pulse wave, explaining- the appearance of 
the percussion wave; the dicrotic wave; the pre- and post-dicrotic 
waves. 

80. Describe the appearance of the capillary circulation as 
seen under the microscope in a frog's mesentery. 

81. How is the venous blood-flow maintained? 

82. Describe the peculiarities of the circulation in (a) the brain 
(b) erectile tissues. 

83. What is blood-pressure, and what factors are concerned in 
its production? 

84. How is blood-pressure ascertained and measured? 

85. (A) Complete the following table; cardiac force normal and 
vascular tension increased, what is the condition of (a) blood-pres- 
sure, (b) blood-flow? (B) Cardiac force increased, vascular tension 
normal, what is the blood-pressure and blood-flow? (C) Cardiac 
force and vascular tension both increased, what is the condition of 
blood-pressure and blood-flow? 

SOPHOMORE PHYSIOLOGY. 

i. W T hat are the histological components of nervous tissue? 

2. How are nerve fibers classified as to histological structure? 

3. Plow are nerve fibers classified as to the impulses they 
transmit? 

4. Define neuron; neuraxon; dendron; neurocyte. 

6. (a) What is the velocity of nervous impulse in a human 
motor nerve? (b) How is it ascertained? (c) What conditions 
modify it and how? 

7. What methods are used in the study of the nervous system? 

8. What phenomena follow the section of a nerve? 

9. Describe the changes which take place in the degeneration 
of a nerve fiber. 

10. What phenomena follow section of the spinal nerve 
roots (a) of the anterior root, (b) of the posterior root on the distal 
side of the ganglion, (c) on the proximal side of the ganglion, (d) of 
the spinal nerve after the roots have joined? 

11. What changes can be detected in a nerve during activity? 

12. What determines the direction of an impulse in a nerve 
fiber in the living body? 



166 Examination Questions: Dodson. 

13. What are the chemical constituents of nervous tissues? 

14. (a) What are electrotonic currents? (b) How are they 
demonstrated? (c) What is their direction? 

15. How is the excitability of a nerve altered by the passage 
of a continuous electrical current through it? 

16. What is Pfliiger's law of contraction with the make and 
break of a continuous current, (a) ascending- and (b) descending, with 
very weak, weak, medium and strong currents? 

17. What are the changes manifested by a degenerated nerve 
in regard to excitability by electrical currents? 

18. What are the principal varieties of nerve cells found in the 
body? Describe them. 

19. (a) What is a reflex act; an automatic act; a voluntary act? 

(b) Describe by diagram, or otherwise, our present notion of the 
mechanism of a reflex act. 

20. What are the columns of ascending", and what those of 
descending degeneration in the spinal cord? 

21. What columns of cells do we find in the gray matter of the 
spinal cord? 

22. In what regions of the spinal cord is the gray matter most 
abundant? 

23. What is the course taken by the fibers of the posterior nerve 
roots as they enter the cord? 

24. What are the results of (a) complete section of the spinal 
cord; (b) of hemisection of the cord in any region? 

25. What are the principal reflex centers situated in the spinal 
cord ? 

26. Describe the method of action of the vesico-spinal center 
fully. 

27. W r hat portions of the adult brain are developed from the 
(a) fore-brain, (b) mid-brain, (c) secondary fore-brain? 

28. In what situations do we find gray matter in the brain? 

29. Describe the change in the course of the fibers of the vari- 
ous columns of the cord as they pass into the medulla. 

30. What are the nuclei of the fasiculi gracilis and cuneatus ; 
the fillet; the anterior decussation; the alivary body? 

31. What are the functions of the medulla oblongata? 

32. What are the simple reflex centers in the medulla? 

33. What the the (a) automatic centers; (b) control centers; 

(c) tonic centers in the medulla? 

34. Give the name, foramen of exit, point of emergence from 
the brain, basal nucleus, cortical center, distribution functions and 
results of lesion of the first cranial nerve. 



Examination Questions: Dodson, 1(57 

Questions 35 to 45, the same data for the other cranial nerves 
in order. 

46. Describe the course and termination of the crura cerebri. 

47. (a) What is the internal capsule? (b) What tracts of fibers 
are found in it and in what order from before backward? 

48. Name the lobes, convolutions and sulci on the lateral sur- 
face of the cerebral hemispheres. 

49. Name the sulci and convolutions on the mesial and basal 
surfaces of the cerebrum. 

50. What is the histological structure of the cortex in the motor 
area? John M. Dodson. 



The Corpuscle. 



EDITOKS. 

T. R. CROWDER, '97, Editor-in-Chief, 

226 South Paulina St., Chicago. 

E. L. McEWEN, '97, Secy and Treas. 

FRED. BARRETT, '97. A. F. STEVENSON, 



Communications relative to advertisements and subscription (Subscription price 
$1.00 per annum) should be addressed to the publisher. Remittances should be made 
by money order, draft or registered letter, payable to "The Corpuscle," and addressed 
to H. G. Cutler, Unity Building, Chicago. 



Ruby Red and Black: Colors of Lake Forest University. Orange: Color of Rush 

Medical College. 



A NEW REGIME. 

With this issue of the Corpuscle a new editorial staff takes 
charge of the journal, Mr. Luckey, Editor-in-Chief since last May, 
retiring. Since his connection with the paper, beginning in his 
freshman year, Mr. Luckey has shown himself to be a competent 
editor. His efforts to advance the interests of the Corpuscle have 
been untiring and efficient. His ideals of college journalism are 
high and he has been constant in striving to attain them. How 
well he has succeeded the students and alumni know. That he is a 
writer of no mean ability and a compiler of sound judgment are tes- 
tified by the editorials and articles that have appeared under his 
management. Mr. Luckey retires leaving one place on the board 

for the present vacant. 

* * * * 

In assuming the duties of carrying on the publication of the 
Corpuscle the newly organized editorial board appreciates a consider- 
able responsibility in maintaining the journal in its proper high place 
among college publications. That this may be done it is very desir- 
able that there be an increased interest on the part of both students 
and faculty. The amount of material desirable for publication that 
can be actually produced by the editors is but slight compared to the 
amount necessary to fill the several issues of the year. The faculty, 
alumni and student body must be depended upon for most of this. 

1 68 



Editorials. 1G9 

We shall strive to represent the interests of all in their true light 
and to reflect the college life as it is. 

To add to the worth of the paper and to make it more interesting 
to students and alumni, it is our intention to give in each month's 
issue selected cases from,, or complete reports of, at least one of the 
many valuable clinics held by the professors in Rush Medical Col- 
lege. The clinical lecture on Nephritis by Professor Herrick, 
printed in this issue, is but one of the many of value. It is in obtain- 
ing such reports that we need the aid and cooperation of the faculty, 
which Professor Herrick has so generously tendered in this instance. 

Communications from the students upon any subject will be at 
all times gladly received and will be printed when of sufficient value 
or suggestiveness. The board has been little burdened by such com- 
munications in the past. There are productive minds enough 
among the students and plenty of material for them to work on. We 
hope for more aid in this way in the future. 

The business management of the Corpuscle has been trans- 
ferred from Dr. Fred C. Honnold to Mr. H. G. Cutler, Dr. Honnold's 
professional duties being too pressing to permit of proper attention 
to the duties connected with publishing. Our best wishes and heart- 
iest support go with Mr. Cutler in assuming this place, and we trust 
that he may be able to bring the paper to a sounder financial basis 
and to improve it in size and appearance. We beg of the students a 
wider circulation among them. Mr. Cutler began publishing with 
the December issue, and has already succeeded in making consider- 
able typographical improvement. The paper is of better quality than 
has been used heretofore, and the cover has been changed from the 
old heavy manilla to something more fitting to such a publica- 
tion — something with "character,'' as the bookman expresses it. 



DEATH OF ALBERT J. BENNETT, 99. 

Albert J. Bennett of Rockford, 111., and a member of the 
class of '99, met with a fatal accident at Freeport, on Sunday, 
December 20. Mr. Bennett had been, for a dozen years previous 
to his matriculation at Rush, a brakeman on the C. & N. W. Road. 
He was forced to give up his position upon entering college, but 
he still made short Sunday runs between Chicago and Freeport. 
The accident occurred in the middle of the afternoon. The coro- 
ner's jury decided from circumstantial evidence, there being no 
eye witnesses, that the deceased, while turning the switch to let 
his train pass from the roundhouse to the main line, must have 



170 Editorials. 

caught his foot and been dragged under the wheels of the engine. 
Death was almost instantaneous. The remains were taken to his 
home in Rockford, where he leaves a mother, three brothers and 
three sisters. 

Mr. Bennett first entered Rush with the class of '97, but, 
through financial stress, was forced to leave at the end of his first 
term. He returned to his position as brakeman, and, by the fall 
of the same year, found himself able to resume his medical studies, 
entering the class of '99. He was thoroughly conscientious in 
whatever he undertook and always gave out the best there was 
in him. He was of a modest and retiring disposition, and had 
many firm friends, all of whom have words of praise for his steadi- 
ness of purpose and determination to make the most of himself 
and his life. His employers considered him one of their most 
trustworthy men, while his classmates regret that the profession has 
lost a man of so much promise. No man, without a real love of 
this profession, would undergo such sacrifices as Mr. Bennett, 
and it is this love of medicine that makes the true and successful 
physician. 

A PLEA FOR THE STUDY OF HYPNOTISM. 

It is to be deplored that, to the mind of honest and discrim- 
inating men, the touch of the charlatan contaminates whatever the 
latter may make use of to his own advantage, be it a trick of 
art, a thing or a phenomenon. It is deplorable, because this "let 
alone" tendency allows many preventable frauds to continue un- 
molested, and because humanity might be greatly benefited were 
the ways and means of the mountebank investigated, his stock 
in trade appropriated by men of scientific ability, and by them 
modified as honesty and utility might dictate. 

Hypnotism has long been a favorite resource of the charlatan. 
Its mysterious phenomena are well fitted to attract and awe the 
people; and when once a morbid curiosity is aroused in 
them access to their pocket books is made easy. The 
traveling fakir, the juggler and the patent medicine man 
drag in hypnotism as a sideshow with marked pecuniary success; 
the author and playwright are not above distorting and misrepre- 
senting hypnotic facts to fill their coffers. The result is that the 
people are deceived and misled, scientific men are disgusted, and 
hypnotism itself is misunderstood, misapplied, regarded as without 
useful merit, and by the ignorant as a visible manifestation of the 
power of the devil. 

But after all, is not hypnotism a legitimate subject for investi- 
gation by the medical student. We certainly believe it is. Much 



Editorials. 171 

prejudice must be removed from the mind of the investigator, and 
a deal of rubbish must be thrown aside before the real facts are 
reached; but when this preparation is made the study of the subject 
cannot fail to be interesting and profitable. The field rightfully 
belongs to the medical profession; the laity have no right to meddle 
with the striking psycho-physical phenomena of hypnotism. Only 
the specially educated are fitted to recognize and deal with dangers 
that might arise. 

In the brief space of this article it will be impossible to discuss 
at length the value of hypnotism from a medical standpoint. A few 
suggestions to stimulate thought must suffice. The physiological 
realization of an idea — Ideoplasty as it has been called — is a demon- 
strated fact. When an idea of a physiological act or process sufficiently 
dominates the mind, that act or process is performed. Examples: 
The blushing of a bashful and sensitive girl, on merely suggesting 
to her the idea of blushing; the yawning that follows the thought 
of yawning, when the mind is languid and may be easily dominated 
by one intense idea. If so much be true, then it is but a step from 
the physiological to the pathological. If a physiological process 
resulting from an action upon the vaso-motor nerves — blushing — 
may be produced by the domination of the mind by one idea, may 
not the pathological condition of inflammation be produced through 
the same nerves by the same means? Such, indeed, has been ac- 
complished many times by the distinguished French and German 
investigators of the subject. Tumefication, urticarial wheals, arti- 
ficial burns, and vesication have been produced repeatedly in the 
hypnotized. The pathological action of a dominating idea upon 
the organism is illustrated in many other ways. Everyone who 
reads these lines can call to mind some individual who is suffering 
from illness largely the result of imagination. Hysteria is recog- 
nized as a striking example of the truth of the principle, and the 
cures of the Christian Scientists argue in its favor. 

If, therefore, domination of the mind by one idea can produce 
diseased conditions, may not the substitution for it of another ex- 
actly opposing idea, which shall dominate in its stead, bring about 
the removal of the abnormal condition? It is fair to assume that 
such is true. Herein lies the therapeutic value of hypnotism. It 
has been found that in certain stages of the hypnotic condition 
the mind is in a state of extreme receptivity. The term Monoideism 
has been used to designate this mental condition, in which one idea 
dominates; and that idea in the hypnotized is under the control of 
the operator. The mind is like a' clean sheet upon which may 
be written one thought to the exclusion of all others. The appli- 



172 Editorials. 

cation of this fact is obvious. An opportunity is given the operator 
to create in the subject's mind an idea diametrically opposed to that 
which has been responsible for the pathological state. This idea, 
by dominating, operates to overcome the effects of its opponent, 
and a step is taken toward restoration of normal conditions. This 
principle has been used with success in the treatment of hysteria, 
sexual perversion, alcoholism and various habits of a vicious nature. 
The above is merely a suggestion. There are many ins and 
outs that the student must learn by reading and observation. But 
investigation of hypnotism should not be neglected. The interest- 
ing lectures from the chair of medicine upon hysteria, epilepsy and 
kindred subjects should incite every student to the acquisition of 
a more extended knowledge of all physical and psycho-physical 
phenomena; and it is most earnestly to be hoped that the proposed 
demonstration of hypnotism may be given without fail this winter, 
that a keener interest in the psychical aspect of a physician's work 
may be awakened. 



Why can't Rush have a library? A few hundred dollars a year 
devoted to medical literature would give us, in a short time, a fair 
start. Charge each student a dollar, or two dollars, or five dollars, if 
necessary, as a library fee ; he can well afford it. Whatever the plan, 
let us have the books. 



An effort is being made to collect funds for the erection, in one 
of the squares of Paris, of a monument to the memory of M. Pasteur. 
Statues or busts will also be located at his birthplace and in other 
cities. It is an international movement, the work in this country 
being in the hands of the Cosmos Club at Washington, D. C. Con- 
tributions are solicited from fifty cents to ten dollars, and can be made 
to George M. Sternberg, Treasurer Pasteur Monument Committee, 
Washington, D. C, thence forwarded to the Paris committee. 



MISCELLANEOUS. 

Essentials of Physical Diagnosis of the Thorax. By A. M. 
Corwin, A. M., M. D., Demonstrator of Physical Diagnosis in 
Rush Medical College. 

The little book used by the students in the classes in physical 
diagnosis has been revised and enlarged by Dr. Corwin until it is 
now more than twice its former size. All departments have been 
worked over and made more complete, while an entirely new addi- 
tion has been made giving- the physical findings in all the important 
diseases of the thoracic organs. 

In the work, as it now appears, Dr. Corwin has produced some- 
thing of value, both to practitioner and student. While attempting 
in no way to be an exhaustive treatise on the diseases of the chest, it 
sets forth in a concise, systematic and easily comprehended way the 
various physical findings elicited by all the various methods of phys- 
ical examination, both in health and disease. It is a matter of the 
utmost importance to the student to learn to pass in review the find- 
ings in the different regions of the body, and especially of the thorax, 
before pronouncing his diagnosis. And in learning to do this thor- 
oughly and well, Dr. Corwin's book will certainly be a safe guide 
and an efficient aid. It is well worthy of a place in any physician's 
library. 

The binding is in dark red cloth, stamped in gold. The back 
is thin and flexible, making a very handsome and convenient little 
volume. The book is published by W. B. Saunders, Philadelphia. 



SUGGESTIONS TO CONTRIBUTORS. 

To publish something does not necessarily mean the acquire- 
ment of fame. The wise reader, the one whose good opinion we all 
covet, reads quite as much between the lines as in them; quite as 
much in what might be said as in what is said. The great thing is 
to have something to say — something worthy the attention of the 
careful searcher after truth. It is always more pleasing to the edu- 
cated to have thought presented in a clothing of faultless rhetoric; 
but they want thought, and prefer thought without elegance of dic- 
tion, rather than elegance of diction without thought. 

If you intend publishing an article, be sure to use good, plain 
English. The great advantage offered by a free school system and a 
cheap, excellent literature render it inexcusable for any man seeking 
recognition by the medical profession to be unable to express himself 
grammatically and exactly, though he may not do it elegantly. 

173 



174 Aliscella neous. 

An article worthy of publication must have something in it de- 
manding the attention of readers. To know whether a thing is 
worthy of publication requires an adequate acquaintance with the 
literature on the subject. Any valuable discovery should always be 
made known to the profession. The manner of some in presenting 
old thoughts as their own disgusts their readers and, instead of 
broadening their reputation as scholars and up-to-date men, stamps 
them as ignorant seekers after undeserved fame. 

The manner of presenting a subject has very much to do with 
its reception. Thought always takes best when presented in its 
logical sequence. Many a man with valuable knowledge fails to 
gain attention because his thoughts are so illogically strung together; 
their force and true import are entirely lost. 

The too ready use of the pronoun I — egoism — is the charac- 
teristic of small minds, therefore avoid it. 

"There are three difficulties in authorship: to write anything 
worth the publishing, to find honest men to publish it and to get 
sensible men to read it." — Colton. If the first difficulty is overcome 
it is not hard to find a publisher and plenty of sensible men will read 
it. J. E. Luckey, M. S. 



TO THE MEMBERS OF THE MEDICAL PROFESSION. 

I would be pleased to have an expression of opinion from you, 
either personally or through some medical journal, as to the rela- 
tions of the lay-publishing firms of medical journals and the pro- 
fession. The request is suggested by the fact that Messrs. Wm. 
Wood & Co. of New York, refuse to permit the editors of "The 
American Year-Book of Medicine and Surgery" to use in our ab- 
stracts of Medical Progress articles and illustrations first printed in 
the "Medical Record" and the "American Journal of Obstetrics." 

This decision seems to me to be wrong for the following reasons : 

i. It prevents the dissemination of medical knowledge. The 
Year-Book condenses, systematizes and criticises the year's medi- 
cal work in a shorter space and more permanent manner than the 
journals, and has thousands of readers no single journal can claim, or 
hope, to reach. Every physician writes and publishes articles in 
order that, every member of the profession may, if possible, learn of 
his work, and that science and progress may thus be furthered and 
humanity benefited. To interfere with such dissemination of our 
literature in reputable publications is, I think, discourteous and un- 
just to the profession and an injury to medical science. 

2. This injustice and injury to medicine become all the more 



Miscellaneous. 175 

striking when physicians do not receive a cent of pay for con- 
tributions from the publication of which the lay publisher is sup- 
posed to make considerable financial profit. 

3. No other publishers in the world, not even those who pay 
authors for their contributions, have in the least objected to our 
reproduction of quotations, abstracts and illustrations from their 
journals. 

Do you wish to limit the dissemination of your contributions to 
medical science by such an exclusion of them on the part of pub- 
lishers from reputable publications? Is this literature the property 
of yourself and of the profession or not? Does your gift of it to a 
journal make it forever the private property of the publishers of that 
journal? Is it not rather a loan for temporary use only? 

Will you not hereafter demand that there be printed with your 
article a statement that the right of abstracting the text or reproduc- 
ing illustrations is guaranteed? Sincerely yours, 

119 S. 17th St., Philadelphia, Pa. Geo. M. Gould. 



PERSONAL NOTES. 

Drs. Witte and Beebe, Presbyterian internes, spent a part of the 
holidays at their homes. 

Dr. W. H. McLain, '96, commenced service as interne in the 
Presbyterian Hospital in December. 

Professor Klebs will not resume his Wednesday afternoon lec- 
tures at the college until January 27. 

Mr. Gordon, '97, lately operated upon in Professor Senn's clinic 
for appendicitis, has recovered and has been discharged. Mr. Austin, 
'97, operated upon for inguinal hernia, is attending clinics. 

Dr. Oliver S. Ornsby, '95, late interne in the Presbyterian Hospital, 
was married at Rogers Park December 14, to Miss Joscelyn of the Il- 
linois Training School. Dr. and Mrs. Ornsby will make their home 
in Utah. 

Professor Senn is hunting in Texas, where he will remain until 
about the first of next month. During his absence his clinic hours 
will be filled by Professor Hamilton and his lecture hours by Profes- 
sor Belfield. 

Dr. S. T. Holbrook, '95, finished his service as interne in the 
Presbyterian Hospital on December 31. He was called to Water- 
town, New York, by the illness of an aunt. After leaving there Dr. 
Holbrook will locate in Milwaukee. 



176 Miscellaneous. 

At a recent clinic for diseases of the skin the senior class had 
a good laugh at the expense of Professor Hyde. A patient came 
into the clinic with a marked syphiloderm covering the whole body, 
except the feet and lower part of both legs. After commenting at 
some length upon the case Professor Hyde outlined the treatment 
that would be recommended for the patient. A prominent feature 
of this was the rubbing of a mercurial ointment into the soles of the 
feet. A little confusion was occasioned when this part of the treat- 
ment was given. Lest that very important item should be lost 
in the confusion, it was emphatically repeated. Greater laughter 
was occasioned by that and Professor Hyde looked blank. The 
joke lay in the fact that the man had walked into the arena upon his 
knees, both legs having been amputated. 



iniumni Department. 

JAMES B. HERRICK, A. B., M, D., Editor. 



Membership in the Alumni Association of Rush Medical College is obtainable 
at any time by graduates of the College, providing they are in good standing in the 
profession, and shall pay the annual dues, $1.00. This fee includes a subscription to 
The Corpuscle for the current year. This journal is the official organ of the Association. 

Dues and all communications relating to the Association should be sent to 

JOHN EDWIN RHODES, M. D., Sec'y and Treas., 34 Washington St., Chicago. 



DEATH OF DR. E. J. H. WARNSHUIS. 

Rock Valley, Iowa, December 29, 1896. 
Prof. J. B. Herrick, Editor Alumni Department, Corpuscle, Chicago. 

Dear Professor: — It is my sad duty to announce to the class of 
'94 the death of one of their number, Dr. E. J. H. Warnshuis, oi 
Maurice, Sioux County, Iowa, on the morning of the eleventh of 
December. , 

The immediate cause of his death was acute obstruction of the 
bowels, complicated, perhaps, by appendicitis. Operative measures 
were out of the question, as he was already in a state of collapse 
and pulseless when he called in a neighboring physician ; the physi- 
cian then was not called to administer to his needs, but to those of his 
patients, whom he had on the previous day attended. The first 
night of his illness he suffered intensely, but this did not stop him 
from being out all night to attend a case of confinement, and the fol- 
lowing day, the day before the night of his death, he wrote several 
prescriptions while in bed. It was not until this day that he fully 
realized his condition, and asked for an operation, if it was possible 
to stimulate him enough so that he could survive it. But our hopes 
were not realized, as he slowly lapsed into a semi-conscious condi- 
tion, and died early the following morning. 

He had established himself in a good field and was most highly 
regarded by all who had ever been under his care. He leaves, to 
mourn his loss, his wife, to whom he had been married but a year, and 
to whom he was devoted with more than an ordinary devotion. Not 
only his dear wife, but all those who have ever known the doctor, will 
feel keenly her loss and condole with her in this sad hour. 

F. J. Huizenga. 

P. S. Professor Herrick: Should the class secretary, or any 

177 



178 Alumni Department. 

member of the class, wish to send letters of condolence to the widow 
she may be addressed, Mrs. M. S. Warnshuis, Rock Valley, Sioux 
County, Iowa. 



Dr. Bernard F. Bettelheim, '95, is located at Brookfield, Mo. 
and is doing well. 



Dr. Walter B. Coe is located at Tongonoxie, Kan., where he re- 
ports a growing practice. 



Dr. C. Travis Drennen of Hot Springs, Ark., was made first vice- 
president of the Tri-State Medical Society at its last meeting, held 
in Memphis. 



Dr. Arnold, '95, of Freeport, was in the city a few days ago. He 
and his brother are in general practice there and report a good and 
increasing- business. 

Dr. W. N. Nolan, '94, was in the city during December. He 
is located at Kaukauna, Wis., and reports that he has made a success- 
ful start in practice, and is doing better than he had expected. 



Dr. O. B. Will of Peoria called a few days since. Dr. Will is 
now editor of the "Peoria Medical Journal." He is a loyal son of old 
Rush. After spending a few days in the city and visiting the clinics 
at the college, he went East, and will look in on the medical colleges 
of Boston and New York. 



The following, clipped from the "Smith County Journal," Smith 
Centre, Kan., is self-explanatory: "Dr. D. W. Relihan was notified 
to-day of his appointment as a member of the pension examining 
board for Smith County, Kan., to fill the vacancy caused by the 
resignation of Dr. J. B. Dykes. His many friends congratulate him 
on the good fortune in securing the place, for which he is amply 
qualified." Dr. Relihan was a member of the class of 1896, and 
many of the students now at Rush are acquainted with him. 




FRED. BARRETT 

Retiring Assistant Editor of "The Corpuscle. 



The Corpuscle. 

RUSH MEDICAL COLLEGE, CHICAGO, ILL. 
Medical Department Lake Forest University. 



Vol. VI. FEBRUARY, 1897. No. 6. 

CLINIC. 

BY E. FLETCHER INGALS, PROFESSOR OF LARYNGOLOGY AND DISEASES 
OF THE CHEST. RUSH MEDICAL COLLEGE, NOVEMBER 4, 1896. 

Case No. I (Hypertrophy of the Faucial and Pharyngeal Tonsils). 

Gentlemen: — The first case that I present is this boy eight 
years of age, who, we are told, has had considerable difficulty in 
breathing through the nose ever since birth. The symptoms are 
especially troublesome at night, so that he makes a great deal of 
noise while sleeping. Although he appears to be bright, he is 
obliged to keep his mouth open all of the time, indicating some 
obstruction either in the nose or nasopharynx. The intelligent ex- 
pression observed in this case is more remarkable when we find that 
the 'hearing is considerably obtunded ; as the child hears my watch 
on the rigiit side only about nine inches and on the left side at 
only two inches distant. My watch is a low ticker, but can be 
heard by the normal ear at about eighteen inches. I find enlarged 
lymphatic glands on each side of the neck just beneath the angle 
of the jaw. Upon anterior rhinoscopic examination we find the 
nasal cavities as large as in other children of this age, therefore the 
difficulty in breathing cannot result from obstruction in the nose. 
An examination of the fauces reveals enlarged tonsils, so large, in- 
deed, that I am unable to see the nasopharynx, but yet not large 
enough to interfere with nasal respiration. I, therefore, conclude 
that the cause of the mouth breathing must be an obstruction 
either at the posterior end of the nasal cavities or in the naso- 
pharynx, and I am so confident in the diagnosis that I will not 
annoy the child by passing my forefinger up behind the palate 

179 



180 The Corpuscle. 

before giving the anesthetic. It is still a mooted point whether 
hypertrophy of the faucial tonsil leads to tuberculosis or any other 
serious constitutional disease. In this case the enlarged cervical 
glands are found associated with hypertrophy of the faucial tonsils 
and it is not improbable that infection of the cervical glands is the 
result of the tonsilitis. 

The child has now been anesthetized with chloroform and we 
will place it upon the abdomen and right side of the face for • 
operation upon the right tonsil. In performing these operations 
upon the faucial and pharyngeal tonsils, I find it preferable to place 
the child in this position at the beginning of the operation with 
its back to the light and my left hand toward its head; with a 
reflector I can then illuminate the fauces thoroughly for the re- 
moval of the right tonsil. The child's mouth is now opened and 
held by a gag between the left molars. Pressing down the tongue 
and illuminating the fauces by means of the reflector, I find the 
anterior pillar of the fauces closely adherent to the tonsil. I now 
slip a blunt hook between the pillar of the fauces and the tonsil. 
The instrument used for this purpose is a uvula elevator. Fol- 
lowing this hook with the forefinger of my left hand I succeed 
in crowding the tonsil away from the anterior pillar, and by work- 
ing the hook and finger in opposite directions behind the pillar the 
tonsil is separated throughout its entire course. This part of 
the operation always causes some bleeding, therefore the throat 
has to be wiped out with sponges before we proceed. I now catch 
the tonsil with my tonsil forceps, the assistant at the time making 
pressure externally from behind the jaw. The forceps are locked 
and the tonsil is held firmly. I now take a strong polypus snare 
armed with a number five piano wire loop, which is slipped over 
the tonsil forceps and carried into the fauces. At this point 
in the operation there is great danger of catching the uvula in the 
snare; sometimes the wire can easily be passed beyond it, but in 
many instances the uvula must be lifted until the wire loop has 
passed over the end of the tonsil forceps. If the throat is large 
the wire loop can be crowded down beyond the end of the tonsil 
forceps with the forefinger, but where it is small it is best to make 
a little traction upon the tonsil; then taking care that the wire 
has first passed the uvula, it is comparatively easy to carry the loop 
beyond the end of the tonsil forceps and to tighten it so that it 
will slide below the forceps and engage the base of the tonsil. 
I have now succeeded in securing the gland, and all that remains 
is to cut it off by tightening the wire loop, which is easily done 
by the milled wheel. The snare has now cut through the base 



Clinic: Ingals. 181 

of the tonsil and I find the gland held in the tonsil forceps. We 
now turn the child with its face to the opposite side of the table. 
Dispensing- with the reflector, I use direct light for illumination. 
The left tonsil is then removed in the same manner as the rig-lit. 
Upon tightening the snare on the base of the left tonsil about 
half a drachm of pus escapes which had been encysted, though 
it was not apparent when the operation began. I pass my fore- 
finger into the nasopharynx and find, as I had expected, that it is 
nearly filled with adenoid growths, or an enlarged Luschka's ton- 
sil. For the removal of Luschka's tonsil, I prefer the modification 
of Loewenberg's forceps, suggested by John N. Mackenzie of 
Baltimore. This is a strong forceps, more bent than Loewenberg's; 
the larger one that I use having blades about an inch and a half 
long from the angle, and the smaller, for small children, having 
blades about an inch in length. In this part of the operation I 
rely entirely upon the sense of touch. With the forefinger of the 
left hand behind the palate in the nasopharynx to direct the for- 
ceps, I carry the instrument up behind the finger and seize as 
much of the growth as possible. It is torn off with a slight lateral 
movement of the forceps and removed. Two or three bites are 
sufficient to remove the main part of the gland, but now we 
find a mass behind the orifice of the Eustachian tube which has 
to be seized carefully in order to avoid the latter. The forceps 
should never be closed upon any tissue in the nasopharynx that 
is not distinctly felt by the finger of the left hand at the time. 
These operations require considerable time and much care to thor- 
oughly remove the adenoid tissue from the lower part of the 
pharynx, just above the edge of the palate, and from behind the 
orifices of the Eustachian tube, and from the vault of the pharynx 
close to the posterior opening of the nares. At the latter point 
a portion of the gland is likely to remain, which is easily crowded 
forward into the nares, so that it is difficult to reach with the naso- 
pharyngeal forceps. I now have the nasopharynx completely 
cleared excepting a small mass in the position just referred to. 
This I will remove with a blunt-pointed bone forceps passed through 
the naris. I will pass the instrument through both sides to make 
sure that the posterior opening is free. I believe that in from 
twenty-five to forty per cent of all cases of enlargement of Luschka's 
tonsil one or the other of the choanse is greatly constricted or en- 
tirely occluded; therefore, I think it very important to pass the 
forceps through the nares. In this case I find the posterior naris 
of the left side completely closed, so that I am obliged to break 
through about a quarter of an inch of tissue to reach the naso- 



182 The Corpuscle. 

pharynx. This is not difficult with the bone forceps, and after break- 
ing through I open the blades and withdraw it so as to thoroughly 
dilate the opening. I still keep the forefinger of my left hand 
in the vault of the pharynx, so that I may know exactly the 
position of the forceps. This operation is always attended by 
considerable hemorrhage, the blood flowing freely, sometimes from 
three to five minutes, but I have never seen a case in which it 
did not stop of its own accord in a comparatively short time. 
However, in a few cases the patient must have bled from half 
a pint to a pint, and the bleeding is so free in the early part of 
this stage that it seems dangerous. 

This child should be kept in the house for the next few days 
to avoid taking cold, and should gargle the throat, if practicable, 
every hour of the day. The nares should be treated four or five 
times daily with a mild antiseptic spray of a third of a grain of 
thymol and three minims of the oil of cloves to the ounce of liquid 
albolene. If there is much swelling of the nares a powder should 
be insufflated two or three times a day containing twenty-five per 
cent of iodol and three per cent of cocaine in sugar of milk ; about 
a grain being thrown in at each insufflation. The insufflated tube 
should be held horizontally so that the powder will go through 
to the nasopharynx. I think it best to> adopt all of these pre- 
cautions, although I have never seen any serious results from 
the operation when they have been neglected by the patient. As 
the result of the operation in this case we will expect that before 
long the deafness will be relieved and the child will be able to 
breathe through the nose. It would not be surprising if for the 
first night or two the friends should be alarmed because the child 
sleeps so quietly. Afterward they will be free from the annoy- 
ance they have had so many years caused by the child's snoring 
and difficult respiration at night. Two questions with reference 
to this operation may very properly be asked: First, why was 
chloroform used instead of ether as an anesthetic? Second, 
why was the snare used instead of the tonsilotome? I realize 
fully that in general chloroform is not as safe an anesthetic as 
ether, but I believe that in obstruction of the respiratory passages the 
free secretion caused by ether is a serious objection, not so appar- 
ent with chloroform; therefore, all things considered, it has ap- 
peared to me that chloroform is a better anesthetic for children 
in these operations. Of course great care should be taken in its 
administration, and I think it important that the physician giving 
the anesthetic should watch not only the pulse but the respiration ; 
placing rather more stress upon the latter. For other operations 



Clinic: Ingals. 183 

I have seen four fatal results from chloroform, and 1 have had 
one case in which I was doing this very operation when the 
child was saved with difficulty. Nevertheless, I believe that I 
would not have been more fortunate had I been using ether. In 
answer to the other question — if the tonsils alone were to be re- 
moved, and there were no adhesions of the anterior pillars, the 
operation with the tonsil forceps and snare would be prac- 
tically bloodless; if, however, the anterior pillars were adherent 
a complete operation could not possibly be made by the tonsilo- 
tome, unless they were first separated, and in that case the bleed- 
ing would be much greater than in the operation we have just per- 
formed. Again, the tonsilotome is difficult to use satisfactorily 
when the patient is under an anesthetic lying down, and it would 
not be safe for the patient thoroughly anesthetized to be kept 
erect. Furthermore, when we have reason to believe that there 
is obstruction in the nasopharynx we should prepare to remove 
that at the same time that the faucial tonsils are taken out, and 
the Luschka's tonsil can seldom be thoroughly removed unless 
the patient is completely anesthetized. I am well aware that 
rapid operations may be made in which a large part of the gland 
can be scraped out, or even taken out with forceps, and I am 
well aware that it is easy for several strong men to hold a small 
child while the operation is being performed; but it is not easier 
for the patient than it would be to endure the pain caused by 
amputation of the thigh; therefore, in practically all cases where 
there is reason to believe that the Luschka's tonsil is enlarged 
the patient should be given a general anesthetic so that a thorough 
operation can be made while it is free from pain. 

Case No. 2 (Hypertrophy of the Pharyngeal Tonsil). 

This girl is twelve years of age and complains of constant 
obstruction in the nares, which had existed for a long time, but 
she cannot tell us how long. We find in this case a degree of 
mental hebetude probably resulting from the disease, and we find, 
also, that she is partially deaf. She is able to hear my watch only 
three inches with the left ear and one inch with the right. The 
deafness has come on so gradually that she cannot tell us when it 
began, and doubtless the appearance of stupidity due to the con- 
stantly open mouth is much aggravated by her difficulty in hear- 
ing. In this case, as in the patient you have just seen, there has 
never been inflammation of the tonsils, but both of them illustrate 
in different degrees the result of blocking up of the nasopharynx. 
An examination of the fauces in this case shows very slight en- 



184 The Corpuscle. 

largement of the faucial tonsils, and upon anterior rhinoscopie 
examination we find that the nasal cavities are free. The symp- 
toms, therefore, of partial deafness, mouth breathing- and a nasal 
twang to the voice must be due to enlargement of the pharyngeal 
tonsil, and I need not attempt to verify this diagnosis by palpation 
before giving the child an anesthetic. She will now be given chlo- 
roform, and then placing her upon the abdomen and left side 
of the face we will proceed to remove at once the pathological 
products which fill the nasalpharynx. In this case I find 
the nasopharynx well filled with adenoid tissue and its removal 
is attended by sharp hemorrhage; but from experience I have 
no fear it will be serious. I am always careful to inquire before- 
hand whether or not the patient is a bleeder, for if we should 
happen to> operate upon a case of hemophylia we would be likely 
to get a fatal result. It is well to leave the gag in the mouth to 
keep it open a few minutes after the operation until the bleeding 
ceases. The subsequent treatment in this case will be the same 
as that recommended for the preceding, with the exception of 
the gargle, which is not needed here because there was no opera- 
tion upon the faucial tonsil. This patient will have little if any 
pain. She is liable to vomit three or four times during the after- 
noon from the anesthetic, and in doing so will probably bring up 
a considerable quantity of blood that has been swallowed during 
the operation. 

In the position in which I have placed these patients for oper- 
ation blood will not run into the trachea, but will be swallowed 
to a great or less extent. We will expect this patient to be com- 
pletely relieved of the necessity for mouth breathing, though the 
habit may continue for a considerable time. We will expect also 
that the deafness will be cured; at least, such is the result in about 
forty per cent of all cases, and as the deafness here is not abso- 
lute we think the chances of its disappearance are very great. We 
expect also that the peculiarity of the voice will be largely if not 
entirely relieved in the next five or six months. Usually the im- 
provement in respiration is noted immediately; the improvement 
in the hearing occurs during the first three or four weeks, and 
the improvement in the voice within from four to six months. 

Case No. j {Chronic Cervical Adenitis). 

I have also to present a little girl nine years of age who comes 
here because of enlarged cervical glands. We find that the glands 
upon the left side of the neck have been hypertrophied for the 
last five years and that there is some enlargement of those upon 



Clinic: Ingals. 185 

the right side. Her general health is good and her weight is about 
normal; for the past few months she has had a little pain in the 
left side. In this case there are no symptoms indicating disease 
either of the nose, throat or chest, and we can find no satisfactory 
cause for disease of these glands. Formerly it would have been 
termed scrofulous; latterly, it has been the fashion to call all such 
affections manifestations of tuberculosis. Only four or five years 
ago it was the practice among most surgeons to remove these 
glands as quickly as possible, but I am glad to say that among 
the best conservative surgeons, of whom Professor Senn may be 
considered a conspicuous example, it is not now the custom to 
recommend operations in all cases where the enlargement is 
slight and there are no constitutional symptoms. I believe that 
internal treatment is indicated in the beginning, although under 
certain conditions indicative of tubercular infection, and where a 
perfect operation could be performed, removal of the gland should 
be recommended. Among the remedies that have been found most 
beneficial in chronic adenitis are iodine, guaiacol, creosote, iron 
and the chloride of calcium. In this patient the general health 
appears good; therefore we will order the chloride of calcium to 
be given in the compound sirup of sarsaparilla in doses of seven 
and one-half grains after each meal. We will add to this about 
three grains of the chloride of ammonium, which renders the taste 
of the calcium salt a little less objectionable The dose of the chlo- 
ride of calcium will be gradually increased in the next three or 
four weeks to about fifteen grains. In this connection I have to 
present also a woman forty years of age, who has suffered from 
enlargement of the cervical glands for the last ten years. During 
this time she tells me she has had two surgical operations for 
their destruction, but the tumors have again returned and she now 
objects to farther operation. We find a large mass of enlarged 
lymphatics upon the right side of the neck, with considerable in- 
durated tissue about the old scars, so extensive that a thorough 
operation would be most serious, and I am inclined to think that 
she is wise in declining further operative measures. We will give 
her the chloride of calcium in doses of from ten to thirty grains 
after each meal. We will combine with it from five to ten grains 
of the muriate of ammonia and will give it in sirup of glycyrrhiza. 

Case No. 4 (Chronic Endocarditis, or Valvular Diseases of the Heart) 
This patient is a railroad man twenty-six years of age. He 
tells us that he had one brother die of typhoid pneumonia, but 
that his father died of heart disease and that his sister is affected 



18(5 The Corpuscle. 

much as he is. He tells us that he was sick and confined to the 
bed for several weeks during the latter part of last Winter, but 
we cannot get a very satisfactory account of that illness. He com- 
plains of shortness of breath and cough, with a little expectoration. 
He has a pale, yellowish skin, the ankles are slightly cedematous, 
and he tells us that swelling has been worse than at present; the 
pulse is rapid and irregular; there is no abnormal temperature; his 
appetite and digestion are good and the bowels regular. Upon 
physical examination I find cardiac dullness extending almost to 
the midaxillary line; upon auscultation I find a distinct systolic 
murmur at the apex of the heart, which is transmitted to the left 
and downward, and is also heard behind between the sixth and 
the eighth ribs, a little to the left of the spinal column. There is 
no murmur at the base of the heart; the pulmonary signs are 
normal. The diagnosis is dilatation of the heart, with mitral re- 
gurgitation or chronic endocarditis. The condition of the heart 
readily accounts for his d3'spncea and the congestion of the lungs 
which would necessarily result from the mitral regurgitation ac- 
counts for the cough. This patient has never suffered from rheu- 
matism; indeed we can find no history of the ordinary causes of 
chronic endocarditis; we find, however, that a father and sister 
both suffered from heart disease, and it is not improbable that we 
have here one of those comparatively infrequent cases of heredi- 
tary heart disease that develop in early life. There are two indi- 
cations for treatment in this instance: The first, to furnish the 
heart with better nutrition by supplying better blood; and the 
second, to strengthen muscular action of the organ. With the 
first indication in view we will give tincture of the chloride of 
iron in doses of fifteen minims in the sirup of tolu fifteen minutes 
before each meal. It is better to give it on an empty stomach in 
order that it may not come in contact with tannin and be trans- 
formed into the tannate of iron. The dose should be taken in a 
tablespoonful of water and the patient should drink several swal- 
lows of water before and immediately after, in order that it may 
cause no irritation. To meet the second indication I shall pre- 
scribe ten minims of the tincture of digitalis to be given after meals 
three times daily and I wish to call your attention to the fact that I 
prescribe minims, not drops. Some physicians make the mistake 
in treating these patients of prescribing the digitalis in drops, under 
the impression that they are giving minims, and therefore giv- 
ing only half the quantity that is necessary. Under this treatment 
we will expect to diminish the frequency of the pulse and to ren- 
der it more regular. If at the next visit we find that the pulse 



Clinic: Ingals. 187 

is still rapid we will increase the dose of the digitalis — we may run 
it up even to twenty or twenty-five minims three times a day, 
providing- it does not disturb the stomach. If, however, the digi- 
talis does not appear to strengthen the heart sufficiently, we will 
combine with it an equal quantity of tincture of mix vomica. The 
two together appear to act much more satisfactorily than either 
one of them alone. Under this course of treatment it is probable 
that the strength of the heart can be greatly increased, its size 
considerably diminished, the cough and dyspnoea largely relieved 
and the patient's life prolonged for many months and possibly 
for several years. The prognosis as to time, however, will have 
to be determined more definitely after we 'have ascertained how 
well the heart responds to the treatment. 



EXAMINATION QUESTIONS.* 

BY JOHN M. DODSON, A. M. , M. D. 

86. (a) What is the function of the vaso-motor nerves? (b) 
What is the anatomical course of the vaso-constrictor and of the vaso- 
dilatator nerves? (c) Where is the vaso-constrictor and where the 
vaso-dilatator center? 

87. (a) When a nerve containing both vaso-constrictor and 
vaso-dilatator nerves is stimulated, what is the primary effect upon 
the blood vessels? (b) If the stimulation is continued for some time 
what will be the condition of the vessels? (c) Which fibers degen- 
erate first after section of the nerve, the vaso-constrictor or vaso- 
dilatator fibers? 

88. Detail an experiment demonstrating the existence of vaso- 
dilatator nerves in some particular part of the body. 

89. (a) What is the significance of the Traube-Hering curves? 
(b) Describe the oncometer. 

90. (a) Of what does the respiratory apparatus consist? (b) 
What is the essential process in respiration and where does it take 
place? 

91. (a) What is the histological structure of the trachea and 
bronchi? (b) Describe fully the structure of a lobule of the lung. 

92. Describe, briefly, the vascular, lymphatic and nervous sup- 
ply of the lung. 

93. What are the muscles concerned in (a) ordinary and (b) 
extraordinary inspiration? 

94. (a) How is ordinary expiration performed? (b) What 
muscles are concerned in extraordinary expiration? 

95. (a) Describe the movements of the ribs in respiration, (b) 
What types of respiration are recognized? (c) What is the cause of 
the superior costal type? (d) What is the respiratory rhythm? 

96. (a) Define and give the usual amounts of tidal air; com- 
plemental air; supplemental or reserve air; residual air. (b) What 
is meant by the respiratory capacity? (c) How may the vital capacity 
be determined? (d) What circumstances affect the vital capacity? 

97. (a) What is meant by the pulse-respiration ratio? (b) 
What is the force exerted by the expiratory and what by the in- 
spiratory muscles? 

98. Describe the nature of the control exercised by the nervous 
system over the act of external respiration. 

* Continued from January number. 



Examination Questions: Dodson. 189 

/ 99. (a) What is meant by apnoea; orthophoea; dyspnoea; I 

I asphyxia? (b) Describe the stages of asphyxia. ' 

100. (a) Describe the special acts of coughing, sneezing, sigh- 
ing, sobbing, (b) What is asphyxia? (c) Describe the stages of 
asphyxia. 

1 01. What is the effect of respiration upon the circulation? 
Describe fully. 

102. What are the differences between expired and inspired air? 

103. What are the differences between the blood in the pulmo- 
nary vein and that in the pulmonary artery? 

104. What are the data for calculating the amount of ventilation 
required in a given room? 

105. (a) How do we classify the food stuffs? (b) What are the 
objects of cooking? 

106. (a) What is the purpose of digestion? (b) Name the stages 
of digestion, (c) Describe the process of mastication, giving the 
muscles concerned and the nervous supply to each, (d) What are 
the uses of the tongue? 

107. (a) What are physical and chemical properties and the 
average daily quantity of saliva? (b) What are the functions of 
saliva. 

108. (a) What nerves are connected with the submaxillary gland 
and what are the effects of division and stimulation of each? ('b) 
Describe the minute structure of the salivary glands and the changes 
which occur in the epithelial cells during secretion. 

109. (a) Describe the process of deglutition, (b) What muscles . 
and nerves are concerned in the process? 

no. Describe the histology of the gastric mucous membrane 
and of the glands connected with it. 

in. (a) Describe the muscular coats of the stomach? (b) What 
is the purpose of the muscular movements of the stomach? 

112. (a) What are the physical and chemical properties and the 
chemical composition of the gastric juice? (b) What are the func- 
tions of the gastric juice? 

113. (a) What nerves control the secretory activity of the gastric 
glands, and how? (b) Detail an experiment demonstrating these 
facts. 

1 14. (a) Describe the gross anatomy of the small intestine briefly, 
(b) Describe the villi, valvulse conniventes, and the various glands 
found in the mucous membrane of the small intestine, (c) What are 
the uses of the succus enteritis ? 

115. (a) Describe the histology of the pancreas, (b) What nerves 
control its secretory activity, and how? 



( 



) 



%-t 



\ ^l 



*( ; 



190 T 7 ^ Corpuscle. 

117. What are the properties and composition of pancreatic 
juice? 

118. What are the functions of the pancreatic juice? 

119. (a) Describe the histology of the liver, (b) What are the 
properties and composition of bile? 

120. (a) What are the uses of bile? (b) Describe two tests for 
the presence of bile in a liquid suspected to contain it? 

121. (a) What changes do bacteria produce in the intestinal 
contents, (b) Describe briefly the physical and chemical properties 
of chyme; chyle; the feces, (c) What are the chemical constituents 
of the feces? (d) Name the structures involved in defecation as 
a reflex act. 

122. (a) What are the forces concerned in absorption? (b) 
Define colloids; crystalloids. 

123. (a) What conditions favor absorption? (b) From; what 
situations in the body may absorption take place? 

124. Describe the structure of the lymphatic capillaries; larger 
lymphatic vessels; a lymphatic gland. 

125. (a) What are the physical and chemical properties and the 
composition of lymph? (b) What is the purpose of lymph? 

126. (a) What is a secretion; an excretion? (b) What is the 
essential structure of a gland ? (c) What varieties of glands are there ? 

127. (a) What kind of a gland is the kidney? (b) Describe the 
shape, position, size and general structure of the kidney. 

128. Describe the course and microscopical structure of a kid- 
ney tubule from Bowman's capsule to its termination at the pelvis 
of the kidney. 

129. Describe the vascular and nervous supply of the kidney. 

130. Describe the generally accepted theory as to the manner 
in which the urine is secreted by the kidney. 

131. Detail and explain the significance of Heidemhain's experi- 
ment with sulphindigotate of sodium. 

132. Explain the relations between general blood-pressure and 
the rapidity of urinary secretion. 

133. What are the physical and chemical properties of the human 
urine and the chemical composition? 

134. (a) What is the chemical composition of urea? (b) Show, 
by chemical equation, the manner in which we determine the amount 
of urea present in a given specimen by the hypobromite of sodium 
method. 

135. (a) What is the gross and what the microscopical appear- 
ance of free uric acid in urinary sediment? (b) In what form does 
uric acid usually occur in normal urine? 



) 



Examination Questions: Dodson. 191 

136. Name the principal inorganic constituents of the urine and 
give a test for the presence of each. 

137. (a) What is the average daily amount of urine passed by a 
healthy individual ; of total urinary solids ; of urea? (b) How may the 
total solids be determined from the specific gravity? 

138. Describe the mechanism of micturition. 

139. Describe the histology of the skin, including the glands. 

140. Describe the histology of the hair and hair follicle. 

141. (a) What are the functions of the skin? (b) What are the 
physical and chemical properties, and the chemical constituents of 
the sweat? 

142. Define elasticity, extensibility and contractility, as proper- 
ties of muscle. 

143. (a) By what stimuli may muscle be excited to contrac- 
tion? (b) What are the phenomena which accompany muscular 
contraction? 

144. Detail an experiment in which we make a graphic record 
of a muscular contraction. 

145. (a) Describe the curve resulting in such an experiment from 
a single muscle twitch, and explain it fully, (b) Show the curve of 
tetanus. 

146. (a) What is meant by the terms minimal stimulus; maximal 
stimulus; minimal effect; loaded muscle; after-load? (b) What 
conditions favor muscular contractility? 

147. (a) What is rigor-mortis? (b) When may it begin, and 
how long may it last? (c) What phenomena accompany it? 

148. Describe the stages of rigor-mortis. 

149. What is the chemical composition of muscle? 

150. Describe the electrical phenomena observed in a portion of 
muscle removed from the body, and in a muscle in activity. 

SOPHOMORE PHYSIOLOGY. 

51. (a) Outline the motor and somsesthetic (Flechsig) area of 
the cortex, (b) Where is the cortical motor center for the leg; for the 
foot; for the arm; face; head; muscles concerned in speech? 

52. Where are the cortical centers for vision, hearing and 
smell? 

53. From what kind of data has been derived our knowledge 
of these cortical centers? 

54. Trace a nervous impulse resulting in movement of the left 
hindleg, as in climbing, from the area of the cortex in which it origi- 
nates to the muscles concerned in the act. 

55. Trace the course of a tactile impression produced at the 



192 The Corpuscle. 

tip of the right index finger to the area of the cortex in which it is 
received, by any possible route. 

56. What, in general, are the functions of the cerebellum? 

57. Have we any definite knowledge of the functions of the 
corpora striata and optic thalami, and if so, what? 

58. Describe the general arrangement of the sympathetic 
nervous system. 

59. What are the functions of the sympathetic nervous system? 

60. Describe the structure and functions of the sympathetic 
ganglia. 

61. Define common sensation as distinguished from the special 
sensations, and name some of the common sensations. 

62. Define subjective sensations; objective sensations; per- 
ception; judgment; illusion; hallucination; delusion. 

63. (a) On what data do we differentiate tactile pressure and 
thermal impulses? (b) To what are sensations of pain probably due? 

64. (a) How do we measure the acuteness of tactile sense? (b) 
Name three situations where tactile sense is most acute and what is 
the degree of its acuteness in each ; name three where it is least acute. 

65. Where is pressure sense most acute and how do w,e measure 
its acuteness? 

66. How is thermal sense detected in different parts of the 
cutaneous surface, and how is it distributed? 

6y. (a) Where is the sense of taste resident? (b) What nerves 
mediate the sense of taste? (c) Describe the taste-buds in the 
tongue. i ! 

68. Where are bitter substances most acutely perceived ; where 
sweet; where sour, and where salty substances? 

69. What conditions are essential to the perception of sub- 
stances by the sense of taste? 

70. (a) To what portion of the nasal mucous membrane are the 
terminal filaments of the olfactory nerve distributed? (b) Describe 
the histology of the olfactory mucous membrane. 

71. (a) What conditions are necessary to the detection of sub- 
stances by the sense of smell? (b) Give an illustration of the acute- 
ness of the sense of smell? (c) How may purely subjective sensations 
of smell be aroused? 

J2. Define sound; its pitch; intensity; timbre or quality; noise; 
musical sounds. 

73. Describe, briefly, the gross anatomy of the tympanum. 

74. (a) What is the action of the tensor tympani muscle; of 
the laxator tympani muscle? (b)Describe or illustrate, by diagram, 
the mode of action of the ossicula auditus in transmitting sound waves. 



Examination Questions: Dodson. 193 

75. (a) Describe the Eustachian tube, (b) Describe the bony 
labyrinth, (c) Describe the membranous labyrinth. 

76. (a) Describe the cochlea, excepting- the organ of Corti. 
(b) Describe the organ of Corti. 

yy. (a) What are the functions of the external ear? (b) What 
are the functions of the mcmbrana tympani; of the ossicles; of the 
mastoid cells; of the Eustachian tube? 

yS. (a) What are the functions of the semicircular canals? (b) 
What are the functions of the otoliths? (c) What are the functions 
of the cochlea? 

79. (a) How do we judge of the direction; of the distance; of 
the intensity of sound? (b) Mention some of the purely subjective 
sensations of sound, and state their significance. 

80. Describe the anatomy of the eyelids and of the lachrymal 
gland and ducts, and state the functions of each. 

81. Describe, briefly, the gross anatomy of the eye-ball. 

82. Describe the microscopical structure of the cornea; of the 
choroid; of the sclerotic. 

83. Describe the structure of the iris; of the crystalline lens; of 
the ciliary body. 

84. Describe the character and composition of the aqueous 
and vitreous humors. 

85. What are the canal of Schlemm; the canal of Petit; the 
membrane of Descemet; the membrane of Bruch; the spaces of 
Fontana; the uvea? 

86. Describe the minute structure of the retina. 

87. What are the era serrata; the macula lutea; the fovea cen- 
tralis; the porrus opticus; the mcmbrana hyaloidea; the zonule of 
Zinn? 

88. (a) In general, of what parts may the optical apparatus be 
considered to consist? (b) Name the refractive media from before 
backward. 

89. Define light; sight; reflection; refraction; a lens; a prism. 

90. Define the following functions of a lens: center of curva- 
ture; radius of curvature; principal axis; focus; conjugate foci; prin- 
cipal focus; optic axis; principal point; refractive index; visual axis. 

91. (a) What is the schematic or reduced eye? (b) In the re- 
duced eye what is the distance from the anterior surface of the cornea 
to the principal point; from the posterior surface of the lens to the 
nodal point; of the posterior chief focus from the cornea? (c) What 
is the radius of curvature and what the refractive index of the sche- 
matic eye? 

92. (a) What is accommodation? (b) What are the structures 



194 The Corpuscle. 

concerned in accommodation? (c) What is the experiment of San- 
son's images (describe fully)? 

93. (a) Define the near-point; the far-point, (b) Describe 
Schemer's experiment and tell what it demonstrates. 

94. (a) What changes occur in the eye and the surrounding 
structures during accommodation? 

95. (a) Under what circumstances may contraction of the pupil 
occur? (b) Under what circumstances may dilatation occur? 

96. Name the ocular muscles, giving the nervous supply of 
each, and describe their action. 

97. Illustrate, by diagram, or describe fully, the nature of 
the defects in the eye which result in (a) myopia; (b) hypermetropia ; 
(c) astigmatism. 

98. What sort of lens is used to correct (a) myopia ; (b) hyper- 
metropia; (c) presbyopia; (d) astigmatism, and why? 

99. (a) What are spherical aberration; chromatic aberration; 
heterophoria; exophoria; esophoria? (b) To what is each of these 
things due? 

100. (a) What is irradiation? (b) In what respects is the eye 
superior to a camera? 

101. (a) What layer of the retina is alone sensitive to light? (b) 
What are the proofs of this? 

102. What is the blind spot and how may its existence and 
size be demonstrated? 

103. (a) What do we know of the duration and intensity of 
visual sensation? (b) What is the Weber-Fechner law? 

104. Describe the ophthalmoscope and the method in which it 
is used. 

105. (a) What is the visual purple? (b) What appreciable 
changes may be detected in the retina as the result of light falling 
thereon? 

106. (a) What is meant by the "field of vision" and how is it 
ascertained in a given case? (b) How do we estimate the size, form 
and direction of external objects by vision? 

107. (a) What is color? (b) What are the two principal theories 
in regard to the manner in which color is perceived? 

108. (a) What are the six colors of the solar spectrum? (b) How 
is their relation to each other shown by the color triangle, and 
what does that illustrate? (c) What is color-blindness? 

109. (a) Explain how, with two eyes, we see objects as single, 
(b) What is diplopia, and to what may it be due? 

no. (a) How do we judge of solidity? (b) What is the stereo- 
scope? 



A CASE OF SKIN GRAFTING. 

BY W. L. BROWN, M. D. , '96. 

[Lately Appointed Interne Cook County Hospital. 

Emma H., aged five years, was left alone near the fire in Novem- 
ber, 1895. Her clothes caught fire and a large area over the back 
was burned, beginning at the fifth dorsal vertebra and extending 
down to the middle of the sacrum and latterly to within two and 
one-half inches of the umbilicus on each side, the outline being ir- 
regular. These dimensions are of the greatest extent of the burn. 

The case came under our care on June 13, 1896. The child was 
not very well nourished, had a large protruding abdomen and was 
rather under size for one of her age. 

The burn was over the lower part of the back. There was a 
large cicatrix, beginning about the fifth dorsal, and measuring in 
the vertical nine inches; transversely, in longest axis, eleven inches 
— this measurement being- about on a level with the umbilicus. This 
immense scar was not in the form of a square, but an irregular cross, 
the left limb of the horizontal bar being considerably longer 
than the right and extending around the left flank toward the umbili- 
cus. This limb measured in length from body of scar three and one- 
half inches, and in breadth three and one-half inches at base and 
two and three-quarters at outer end. The right limb extended from 
body of scar two inches. The vertical bar extended above the body 
of the scar two and a half inches, and below two and a half inches, the 
body of the scar measuring vertically four inches, and transversely, 
five and a half inches. 

In the center of this immense scar was a granulating surface with 
the long axis transverse, measuring six inches, and being contracted 
to a neck one-half inch wide near the left end, the mean width being 
two inches. This was covered with large, pale, flabby granulations 
which projected above the level o>f the surrounding scar and were 
bathed in thick yellow pus. The history was that the entire ulcer 
had been healed at one time a few months previous, but had again 
broken down. 

My colleague, Dr. Berry, and I at once advised dissection of 
all or a part of the scar, thorough disinfection, scraping away of 
granulations and skin grafting. The parents, having exhausted 
their patience with physicians trying to heal the wound with oint- 

195 



196 The Corpuscle. 

ments, and having almost given up in despair of a cure, at once con- 
sented. 

My first object being disinfection, I thoroughly washed the 
surface with 1-2000 bichloride, then applied a large moist boric acid 
dressing, covering it with oiled silk, repeating this process and apply- 
ing fresh dressing each day for eight days, at the end of which time 
the dressing could be removed apparently not soiled. 

On June 21 the right thigh and hip were thoroughly washed in 
soap and water, then bichloride 1-2000, again in sterilized water and 
a moist boric acid dressing applied, hence preparing it for removal of 
Thiersch grafts on the following day. 

On June 28, at 8 a. m., we were ready to operate, Dr. Berry 
administering chloroform and his son, who had only been introduced 
to surgery once before and then fainted, acting as assistant. 

At this time nothing was used in the way of disinfectants, except 
for our hands, only normal salt solution being used in the operation. 
All the granulations were thoroughly scraped away down to firm con- 
nective tissue covering muscles, encroaching well upon the surround- 
ing scar tissue and sponges applied with pressure until the bleeding 
stopped. Thiersch grafts were then applied at the right extremity 
of the wound, which has but little scar tissue surrounding it, and 
worked toward median line, allowing the grafts to be closely approxi- 
mated or to slightly overlap. After fifty-three had been applied, 
as much surface over the little thigh as was deemed safe had been 
removed, so the gutta percha strips and a moist dressing of normal 
salt solution were applied, about one-third of the surface having 
been covered with grafts. 

This dressing was not removed until the fourth day, when the 
whole was irrigated with normal salt solution. The grafts looked 
white, only a few having shed their upper layer of epithelium, pre- 
senting a vascular appearance. There was a slight amount of sup- 
puration in the part not grafted. 

After the first dressing the grafts were irrigated every day with 
salt solution, allowing the water to run from the grafts toward the 
part not grafted. Chloroform had to be given at each dressing, as 
the patient would become frantic as soon as she saw us coming, be- 
cause of the painful treatment she had been subjected to so long 
before. 

After the first dressing the grafts became slightly infected from 
the remaining ulcer and about one-fourth of them were lost, but 
scattering, so that enough remained to cover all the surface which 
had been grafted. 

After a few dressings moist boric acid dressings were again re- 



A Case of Skin Grafting: Brown. 197 

sorted to. On June 30 the large scar extending around the left side 
was dissected out, the skin above and below dissected, and not much 
difficulty was experienced in bringing the edges to a line of suture at 
the outer part; but at the inner, where they were so far apart, they 
could not be brought together; consequently a V-shaped incision 
was made below the wound with the apex up, the flap was pushed 
up, and by using one tension suture and scarifying the skin above, 
it was brought together the entire length. The V-shaped incision 
was closed as Professor Senn does in pushing up the skin for a lower 
lip. The entire suture (three and a half inches) healed by first in- 
tention, except for a very short distance next the open ulcer. 

Part of the sutures were removed on the fourth day, the balance 
on the seventh day. These were left seven days because of the 
situation; every movement and breath would tend to separate the 
edges of the wound. 

By this time the grafts on the opposite side were looking so 
well and the family were so much pleased with them that they in- 
sisted that I should graft the remaining ulcer and not remove any 
more scar tissue. As the scar had not separated any from the 
grafts, I finally consented to finish the case by grafting. 

As the mother was anxious to give enough to finish the opera- 
tion at one more sitting, on July 27 the opposite leg of the child was 
prepared as the one previously, and, in addition, the right arm of the 
mother was taken through the same process, namely, scrubbing with 
soap and water, bichloride 1-2000, sterilized water and a moist boric 
acid dressing applied. 

The ulcer by this time was fairly well disinfected by the moist 
boric acid dressings, which had been applied for about two weeks. 
On the following morning, July 28, after preparing in the same 
manner as before and thoroughly removing the granulations, forty- 
seven grafts from the child's thigh and fourteen from the mother's 
arm were applied, making the total number sixty-one. They were 
removed from the mother without any form of anesthetic and she 
did not make a demonstration. This number was sufficient to cover 
the entire remaining ulcer. The gutta percha strips were applied 
in the usual manner and over this a moist dressing of normal salt 
solution, oiled silk, cotton compress and a binder. 

The site of removal of the grafts from both mother and child was 
dusted with iodoform and boric acid, and iodoform gauze, cotton 
and bandages applied, which were not disturbed for ten days, at the 
end of which time most of the wounds were nearly healed. The 
dressing of these wounds was changed only once during the entire 
process of healing. 



198 The Corpuscle. 

At the end of four days the child's dressings were changed and 
not a graft seemed to be disturbed, though she had lain on her back 
most of the time. 

At the second dressing one graft came away with a strip of 
gutta percha tissue, the only one lost out of the entire sixty-one. 

There was not a particle of suppuration following this opera- 
tion. Every graft, except the one just mentioned, became vascular- 
ized and there were no granulations between them, because of their 
having been placed so close together. 

By August 15 both the wounds made by removing the grafts 
were healed and without dressings, and mother and child returned to 
their home. The grafts required dressing some weeks longer for 
protection, but this was done at home, the patients returning here 
occasionally that I might watch results. 

On September 1 the patient returned and upon examination 
it was found there had been a slight infection, and some five or six 
grafts in the center of the wound had been lost. Each one lost be- 
longed to the ones taken from the mother. It was also noticed that 
during the progress of union of the grafts, those taken from the 
mother were not so quickly vascularized, that there was more of the 
superficial epithelium lost and that they did not spread so rapidly 
as the ones taken from the child, showing that auto-grafting is more 
successful than borrowing grafts, and especially that grafts do not 
do so well when taken from elder persons and transplanted to the 
young. 

On October 1 the father of the child reported that the wound was 
entirely well and, using his own words, "a grand success," for which 
he pays his bill in cash and assures us of their everlasting gratitude. 

I report this case in full, thinking it may be of interest to some 
of the Corpuscle readers, especially the class of '96 — the grandest 
class, of course, that Rush ever sent out — as it has been to myself 
and to a great many others here, it being the first thing of the kind 
ever done in this locality. 

We have had several other cases that I would like to report, but 
could not ask the Corpuscle for more space. Would urge the class 
of '96 to let us hear from them, as I know they have had experiences 
that would interest us all. 



A CASE OF NASAL OBSTRUCTION IN THE NEW-BORN. 

ELIZA H. ROOT, M. D., PROFESSOR OBSTETRICS NORTHWESTERN UNIVER- 
SITY WOMAN'S MEDICAL SCHOOL, ATTENDING OBSTET- 
RICIAN TO WESLEY HOSPITAL. 

In October last I was called to a case of labor, which was normal 
as to duration and severity. But the baby was asphyxiated and with 
difficulty resuscitated. The child was well nourished and no cause 
for the asphyxia was apparent. 

The mother stated that this was her fourth child; that her 
previous pregnancies were normal and that the children, living with 
friends in a neighboring state, were all healthy. During her last 
pregnancy she had been obliged to work hard for the support of 
herself and children, her husband having deserted her early in her 
pregnancy. Otherwise the mother's history was negative. 

After the baby was cared for I noticed its integument remained 
quite cyanosed, but nothing further was noted until my visit on 
the following day when the mother informed me the baby could not 
take the breast. 

On making an investigation I found the infant was not breath- 
ing through its nose at all, and when the mouth was closed upon the 
nipple respiration was entirely cut off. Swallowing from a spoon 
was nearly as difficult. I examined the pharynx and found the 
mucous membrane congested and dry, there being no discharge 
of mucus or pus. In the effort to breathe the uvula with the 
arches were drawn backward and the pillars of the fauces re- 
laxed so as to almost close the pharynx as if paralyzed. The true 
character of the nasal obstruction I failed to determine at this time. 
The child lived one week, taking what little nourishment it could 
from the spoon. It suffered from renal insufficiency with uric acid, 
and prior to death developed a rise of temperature, ranging from ioo 
to 101 degrees Fahrenheit, but had no convulsions. 

Post-mortem three or four hours after death : In the right nasal 
cavity the inferior and middle turbinated bodies were greatly en- 
larged and engorged with blood, resembling two small and well-filled 
leeches lying one above the other, completely occluding the nasal 
passage. The superior turbinated body appeared normal. In the 
left nasal cavity the turbinated bodies were congested, but not so 
enlarged as to occlude, of themselves, the nasal passage. 

The brain: Over and following the fissure of Sylvius, on the 

199 



200 The Corpuscle. 

right side the pia mater was deeply engorged, as were all the blood 
vessels about the base of the brain, fluid lay in the fissure and at the 
base of the brain, while the cerebellar cavity of both sides contained 
a considerable quantity of fluid. 

Capillary engorgement was very considerable everywhere, ex- 
cept in the liver, which was pale and smaller than normal. The 
spleen was firm, dry and darker than normal. Kidneys were con- 
gested and some post-mortem (?) changes in the stomach were ob- 
served. 

During life the engorgement of the enlarged turbinated bodies 
was necessarily greater than post-mortem, and pushed the soft nasal 
septum against those of the left nasal cavity, thus effectually occlud- 
ing both nasal passages. The rise of temperature was doubtless 
due to inanition. As to treatment, palliative measures were fruitless, 
while the value of surgical interference, upon such highly vascular 
tissue in so young a child could only be known after trial. As to 
the cause of this condition I am wholly in the dark, and have, so far, 
been unable to find recorded a similar case. 



The Corpuscle. 



EDITORS. 

T. R. CROWDER, '07, Editor-in-Chief, 

226 South Paulina St., Chicago. 

E. L. McEWEN, '97, Secy and Treas. 

P. E. PIERCE, '98. A. P. STEVENSON, '98. J. P. SEDGWICK, '99. 



Communications relative to advertisements and subscription (Subscription price 
$1.00 per annum) should be addressed to the publisher. Remittances should be made 
by money order, draft or registered letter, payable to "The Corpuscle." and addressed 
to H. G. Cutler, Unity Building, Chicago. 



Ruby Red and Black: Colors of Lake Forest University. Orange: Color of Rush 

Medical College. 



A STUDENTS LIBRARY. 

In another column will be found a communication from one 
of the students concerning' the needs of an open library at Rush. 
The desirability of such an institution and what its aim should finally 
be are clearly pointed out by the communicant. The idea appeals 
to us strongly. Indeed, its necessity is obvious. If we hope to 
thrive and prosper in the future as we have in the past, and to keep 
Rush at the front as a medical educational center; if we hope to 
maintain our pre-eminence as a desirable and profitable place to 
pursue a medical course; if we hope to continue to turn out the 
most competent young 1 practitioners; if we hope to continue to 
progress and to keep abreast of the medical world — in short, if we 
hope to continue to outrank the other medical institutions around 
us, we must have a library as a working basis of our study. Realiz- 
ing this necessity, other colleges are outdoing us. Few of them, 
indeed, there are that have not on foot some plan for providing this 
want. The provision is a meager one in many instances, but it is the 
beginning of something greater. 

It may be objected that the average student has little or no time 
to spend in a library; but with the inauguration of the four-year 
course the ground to be covered becomes little greater and the time 
is increased one-third; we only hope to do more thorough work. 
Practical courses, save one or two, will be worked off in the junior 

201 



202 The Corpuscle. 

year, many recitations now coming in the senior course will fall 
back to the junior course, thus leaving the senior year free for clini- 
cal and original work. 

When we go out into practice our reputation in the profession 
will be largely established by what we do in the local medical 
societies — by our ability to do original work. It has been suggested 
by one of the faculty that there be organized in the senior class a 
"Clinical Society" for the purpose of instructing students in the 
proper manner of conducting medical societies, carrying on discus- 
sions and, above all, in how to prepare papers for them. The society 
should meet once each one or two weeks, and at each meeting two 
or three papers would be read by senior students on special topics 
assigned to or selected by them. Members of the faculty would act 
as instructors. But it is obvious that this is next to impossible until 
we have a library within easy reach of the student, affording a 
ready means for his investigation and research. 

A matter of less, but still of no inconsiderable importance to 
the student, is the provision of an open reading room, where he 
may spend spare hours of the day and evening keeping abreast of 
the current events in the scientific world, where he may read medi- 
cal journals and pamphlets, look over new books and broaden his 
ideas of medicine and medical education, where he may become 
acquainted with medical men outside his own college or city. 

But how is all this to be obtained? How are books to be se- 
cured and journals paid for? These are indeed difficult questions 
to answer just at present. The success of all our college enterprises 
depends largely upon the support of each individual student; and 
the spirit of loyalty to' all departments of our college life is a feature 
which every Rush man should carefully foster. To be a live, active 
college we must have a student body ever in sympathy with all 
college enterprises. Especially may this be said of those things 
which reflect credit upon the student body and bring them in the 
end material benefits. The solution of the questions proposed above 
lies with the students themselves; and if they but see their own ad- 
vantages and make a slight effort to provide, the solution is easy 
enough. If the benefits accruing from their effort shall not be of 
use to a part of those now in the college they should certainly look 
with pride upon what will grow from their beginnings. 

Our plan is briefly this, and if it can be carried out will, we 
believe, give us a start by the beginning of the next college year, the 
effects of which would soon commence to be felt. Let each student 
authorize the college clerk to keep from his rebate on the ten-dollar 
"breakage deposit" a specified sum, say one or two dollars, when 






Editorials. 203 

such rebate is returned to him in the spring. Few, if any, would 
feel the loss, and it would give the "students' library fund" a start — 
enough to begin work on next year, or so soon as the college would 
set apart a place. When the "breakage deposit" is made for next 
year let each student specify the amount of his rebate that is to be 
left as a library fee, and this placed on the stub. 

As to literature, one hundred dollars of the money raised 
would pay the subscription for thirty of the best medical journals, and 
the Corpuscle would donate a dozen exchanges. That is enough for 
the present, so far as periodicals are concerned. The faculty and 
alumni would, if properly appealed to, no doubt donate books, jour- 
nal files and current journals. With the remaining proceeds new 
books could be obtained. It would take some time for the library to 
become well established, but from observation of like affairs in the 
past we may safely predict that its growth would be surprising, if 
only interest in its welfare could be enlisted. In a few years we 
would not have to go to the Newberry Library to look up special 
topics. More and more would the students learn to broaden their 
knowledge beyond the confines of their text-books, more and more 
would they find library work an aid to and a demand of their college 
work. 

Can we not hear expressions from others on the subject of a 
"students' library?" Let our loyalty to Old Rush assert itself and 
provide for the future. 

EXPECTORATION IN PUBLIC. 

The movement recently inaugurated in this city against the 
practice of expectoration in public places is worthy the commenda- 
tion and support of everyone. At best, it is a filthy habit, to say 
nothing of its dangerous features. Common decency and the right 
of finer instincts to displace those of baser quality in the onward 
march of progress would justify the crusaders in the use of stringent 
measures. The most potent factor in awakening the repugnance 
and consequent activity of the people at large is the intrinsic vileness 
of the habit. The scientist, however, sees, in addition to uncleanliness, 
the grave danger to human lives that lurks in desiccated, wind-tossed 
sputum. It is manifest that, in a great city like Chicago, where 
population, and, therefore, disease, is concentrated within a limited 
area, and where the various demands of active life bring hundreds 
and thousands of people daily into the public thoroughfares and 
places, the number of expectorating tubercular individuals upon 
the streets must be very large, and the number of healthy people ex- 
posed to infection by desiccated tubercular sputum must be vast. 



204 The Corpuscle. 

indeed. The facility with which the sound lung- and the tubercle 
bacillus are brought in contact through the medium of infected ex- 
pectoration is sufficient to warrant active legislation on the subject, 
with subsequent vigorous enforcement. But laws come only with 
the growth of public opinion. The movement is new and some time 
will elapse before the sanitary aspect of the question will impress the 
people so strongly as to lead them to demand stringent laws relating 
to the matter, with strict execution thereof. In the meantime the 
general revolt against the unmitigated nastiness of the spitting habit 
will educate the public mind to appreciate some other considerations 
of the subject. 

We regret to say that it is not always necessary to resort to the 
sidewalks for evidences of expectoration. Contrary to what might 
reasonably be expected in a medical college, the brimming pool of 
tobacco juice is all too frequent in our amphitheaters. Eyes are not 
needed to detect its presence; the slippery feel under the foot and a 
peculiar sense of impending' danger warn one of the quagmire 
ahead. Fortunately, two courses are then open to the victim — he 
can backwater or jump. It is not stimulating to the mind nor sooth- 
ing to the nerves to hear, during the hour of an interesting lecture, 
the steady, rythmatic plunk of several drachms of liquid amber from 
the jaws of a tobacco chewer in the seat behind; and if there is one 
thing above all others that is fitted to make a man indescribably, 
belligerently and righteously mad, it is to accidentally trail his over- 
coat through an offensive mess of salivary offal on the floor. But, 
seriously, students as coming physicians, whose lot it will be in the 
future to inculcate sanitary principles, should do as was recently 
suggested: "Either swallow it or put it in your pocket," the latter 
method, of course, being- far preferable. Such a rule, however, 
would be hard on the tobacco- chewers. To follow the first sugges- 
tion he would need to* carry a sputum cup — a sort of a pocket-flask; 
and as for swallowing it — well, he would not be more sickened than 
are other people by the sight of his filthily contaminated secretion so 
freely expectorated. 

"passing up." 

Children outgrow their clothes. Old customs are gradually re- 
placed by new in all progressive communities. Most of the colleges 
of the country have found that the old regulations of the early New 
England colleges are not fitted for larger institutions. 

In a like manner, certain venerable traditions have been laid 
aside and a great many boyish follies, grown gray, have given 
way to practices more becoming men and smacking less of the high 



Editorials. 205 

school. For instance, the annual good-natured fight so long in- 
dulged in by the Sophomores and Freshmen, known as the "cane 
rush/' has been met squarely by the heads of the various literary 
institutions and has been done away with in most cases. 

After a few months we are able to see the effect of the deter- 
mined stand taken by our faculty in regard to the time-honored 
"passing up." As is generally the case with practices that gain so 
strong a foothold, there are some arguments in its favor. It is surely 
exasperating to an upper classman to find the front row in a clinic 
filled with freshmen. Force is the first thing which suggests itself, 
but it is a poor way to settle the matter. It is now too late to go into 
the details of the trouble, but however we regret the almost sensa- 
tional and unnecessary publicity given to the affair by the daily 
papers at that time; and notwithstanding we may be sorry that such 
severe measures were necessary at first to enforce the rule, it is grati- 
fying now to witness their salutary effect. This year the students 
have quietly and gentlemanly obeyed the order, and there seems to 
be little probability of a return of the old practice. In fact, "passing 
up" to the new man of the class of nineteen hundred is but a tradi- 
tion and a "bug-a-boo," whose only value is to frighten Freshmen. 

Perhaps this otherwise unimportant matter is an indication of the 
progressive feeling at Rush. May it be but one step in the direc- 
tion of a broader and stronger growth. 



The excellent article by Dr. Montgomery on "Methodical Diag- 
nosis in Diseases of the Skin," which appeared in part in the January 
Corpuscle, will be completed next month. 



We do not wish to criticise the senior course in Morbid 
Anatomy, but if the following, from a western paper, is authentic, 
valuable information is being withheld from us. Those who contem- 
plate locating in the state mentioned should investigate and prepare 
themselves accordin^lv: 



l s»v 



Kansas objects to graduates of Chicago medical colleges prac- 
ticing medicine in that state, on the ground they don't understand 
the internal mechanism of the average Kansan, which appears to 
differ from that of an American. It appears that when a Kansas 
Populist was dissected recently in Chicago, the medical faculty was 
astounded to find a small bale of hay where the viscera should be, and 
a wad of repudiated notes where the heart should have been. A 
rotary blower, badly worn, occupied the plural cavity, and seven sets 
of silver-tongued reeds were found in the larynx, which when touched 
seven days after death emitted a howl in which the words free silver 



206 The Corpuscle. 

and plutocrats were distinctly noted. A few shingle nails and barbed 
wire were found in other parts of his system, and the faculty was so 
dumbfounded that they concluded that their students should study 
threshing- machines and fence weaving factories in order to com- 
prehend the anatomy of a Kansan; hence the "kick" of the Kansas 
authorities against the Chicago doctors. 



We desire to call attention to the retirement of Mr. Fred. Barrett, 
'97, whose picture appears this month as a frontispiece, from the 
editorial board of the Corpuscle. Mr. Barrett has been on the 
board a year and has done efficient service. Mr. Luckey, who retired 
last month, and Mr. Barrett will be succeeded by Mr. Frank E. 
Pierce, '98, and Mr. J. P. Sedgwick, '99. 



NEEDS OF A COLLEGE LIBRARY. 

To the Corpuscle: 

I venture to make a few remarks on the much talked of subject, 
a college library, fully appreciating my incapability of doing jus- 
tice to so important a subject, but hoping, however, that the 
students in Rush may more fully realize how valuable such an 
acquisition to the college would be. 

Those students who have never been accustomed to use a 
library in the pursuance of their studies do not, perhaps, realize 
its importance; but graduates from literary colleges or univer- 
sities, in fact, all those who have been benefited by this method 
of study, must, upon entering the medical college, be struck with 
the absence of so important a factor. This applies not only to Rush, 
but to most of the other medical colleges in this country. There 
are a number of public medical libraries to some of which students 
may gain access, and here in Chicago there may be found in the 
Newberry Library nearly 30,000 volumes of medical literature; but 
the libraries which are directly connected with medical colleges 
are rare, and where they do exist the number of volumes con- 
tained is small. 

Of the professional occupations, what greater or nobler one 
can be named than that of medicine, and can one name any other 
of which is demanded a more thorough knowledge? Yet com- 
pare the medical library, for example, with the libraries connected 
with colleges of law and theology. Is not the medical library of 
equal value? 

I believe that every medical college should have a library, and 
the chief ends which I would have it accomplish are: (1) To con- 



Communications. 207 

tain material for the study of all the sciences collateral to the study 
of medicine; and (2) to contain material for the thorough study 
of all the branches of medical science as found in a medical cur- 
riculum. There are other ends to be accomplished, but which 
seem of less importance, and such as could be added to a library 
after the first two were acquired. The first two, I believe, would 
meet all the demands of the student. 

In the first I would include such branches as physics, anthro- 
pology, biology and chemistry. The best encyclopedias and com- 
pends embracing these branches should be secured, and if the 
funds were ample a more extensive outlay could be advantageously 
made. 

In the second I would obtain the latest and best encyclopedias 
of general medicine and the leading text-books on the different 
branches, together with compends and monographs, and a num- 
ber of the best journals of American and foreign publication. 
Of the foreign journals, probably the essential ones would be 
those from England, France and Germany. It would not be pos- 
sible to have all the medical literature on the different branches, nor 
would it be necessary. 

I believe it would be practicable for "Rush" to have such a 
library, and that it could be secured at no very great expense. Of 
course it could not be fully equipped at once, but would have to 
be started with a few books and let the number be increased each 
year. There are many, I believe, who would contribute to a library 
which was started who would not take the first steps toward forming 
one. 

In order that a library might be secured, however, the initiative 
steps would have to come from the students themselves. The 
question arises, "Do they want one, and, if so, would they be willing 
to assist in starting one?" 

The subject is an important one and worthy of the students' 
consideration. P. F. 



CONDITIONS OF ENTRANCE TO THE ROYAL COLLEGE OF PHYSICIANS 

AND SURGEONS. 

About a year ago Rush became one of the very few American 
medical colleges whose work is recognized by the Royal College 
of Physicians and Surgeons in England. It will be interesting 
to many to know just the terms of admission, which are stated 
in the following letter, written by the secretary of the examining 
board to the warden of St. Bartholomew's Hospital, London: 



208 The Corpuscle. 

London, Jan. 26, 1897. 
Dear Doctor Shore: 

A graduate in medicine of the Rush Medical College is admis- 
sible to the final examination of this board without passing the 
first and second examinations. We do not require him to pro- 
duce all the certificates mentioned in our regulations, applicable 
to the ordinary student, but we do require him to produce the 
following: 

1. Evidence of having passed a recognized preliminary ex- 
amination, in w'hich Latin must have been a subject. 

2. Evidence of having completed not less than four Winter 
and four Summer sessions, or five Winter and five Summer sessions 
of professional study, according to the date at which he com- 
menced attendance at the Rush Medical College. 

3. Evidence of age. 

4. His degrees. 

5. A certificate of proficiency in vaccination from a govern- 
ment teacher in England. 

Yours very truly, 

Julius S. Hallett, Secretary. 

This letter was inclosed in a letter from Dr. Shore to Mr. 
Plummer, of the present senior class in Rush. Dr. Shore says in 
his letter: "It would be desirable before presenting yourself for 
this examination to spend from three to six months attending the 
practice of this hospital and the classes held in preparation for 
this examination, for the exact method of practice here and the 
character of the examination are such that you would require to de- 
vote about that time to acquainting yourself with their peculiarities." 



COLLEGE NOTES. 



GLEE CLUB CONCERT 



The first concert of the Rush Medical Glee Club was suc- 
cessfully held in the college amphitheater on the evening of the 
eleventh of February. The audience was large and enthusiastic and 
the future of the club is assured. The members deserve credit 
for their earnest work and perseverance in the face of the dis- 
couragements which present themselves to a new organization. A 
certain nervousness which was noticeable in the first number grad- 
ually wore off, and the club ignored hearty encores with all the 
coolness of an organization with an established name. 

The mandolin club's number was very well rendered. The 
club shows marked improvement over last year. Able assistance 
was given by Messrs. W. W. Millner, Max Kramm, C. E. Chapell, 
R. Chisholm Bain and T. B. Webster. The following is the 
program as given: 

PART I. 

i. Breezes of Night Lamothe 

Glee Club. 

2. Gabriel's Blanket Amy Leslie 

Mr. Millner. 

3. (a) On Wings of Song Liszt 

(b) Air de Ballet Wittkowsky 

Mr. Kramm. 

4. In Absence Buck 

Glee Club. 

5. Le Tortorelle Arditi 

Mr. Bain. 

6. A Dream Bartlett 

Mr. Chapell. 

7. Vita Gaia Tipaldi 

Mandolin Club. 

PART II. 

1. The Monkey said to the Chimpanzee Nevin 

Glee Club. 

2. The Nightingale's Trill Ganz 

Mr. Bain. 

3. Armorer's Song, "Robin Hood" De Koven 

Mr. Webster. 

4. Selections from Col. Carter of Cartersville Smith 

Mr. Millner. 

5. Valse de Concert, Op. 34 Moszkowsky 

Mr. Kramm. 

6. Comrades in Arms Adam 

Glee Club. 
209 



210 The Corpuscle. 

The glee club is made up as follows: First tenors, W. H. 
Walker, R. L. Whitley, F. O. Brown, E. C. Williams, R. E. Doidge; 
second tenors, W. H. Bennett, J. M. Mitchell, P. J. Little, H. R. Rey- 
nolds, J. H. McHenry, H. Duncan; baritones, D. Fisk, L. F. Rich- 
ardson, A. W. Dowd, C. E. Cook, J. F. Clark, A. N. Murray; bassos, 
J. A. Purtell, G A. Shaw, W. M. Phelps, H. A. Ware, M. L. Galliger. 

THE BASEBALL OUTLOOK. 

It is unfortunate that the baseball season is so short in Rush. 
The team barely gets into playing form before college closes; 
hence our team must content itself with a second rate position in 
the ranking of collegiate baseball clubs. This year, however, there 
seems as never before to be a spirit among the candidates that 
makes them ready to do gymnasium work in preparation for the 
outdoor playing which will, if persisted in, put us in playing form 
much earlier than heretofore. 

No previous season has shown such a wealth of new candi- 
dates or candidates of such ability. This is shown by the fact 
that many of them are followed by their reputation as players rather 
than that they bring it themselves. Of last year's team the ma- 
jority are still in school, so that a good, healthy nucleus is provided 
from which a fine team should develope. The weak point of last 
year — behind the bat — is now especially strong. Two men who 
have figured in minor league teams and one first-class amateur 
are now after the place. Three new pitchers have entered school 
this year, as well as two or three new men for each of all the other 
positions on the team. With such material a team will develop 
second to none in the West, if conscientious work is done by each 
candidate. Not one of last year's team is sure of retaining his 
position in the face of all this new material, personal mention of 
which is reserved for a later article. 

We are particularly fortunate this year in securing the use 
of the Dental College gymnasium, which is fitted up as an excel- 
lent "cage." In this each man, at a nominal expense of one dollar, 
has the opportunity of working the "glass" out of his arm before 
the season opens. The importance of this cannot be too strongly 
urged, in view of our short season and the strong competition for 
positions. The season is so short that men must be chosen for the 
positions largely on their work of the first week or ten days. It is 
easily seen, then, that the candidate with gymnasium training will 
have his chances doubled by his preliminary work. This is a 
pointer that the candidates will do well to consider. 

Heretofore the members of the faculty have very generously 



College Notes. 211 

supported the athletic teams. It is hoped this season that the ball 
team will be self-supporting, or, in other words, supported by the 
students themselves, who have very little of that kind of expense 
to bear. As a beginning a benefit entertainment will soon be 
given, to which it is hoped every student will come, thus helping 
to put the team on its feet financially. 

An excellent schedule is being arranged, to consist of city 
games with Chicago, Northwestern and Lake Forest Universities, 
and minor teams. Besides this a short trip will be made to Wis- 
consin, Indiana, and perhaps Ohio, and after commencement an 
extended Western trip. Ample reward will be in store for the ones 
who by hard work secure positions. 



Dr. Skinner, of the Chemistry Laboratory, has recently brought 
out a convenient device for the approximate quantitative determina- 
tion of albumen in urine. It consists briefly in a scale-bearing card 
to be used in connection with an ordinary test tube. One scale 
gauges the diameter of the test tube; another marks the bottom 
of the tube, the amount of urine to be used and the quantity of 
reagent to be added to effect precipitation; a third indicates in 
grammes per litre, after twenty-four hours' subsidence, the amount 
of albumen present. Full directions for preparing the reagent 
and for using the card are printed upon the back. It is a neat 
and handy device that is destined to find a wide sphere of useful- 
ness in the hands of busy practitioners. We congratulate Dr. 
Skinner upon this the latest offspring of his ingenious brain. 

Patterson & Shinnin, 93 Ashland Boulevard, have been selected 
by the Seniors as class photographers. 

Mr. Waterman, of the South Side, is making some excellent 
group pictures of the various college classes. 

Dr. M. D. Bates, of the class of '96, began service as interne 
in the Presbyterian Hospital the first of February. 

Dr. Wilder has changed his Cook County clinic from Thurs- 
day morning at eight o'clock to Monday morning at the same hour. 

Professor Brower began his course of lectures on Insanity to 
the Senior class February 4. He was given a rousing reception 
by the Seniors. 

A complete file of "The American Journal of the Medical Sci- 
ences" has been placed in the laboratory of pathology. A depart- 
mental library of considerable efficiency has grown up under the 
care of Professor Hektoen. 



212 The Corpuscle. 

Dr. Samuel C. Beach, for several years instructor in Chemistry 
and Diseases of the Chest, has located at McCook, Neb. He has 
gone in with Dr. William Gage, of his own class at Rush, who 
has started a private hospital at McCook. 

During Dr. Montgomery's absence his class in Diseases of the 
Skin was heard by Dr. Sippy, late from the Cook County Hospital 
and European clinics. That the class suffered little or nothing by 
the change is certainly very complimentary to Dr. Sippy. 

Professor Senn returned February i from his trip "hunting, 
visiting medical schools of the South, and preparing a presidential 
address for the next meeting of the American Medical Association," 
and is again in charge of his clinic. He said of the physicians of 
the South that they are "strong, hearty, courageous, and, as a 
rule, very able men." 

The many admirers of Professor Hektoen will be pleased to 
learn that he has been invited to deliver the annual address before 
the Philadelphia Pathological Society the coming April. The 
choice of speakers is a happy one. Professor Hektoen is eminently 
worthy of the honor and the society is certain of a rare feast of 
pathological good things. 

This is a gratifying piece of news. At a recent meeting of 
the executive faculty the college clerk was instructed to figure 
the students' breakage accounts and have the rebate ready at least 
a week before commencement. Another thing that will gladden 
the students' heart is that every indication is to the effect that 
the rebate will be quite large. 

Lately heard in recitations: 

"Millinery tuberculosis." — Mattei. 

"Military tuberculosis." — Vaughn. 

"Vicious fluid." — Lowenthal. 

"Incontinence of urine may be caused by cyanosis." — Bradley. 

"The therapeusis of cod-liver oil in tuberculosis is that it fur- 
nishes food for the bacilli so that they let the tissues alone." — Page. 

"Chloride of gold was first used in tuberculosis by Keeley." — 
Mahony. 







l&fiRONyfti? Iabricius 









The Corpuscle. 

RUSH MEDICAL COLLEGE, CHICAGO, ILL. 
Medical Department Lake Forest University. 



Vol. VI. MARCH, 1897. No. 7. 



THE LEEDS SCHOOL OF MEDICINE. 

BY A. J. OCHSNER, M. D. 

During my recent visit abroad I had an opportunity to study 
an institution of learning from which our American medical schools 
might very profitably copy many important features. I refer to 
the Leeds School of Medicine. 

We are not generally in the habit of classifying this school and 
the hospital in which its students obtain their practical training 
with the great medical schools abroad, probably because of its 
location in a great commercial and manufacturing center, which 
is somewhat out of the usual course of travel of the American 
student in pursuit of medical or surgical instruction. 

Still there is scarcely an American student who is not familiar 
with the names of Teale and Hey, the famous teachers of this 
school, or Sir Spencer Wells, whose fame is familiar to all and 
whose career began in Leeds. A number of names of members 
of the present faculty are constantly quoted by American writers, 
but somehow we rarely see any reference to the school they repre- 
sent. 

I will describe the methods of clinical instruction in this school, 
especially as regards the work in the department of surgery, because 
I was especially interested in this work and gave it more careful 
attention than the other departments. 

The college building proper is a large, modern four-story 
building, with a capacity exceeding that of any college and labora- 
tory building combined in Chicago. It is splendidly arranged, 
containing about twenty laboratories and an equal number of 
lecture and recitation rooms; a library supplied with medical 

217 



218 The Corpuscle. 

books and a large number of current medical journals; a patho- 
logical museum, and, of course, a well-arranged dissecting room. 
All of the laboratories are well supplied with apparatus. 

The first three years of the five years' course are spent in this 
portion of the institution in studying the elementary branches, 
performing laboratory work and making dissections. During the 
last two years a great portion of the students' time is spent in 
clinical work in the General Infirmary, which is located across 
the street from the medical college. 

This was one of the first great hospitals constructed on the 
pavilion plan nearly thirty years ago. It is composed of a main 
portion and six wings, having a capacity of 470 beds. The first 
floor contains a large hall, furnished with settees, which will com- 
fortably seat about three hundred patients. This is the waiting 
room for the free dispensary. On two sides of this hall are twenty 
large, well-lighted rooms, fitted with all desirable appliances for the 
examination and treatment of dispensary patients. Each depart- 
ment occupies two rooms, and there are especial dark rooms for 
ophthalmoscopy, laryngoscopy, etc. Both the large hall and the 
clinic rooms are kept clean and pleasant, which at once attract the 
attention of one accustomed to seeing our dispensaries. The aver- 
age number of patients treated each day in this dispensary during 
the past year was 435. Each one of these patients is utilized for 
the instruction of the fourth and fifth year students. 

The dispensary staff is composed of the younger members of 
the faculty and members of the regular hospital staff, who are 
supplied with the same facilities for examination and treatment 
of patients that a physician would have in a splendidly appointed 
office and laboratory. But in order to fully comprehend the bene- 
fits these students derive from this great material one must follow 
them through their course of instruction, which extends over five 
years of nine months each. The requirements for entrance cor- 
respond very nearly to the amount necessary for graduation from 
our average literary college, giving the student in this country 
the title of B. S. or A. B. During the first two years the work is 
confined to didactic instruction, laboratory work and dissection; 
during the third year this is combined with clinical work, and during 
the fourth and fifth years the student spends a great amount of 
time in actually examining and treating patients. 

The practical work is divided in the following manner: For 
a term of three months each student is required daily to actually 
examine a number of patients, write their histories, make diagnosis 
and advise the treatment, under the supervision of an instructor in 



The Leeds School of Medicine: Ochsner. 219 

the department of internal diseases in the dispensary. Then he 
takes a service in the surgical department for an equal period of 
time. He now examines patients, writes histories, dresses wounds 
and assists in reducing- and dressing fractures and dislocations. 
Each student has a number of cases assigned to him each day, 
the new patients being distributed equally among the students in 
each department by the instructor. A patient who has been 
assigned to one of these students is treated by him throughout 
the illness precisely as he would be were the student a practicing 
physician and the patient a private patient, with the exception 
that the examination, diagnosis and treatment are all conducted 
under the supervision and advice of an instructor. 

These two important services having been completed, the 
student takes up a shorter service in gynecology, ophthalmology, 
laryngology and obstetrics. After this come practical courses 
in performing autopsies and recording the pathological conditions 
found, and a course of surgical operations on the cadaver. This 
amount of practical work seems very great to an American student, 
but it is only the beginning with the student at Leeds, who is now 
transferred from the dispensary to actual service in the wards of 
the hospital. 

Each attending physician has the care of four of these students, 
and among them he distributes all of his patients uniformly as they 
enter his wards in the hospital, so that each one of these students 
lias charge of one-fourth of the patients of the attending physician. 
Under the supervision of the interne the student makes the ex- 
amination, writes the history, examines the urine, sputum, blood, 
etc., suggests the treatment and records the condition of the 
patient from day to day. In fact he treats the patient precisely 
as though he were called to his bedside, in his own house, as a 
family physician, with the exception that he must be prepared to 
demonstrate to the interne and the attending physician, who is a 
professor in the college, that he is right in his diagnosis and treat- 
ment. This work he carries on for a term of six months, when he 
takes up the service of surgical dresser for an equal period under 
the instruction of one of the attending surgeons. 

Each attending surgeon has also an interne or resident sur- 
geon and four undergraduate assistants, known as dressers. Each 
dresser has assigned to him every fourth case which comes under 
the care of his attending surgeon in the hospital. He examines 
the patient, writes the history, prepares the case for operation by 
scrubbing, shaving and disinfecting the surface and applying a 
moist antiseptic dressing. During the operation he handles the 



220 The Corpuscle. 

instruments and sutures and ligatures, while the surgeon is assisted 
in his work by his interne and one of the other dressers, another 
one giving the anaesthetic under the direct supervision of one of 
the other resident surgeons, the fourth dresser in the meantime 
looking on or preparing the next case for operation. Until this 
patient leaves the hospital the same dresser sees him daily, records 
his condition on the history sheet and dresses the wound himself, 
or if the case is serious he assists the interne in doing this. If 
any pathological tissue has been removed he makes a microscopic 
examination, under the direction of the pathologist of the college. 
After finishing his six months' service as a dresser his five years' 
course will be completed, and by passing the final examinations 
he will be permitted to graduate, or qualify, as it is called in his 
country. Now he may apply for a year's service as resident physi- 
cian or surgeon in the hospital, or he may serve in each of these 
capacities for one year. 

Over 6,000 patients are treated in the hospital during the year, 
each patient remaining on an average about three weeks; severe 
cases, of course, a much longer, and simple ones a shorter time. 
During the past year 8,138 patients were treated in the hospital 
and the dispensary for injuries. This great number of cases is 
accounted for by the fact that the city contains numerous factories 
and the surrounding country many mines, this being the only 
public hospital for a population of half a million of people in the 
city and an equal number in the densely populated surrounding 
country. When we remember that this vast material is carefully 
utilized for the practical instruction of less than one hundred students 
we can see how vastly superior their practical instruction is to that 
in our medical schools. 

I remember hearing one of our students boast that he had 
witnessed over fifty laparotomies during his course at a well-known 
medical college, but his pride took a sad fall when he had to admit 
that he had never felt crepitation in a broken bone, nor dressed a 
wound, nor conducted a confinement, nor made a visit at the bed- 
side, nor written a clinical history, nor given an anaesthetic. The 
college contains about 200 students, but as the practical work in 
the dispensary and the hospital is confined to those in the fourth 
and fifth years, there are about forty on duty constantly in the 
dispensary and an equal number in the hospital. From this it is 
plain that each student personally treats about 730 dispensary 
patients throughout their illness, seeing each patient four times on 
the average. He would have charge of at least 100 injury cases, 



The Leeds School of Medicine: Oc/is/ier 



221 



and he would treat more than sixty patients at the bedside in the 
hospital from the time of admission to the time of discharge. 

Several years ago our laboratory instruction was as lame as is 
our clinical instruction at the present time; but this is no longer 
the case, and it is to be hoped that our schools may learn as much 
from the English schools in the direction of clinical instruction as 
they have learned from the German schools in the way of laboratory 
teaching. Nearly twenty years ago, when the Cook County Hos- 
pital was developed in its present location, bedside instruction was 
practiced to a very creditable extent; but it was soon prohibited for 
a number of reasons, chiefly on account of a spirit of selfishness 
which was even more marked in this city at that time than it is now. 
Ultimately it will undoubtedly again come to a similar plan in this 
city, but much will depend upon the students, as well as upon the 
hospital staff, to make such a plan permanently practicable. 

In Leeds I was struck with the fact that throughout the work 
in the hospital the patient and his interests were considered of 
primary importance. From the professor to the lowest assistant 
all seemed to bear this principle in mind. Whatever was done 
was for the best of the patient, not for the glory of the professor 
nor for the benefit of the student. Of course, the professor's glory 
and the student's benefit were inevitable, but they were not the 
primary object. This is in very marked contrast with the condi- 
tions found in many of the institutions on the European continent, 
where the professor poses as a most exalted being, his assistant as 
not much less, and even the student looks down upon the patient 
as simple material, probably produced by Providence for his personal 
advancement. Unfortunately it seems easier to follow the ex- 
ample found on the continent, but it is certainly to be hoped for 
the advancement of medical education in this city that the methods 
in vogue in Leeds be adopted here. 

Besides the benefit obtained from personal care of patients 
in the dispensary and in the hospital wards, there is a remarkable 
benefit to the student from observing the manner in which success- 
ful men deal with their patients. In order to develop public opinion 
in favor of permitting students to the privileges of bedside study 
it seems important that everyone connected with hospital work see 
to it that the benefits obtained by the student are always perfectly 
compatible with the best interests of the patient, and that the idea of 
looking upon the patient as clinical material be banished from our 
institutions. 



A SYNOPSIS OF THE PRACTICAL WORK IN OPHTHAL- 
MOSCOPY AND REFRACTION AT RUSH 
MEDICAL COLLEGE. 

BY CASSIUS D. WESCOTT, M. D. , INSTRUCTOR IN OPHTHALMOLOGY 

AT RUSH MEDICAL COLLEGE | OPHTHALMOLOGIST TO THE 

SANITARIUM FOR BABIES, ETC. 

As most of the readers of the Corpuscle are aware, a practical 
course in the use of the ophthalmoscope and the study of errors 
of refraction has been a requirement for graduation at Rush Medical 
College for the past three years. Since the first course was given 
the work has naturally become more and more systematized, and I 
give below a very brief synopsis of the facts which I have endeavored 
to impress upon my classes during the term now drawing to a 
close. The instruction has been thus far given to classes of about 
thirty-five men, and each class has had twelve lessons, two of which 
have usually been given to the examination of the ear. Each lesson 
occupies one hour. 

It is manifestly impossible, in so short a time, to teach students 
to fit glasses, and that has not been the intent. It has also been im- 
possible to show them many cases illustrating the pathological 
fundus oculi. We have, however, succeeded in teaching the prin- 
ciples of refraction and pointing out how the general practitioner 
may quickly and readily recognize those cases requiring the atten- 
tion of the skilled refractionist, and we have also taught the majority 
of our students to use the ophthalmoscope successfully and to recog- 
nize the normal fundus. This is, of course, but the beginning of 
ophthalmoscopy, but all those who are expert in the use of the 
ophthalmoscope realize that it has required months, or even years, of 
practice to acquire their skill. 

I feel confident that if the students will but continue the practice 
with the eye model, as we have advised, until opportunity presents 
for the routine use of the instrument in the examination of patients, 
they will in time become expert and very soon learn the immense 
advantage of ophthalmoscopy in general diagnosis. 

REFRACTION. 

Light is a form of radiant energy and is the physical cause of 
our sensation of sight; it is emitted from every point of every 
luminous body and travels in straight lines. These lines are spoken 
of as rays, and the rays of light originating from a single point are 
spoken of as forming a pencil of light or a pencil or rays. 



Practical Work in Ophthalmoscopy: Wescott. 



223 



Nonlnminous objects become visible by the light which is re- 
flected from their surfaces into our eyes. 

Ravs of light coming from points on the sun's surface arc so 
nearly parallel that they are spoken of as forming- parallel pencils 
of light. 

That light always travels in straight lines can be demonstrated 
by a simple experiment with the "pin-hole camera.'' (Fig. I.) 





i 

LI" 

A' 


i 

i 

[ 

y 




Fig. 1. 



The inverted picture formed in this experiment is spoken of as 
an image of the candle flame. A small pencil of rays from each 
point upon the surface of the candle flame, A, B, passes through the 
hole O in the card and impinges upon the screen, forming there 
a spot of color, A', B', the brightness of the spot depending- upon 
the color and brightness of the point from which the rays emanate. 
As the rays from the top and bottom of the candle flame must cross 
in the pin-hole the image is inverted. The entire picture is a col- 
lection of spots or foci formed by the pencils of rays given off from 
all of the different points upon the surface of the candle flame. 

By the refraction of light we mean a change in the direction of 
the rays passing from one medium to another of different density. 
When a ray of light strikes the surface of a plate of glass obliquely, 
it is bent or refracted, in passing through the glass, toward a line 
drawn perpendicular to its surface. 

Rays of light passing through a prism are refracted toward its 
base. 

A convex lens may be said to be made up of an infinite number 
of prisms with their bases together. 

A concave lens may be said to be made up of an infinite number 
of prisms with their apices together. 

The line joining the center of two spherical surfaces which 
bound a lens is called the axis of the lens. 

A convex lens is thickest at its axis and refracts rays which 
traverse it toward its axis. 



'224 The Corpuscle. 

A concave lens is thinnest at its axis and refracts rays which 
transverse it from its axis. 

If a pencil of parallel rays of light fall upon the surface of a 
convex lens in a direction parallel to its axis they are made to con- 
verge and meet in a point upon the axis. This point is called the 
principal focus of the convex lens. 

If a pencil of parallel rays fall upon the surface of a concave 
lens in a direction parallel to its axis they are made to diverge and 
appear after refraction to proceed from a point on the axis. This 
point is the principal focus of the concave lens. 

The distance between a lens and its principal focus is called 
the focal length of the lens. 

The unit of measure of lenses is a convex lens of one meter 
focal length and such a lens is called a diopter. A lens of two 
diopters has a focal length of half a meter. A lens of half a diopter 
has a focal length of two meters. 

A spherical lens is so called because at least one of its surfaces 
is a segment of a sphere. 

A cylindrical lens is so called because one or both of its surfaces 
are segments of a cylinder or cylinders. 

The axis of a cylindrical lens is that meridian in which there is 
no refraction. 

Rays of light coming from a point beyond the principal focus 
of a convex lens will, after passing through the lens, come to a 
focus at some point on the other side of the lens. These two points 
are called conjugate foci. 

By the refraction of the eye we mean its power, when at rest, of 
focusing parallel rays of light. 

By the accommodation of the eye we mean its power of adapt- 
ing itself to vision at different distances. The chief factors of ac- 
commodation are the elasticity of the crystalline lens and the action 
of the ciliary muscle. The ciliary muscle surrounds the anterior 
border of the choroid, outside of the ciliary processes ; its fixed point 
is in front from the circular line of junction of the cornea and scler- 
otic. Its fibers, which are chiefly longitudinal, pass backward and 
are lost in the substance of the choroid. It has also a circular net- 
work of fibers, lying beneath the longitudinal fibers and in contact 
with the ciliary processes. It is evident from the arrangement of the 
fibers of this muscle that its action must be to approximate the 
border of connection of the sclerotic and cornea and the circumfer- 
ence of the choroid, compressing the vitreous humor and relaxing 
the suspensory ligament of the lens. When the suspensory ligament, 
which, when the eye is at rest, holds the crystalline lens in a state 



Practical Work in Ophthalmoscopy: Wescott. 225 

of tension, is relaxed, the lens tends to assume a spherical form, the 
greatest change taking place in its anterior surface. As the con- 
vexity of the lens is increased the refracting power of the eye is in- 
creased and it is adapted to vision at the near point. 

Emmctropia is that condition of the eye in which parallel rays 
of light are focused upon the retina when the eye is at rest, i. e., with- 
out the aid of accommodation. 

The human eye is a living camera. The cornea, the aqueous 
humor, the crystalline lens and the vitreous constitute its dioptric 
system, the optical center of which is at the posterior surface of the 
lens. The iris is a perfect diaphragm, automatically contracting and 
dilating to regulate the amount of light admitted to the eye, and at all 
times shutting out marginal rays. The delicate retina not only 
forms a most excellent screen for the reception of images through 
the fibers of the optic nerve to the brain as definite sensations. 
Rays of light entering the glohe from an external object will un- 
dergo a series of refractions, all tending to make them more con- 
vergent, and a real and inverted image will thus be formed of any 
external object to which the eye is directed. If this image falls on 
the retina the object is seen; and if the image thus formed is sharp 
and sufficiently luminous the object is seen distinctly. 

Hyperopia is that condition of the eye in which parallel rays of 
light are brought to a focus at some point behind the retina. It 
may be due to the fact that the antero-posterior axis of the eyeball 
is too short, axial hyperopia, or the refractive apparatus may be too 
weak, refractive hyperopia. 

Axial hyperopia is due to an imperfect development of the eye- 
ball and is congenital. After the removal of a cataractous lens our 
patient has refractive hyperopia. 

Patients who have hyperopia come to us complaining of eye 
fatigue, sometimes amounting to pain, after near work, with occa- 
sional blurring of the types and headaches. Convergent strabisms 
and inflamed lids may be due to hyperopia alone. 

For the correction of hyperopia we use convex lenses to in- 
crease the refractive power of the eye and the strongest convex lens 
with which the patient sees best when the eye is at rest is the measure 
of his hyperopia. 

Myopia is that condition of the eye in which parallel rays are 
brought to a focus at some point in front of the retina. It may be 
due to an elongation of the globe, axial myopia, or to an increase 
in the strength of the refracting apparatus of the eye, refractive 
myopia. This is usually an acquired defect and is due to straining 
an eye, whose coats are perhaps already weakened from malnu- 
trition. 



226 The Corpuscle. 

Patients who are myopic complain chiefly of poor distant vision, 
but sometimes of aching eyeballs and burning lids. Divergent 
squint is often a consequence of myopia. The dangers of myopia 
are that it is often progressive and accompanied by destructive 
changes in the choroid and retina. 

We use concave lenses for the correction of myopia in order 
to make the rays of light entering the eye divergent. 

The weakest concave lens with which the myope can see best 
when his accommodation is suspended is the measure of his myopia. 

Astigmatism is that condition of the eye in which the refraction 
is not the same in all meridians. It is usually due to imperfect curv- 
ature of the cornea. Astigmatism may, however, be lenticular, and 
corneal astigmatism may be increased or neutralized by astigmatism 
of the lens. By regular astigmatism we mean that form in which 
the refraction of each principal meridian is the same throughout. 
By irregular astigmatism we mean that form in which the refraction 
is different in different parts of the same meridian. 

By the principal meridians of an astigmatic eye we mean the 
meridians of greatest and least refraction. They are usually at right 
angles to each other but may fall at any degree of the circle. 

Simple hyperopic astigmatism is that condition of the eye in 
which one of the principal meridians is emmetropic and the other 
hyperopic. 

In simple myopic astigmatism there is emmetropia in one of the 
principal meridians, but myopia in the other. 

By compound hyperopic astigmatism we mean that condition of 
the eye in which there is hyperopia in both principal meridians, but 
more in one than in the other. 

In compound myopic astigmatism the eye is myopic in both 
principal meridians, but more so< in one than in the other. 

Mixed astigmatism is that condition of the eye in which there 
is myopia in one principal meridian and hyperopia in the other. 

The commonest symptom of astigmatism is headache, but 
astigmatic patients usually complain of fatigue, burning and smart- 
ing after the use of the eyes, and if the astigmatism is of high de- 
gree, the vision is imperfect, both for distance and near. 

For the detection of astigmatism we use the astigmatic dial, 
which is the picture of a clock dial with radii running from the center 
to the numerals, indicating the hours on the clock. When the as- 
tigmatic eye looks at the center of such a dial the two radii corre- 
sponding to the most faulty meridian of the eye are seen most 
distinctly, for the reason that the image produced upon the retina 
of the astigmatic eye by rays of light coming from a point is a line, 



Practical Work in Ophthalmoscopy: ll'cscolt. 227 

rather than a point, and the direction of the line is at right angles to 
the meridian whose principal focus is upon the retina. 

For the correction of astigmatism we use cylindrical lenses. 

For the correction of simple hyperopic astigmatism we use 
simple convex cylinders of sufficient strength to equalize the refrac- 
tion of the two principal meridians. Naturally the axis of the cylinder 
must correspond to the direction of the emmetropic meridian. 

For the correction of compound hyperopic astigmatism we use 
a compound lens, upon one side of which is ground a convex 
spherical lens of sufficient strength to correct the hyperopia present 
in the best meridian of the eye. Upon the other side is ground a 
convex cylinder of sufficient strength to equalize the refraction of 
the two principal meridians and its axis must correspond to the 
meridian of greatest curvature, or, in other words, to the least faulty 
meridian. 

For the correction of simple myopic astigmatism we use sim- 
ple concave cylinders of sufficient strength to make the faulty 
meridian emmetropic. 

For the correction of compound myopic astigmatism we use 
compound cylinders made up of a concave spherical lens and a 
concave cylinder. 

For the correction of mixed astigmatism we may use crossed 
cylinders made by grinding a convex cylinder on one side of the glass 
and a concave cylinder on the other, or, we may obtain the same re- 
sults by the use of a concave spherical glass combined with a convex 
cylinder. 

Presbyopia is a failure of accommodation due to age and de- 
pends upon the progressive hardening of the lens, which makes it 
less elastic and less responsive to the action of the ciliary muscle. 
The lens really begins to lose its elasticity early in life, but when the 
emmetrope can no longer read fine print at a convenient distance 
we say that he has become presbyopic, and in normal eyes presbyopia 
usually occurs at about 45 years of age, and convex glasses then 
become necessary for reading and other near work. Presbyopia 
usually increases in normal eyes at the rate of about one diopter for 
every four years up to the age of seventy or seventy-five, when all 
accommodative power is lost. The proper reading glasses for the 
prebyope who is also hyperopic is the glass which corrects his 
presbyopia plus his corre'etion for hyperopia. 

As myopes usually have little power of accommodation, be- 
cause the ciliary muscle is so little used, different glasses are required 
for reading earlier than in emmetropia or hyperopia, and the myope 
who has less than three diopters of myopia may always prefer to 



228 The Corpuscle. 

read without glasses, unless he also has astigmatism. In any event 
the proper reading glass for a myope must be determined by careful 
and repeated tests in each individual case. The effort should be, 
however, to give that glass which restores the near point to a normal 
distance of twelve or fourteen inches from the eye. 

THE OPHTHALMOSCOPE. 

Growers, in his excellent work on Medical Ophthalmoscopy, 
begins his introduction ^as follows: 

"The ophthalmoscope is of use to the physician because it 
gives information, often not otherwise obtainable, regarding the 
existence or nature of diseases elsewhere than in the eye. This 
information depends upon the circumstance that we have under ob- 
servation, i. The termination of an artery and the commence- 
ment of a vein, with the blood circulating in each. 2. The termi- 
nation of a nerve, which, from its close proximity to the brain, and 
from other circumstances, undergoes significant changes in various 
diseases of the brain, and in affections of other parts of the nervous 
system. 3. A nervous structure, the retina, and a vascular struct- 
ure, the choroid, which also suffer in a peculiar way in many general 
diseases." 

The ophthalmoscope may give us valuable aid in the study 
of cases of injury and disease of the brain and its membranes, 
especially cerebral tumor and abscesses; disease and injury of the 
spinal cord; so-called functional disease of the nervous system, in- 
cluding insanity, diabetes, nephritis, disease of the heart and of the 
blood, syphilis, tuberculosis, rheumatism, pyaemia and septicaemia, 
typhoid and many other fevers, etc., etc. 

It is evident, from a study of the refraction and accommodation 
of the eye, that if we would see the fundus of an eye, we must throw 
light through the pupil and upon the retina and receive the light 
reflected therefrom into our own eye in such a way as to> form a sharp 
image. Helmholtz first accomplished this in 1857 by placing 
obliquely before the eye a simple plate of glass. Rays from a con- 
venient lamp, falling upon the glass plate, were, in part, reflected 
into the eye and illuminated the retina. The rays reflected back 
from the fundus arriving at the glass plate were again reflected, in 
part, back to the source of light, but some of the light passed 
through the glass plate into his own eye, enabling him to see the 
illuminated fundus. Much more light is obtained by using a piece 
of glass with a mirror coating, a round hole through the coating en- 
abling the observer to see through it. Still more light is obtained 
by using a concave mirror, because the rays reflected from such a 
surface are rendered convergent. 



Practical Work in Ophthalmoscopy: Wescott. 229 

An ophthalmoscope consists essentially of a mirror with a hole 
in it, but our modern instruments are provided with a concave 
mirror and a revolving" disc containing- a series of convex and con- 
cave lenses which can be rotated at will behind the perforation in the 
mirror. 

Figure 2 represents the path of the rays when the ophthalmo- 
scope is used in the direct method. In this method the observer 
sees the eye just as he would see an object through a convex glass 
or simple microscope. The image of the eye-ground is a virtual 
one; that is, it seems to be behind the eye. It is magnified and erect. 
From the candle L the divergent rays falling on the mirror O are 
rendered convergent. Passing through the refractive media of the 
eye, they are rendered still more convergent and come to a focus in 
the vitreous humor; diverging again, they form on the retina, the 
illuminated circle, whose diameter is a b. If this eye is emmetropic, 




Fig. 2. — Formation of the image in the direct method of Ophthalmoscopy. 

rays from the points x and y will pass out of the eye into the eye of 
the observer. All the rays from the point x will be parallel. Rays 
from the point y will also be parallel. No image is formed, but the 
rays continue their course, and, entering the eye of the observer, 
come to a focus on his retina at the points x and y . Rays from the 
point x in the patient's eye unite at the point x on the observer's 
retina. In a similar manner rays from the point y in the patient's 
eye unite at the point y' in the observer's eye. These rays, projected 
backward, seem to lie in their true position. Rays from the middle 
point m of the patient's eye unite on the middle point m of the ob- 
server's eye, and are projected backward to the point from which 
they originated. The point x, above m in the patient's eye, is repre- 
sented by x in the observer's eye below the middle point m. The 
point y below m, in the patient's eye, is represented by y above m in 
the observer's eye. (The figure and explanation are from Dr. 
Schweinitz.) 



230 . The Corpuscle. 

It is evident, from a study of the above diagram, that in order 
to see any details in the fundus of a patient's eye, the surgeon's eye 
must be in a condition to focus parallel rays of light upon its retina. 
In other words, it must be emmetropic and he must be able to relax 
his accommodation as in distant vision ; but we are all so thoroughly 
habituated to the use of the accommodation in looking at things 
close by that the first thing we have to learn in using the ophthal- 
moscope is to break this habit — to relax the accommodation at will, 
so that the eye of the surgeon, placed close in front of the patient's 
eye, is in a condition to receive parallel rays of light and to focus 
them upon the retina. In order to acquire this ability I have found 




Fig. 3. — Queen's model of the eye for Ophthalmoscopic practice. 

it of service in approaching the patient or the eye-model in the dark 
room to stare at the black wall as if looking into vacancy. 

The ophthalmoscope should always be held in the same position 
— the handle resting easily in the hand, the index finger upon the 
side, and steadied by resting it against the nose and brow in such a 
way that whenever it is put up it comes naturally in position for the 
eye to see through the aperture. 

The schematic eye used is made by Queen & Co., constructed 
upon suggestions made by Dr. William Thomson of Philadelphia 
several years ago, Figure 3. It is in accordance with strict mathe- 
matical formulae, and consists essentially of two pasteboard tubes, 
one sliding into the other, the first one containing in the front part 
a convex lens of twenty diopters. At the back of the sliding tube 
there is a picture representing the retina, which can be brought 
nearer to or farther from the lens, representing the refractive media 
of the eye. By this movement all refractive states of axial ametropia 
up to 6 D. hyperopia and 6 D. myopia can be exactly reproduced, 
and are read off by means of a scale on the sliding tube. 

Each student should provide himself with one of these models 
to practice upon at home. In the college laboratory we have stand- 



Practical Work in Ophthalmoscopy: Wescott. 231 

ards upon the top of which are three of these schematic eyes; one 
is emmetropic, one is hyperopic and the other is myopic. Students 
are advised to practice, first, the examination of the hyperopic eye, 
because it is easy to see the details of the fundus without complete re- 
laxation of the accommodation. When they are able to see the fun- 
dus of the hyperopic eye easily, they are advised to practice upon 
the emmetropic eye. In the examination of the myopic eye we very 
soon discover that it is quite impossible to see the details of the 
retina without employing the concave lenses which are contained in 
the ophthalmoscope. This is readily understood when we consider 
the path of the rays of light coming out from the myopic eye. 

They come to the surgeon's eye convergent and must be made 
parallel or divergent by passing through a concave lens before they 
can be made to focus upon his retina. For this reason we have in 
the revolving disc of the ophthalmoscope a series of concave lenses 
which can be rotated at will behind the aperture of the mirror. 
Likewise, if the surgeon is myopic he must, in using the ophthalmo- 
scope, either wear his correcting glasses, or, what is more convenient, 
turn into the aperture of his instrument a lens equal in strength 
to the degree of his myopia. If the surgeon be hyperopic he may 
first render his eye emmetropic by turning into the instrument a 
convex lens of proper strength. 

If we desire to estimate the degree of myopia with the opthal- 
moscope we may do so by finding the weakest concave lens, through 
which we can see the details of the eye ground clearly, after allowing 
for error in our own eye and completely relaxing the accommoda- 
tion. Likewise we may estimate the amount of hyperopia in an 
eye under the influence of a mydriatic by finding the strongest con- 
vex lens with which we can see the fundus clearly. Unless we have 
perfect control of our accommodation at all times, it is evident that 
the measurements cannot be depended upon and the surgeon must 
also know the refraction of his own eyes and allow for any defect. 

In using the ophthalmoscope by the indirect method we inter- 
pose between the instrument and the patient's eye a convex lens of 
about three inches focus and turn into the aperture of the ophthal- 
moscope a convex lens of ten inches focus. A real, inverted image 
of the interior of the eye is formed and the method is similar in prin- 
ciple to that of the compound microscope. 

The ophthalmoscopic mirror O (Figure 4) is held at a con- 
siderably greater distance from the patient than in the direct method. 
The rays from the candle come to a focus before reaching the eye 
or object-lens. They then diverge, and, passing through the object 
lens /, are rendered convergent. After traversing the dioptric media 



232 The Corpuscle. 

of the eye, their convergence is increased, and once more they unite 
somewhere in the vitreous humor, from which point they diverge and 
form a circle of illumination on the retina. Their course, in passing 
from the candle until they reach the retina, is shown by the arrow- 
heads in the figure. 

A portion of the retina, a to b, represented by the arrow, forms 
an image, b a , between the lens and the observer's eye, represented 
by the inverted arrow. Rays from the point a, on the upper part of 
the retina, pass out of the eye parallel to each other. After passing 
through the object-lens /, they are rendered convergent and come to 
a focus at the point a in the lower part of the inverted arrow. In 
the same way rays from the point b on the lower part of the retina 
are parallel on passing out of the eye, but are rendered convergent by 




Fig. 4.— Formation of the image in the indirect method of Ophthalmoscopy. 

the lens /, and come to a focus at a point b in the upper part of the 
inverted arrow. It is this aereal image that the observer sees, and 
not the eye-ground of the patient. Rays from this image are focused 
on the observer's eye, just as rays from the retina are focused in the 
direct method, i. e., the rays from the point a are focused on a higher 
portion of the observer's retina, and rays froni the point b are fo- 
cused on a lower portion. They are likewise projected back to the 
points in the image from which they originated. (De Schweinitz.) 

By the direct method the objects seen are magnified about fif- 
teen diameters, but in the indirect method we obtain a view of a 
much larger portion of the retina at one time, magnified about four 
diameters. As in microscopy it is best to examine specimens first 
with low power, so in ophthalmoscopy it is best to use first the 
indirect and then the direct method in every examination. 

In the choice of instruments I give my preference to those of the 
Knapp model, having the circular, fixed mirror, and containing 
about fifteen lenses. Such an instrument can be had for about ten 



Diagnosis of Skin Diseases: Montgomery. 283 

dollars, and will not only last a lifetime, with good care, but is 
sufficiently elaborate for any examination which the general prac- 
titioner is called upon to make. 

There are a number of atlases of ophthalmoscopy. That of 
Frost is most elaborate, and most modern, but I know of no better 
guide for the student and general practitioner than "Medical 
Ophthalmoscopy'' by Growers, already referred to. 



METHODICAL DIAGNOSIS IN DISEASES OF THE SKIN. 

(Concluded.) 

BY FRANK H. MONTGOMERY, M. D. 

The January number of The Corpuscle contained an outline 
for the methodical examination of a case of skin disease. It was 
followed by paragraphs illustrating in part and explaining the work- 
ing of the first section of the outline. 

The two second sections will be readily understood by all who 
are at all familiar with cutaneous affections, and indeed should be 
easily understood by any student who has carefully studied in any 
good text-book on dermatology, the chapters devoted to diagnosis 
any symptomatology. Such chapters contain many details and 
much in way of explanation of terms that cannot be given in the 
following paragraphs, which are intended solely to illustrate briefly 
the working of the outline, to explain a few of the more important or 
less readily understood points and terms, to direct attention briefly 
to the important steps in diagnosis, and to encourage the student to 
use the outline thoughtfully and intelligently instead of following it 
blindly. Some of the headings are self explanatory and are not 
considered in the following paragraphs; for the others, the order of 
the outline is followed. 

OBJECTIVE SYMPTOMS. 

A — Accidental Features: Frequently the original manifesta- 
tions of a cutaneous disease are masked or entirely hidden by the 
lesions produced by scratching, or by a dermatitis due to local appli- 
cations, or to drugs swallowed for the relief of the original disorder, 
or there may be no lesions but those produced by scratching, the 
irritation of coarse clothes, dirt, or by treatment for some other dis- 
order, real or fancied. It is of the greatest importance that the acci- 
dental nature of these symptoms be recognized, as they otherwise lead 
great confusion in diagnosis. To prepare himself to make such dis- 
tinctions, the student should study the medicamentous eruptions, 
dermatitis due to artificial causes, and pruritus. 



234 The Corpuscle. 

B — Site : The location of an eruption may be of great value in 
diagnosis, as some diseases are limited to definite portions of the 
body, while others have more or less marked tendencies to appear 
on certain regions. For example, in palmar lesions, the diagnosis 
of which is in doubt, it is well to remember that the palmar syphilo- 
derm is of frequent occurrence, while psoriasis is of the palm is ex- 
ceedingly rare. 

A very few diseases may involve the entire surface of the body, 
leaving no part unaffected, and are then called universal. More 
frequently an eruption affects at one time several or most of the 
regions of the body surface, and is then called generalised. Much 
more commonly an eruption affects a considerable portion of but 
one or several regions, and is said to be diffuse, or it is limited to small 
areas of one or several definite regions and is known as a local 
eruption. In localized and persistent lesions a cause may often be 
found in an external irritation due to dress, habits or occupation. 
Not infrequently lesions follow the course and distribution of a 
nerve, as in zoster, lichen planus and some other affections. 

C — An eruption is said to be symmetrical when it involves 
corresponding regions on both sides of the body ; it is not necessary 
that the affected surfaces be identical in size and shape. In general, 
symmetrical lesions are due to< internal, and asymmetrical lesions to 
external, causes. 

F — After obtaining an impression of the general features of 
an eruption, the individual lesions should be carefully studied. The 
type of lesion (papule, tubercle, vesicle, etc.) should be noted. When 
the lesions are multiform the different types should be examined to 
determine, if possible, which are primary and which secondary in ap- 
pearance, w T hich are essential and which are accidental in the 
process. For the purpose of studying the characteristics of the 
individual lesions, those of most recent appearance (usually at the 
border of a patch) and as yet unmodified by scratching, treatment 
and other influences should be selected. Often, however, the full 
evolution of a lesion requires time, and its successive stages should 
be determined by observing a number of lesions of different ages. 

The arrangement of lesions differs greatly in different diseases. 
When grouped they may form circular, oval, angular or irregular- 
shaped areas, or circinate, gyrate, serpiginous, straight or irregular 
bands and lines. In some affections (as ringworm, psoriasis, 
syphilis) the areas may clear in the center as the border progresses. 
Lesions may be grouped and yet discrete in that each lesion pre- 
serves its outline and identity, or they may coalesce so completely 
that all trace of the form of the individual lesion is lost. 



Diagnosis of Skin JJiseascs: Montgomery. 23" 

The definition of lesions is another important diagnostic feature 
in which cutaneous affections vary greatly; the line dividing the 
diseased from the normal skin may be so sharp and fine that it could 
be traced with the point of a knife, or the lesion may shade out so 
gradually into the normal skin that its outline cannot be definitely 
determined and it is said to have poor definition or none. 

The color of lesions on the skin often depends greatly upon 
circumstances, having no bearing upon the disease in question. It 
thus varies with the natural color (light or dark) of the individual's 
skin, with the temperature of the surface and with the amount of 
irritation to which the surface has been subjected by friction of 
rough clothing, scratching, treatment, etc. There are, however, 
some diseases (syphilis, lichen planus, tinea versicolor, favus and 
others) in which the color may be of greatest importance in the 
diagnosis, and there are many in which consideration of this char- 
acteristic of the eruption is of value if the accidental modifications 
be borne in mind. The acuteness or chronicity of a disease is often 
indicated by the color of the lesions. 

In judging of the size of a lesion it is sometimes important to 
know how much of it is above the general surface of the skin and 
how much is more deeply situated. In noting the shape of papules, 
tubercles, vesicles and pustules, both apex and base should be 
taken into consideration. Thus the apex may be pointed (acumi- 
nate), rounded (obtuse), flat (plane) or depressed (umbilicated). The 
base may be round, oval, angular, polygonal or irregular. 

The situation of lesions in or about the hair follicles or at the 
opening of the ducts of the sebaceous or coil-glands is occasionally 
a diagnostic point of great value. It is sometimes important to 
know if certain lesions appeared first on normal skin, or if they 
originated in other lesions. Thus vesicles and pustules may arise 
from sound surfaces, or from the apices of papules or tubercles. 
The majority of even the elementary lesions are probably preceded 
by macules, which, however, are usually so transitory as to be un- 
recognized and unimportant. 

The career of the individual lesion should be noted, since it often 
bears no relation to the duration of the disease as a whole. Thus the 
vesicle of eczema rarely exists as such more than a few hours, 
though by the formation of new vesicles eczema may persist for 
months, while in zoster the individual vesicles last several days, 
though the disease as a whole is short-lived. In some diseases the 
type of lesion remains the same throughout its career — unless modi- 
fied by treatment or external influences — while in others the type 
changes or is complicated by other types. Thus the papule, for ex- 



236 The Corpuscle. 

ample, may be modified by developing- at its apex a vesicle or pus- 
tule. The career of the lesions can usually be studied, not only by 
watching them from day to day, but also — and more easily — by 
observing at one time a number of lesions in various stages of de- 
velopment. 

As lesions vary greatly in different affections in their evolution 
and career, so do they in their involution. While in the majority of 
instances it is the recent and newly formed lesion that is most desir- 
able for purposes of study, there is often much to be learned from 
the manner in which lesions disappear and in the traces they leave 
behind them. The papule or tubercle which ulcerates usually sug- 
gests (aside from some rare diseases) syphilis, tuberculosis or carci- 
noma, and may be sufficient to exclude from the diagnosis the 
possibility of psoriasis, seborrhcea, and other superficial affections. 
In a doubtful case the termination of some of the lesions in scar 
tissue may be the one fact needed to make a differential diagnosis 
between seborrhcea and lupus erythematosus, or between a circi- 
nate form of psoriasis and a similar type of syphilitic eruption. Pig- 
mentation sufficiently characteristic for a diagnosis is left after 
the otherwise complete involution of some lesions. This is most 
frequently true in zoster, lichen planus, and some forms of syphilitic 
eruptions. In estimating the time of involution of lesions and in 
making a prognosis regarding the future disappearance of pigmen- 
tation (a matter regarding which patients are often very solicitous) 
it should be remembered that pigment is usually removed very 
slowly from the lower extremities and other dependent portions of 
the body, and that in such localities it may persist for months or 
years after it has disappeared from parts in which the return circula- 
tion is better. 

The third part of the outline supplements the second part by 
naming in detail special features, in addition to those given in part 
two, to be observed in the examination of certain lesions, and is of 
value only when such lesions are present. As the various divisions 
of this section of the outline are for use in special cases only, they 
have been given in greater detail, and further explanation would seem 
unnecessary. 



SYMPOSIUM. 

a student's library. 

On the sixth inst. letters were sent to the members of the faculty, 
calling' their attention to the subject of a general library for Rush, 
and asking- for a reply, briefly stating their opinions. So far the 
following replies have been received, and we are sure will be of great 
interest to the students and alumni. We hope to be able to present 
others in the next issue: 

Editor of the Corpuscle. 

My Dear Sir: — Yours of the sixth inst. received. My views 
with reference to a library at the college are not thoroughly crystal- 
lized, yet I feel confident that it would be advantageous to some 
students and I should be very much pleased if the student body 
would take it up. In one school with which I am acquainted the 
student body took up a contribution of, I think, fifty cents each, with 
which sum they subscribed for a few of the best medical journals, 
and also for the magazines of current literature. They had a duly 
appointed committee to take charge of the library work, and it has 
been found very satisfactory to many of the students. I think that a 
well selected library of current literature should contain perhaps two 
or three copies of each journal, and would be valuable in teaching 
students how to occupy any spare time which they may have. With 
the enormous amount of work now crowded into the curriculum it 
is impossible for many students to do much outside reading; indeed, 
I think there are very few who can devote any time to it. Unfor- 
tunately, probably three-fourths of what is written in the current 
medical journals, even of the best type, is unreliable, but students 
may as well learn while they are with the faculty what things should 
be given credence; otherwise, for a few years after graduation, they 
are going to be constantly misled by the effusions of too enthusias- 
tic, superficial or vain writers. Without in any way curbing the 
enthusiasm of students, I think it important that they should be 
taught to discriminate between facts and fancy, and I believe that 
could the defects in most of the current literature be pointed out to 
them they would be less likely after graduation to rush into print 
with subjects that are already well understood by their seniors, or 
with ill-considered theories or visions that are of no value to medi- 
cal science. No one should write who has nothing to say that he 
believes will be of benefit to the profession, and it would be indeed 
fortunate for our alumni if all our students could be taught that 

237 



238 The Corpuscle. 

conservatism which would enable them to recognize the difference 
in the writings of those who are aiming to vaunt their own attain- 
ments and those who are honestly working and writing to contribute 
their small mite to the cause of science. I am, 

Yours very truly, 

E. Fletcher Ingals. 
Editor of the Corpuscle. 

Dear Sir: — In answer to your letter of the 5th, permit me to' 
state that I think a library of the Rush Medical College will be use- 
ful mainly to senior students and to post-graduates as a means of 
reference study. It is impracticable to have such a library for the 
rank and file of the students of the college. Such a library should 
not contain the ordinary text-books, because every student should 
have his own text-books. Undergraduate students need only those 
books with which they pursue their studies, their lectures, recitations 
and their practical work. 

I have seen many colleges with libraries that are almost entirely 
neglected. 

After this year, the members of the senior class will be en- 
couraged to write essays and to prosecute original work. Their 
studies will be almost entirely clinical; they will have passed the 
examinations virtually necessary to receiving the diploma before 
they shall have entered the senior year. This will enable them to 
devote almost their entire time to clinical work. For this class of 
students, a library can be of great use. 

When the subject of starting a library takes a tangible shape, I 
will take great interest in it. Very truly yours, 

J. H. Etheridge. 
Editor of the Corpuscle. 

Dear Sir: — I am heartily in favor of establishing a student's 
reference library in connection with Rush Medical College. I am 
confident that in a short time a valuable collection of books could 
be made by soliciting contributions from members of the faculty 
and preceptors. Very truly yours, 

N. Senn. 

Editor of the Corpuscle. 

Dear Sir: — Replying to your letter inquiring as to my opinion 
of a proposed student's library at Rush Medical College, I would 
say that I am heartily in favor of such a library, and I believe the 
plan to be a feasible one. As I said in the address delivered at the 
opening exercises of the college in September, 1895, I am of the 
opinion that the proper use of medical literature is a subject which 
should be taught to the medical student during his course. The 



Symposium — A Student's Library. 239 

sum total of medical books and periodicals, good, bad and indiffer- 
ent, is to-day so vast and the annual, or, one might better say, daily, 
output, is so great that it is, of course, impossible for any one man to 
read any considerable part of these publications. The amount of time 
wasted in reading* bad literature and in reading good literature in 
the wrong way, is enormous, and this is so because the average doc- 
tor has not learned what to read or how to read it. In the graded 
four years' curriculum the senior year will be mainly occupied with 
clinical work and the study of the special branches. I am of the 
opinion that the work of this year should be so planned as to leave 
a considerable amount of time for research work on the part of each 
student. The old system of requiring a thesis for graduation has 
fallen into disuse in this country, and deservedly so, if the theses were 
to be of the perfunctory sort formerly in vogue. Prepared in the 
proper way, however, the preparation of such a thesis may be of 
great value to the student. I would have every student in the senior 
class select, or have assigned to him, a subject upon which he should 
prepare a thesis, involving original work and a study of the literature 
of the subject, such subjects, for instance, as are now assigned in 
competition for the Freer prizes. In this connection the current 
literature, especially, would be of great value, and it is to be regretted 
that no such collection of the medical periodicals is accessible to the 
student outside the Newberry Library. Then I would suggest the 
formation of a senior medical society, meeting, say, fortnightly, 
where one or more of these papers should be read at each meeting 
and discussed by members who had prepared themselves for the 
purpose. Some members of the faculty should be present at each 
meeting to assist, direct and take part in the discussions. One or 
more members of the faculty might occupy a portion of this time 
in explaining the nature and relative value of the leading medical 
journals, and how to use them to the best advantage; especially 
should he explain the nature and use of the Index Medicus. 

I know of no way in which from eight to ten hours per week 
of the senior year could be more profitably utilized than in such 
work as I have outlined. To be done to the best advantage it would 
require a library and reading room supplied with a well selected 
(not necessarily a large) collection of books, and about forty of the 
leading medical journals of the world. More extended laboratory 
and clinical facilities would be needed than we have at present. The 
chief difficulty in the way, as it seems to me, is the lack of a suitable 
room for the library. Both buildings of the college are already 
fully occupied and I do not see how any of the space could be 
utilized for this purpose without seriously interfering with the work 



240 The Corpuscle. 

now going on. As to the library, the college already possesses an 
excellent nucleus in the Allen Memorial Library, and the library 
of the pathological department, which, I presume, could be made 
available for students' use under suitable regulations. The current 
literature, I would suggest, might be provided by subscription from 
the members of the senior class; a small sum from each would 
suffice. 

I sincerely hope that a way will be found in the near future to 
solve these difficulties and to secure the fulfillment of such a plan of 
work as I have indicated. 

Very truly yours, 

John M. Dodson. 

Editor of the Corpuscle. 

Dear Sir: — It would be a good thing if we had a library con- 
nected with Rush Medical College. But to secure a library that 
would be worth having-, and to run it in a way that would be useful 
to students, would cost such a sum of money that it will for a long 
time be wiser to let the Newberry Library do the work for the stu- 
dents. They are always welcome in its halls. 

Truly yours, 

Henry M. Lyman. 

To the Editor of the Corpuscle. 

It is to be regretted that Rush Medical College has no library 
and no library room in which students can read and consult the 
works of our best authors. 

I am heartily in sympathy with any well directed plans for ob- 
taining this addition to the college. Until, however, the corporation 
can secure the large building which it needs and which, I trust, it 
will soon possess, for museum, additional laboratories, lecture hall, 
etc., with a spacious reading and library room, I deem any effort 
in this direction futile. Most truly, 

E. L. Holmes. 
Editor of the Corpuscle. 

My Dear Sir: — Your kind favor of the 5th inst. is at hand, and 
in response I have to say that I think it desirable that the students of 
a college should possess a library of medical works, to which they 
have access, and which should be so planned that it might be in- 
creasingly valuable, and the number of its books be multiplied in 
successive years after those in which the graduating class passes 
away from the college. 

I have noticed that whenever a new edition of one of my trea- 
tises appears there is a demand from small institutions here and 
there over the country for the book to be placed on the shelves of 
the students' library, where access can be had to it. 



Symposium — A Student's Library. 24 1 

A library grows and is not often made. If you are to have a 
student's library I would advise you to begin in a small way and 
provide for an increase each year, with great care of the books, so 
that they be not mutilated or lost, and that the old ones be preserved 
as valuable, even after the new ones have taken their places. 

No more feasible plan occurs to me, if you have not a reason- 
able sum of money to expend in this way, than to write a personal 
letter to the author of each volume which is placed upon the market, 
stating to him the number of students in the college who will have 
access to the library and ask him to donate a copy to the library for 
their benefit. Believe me to be, with kind regards, 
Yours very truly, 

James Nevins Hyde. 
Editor of the Corpuscle. 

Dear Sir: — The idea of having a library accessible to the stu- 
dents is a very good one. Our revered president, Professor J. 
Adams Allen, must have had this in view when he bequeathed his 
large library to the Presbyterian Hospital, but so far as it being of 
any benefit to the students is concerned, it might as well be located 
in Iceland. 

The w r ay to secure a library is to- get it, and as a preliminary 
step I would suggest asking members of the faculty and alumni 
association what works they will contribute. Since my practice has 
drifted almost exclusively into internal medicine I have several 
works I would be glad to donate to the library. 

Yours truly, 

John A. Robison. 
Editor of the Corpuscle. 

Dear Sir: — In answer to your favor of the 6th inst, relative 
to the founding of a student's library at Rush Medical College, I beg- 
to say that I am heartily in favor of the plan proposed by the 
Corpuscle. There are already at Rush College substantial nuclei 
for department libraries, and in the Presbyterian Hospital there is 
quite an extensive collection of medical books of various kinds. As 
time goes on additional department libraries are bound to spring up; 
those libraries will contain the works and the more important series 
of medical publications relating to the various departments. 

Now, it seems to me that a central library, such as the one pro- 
posed by the Corpuscle, would fill out very nicely the library needs 
of our students. This central library, or students' library, should 
contain current files of the more important general medical journals, 
encyclopaedias, systems, catalogues and also full and complete in- 
dices of the department libraries in the college and of the library in 



242 The Corpuscle. 

the Presbyterian Hospital; in this way the department libraries 
would be made accessible to the student. These smaller libraries, 
such as the one contained in the pathological laboratory, for in- 
stance, all possess a large number of reprints, books and medical 
journals which do not relate directly to the work in the department, 
and which could consequently very well be turned over to the 
students' library. 

It is not necessary for me to dwell upon the absolute necessity 
of library facilities of easy reach for medical students at the present 
day; text-books no longer fulfill the requirements of the progressive 
medical student. He must investigate medical literature for him- 
self, and thus form his own ideas concerning important questions, 
just as he must cultivate his own bacteria, prepare and study his own 
specimens in the laboratory. Individual work and investigation is 
the foundation of true medical education. 

All the important discoveries and investigations are first pub- 
lished in current medical literature; students engaged in special in- 
vestigations and in the study of different questions must familiarize 
themselves with the latest results of previous investigations, and 
must therefore turn to current medical literature for guidance in 
their studies. 

If a nucleus for a student's library was once founded upon a 
practical basis the collection would grow, perhaps slowly, but in 
the course of time it would become an adjunct to the educational 
facilities of the college of the greatest, importance. I therefore wish 
the Corpuscle all possible success in its efforts in this direction, and 
I wish to thank you, Mr. Editor, for bringing the matter up for gen- 
eral discussion in the way that you have done. I beg to remain, 

Yours sincerely, 

Ludvig Hektoen. 
To the Editor of the Corpuscle. 

Dear Sir: — In response to> your inquiry as to my opinion con- 
cerning a student's library and reading-room, I would say I am 
now, and long have been, warmly in favor of such a plan. 

In addition to the reasons given in your editorial, and in the 
communication from P. F. in the February number, I would add 
that it would make possible the teaching of special and advanced 
work by the seminary method. Special topics could be assigned to 
students, references given, essays prepared, read and defended by 
the writers and criticized by the class and by the instructors. The 
preparation of such papers, requiring weeks of work, would be of 
inestimable value. Not only would a student obtain a thorough 
knowledge of some particular topic, but he would learn how to ob- 



Capillary Abdominal Drainage (Extract), 243 

tain knowledge on any topic, for it demands training and experience 
to know how to consult and utilize monographs and magazine arti- 
cles. 

With a proper room and a moderate sum of money a start could 
be made within two months. I repeat, I am heartily in favor of 
the plan. Truly yours, 

James B. Herrick. 



Capillary Abdominal Drainage. — According to Van Hook 
("American Gynecological Journal") the following propositions are 
warranted : 

1. Since the quantity of fluid to be removed per hour cannot 
be more than approximately estimated, the amount of drainage ma- 
terial employed must be well equal to maximum requirements. 

2. Capillary (gauze) drainage has the advantage over tubular 
drainage that a minimum amount of damage is inflicted upon the 
peritoneum. 

3. Capillary drainage acts independently of gravity and suction 
apparatus, and delivers a constant current of fluid. 

4. By its appropriate disposition among the peritoneum-clad 
viscera it not only aids coagulation in ruptured capillaries, but carries 
away fluids secreted at some distance (ten centimeters) from the lim- 
its of the gauze, since capillary action takes place between the closely 
approximated peritoneal surfaces. 

5. The amount of plastic reaction depends more upon the infec- 
tion present than upon the action of the gauze. 

6. The utmost attention should be paid in septic cases to the 
accurate application of gauze over the uninfected surfaces of the 
peritoneum near the focus of infection, and this gauze should not 
be disturbed or replaced during or at the end of the operation. 

7. The strips of drainage gauze should be left long, in order 
that, hanging over the side of the abdomen, the fluid from the peri- 
toneum may be delivered with great freedom and rapidity into the 
dressings. — Canada Lancet. 



The Corpuscle. 



EDITORS. 

T. R. CROWDER, '97, Editor-in-Chief, 

226 South Paulina St., Chicago. 

E. L. McEWEN, '97, Secy and Treas. 

F. E. PIERCE, '98. A. F. STEVENSON, '98. J. P. SEDGWICK, '99. 



Communications relative to advertisements and subscription (Subscription price 
$1.00 per annum) should be addressed to the publisher. Remittances should be made 
by money order, draft or registered letter, payable to "The Corpuscle," and addressed 
to H. G. Cutler, Unity Building, Chicago. 



Ruby Red and Black: Colors of Lake Forest University. Orange: Color of Rush 

Medical College. 



FALLOPIUS FABRICIUS. * 

Gabriel Fallopius was an early and famous Italian anatomist, 
born 1523, died 1562. He was justly celebrated for his researches 
in the anatomy of the human subject and discovered and described 
several structures to which either he or subsequent investigators 
have given his name — for example, the Fallopian tubes, Fallopian 
arteries, aqueduct of Fallop., canal of Fallop., Hiatus of Fallop., 
and arch of Fallopius. 

It is of interest to learn that (as many scientific men of to-day 
are advocating) Fallopius obtained criminals from the court to 
dissect. He poisoned them first, as he himself describes in his work, 
"Vera Omnia,'' viz: "The prince ordered a man to be given to us, 
whom we killed in our fashion and dissected. I gave him two 
drachms of opium; he, having a quartan ague, had a paroxysm, 
which prevented the opium taking effect. The man, in great exul- 
tation, begged us to try once more, and if he did not die to ask the 
prince to spare his life. We gave him two other drachms of opium 
and he died." 

This insight into the medical profession of the sixteenth cen- 
tury shows us, possibly, why the men of physic were somewhat 

* The cuts appearing as a frontispiece are taken from some valuable old plates 
loaned by Mr. E. R. Larned. 

244 



Editorials. 245 

feared by the common people, and why much of the important experi- 
mental work was of necessity done in secret. 

Fabricius of Aquapendente was a professor of medicine and 
anatomy in the famous University of Padua in 1597. He was the 
teacher of the English student, William Harvey, who was destined 
to upset in his work, "An Anatomical Disquisition on the Motion of 
the Heart and Blood in Animals'' (1628) all the theories of physiolo- 
gists and anatomists from Galen, the Greek, to Fabricius, the Italian, 
who was the last writer on the blood flow before Harvey. 

Fabricius was particularly interested in the physiology of gen- 
eration and the anatomy of the organs concerned in this mysterious 
process, and also in the circulation of the blood. His work, Fabri- 
cius' "Treatise on Generation," and his writings were the most 
studied of all medical works by Harvey, and to him is due in no 
slight degree some of the fame enjoyed by Harvey's memory as "the 
discoverer of the circulation of the blood." 

Fabricius' idea of the blood flow was that the pulse resulted 
from the contraction and dilatation of the arteries, which contained 
a mixture of blood and air; that the air was obtained by suction, and 
hence that the dilatation of the arteries, like the expansion of a bel- 
lows, was the active process, and the collapse the return to- the pas- 
sive condition of these tubes. It was the idea of a general respira- 
tion carried on all through the body, which, however, not being 
sufficient for the "ventilation and refrigeration of the blood," re- 
quired to be supplemented by lungs placed about the heart." 

Fabricius was the last link in the long chain from Galen down. 
He placed the collected information in bits, where Harvey saw and 
comprehended the grand whole and complete operation. While 
praise is being bestowed on Flarvey, Fabricius, his teacher, should 
not be forgotten. E. R. L. 

ANENT THE QUIZ SYSTEM. 

The "quiz" system, as a means of instruction, has come to stay 
at Rush. Better work is being done to-day than would or could be 
possible without the regular recitations. The more often the mind 
is occupied by a certain idea the more readily is that idea recalled 
when absent from the mind. Merely to hear a fact stated in a lec- 
ture is not sufficient to assure a lasting retention by the average adult 
listener. It must be demonstrated in clinics, explained in the labora- 
tory and told by the student in his own words, before he can feel cer- 
tain of his possession. Constant repetition is an absolute essential 
to the acquisition of knowledge and such an end is admirably se- 
cured by the "drawing out" questions of the quiz master. 



246 



The Corpuscle. 



We use "drawing out" advisedly, because we believe that such 
questions best subserve the true purpose of the quiz. That questions 
should always be leading is not intended. They should be such as 
will by suggestion awaken the mental powers to activity and afford 
a tangible something which will assist confused thought to shape 
itself. It is not at all necessary that the answer be implied. The 
ideas that are present potentially in the mind of the student about to 
recite need some directing influence to call them out and marshal 
them in orderly array. With some a mere word suffices, a chain of 
association is aroused and the whole subject is given explicitly. 
Others need more help before the mind will traverse the unaccus- 
tomed path. 

If, therefore, the true mission of the quiz is to further the stu- 
dent's understanding of a subject and if the principle of repetition 
is of as great pedagogical importance as claimed by our greatest 
educators, then recitations should not be conducted on the how- 
much-do-you-know plan alone. There should be a judicious in- 
termingling of an how-much-can-I4ielp-you-to-know principle, 
shown by carefully chosen questions that assist thought as well as 
elicit facts. 

In direct support of the repetition theory several departments 
are now conducting post-laboratory quizzes with greatest profit. Such 
a plan affords opportunity for an immediate review of the knowl- 
edge acquired in the laboratory, and many facts, otherwise evanes- 
cent, are made permanent by the enforced individual repetition. 
We predict that the day will come when, with few exceptions, every 
lecture will be preceded by a short quiz conducted by the professor 
in charge. While such a plan would be unpopular with many stu- 
dents it would nevertheless redound to> their advantage. It would 
compel repetition; facts of previous lectures would be constantly 
reviewed. Obviously, such a quiz should be conducted from a class 
roll and not along the front seats. The latter procedure accom- 
plishes but little. It certainly does not apply the all important prin- 
ciple of repetition equally, for while the first row might be at a high 
tension mentally, the perch could slumber on undisturbed. 

Faculty and student alike should welcome any plan whatsoever 
that will compel the learner's mind to traverse and retraverse the 
paths of knowledge until they are well beaten, so that to> follow them 
requires no guiding line. 



Because we once in a while have a little unpleasant hilarity, or 
rebel a little at the rulings of our superiors, it is not necessarily a 
sign that we are still in an uncivilized state, at least comparatively 



Editorials. 247 

speaking'. The following, headed "Riotous Students/' is clipped 
from the British Medical Journal of February 20: 

"There have lately been several outbreaks of riotous behavior 
among students in different places abroad. At Athens the medical 
students rose in rebellion against the authorities, apparently with 
the object of getting rid of an unpopular professor. They took 
possession of the University buildings, shot a few 'harmless out- 
siders, and threw the city into a state of anarchy. The work of the 
University was suspended and the Rector resigned. After a time 
the students appear to have capitulated and marched out with the 
honors of war. They then attended the funeral of one of the victims 
of the riot and fraternized with the alarmed citizens. The ring- 
leaders among them have, however, since been arrested, to the great 
indignation of their fellow students, who accuse the authorities of 
a breach of faith. At Bordeaux the other day the ceremony of in- 
auguration of the new University of Bordeaux was marred by dis- 
orderly manifestations on the part of the students, who thought they 
should have had a larger share in the proceedings. Two or three 
medical students have been imprisoned for resisting the police. In 
Rome there has been trouble in consequence of a new regulation 
intended to facilitate the identification of students attending the lec- 
tures. The Rector appealed to the authorities, and the University 
buildings have been taken possession of by the military power. At 
Algiers, some two hundred students recently made a demonstration 
at the gates of the Mustapha College to protest against the appoint- 
ment of a Jew to a professorship. Antisemitic zeal runs high 
among the ingenuous youth of the college." 



The effort of the Corpuscle to get expressions from the mem- 
bers of the faculty on the subject of a student's library has so far 
been very successful, ten having replied. The favor with which the 
idea meets is very promising, and allows us to at least hope that a 
more general interest will be manifested in the near future. To 
some the necessity, or the desirability, of a library does not appeal; 
it certainly does to us. We realize fully that nothing great or ex- 
haustive can be provided at once, but we should be willing to begin 
in a small way. Because we cannot have a great library is no reason 
for allowing ourselves to drift along with none at all and fall behind 
the times. A few things are better than none. That they would be 
used is evidenced by the calls that are now made upon the small 
pathologic library for the loan of books. There are in the depart- 
ments already enough books to make a visible nucleus. To this add 
the current journals, and a way to get at them, and the student has 



248 The Corpuscle. 

what he most needs — a means of finding the latest developments in 
the subjects of medical science. Space and a little student endow- 
ment are the two requisites. The former is apparently the least ob- 
tainable, but even in our present crowded quarters this might be 
provided by a little rearrangement of minor courses. 



The many admirers of Professor Senn will be pleased to learn 
that he has been invited to deliver the address on Surgery at the 
meeting of the Twelfth International Medical Congress at Moscow. 
This is one of the higher professional honors of the Congress, and 
certainly falls upon one who is thoroughly deserving of the honor 
and amply able to fill the place. 

Through the philanthropy of Professor Senn the Du Bois- 
Raymond Physiological Library, comprising fifteen thousand vol- 
umes of physiological research, is to be added tO' the Newberry 
Library. This is, without doubt, the most complete library of 
physiology in the world. Chicago is indeed fortunate in giving it a 
future home and in possessing such men as Professor Senn. 



The way in which the students of the senior class conducted 
themselves in the final examination in dermatology is higdily com- 
mendable. They were put strictly upon honor by Professor Hyde 
and responded to his confidence in a way indicating that they are 
worthy of less watching than some of the professors seem to think 
necessary. That "confidence begets honor" is as thoroughly ap- 
plicable to medical students as to any other class of individuals is 
shown by the gentlemanly conduct, and the disposition not to take 
advantage of a privilege, which was shown in this examination. 



COLLEGE NOTES. 

Mr. J. R. Crowder, '97, has gone to Denver, Colo. 

The freshman class began dissecting on the 8th of March. 

R. W. Webster, '98, has matriculated and says he may attend 
Rush regularly next year. 

The St. Luke's Hospital examinations for internes will be held 
during the week of April 12. 

Prof. Whiting, '97, is on intimate terms with all malarial bugs 
and even gives "demonstrations in blod? 

The examination for prosectors resulted in the selection of 
Messrs. Lewis, I. L. Stewart, E. R. Plering and J. G. Sheldon. 



College Notes. 249 

Edward Dwight Eton, president of Beloit, has accepted the 
faculty's invitation to deliver the "Doctorate Address" on com- 
mencement day. 

The members of the sophomore class were favored with an 
earnest and impressive talk by Professor Daniels of the University 
of Wisconsin, on February 27. 

The first robin and the senior's beard are supposed to be signs 

of spring, but when seniors begin to show cards inscribed , 

M. D., spring is certainly near at hand. 

Dr. Le Count has begun the instruction of a special class in 
pathology. A great deal of laboratory work will be done and gen- 
eral pathology will be covered very thoroughly. 

The Rush Glee Club is still hard at work. The club sang at 
the Fourth Baptist Church on the evening of Sunday, March 14. 
The manager expects to fill several engagements before the end of 
the year. 

On the 27th of February a nine-pound boy was born to Dr. and 
Mrs. Eckard. Dr. Eckard, '96, was upon the Corpuscle board 
while in college. We tender the mother and father our hearty con- 
gratulations. 

The "Professor of Abnormal P." to the "Morbid Professor of 
A.'' — "I have just enough of a cold to be a nuisance.'' The M. P. of 
A. to the P. of A. P. — "The cold is entirely unnecessary in produc- 
ing the other condition.'' 

Professor Senn attended the presidential inauguration at Wash- 
ington the fourth of March. He went with Governor Tanner's 
staff, in his official capacity as Surgeon-General of the Illinois Na- 
tional Guard. His clinic hours at the college were filled by Profes- 
sor Hamilton. 

H. B. Cragin, Jr., '99, won the gold medal for the first place in 
the half-mile running race at the First Regiment Armory, on Febru- 
ary 26. Mr. Cragin is training conscientiously and will probably 
represent Lake Forest University this spring. On the 26th he ran 
under C. A. A. colors. 

The examinations for internes in the Cook County Hospital 
will be held at the hospital the 5th, 6th and 7th, and if necessary the 
8th, of April. Twelve internes and eight alternates are to be ap- 
pointed. Applicants must be graduates of Cook County medical 
colleges or must furnish a certificate from the college faculty certi- 
fying that they are within four months of graduation. 



250 The Corpuscle. 

Kasson, the little son of Professor Dodson, had the misfortune 
to meet with a slight accident a few days since, and Dr. Weaver was 
called in to care for his wound. In relating the incident to a caller 
Kasson remarked, with a great deal of seriousness, that he had to 
have a real doctor come to see him. 

The internes for St. Elizabeth's Hospital have been announced. 
The fortunate men are Thomas C. Gorman, Arthur E. Price, M. U. 
Chesire and W. F. Jacobs, and their alternates, A. M. Wheeler, 
M. M. Loomis and H. A. Patterson. These are all Rush men, and 
every section of the senior class is represented. 

The Presbyterian Hospital examinations for the appointment 
of internes was held Friday, March 12, in the hospital chapel. 
Thirty-one members of the senior class in Rush took the examina- 
tions. Seven internes are to be appointed. In the examinations 
Mr. E. D. Whiting took first place and will begin service on April 1. 
The others will be announced after the Cook County examinations. 

The amphitheater is always full when Professor Etheridge lec- 
tures. The evening of March 5, when he lectured upon the "Code 
of Medical Ethics as Published by the American Medical Associa- 
tion," was no exception. Professor Etheridge took the code up by 
sections and explained it carefully. His rich experience was drawn 
upon for incidents which made the points more easily understood, 
and the students received a great deal of advice of great value to 
young physicians. 

"Murray wanted," was written on the board. All the Freshmen 
wondered what Murray had done that he should be called to> the 
office. It sounded as he went out as if the Professor said something 
about there not being any need of disturbing the class by going out 
SO' near the end of the hour. 

There was a very fine looking young lady sitting in the room 
into which he was shown. They exchanged greetings. 

"Our family physician said that he wished me to see you about 
my trouble." 

"I think—" 

"He wished me to let you make an examination.'' 

"There must be some mistake. There is a Murray in the senior 
class.'' 

"Oh! Are you not Professor Murphy?" Explanations. 

Murray's hat fits since he got a hair cut. 



rllumni L/epartmer^t. 

JAMES B. HERRICK, A. B., M, D., Editor. 

Membership in the Alumni Association op Rush Medical College is obtainable 
at any time by graduates of the College, providing they are in good standing in the 
profession, and shall pay the annual dues, $1.00. This fee includes a subscription to 
The Corpuscle for the current year. This journal is the official organ of the Association 

Dues and all communications relating to the Association should be sent to 

JOHN EDWIN RHODES, M. D., Sec'y and Treas., 34 Washington St., Chicago 

Dr. J. R. Currens, '78, of Two Rivers, Wis., was in the city 
this week. He speaks enthusiastically of "Old Rush" and is coming 
to commencement this year. He was one of the pioneer members of 
the Alumni Association. 

Dr. H. A. Robinson, '89, who was formerly a Chicago practi- 
tioner, is now, and has been for three years, at Morris, Illinois. The 
doctor believes that many young graduates make a serious mistake 
in settling in the large cities. He enjoys his work very much and has 
a constantly growing practice. 

Another physician who has recently told us of the advantages of 
locating in a smaller town is A. L. Berkley, '95. He is at Rensselaer, 
Ind., and though not yet two years out of college, is busy and pros- 
perous. 

J. W. Kirkpatrick, '88, is at Wyoming, Iowa. We remember 
Doctor Kirkpatrick as a fellow member of a quiz class in 1887, and, 
knowing his work as a student, are not surprised to learn of his suc- 
cess as a physician and of the esteem and respect in which he is held 
by his patients and associates. 

We have received the card — business, not wedding card — of 
Arthur Tenney Holbrook, '95. The doctor resides at 175 Eight- 
eenth street, Milwaukee. His pleasing personality, his good record 
for scholarship while in college, and his valuable experience as an 
interne in the Presbyterian Hospital insure him success. 

The following gentlemen will read papers at our scientific meet- 
ing at commencement: Dr. B. W. Sippy, Chicago; Dr. H. B. 
Favill, Chicago; Dr. J. R. Barnett, Neenah, Wis.; Dr. P. R. Fox, 
Madison, Wis.; Dr. A. L. Craig, Aledo, 111.; Dr. James H. Raymond, 
Honolulu, H. I., who will furnish a paper on "Leprosy in the Sand- 
wich Islands." 

Judge Moran will speak at the banquet. An invitation has 
also been extended to Rev. Dr. Hillis. 

251 



252 The Corpuscle. 

C. F. Smolt of the class of '78 was in the city a few days ago. 
The doctor has a long-established practice at Nickerson, Kan. He 
commented on the many evidences of progress in and around Rush 
College. He recalled the fact that at the time he was a student the 
County Hospital was removed to its present location. The total 
number of surgical patients in the hospital at the time of the transfer 
was eighteen. Dr. Smolt hopes to be present at commencement 
time. 

We are in receipt of information to the effect that Dr. J. P. 
Kaster, a graduate of Rush in 1881, has recently been elected to the 
important position of Chief Surgeon of the Atchison, Topeka & 
Santa Fe Railway Company, with headquarters at Topeka, Kan. 
Dr. Kaster has attained an enviable reputation as a surgeon at 
Albuquerque, N. M., where he has been located for many years, and 
enjoys the most lucrative practice in that section of the country. He 
is widely known as the Chief Surgeon of the Atlantic & Pacific Rail- 
road, which forms a part of the Santa Fe system, and therefore his 
selection as Chief Surgeon of the Santa F6 system comes as a sort 
of promotion. He will bring to the duties of his new position the 
qualifications of a conscientious and thoroughly competent sur- 
geon, as well as those of a first-class business manager, which is such 
an essential qualification for the holder of such a position. The posi- 
tion commands a salary of about $6,000 a year and affords the doctor 
unexcelled advantages for first-class hospital work, as the company 
have recently erected a modern hospital at Topeka. Rush sends 
her congratulations. 



PRAG LETTER. 

We were pleased to receive the following communication from 
O. S. Misick, '94. We wish more of our graduates who are abroad 
could spare the time to write a few lines, letting us know where they 
are and their impressions of foreign methods of study: 

Prag, Austria, March 1, 1897. 

Dear Rush: — In looking over some of the Corpuscles which 
arrived the other day, I saw letters from Vienna and other points in 
Europe. I could not resist the temptation to write and tell you that 
there is a place over here in Europe called Prag, which, according 
to the number of American students it has in proportion to some 
other European cities, is very little known. But this is so much the 
better for the student. For those schools that are so popular for 
the American students are like the hotels in Switzerland — they have 
become too much Americanized. 

The opportunities for the student in Prag are excellent, 
especially in pathology, in which most of our American schools are 



Alumni Department. 253 

so deficient. I have visited most of the large universities in Europe 
and can say there are very few places that I found as good as Prag. 
Professor Chiari, under whom I have studied pathology for the last 
year, is not only a great and thorough teacher, but a perfect gen- 
tleman as well, and takes a personal interest in his students, his mu- 
seum being one of the finest in Europe, where everything is syste- 
matically arranged and in perfect order. 

Nowhere have I been treated so nicely by the professors as in 
Prag, where they look upon an American student with respect. To 
the student coming over here for the first time, and who, perhaps, 
knows only of Berlin and Vienna, I would give the advice to go to a 
smaller university first, where he will have greater opportunities 
and come more directly under the instruction of the professors. 
This opinion has been confirmed by many American students whom 
I have met. Many of them said they had made the mistake of going 
to too large a university. Then many make the mistake of stopping 
only a short time here and there, where they are apt to get the differ- 
ent ideas all mixed up: also, many students come over here in the 
summer, when, as a rule, the professors are away on their vacations. 

I find the students here an earnest set of workers, but at the 
same time they do not work as hard as we do. They do not study 
so much from the different books, but take their time and let the 
knowledge soak in. We can do more in four years than they do in 
five. Prof. Bridge, in one of his letters, spoke of the students being 
so quiet and orderly; that is due more to their military training 
which they all must have had. 

I saw a book that is published here in Europe called "Minerva,'' 
which is supposed to give a complete list of all the universities in the 
world. Turning to Chicago, I saw it was rather slimly represented 
medically, giving only two schools, the Woman's Medical and the 
Chicago Medical. Being an alumnus of Rush I felt it my duty to 
tell him that he had not only omitted one of the largest, but also one 
of the best medical colleges America had. 

I have been unable to see any nurses in Europe that are to be 
compared with our Illinois Training School nurses. As a general 
rule they are old and lazy over here. 

I shall remain here some months yet, and then go to Vienna, to 
be under Professor Gussenhauer in surgery; thence to Professor 
Kocher in Bern, Switzerland. I would like to give a description of 
some of the duels I have seen, but I fear you might think I am 
rather barbaric; but then, some of them were very good surgical 
clinics, just the same. With best wishes to dear old Rush, I remain, 
Respectfully, Oel S. Misick, Chicago, Rush, '94. 



EXTRACTS FROM OUR EXCHANGES. 

Dr. J. W. Hickman, in a late number of the "Medical News," 
gives it as his opinion that appendicitis is a purely surgical disease, 
and that the only safe treatment is an operation. He writes: 

"Other therapeutic measures will avail in perhaps a majority of 
cases, at least in the first attack, or, possibly, in the first few attacks. 
I know, however, that any other means of treatment will be marked 
by a mortality rate, and this must be true until we are able to separate 
catarrhal from suppurative cases. This, I repeat, cannot be done at 
present. Then why not operate at once in all cases? Such a course, 
in properly qualified hands, is as nearly absolutely safe as any opera- 
tion can be. Suppose some cases are operated on that would have 
gotten over the attack without an operation? Better this than to run 
so grave a risk as we must encounter when we wait." 

Treating the Syphilodermata. — A careful consideration and trial 
of the various methods of treating the syphilodermata leads a good 
observer to the following conclusions: 

1. In the primary stage, when only the chancre is present, no 
general treatment; calomel locally. 

2. As soon as the secondary period sets in, as shown by the 
general adenopathy, angina, cephalalgia and eruption, the internal 
treatment for mild cases should be one-fourth to three-fourths of a 
grain of the proto-iodide of mercury t. d., continued for three months, 
or until the symptoms disappear. In severe cases, with pustular 
eruptions, severe anginas, persistent headaches, etc., a course of six 
to ten intra-muscular injections of ten per cent, calomel-albolene 
suspension, five to ten minims at intervals of five to fifteen days, 
should be employed. 

3. After completion of the course and cessation of the symp- 
toms, employ tonics, etc., without specific treatment, for three 
months. 

4. Thereupon a second calomel course as above, plus a small 
dose (15 grains) of iodide of potassium in milk after meals. This 
to be given whether later secondary symptoms of the skin and 
mucosae appear or not. 

5. Second intermission of treatment, lasting three to six 
months, according to the presence or absence of symptoms. 

6. In the second year, if tertiary lesions marked by deeper and 
more localized ulceration are present, give the iodide of potassium in 
increasing doses (60 to 600 grains daily, as may be necessary). 
Combine with it occasional courses of calomel injections. If no 
lesions appear, give a mild course of both. 

7. The best local treatment of the syphilodermata is with the 
mercurial plaster-mull. 




W. HARVEY, M„ D. 



Reproduced from an engraving of the original painting in the posses- 
sion of the Royal Society of England. 



The Corpuscle. 

RUSH MEDICAL COLLEGE, CHICAGO, ILL. 
Medical Department Lake Forest University. 



Vol. VI. APRIL, 1897. No. 8. 



FROM PROF. COTTON'S CLINIC. 

Our first case is from the maternity ward. This baby is n 
days old; mother primipara, normal labor, somewhat prolonged, 
but with no complications. At birth the child weighed 6^ pounds. 
The mother is convalescing normally from her confinement and 
the secretion of milk appeared the third day in normal quantity. 
The child took the breast fairly well, but has shown increasing 
disinclination to nurse. The fourth day, or perhaps the third night, 
this peculiar color of the skin began to appear which now marks 
this case. At birth the skin was normal, the pink hue of early in- 
fancy, but about the third day that began to change to a pale yellow 
or dirty yellow, and then orange, an icteroid hue, and this color of 
the skin is called at this age "icterus neonatorum." Some authorities 
state that it is of very frequent occurrence, whereas others claim 
it is less frequent. Moneys finds it in 6o per cent, of normal children 
born; another author equally well known states that it occurs in io 
per cent., and another that it was rather infrequent. In my own 
experience it has been of frequent occurrence, both in private prac- 
tice and in the hospital. As you see in this case, the color is well 
marked. It is impossible for me to show you the conjunctiva, but 
it is distinctly tinged with yellow. I want you to> observe also< the 
contour of the extremities. You see the legs show discoloration 
yellow as butter and at the same time you see the marked emacia- 
tion and immense feet as compared with the size of the legs. The 
baby has just had a bowel movement and we will see what we can 
discover by examining the discharge. There are two very interest- 
ing things presented by that diaper. You notice that the fecal dis- 
charge is of a tarry consistence, with a dark chrome green tinge. 
Some of you will say that it resembles the meconium discharges of 

255 



256 The Corpuscle. 

infants found immediately after birth. Please allow me to state 
that what was formerly considered biliary discharge, in this class 
of patients you will find upon examination to> consist of a quality 
of fecal matter like meconium. Please notice this other stain; it is 
in color an orange red and evidently is not fecal matter. If you 
will examine that diaper carefully you will see the urinary crystals 
deposited there, which come most opportunely to illustrate a 
point that has arisen in this class of cases, namely, as to what the 
kidneys were doing at the time we had this icterus of the skin. You 
will find there that the kidneys are probably troubled with a uric 
acid infarct. You will remember that I stated to you some time 
since that the early urine of the infant was somewhat allied closely to 
that of the reptilian subjects; that it has a tendency to solidity at 
birth (although the infant may pass fluid urine), with the formation 
of infarcts in the uriniferous tubules, and that frequently the loosen- 
ing of those crystals causes an irritation in the tubules, with it 
development of acute Bright's disease. Some of the crystals may 
cause pain in the renal pelvis and in the ureters, and is often an ex- 
planation for the baby's colic, which is usually attributed to intes- 
tinal disorders. What, then, besides icterus, presents itself in this 
baby? Lost i \ pounds in weight during the first eleven days. You 
all know that normally an infant may lose a pound the first week, 
but after that it should hold its own and gain half a pound the 
second week and one pound the third week. This baby has lost i^ 
pounds, although the mother furnished a breast full of milk. It 
presents to you an unusual case of very early infantile atrophy; in 
other words, there is a general atrophy and general shrinking of the 
tissues. The baby gets tired of taking the nipple. Then again there 
may act in this case that strong instinct of the child that it has not 
the right kind of food. 'We will keep this baby under observation 
and at another time we will discuss the atrophic condition and its 
treatment. 

I wish at this time to say a few words about icterus to you. 
Icterus itself does not constitute a disease. Icterus neonatorum 
per se requires no treatment and no particular mention further 
than to put the young practitioner on his guard, that he may not 
be distressed in the presence of innumerable questions propounded 
by the family. 

One of the earliest cases of labor that I had in my practice pre- 
sented a baby which on the third or fourth day showed signs if icte- 
rus. My attention was not called to it until I was hastily summoned a 
day or two later and found my baby as yellow as dairy butter and 
I was asked to give a diagnosis. I had examined that baby in a 






Clinic: Cotton. 257 

dimly lighted room and overlooked the jaundice. Always examine 
children in a good light. Well, I prescribed something for the baby 
and looked as wise as I could. A day or two later I was summoned 
again, and the staining of that baby was then the most perfect that 
I have ever seen. I was at a loss what to do, but rummaging around 
the premises I happened to pick up a tin cup containing saffron tea, 
which they were feeding the baby, and I have found since that we 
can produce icterus at any time with this saffron tea. 

Virchow attempted to explain this icterus of the new born on 
the ground of decomposition of the red blood corpuscles. I think 
that theory does not find much favor with our etiologists of to-day, 
and some of the best observations seem to warrant the theory that 
it is due to the change in blood pressure as between intra-uterine 
and extra-uterine life. Before birth the child is not only subject to 
atmospheric pressure, but also to the pressure of the contracting 
walls of the uterus and abdomen. During labor the pressure is 
greatly increased, many circulatory avenues are entirely occluded 
temporarily, as the umbilical vein and arteries, and some of the 
vessels of the thorax and abdomen. After birth the ordinary intra- 
uterine pressure is relieved, so that nothing but the atmospheric pres- 
sure supports the walls of the new born. The tying of the cord, 
which of itself obliterates the umbilical vessels immediately, espe- 
cially if the lungs do not respond and respiration start in very early 
and stimulate the right side of the heart, and that in turn stimulate 
the pulmonary circulation again, and if this is not as vigorous as it 
might be, then we will have congestion, due to ligation of the um- 
bilical vessels, and this would lead to mechanical congestion of the 
liver. This mechanical congestion of the liver causes oedema, this 
oedema causes pressure on the bile-ducts and it has been demon- 
strated several times that the bile-ducts are subjected to such great 
pressure that they are temporarily occluded. Then icterus may be 
due to mechanical pressure from oedema resulting from interference 
with intra-uterine circulation, and which will usually rectify itself. 

We sometimes find staining in the urine, but it is not the rule. 
They used to say that this stool showed increase of bile in the ali- 
mentary tract. Hundreds of cases, carefully observed, have shown 
that there is a deficiency in the biliary acids in the discharges. 

Give the baby plenty of water, which is the best thing you can 
administer. Relieve superficial congestion of the skin by bathing 
and inunctions. Keep the baby well oiled. 

CASE 2. — Consulting staff: This little girl is three years of 
age. The family history, as far as I can learn, is good. The child 
was born in seventh month of mother's pregnancy. There is a 



258 The Corpuscle. 

history of two miscarriages previous to this child's birth. The 
child's temperature now is 100.2 and her pulse ranges from 136 to 
140 per minute; respiration 27. The mother said child has had the 
mumps, malarial fever, bronchitis. Some time ago the child had a 
cough ending with an inspiratory whooping sound. On the 21st 
day of last October they made a diagnosis at the Cook County 
Hospital of pertussis and she received treatment for same. She 
comes to us to-day not so well, but while there is no whoop the 
child expectorates quite a little mucus after each cough. 

Prof. Cotton: The history is imperfect; the child has simply 
been ailing since October 21st last. The mother says that she 
does not eat very well and that her bowels are sometimes constipated 
and sometimes she has a diarrhoea. She also says that the child was 
in the hospital for one week last October. She was no better when 
she came out of the hospital than when she went in and is about as 
sick now as she was then. 

Upon auscultation we get high pitched expiratory sounds on 
the right upper chest with some harsh rales generally distributed 
over the respiratory area. 

Upon percussion we find little dullness, not very much, over 
right apex. 

The mother's health has always been delicate, but the father is 
healthy. She has had three children and they were all premature. 
They lived two days after birth. She says this last child was born 
at seven months. This statement you must accept with caution. 
However, this is the third child and the only one living and very 
delicate, has had mumps when one year old, bronchitis when six 
months old, and last summer had a fever that was called malaria by 
the doctor. This case is very interesting and one that will require 
your best thinking. Phthisis pulmonalis has been suggested. Are 
we going to rush to the conclusion that this child is phthisical? By 
no means. The child has always had bronchitis and has invited 
pulmonary tuberculosis ever since she was six months old, but she 
has not succumbed, which is in her favor. The mother states she 
weighed two and one-half pounds when born. I think I should 
lean rather away from tubercular lesion, and conclude that this 
baby has had bronchitis and broncho-pneumonia with some thicken- 
ing of the pulmonary parenchyma, that so often occurs in children in 
subacute form of broncho-pneumonia. 

Diagnosis (consulting staff): Pertussis and also some indica- 
tions of constitutional diathesis. 

Prof. Cotton: In the absence of any better family history and 
absence of any positive statement of specific trouble, we are not 



Sarcoma and Carcinoma: Le Count. 259 

allowed to make a diagnosis. The child has a pretty good chest as 
to shape, and is well nourished. If we examine the blood we may 
possibly find some plasmodia malaria and we will keep the child 
under observation and have her come back next week. Bronchitis 
and pertussis is probably correct and this faint suspicion of tuber- 
culosis becomes more and more faint if we examine this fairly well 
nourished child. The history is unreliable. 

(One week later.) Case No. 2 of our last clinic you will re- 
member was referred for further examination. Urinalysis shows 
urine dark amber, acid 1021, albumen none, sugar none. 

Sputum examination, negative. Blood examination shows 
haemoglobin 65 per cent, and the presence of malarial plasmodiae. 
She still has some cough and rapid respiration and pulse, with a tem- 
perature of 101 degrees. 

We wall commit ourselves to a diagnosis of malarial anaemia 
and put her upon quinine and some albuminate or peptonate of iron 
and manganese, and give a favorable prognosis. 



HISTOLOGICAL DIFFERENTIATION BETWEEN SAR- 
COMA AND CARCINOMA. 

Synopsis used in Laboratory Work in Sophomore Pathology. 

BY E. R. LE COUNT, M. D. 

SARCOMA. CARCINOMA. 

1. Stains uniformly because all the 1. Stains non-uniformly, because there 
tumor is one kind of tissue, viz., Meso- are two kinds of tissue, the pre-existing 
blastic tissue. Exception — certain rare and the invading; the invading epithel- 
mixed cell sarcomata do not stain uni- ium, being more embryonal, stains more 
formly. deeply. 

2. Blood vessels are atypical and em- 2. Blood vessels occur in the stroma; 
bryonal with walls made up of tumor they are not usually newly formed, but 
cells — more properly spaces or sinuses. pre-existing. As a rule they resemble 

mature blood vessels, even though they 
are new formed vessels. 

3. Cell characteristics: — Spindle cells, 3. Cell characteristics: — Spindle cells 
giant cells, small or large round cells, the are rare, and giant cells still more so; usu- 
nuclei of which occupy the main portion ally the cells show small nuclei with a 
of the cell. relatively large amount of cell protoplasm. 

4. Cell nests do not occur or at least 4. Cell nests are the rule, — cells sur- 
the stroma is present between the cells. rounded by connective tissue which does 

not penetrate between the individual cells. 

5. No tubules. 5- Tubules: — in columnar cell carci- 

noma. 

6. No pearls. 6. Pearls: — in stratified cell carci- 

noma. 



260 The Corpuscle. 

7. No connection with epithelium. 7. Carcinoma originates in epithelium. 

Epithelial hyperplasia and in-growths of 
the different kinds of surface epithelium 
mark the beginning of carcinoma. 

8. Inflammation usually absent. 8. Inflammation occurs frequently in 

carcinoma. 



FORMALDEHYDE; HOW TO MAKE A FORMALDE- 
HYDE LAMP. 

BY J. E. SKINNER, M. D. 

While the compound Formic Aldehyde has been known for m:ny 
years, the discovery of its great value as a germicide, preservative 
and disinfectant is of quite recent date. It is interesting to note the 
many uses which have already been discovered for it. 

It was first most largely used, in 40 per cent, solution known 
as Formalin, for hardening tissues in microscopic work and for rapid 
fixation and has to a great extent replaced other agents. 

Embalmers have also learned its value in arresting quite ad- 
vanced decay and use it extensively to preserve and deodorize dead 
bodies. 

In the same line it is said to be an excellent preservative for fish, 
meat, fruit, milk, etc. Two or three drops of the 40 per cent, solu- 
tion in a quart of milk will keep it sweet several days. It would 
seem to be a valuable remedy in parasitic diseases of the skin be- 
cause of its diffusability, and a great deal is claimed for it in this con- 
nection. Experments have been made with it in disinfecting books, 
which are most difficult to sterilize, and with very satisfactory re- 
sults. Upon exposure to vapor for 24 to 48 hours they were found 
to be completely sterilized. 

Surgical instruments and ligatures, and especially all articles 
likely to be injured by heat or chemicals, are disinfected thoroughly 
by exposure to the vapor of Formaldehyde. 

It is, however, in the disinfection of rooms that it is so largely 
used to-day and destined, undoubtedly, to a still wider field of use- 
fulness. It is an ideal disinfectant for this purpose, because of its 
great penetration, experiments showing that cultures had been 
completely sterilized by the dry gas when placed inside a thick 
mattress. The gas may be most conveniently supplied by partial 
oxidation of methyl or wood alcohol, using for the purpose a lamp 
of special construction, in which the oxidation is accomplished by- 
means of platinum gauze or sponge. 



Formaldehyde: Skinner. 261 

Several good lamps are on the market, but as they are rather 
expensive I have thought it might be interesting to those of a 
mechanical turn of mind and who are not possessed of an over- 
abundance of income to describe the method of making the lamp, 
which, while simple and cheap, is quite efficient. The essentials are, 
first, a large shallow tin alcohol lamp holding at least a quart, with 
a large wick equal to about five of the smaller wicks. The top of 
the wick should be one and one-quarter inches above the top of the 
lamp, and should be loosely spreading. To make the formalizes take 
a piece of thin sheet tin of six and one-half by two and one-half 
inches. In one long edge cut six tongues one-quarter inch wide 
and three-quarter inch deep and one-half inch apart. These are for 
the admission of air. One and one-half inches from this edge/ and 
parallel to it, a row of small holes should be punched one-quarter of 
an inch apart. Next bend it in the form of a cylinder and wire it 
together with two holes at the bottom and two holes at the top. 

For the next step you will need two feet of very fine platinum 
wire, the finest you can procure. One-half of this is to be woven 
back and forth through the holes to form a loose network. Upon 
this a layer of long-fiber asbestos is to be spread out evenly and 
thinly; another similar layer over this with fibers at right angles to 
the first; then over the whole the remaining foot of platinum wire 
is to be woven, thus holding the asbestos fiber between two meshes 
of the wire. A few drops of the solution of platinic chloride will 
complete the process. This is to be dropped on the asbestos and 
heated after the addition of each drop. In this way platinum is 
deposited in a finely divided condition and gives the asbestos a gray 
or black appearance. About one cu. cm. of a 2 per cent, solution of 
platinic chloride will answer. 

Now bend out the quarter-inch tongues cut in the bottom of the 
cylinder, fill the lamp with methyl-alcohol, heat the platinized asbes- 
tos over the flame of a small alcohol lamp and place quickly over the 
wick of the large lamp. Cut a circle of wire gauze two and one-quar- 
ter inches in diameter and lap over the asbestos. By regulating the 
size of the openings for the admission of air, and by careful atten- 
tion to the height of the wick(about one-eighth inch below the 
asbestos screen) it can be made to do most efficient service. 

One quart of the alcohol is said to disinfect a roornioxioxio in 
the space of two or three hours. Others have placed the limit to size 
at 2,400 cubic feet, though a longer time must be allowed for it to 
act. The temperature of the room should be not less than 65 degrees 
F. Before disinfecting the room all boxes and drawers should be 
opened and contents spread out. Bedding should be thrown back, 



262 The Corpuscle. 

shades pulled down as far as possible and, in short, everything made 
easily accessible to the gas. Ventilators should, of course, be closed 
and windows sealed, preferably from the outside, by pasting strips 
of paper over the cracks. After the lamp is working well the door 
should be closed and sealed in the same manner as was done with 
the windows. 

There seems to have been a difference of opinion as to the effect 
of formaldehyde upon coloring matter, some saying that it has no 
effect, others that it bleaches some of the aniline dyes, especially 
some of the more cheaply dyed fabric. This should be remembered 
and any such articles should be removed previous to the disinfection. 



THE STUDENT'S LIBRARY. 

BY E. L. KENYON, M. D. , '96. 

One consideration which has, and does still, interfere with a 
clear understating of the question as to the need of establishing a 
library for the use of the students of Rush College deserves some at- 
tention. The feeling (perhaps scarcely self-conscious) that the stu- 
dent has free access to the great Newberry Library, has, and does 
still, affect the judgment, or at least the enthusiasm of some of those 
who otherwise might not have tolerated for so long the present lack 
of library facilities in connection with the college. In order that 
the student may spend one hour at the Newberry Library he must 
spend practically two hours in going and coming, besides ten or 
twenty cents in carfare. The time each day which it is possible for 
him, with his assigned daily work, to devote to library study, is 
measured rather by minutes than by hours, and is represented only 
by the odds and ends of his time. The location of the Newberry 
Library, therefore, renders it practically prohibitive. If anyone 
doubts that it is little used by the twenty-five hundred medical stu- 
dents of Chicago, let 'him note upon his visits there how few students 
are availing themselves of its privileges. And if he considers this 
failure to make use of the library as due rather to lack of apprecia- 
tion than to the inconvenience of location, let him consider that the 
overworked student should rather be encouraged to broaden his 
work than hindered to the last degree from so doing. One of the 
correspondents of last month's Corpuscle suggested that the library 
of a college within his acquaintance remained almost unused by the 
students ; the writer, on the other hand, could point to an, institution 
(not medical) in whose library, conducted so as to be readily accessi- 



Student's Library: Kenyon. 263 

ble, may be seen from fifty to two hundred undergraduates hard at 
work at almost any hour of the day. And even if the Newberry 
Library were at our very doors it would still be a question whether 
the college ought not to have a collection of books of its own, over 
which it could exercise full control and which could be regulated 
to conform exactly to the teaching needs of the institution. The 
clearer we realize that, however useful this library may be to the in- 
vestigator or practitioner, yet in so far as it has retarded the estab- 
lishment of working libraries in other parts of the city, it has been 
not an advantage, but a positive hindrance to> medical education in 
Chicago, the nearer shall we come to a right understanding of its 
relation to the medical colleges. 

The correspondence in the March number of the Corpuscle was 
particularly useful in settling two' phases of the discussion, both of 
which must have been settled before much progress could be made. 
In the first place none of the correspondents were unfavorable to the 
idea of a college library, and some of them were enthusiastic in its 
favor. While the students themselves have never doubted their 
own need of a library, the question of the value of such an addition to 
the teaching facilities of the college must have remained a little 
clouded until those w1k> had the teaching in charge should also have 
expressed an opinion. Now that the college authorities have spoken 
favorably to the idea it may be considered as settled that a library is 
needed, and the discussion can now take on a more practical char- 
acter. The second important point settled by the correspondence is 
that the college, as such, is not at the present time in a position to 
enter upon the task of establishing a school library. The discussion 
has then advanced to this point : That library facilities do not exist, 
but are certainly needed; and that, if such facilities are forthcoming 
they must be provided by means outside the official college organi- 
zation. Both these facts were more or less clearly believed before, 
but now they may be considered as settled. 

No one seems to have directly congratulated the college upon 
the fact that a library has actually been started. More than ordinary 
praise is due Professor Hektoen for inaugurating the plan of depart- 
mental libraries. This system, which is proving of such value in our 
literary colleges, includes, ultimately, the establishment of a special 
collection of books in each department, to be used by the students 
under the guidance of their teachers, much as the various laboratories 
are now used. The head of the department maintains complete con- 
trol of his own collection and uses it as part of his teaching 
armamentarium. Such libraries will come to be considered as es- 
sential for the teaching of medicine, and a necessary part of the equip- 



264 - The Corpuscle. 

ment of a college. Thus considered, it will be seen that, however 
excellent and conveniently located a general library may be, it can 
never take the place of a special collection under the direct control 
of a school. So that, whatever may now be done toward establish- 
ing a library at Rush, such effort will merely supplement the later 
efforts of the college authorities. It is too much to expect that an 
extra-official college organization should work so perfectly in har- 
mony with the college as to build a library well adapted to the special 
departments. 

Regarding the practical question as to what can be done in the 
immediate future, three possible lines of effort seem to 'be open. 
First, an organization could be formed, not for the purpose of con- 
ducting a library, but merely to devise means for aiding the college 
authorities in the establishment of a school library proper. Such a 
plan, if it proved feasible, would be likely to produce the most useful 
results; but so much self-abnegation would be necessary for its ac- 
complishment that success might be impossible. Second, an organi- 
zation of alumni, faculty and students might establish and maintain 
its own library. This is the plan which seems to be in the minds 
of those who have thus far spoken in favor of any immediate effort; 
and it perhaps presents less of difficulty than the others. 

Third, all the factors interested in having general medical 
library facilities in close proximity to the County Hospital could 
unite and establish and conduct a West Side medical library. The 
simplest and most economical method of all for maintaining general 
medical libraries in relation with the schools would be found in the 
departmental plan, similar to that of the city public library, with 
preferably the Newberry Library as the controlling center. But 
presuming this to' be impracticable, it seems unwise, with four "regu- 
lar'' colleges within a stone's throw of each other and with a large 
number of West Side physicians needing a library nearer home, that, 
nevertheless, no effort should be made to bring these interested fac- 
tors into cooperation in a matter which equally concerns them all. A 
suspicion lurks in the public mind that physicians are not practical 
as business men, and the waste of money involved in the possible 
future maintenance of three or four or more separate general 
libraries a few blocks apart would go far toward substantiating this 
suspicion. But it must be admitted that the difficulties incident to 
organizing factors, likely to* prove inharmonious, into' on© working 
body might prove to be serious. 

Perhaps the most practicable plan of all would be to first estab- 
lish a Rush College general library; but with the understanding 
that later efforts toward cooperation with the other schools should 



Student's Library: Kenyon. 265 

be undertaken. But before a definite conclusion of any kind is 
reached each of these three plans should be carefully considered. 

The matter of getting the books together is an almost insig- 
nificant obstacle compared with the problems of housing and main- 
tenance. But the most difficult matter of all is the task of organiz- 
ing the interested factors, alumni, faculty and students, into a com- 
pact, effectively-working force. If this task can be accomplished, 
then not only is Rush sure of a library, but she is sure also of having 
other social problems bound to arise also effectively handled. Most 
of all is needed leaders, organizers, and with the right leadership 
who shall say what might not be accomplished? 

Each year the question arises in much the same manner. A 
student protests against the lack of library facilities, others follow, 
and there the matter ends, without any actual progress having been 
made. The undergraduates do not show sufficient independence 
and energy, and they do not seem to be able to organize them- 
selves; and no one else seems sufficiently interested. The question 
has this year been advanced further than usual and no reason exists 
why the movement should not be continued, so that, at the opening 
of the school in the fall, the 'business of organizing a library associa- 
tion can actually be begun. In order to accomplish this an author- 
ized body should take the matter under advisement during the sum- 
mer and prepare themselves to report a definite plan of action in the 
fall. Such a body should include representatives of the students, 
the faculty and the alumni. The only reason why the establish- 
ment of such a body is difficult is that no ome assumes the responsibil- 
ity of the initiative steps. The Corpuscle, which has done so well 
in bringing out this discussion, can also best initiate the work of 
organization. Let the Corpuscle board see that one man from each 
of the lower classes is appointed, at a class meeting, to act upon this 
board; let each class, by resolution, request the faculty to appoint 
one or two of their number as members; and let those thus appointed 
be authorized to bring the matter before the alumni association next 
month. All appointees should be residents of Chicago. During the 
summer this board will have ample time to carefully canvass the 
whole subject, and in the fall, with a full school year before us, it can 
be ready with a practical plan for work. Unless some such idea is 
adopted the ground gained by this discussion is almost sure to be 
lost. The question is one which, in the nature of things, must be 
met sometime, and circumstances seem now to be especially favor- 
able for arriving at a solution. 



PROFESSOR BROWER'S CLINIC AT DUNNING. 

Two hundred and fifty students from the senior classes of Rush 
and the Woman's Medical College attended a special clinic by 
Professor Brower at the County Asylum, March 31. Professor 
Brower has held these clinics for the past fifteen years and they have 
become one of the interesting features of the senior course. 

A large chart with the classification of the different forms of 
insanity was spread before the class and this outline was followed 
in presentation of the patients. 

Assistants had examined the blood and urine of a number of the 
cases. It was interesting to note how often the blood and its 
vessels were deranged. 

Eleven patients suffering from melancholia were first presented, 
each of whom assumed the characteristic position. They sat in 
silence, except one or two of the milder cases, who spoke, but to 
protest against unjust confinement or to answer in monosyllables. 
Each one was suffering from some delusion, the most common being 
that of persecution. In some cases the pulse was small, rapid and 
compressible; in others rapid and noncompressible. The blood 
examination showed haemoglobin varying from 45 to 68 per cent., 
red corpuscles from 3,540,000 to 4,630,000 and white corpuscles 
were sometimes in excess. A number of these patients refused 
to eat and were fed by a nose tube. 

Cases of mania were next presented. The ready movements, 
the fearless looks, the ready talk, contrasted strikingly with the 
sluggish, suspicious, silent conduct of those in melancholia. In 
these cases delusions were also present, but they were of a happy 
nature. Somebody had given them vast treasures or they owned 
the world or something else as exalted. 

Several cases of puerperal mania were exhibited. These cases 
make good recoveries as a rule. Because a woman has become 
maniacal during one pregnancy does not signify that future preg- 
nancies will be attended by the same unfortunate condition, for 
many cases have had repeated pregnancies without recurrence of the 
attack. 

Mania and melancholia, sooner or later, merge into dementia. 
One could readily recognize by the habitual pose of the patient to 
which class he had formerly belonged. Among the dements was 

266 



Clinic: £ rower. 267 

a woman who had entered the asylum in a state of stuporous insanity, 
but under the use of thyroid extract had developed into quite the 
opposite condition, being alert and ready to laugh at everything. 

A case of periodic insanity was presented. The patient was a 
man with three states of mind — I, lucid intervals; 2, melancholia; 
3, mania. These states succeed one another, causing what is fre- 
quently denominated circular insanity. 

Epileptic insanity produced a class of patients among the most 
useful and at the same time most dangerous in the hospital, for they 
act entirely on their impulse. One time they may be generous and 
thoughtful, while at another time they are vicious and dangerous. 

Cases representative of paretic insanity were presented, also 
some due to arrest of development. 

The students returned in the evening on the train they had 
chartered for the occasion, feeling well repaid for the trip and very 
grateful to Professor Brower. 



The Corpuscle. 



EDITOKS. 

T. R, CROWDER, '97, Editor-in-Chief, 

226 South Paulina St., Chicago. 

E. L. McEWEN, '97, Secy and Treas. 

F. E. PIERCE, '98. A. F. STEVENSON, '98. J. P. SEDGWICK, '99. 



Communications relative to advertisements and subscription (Subscription price 
$1.00 per annum) should be addressed to the publisher. Remittances should be made 
by money order, draft or registered letter, payable to "The Corpuscle," and addressed 
to H. G. Cutler, Unity Building, Chicago. 



Ruby Red and Black: Colors of Lake Forest University. Orange: Color of Rush 

Medical College. 



WILLIAM HARVEY A. D. 1578-1657. 

William Harvey, "the discoverer of the circulation of the 
blood," was born at Folkestone, England, A. D. 1578. His par- 
ents w r ere Thomas Harvey, a wealthy yeoman of Kent, and his 
mother "a Godly, harmless woman and a careful, tender-hearted 
mother." At sixteen he went to Cambridge and at nineteen he 
took the B. A. degree. He then went to the famous University of 
Padua, where he began his medical studies under Fabricius, who 
put him on the track of his great discovery. After four years at 
Padua he returned to Cambridge, where he took his degree of M. D. 
Five years after he was admitted as a Fellow of the College of 
Physicians. 

At thirty-one years of age he was appointed physician to 
St. Bartholomew's Hospital, and in 161 5, when thirty-seven years 
old, he began his lectures on the "Motion of the Blood." There is 
no report of these lectures, but it is believed they contained the 
substance of what was published thirteen years afterward (1628) in 
Latin on the motion of the heart and blood in animals. The book 
is dedicated to King Charles I, who took great interest in Dr. 
Harvey's discovery and made him, five years after, Physician to the 
King. This was as a recompense for the treatment he received at 
the hands of his brother physicians on account of the novelty of 
his views. 

268 



Editorials. 269 

After his book came out his practice fell off greatly. The 
vulgar believed him elemented, and all the medical men opposed 
him. The king, however, took an entirely different view. He 
went over his experiments with Harvey and placed at his disposal 
all the does which were killed in the royal forest, that he might 
study their anatomy to further his researches into the physiology of 
generation, in which both the king and his physician were im- 
mensely interested. The king also made Harvey tutor to his sons, 
afterward Charles II and James II of England. 

It is related that Harvey frequently visited George Bathurst, 
B. P., of Trinity College, who had a hen to hatch eggs in his rooms, 
which they opened daily to see the progress of generation. In 
1646, at the age of sixty-eight, he left the service of the king, who, 
defeated by Cromwell, was no longer able to provide does for 
dissection. 

Harvey was of 1ow t stature, olive complexion, round face, small 
eyes, full of spirit, with hair black as coal, but white twenty years 
before his death. In 1651, when seventy-three years old, he pub- 
lished his great work on "Generation," and after honors tendered 
by the College of Physicians, but declined by Harvey, who had 
given that body a handsome gift, he died at the age of seventy-nine, 
in June. 1657. 

The greatness of the work of Harvey does not consist in the 
discovery of the circulation of the blood — that was knocking at 
the door of human intelligence and must very soon have gained 
admittance, even if Harvey had never been born. His great merit 
lies in his independence of mind — prepared to follow the truth at all 
hazards, while still respectful of the authority of his teachers. He 
was not a bold reformer, careless of the opinions of the great men 
before, but, on the contrary, it was with painful effort that he con- 
victed the "divine Galen" of inconsistent reasoning, while he quotes 
his works as authority. It was years after he had convinced many 
eye-witnesses of the truth of his discoveries, and eight years after 
the publishing by his friend, Lord Bacon, the splendid Lord Chan- 
celler of England, of his new Philosophy, that Harvey published 
his little book of eighty pages. Up to Plarvey's time in anatomy 
and physiology "believing was seeing" — men saw what Galen said 
was there. The final appeal was to Galen, not to fact. 

After the publication of his treatise on circulation Harvey gave 
his efforts to the study of generation. He also studied and wrote 
on one of the problems of vital chemistry, "Respiration," and he 
seems to have had a true, though vague, idea of this process, for he 
says that "air is given neither for the cooling nor the nutrition of 



270 The Corpuscle. 

animals. * * * Heat is kindled within the foetus, not repressed by 
!the influence of the air." 

That Harvey should have suspected the truth revealed long 
afterward is remarkable proof of his genius. 

(From "History and Heroes of Medicine." — Russell, London, 
1861.) E. R. L. 

MEDICAL JOURNALS. 

What medical journals shall I take? This is one of the first 
questions which the incipient doctor will naturally ask himself, and 
his decision of the matter will have an important bearing on his 
success and standing as a practitioner. Medical journals occupy 
more than nine-tenths of the reading time of the average doctor. The 
large text-books seem so formidable to him when, fatigued by a 
hard day's work, he has a short hour for reading. They are so in- 
convenient to carry about to be read in the street car or carriage, or 
during hours of waiting on an obstetrical case, they are so apt to be 
out of date in some important particular, that they are usually re- 
served for occasional reference in connection with a difficult and 
puzzling case. The progressive physician keeps himself abreast of 
the times by means of the current medical literature, and it is of the 
utmost importance, therefore, that he should read only the best. 

Of the nearly 400 medical periodicals published in America it 
is safe to say that not more than fifty have any scientific value; half 
that number would cover the thoroughly good ones. And yet, 
strange to say, some of the most worthless of them ail have the 
largest circulation, due, in part, no doubt, to the fact that their 
cheapness appeals to the none too plethoric pocketbook of the 
doctor, and partly because of the small amount of mental effort 
required in the perusal of the "report of a remarkable case," "won- 
derful cure of a case of ingrowing toenail by Toeine," and papers 
of like character. The time and money spent for such trash is 
worse than wasted, and it is humiliating to one's pride in the profes- 
sion that so many doctors should be deluded into buying and read- 
ing them. 

Of the thoroughly high-grade journals, which can be read with 
profit, and filed for future reference with a knowledge that they con- 
stitute an addition of real value to one's library, mention can be made 
in this article of some of the leading ones only. The weekly period- 
ical appeals most strongly to. the general practitioner, combining, 
as it does, the features of a scientific journal of a practical character 
with those of a newspaper, presenting the medical news items of 
interest throughout the world. Of these weekly publications we can 



Editorials. 271 

recommend, unreservedly, the Medical News, published in New 
York and Philadelphia, the Journal of the American Medical Asso- 
ciation, Chicago, the New York Medical Journal, the New York 
Medical Record, and the Boston Medical and Surgical Journal. The 
articles in these periodicals are selected with great care, most of them 
are paid for, securing, thus,the work of the best class of contributors, 
and the medical progress of all parts of the world is promptly and 
fully recorded. One ought to add to such a weekly journal a 
medical magazine of more purely scientific character, whose articles 
are more exhaustive, and involve more of original observation. 
The news features, excepting the notes of medical progress, are 
usually eliminated from such journals. Quite the best represent- 
ative of this class of periodicals in America is the American Journal 
of the Medical Sciences, Philadelphia, whose uniformly high charac- 
ter,during the nearly fifty years of its publication^ one of the glories 
of American medicine. Its present editor, Dr. Edward P. Davis, 
is a graduate of Rush, class of 1882. Of still more purely scientific 
character, devoted exclusively to original work along experimental 
lines in physiology, pathology, materia medica and clinical medi- 
cine, is the Journal of Experimental Medicine, published quarterly 
at Baltimore. Independently of its practical value to the subscriber, 
It should command the support of every patriotic doctor who has a 
proper feeling of pride in the work done in our own country. 
Should the doctor's practice become largely surgical, the Annals 
of Surgery, New York, will naturally find a place on his list. Should 
obstetrical work occupy a large part of his time, the American 
Journal of Obstetrics will be found the best exponent of the devel- 
opment of that branch of medicine. These are monthly publica- 
tions. The Archives of Paediatrics (monthly, New York) and the 
Therapeutic Gazette (also monthly and devoted to experimental and 
clinical therapeutics) will also appeal to the general practitioner 
and can be recommended as of thoroughly high grade. In what- 
ever section of country one may select for a location, there is sure 
to be some local medical journal, which will contain items of 
special interest in regard to the practitioners in that region, and one 
will wish to subscribe for that. It should not be taken, however, to 
the exclusion of the better journals we have mentioned. 

As the doctor's practice increases, and his means therewith, 
his practice may develop into some special line, as ophthalmology, 
laryngology, gynaecology, and the like, in which case he will need 
one or more of the special journals in these lines. 

If one reads German, French or other foreign language (and 
every physician of to-day should read at least one language beside 



^72 The Corpuscle. 

his own), the Deutsche Medicinische Wochenschrift, in German, and 
Le Progres Medical, French, can be recommended. 

Finally, every loyal son of Rush will wish to keep in touch 
with his alma mater, and will not leave the city after graduation be- 
fore subscribing for the Corpuscle. 

*• 

TO THE ALUMNI. 

In a recent number of the American Journal of Obstetrics is an 
article on "Iniencephalus," by Henry F. Lewis, A. B., M. D., in the 
preparation of which the author made efficient use of several speci- 
mens in the Rush Museum. In the course of the article Dr. Lewis 
says : 

"I believe it is in the study of monstrosities that we find the 
most unreliable and unsatisfactory instances of case reporting. To 
ine the most exasperating feature was the titles of the articles. 'A 
Unique Monster/ 'A Curious Teratological Case,' 'A Remarkable 
Monstrosity,' and such lucid titles compelled the overhauling of 
hundreds of articles before finding one bearing on our subject. Few 
men seemed to have sought to classify their monster, and many 
seemed afraid to dissect it, obviously for fear of spoiling the esthetic 
appearance of the specimen. This last fear is groundless, for a 
foetus can be very extensively dissected and afterward completely 
restored to its former beauty by a little sewing and cotton stuffing. 
In many, however, the greatest interest consists in the appear- 
ance of the skeleton. A good photograph of the monster and a good 
dried skeletal preparation, with the report of a complete and care- 
ful dissection, is of far more value to teratology than hundreds of 
uncut foetuses hidden away in jars and thousands of pages dealing 
mostly with the course of the labor and laboriously speculating on 
the possible 'maternal impressions.' '' 

We would call the attention of the Rush alumni to a way of dis- 
posing of the teratological material they may chance to come across 
in the course of their practice which may result in more use being 
made of it in the future. Professor Hektoen will be very glad to 
take charge of specimens forwarded to the Rush Medical College 
Museum, and to see that they are properly classified and recorded. 

The foetus can be well preserved in a 10 per cent, solution 
of formalin or in strong alcohol, or, better, in a mixture composed 
of 10 per cent, of formalin and 90 per cent, of alcohol. 

If the alumni of Rush will go to the trouble and take a little 
care in preserving and forwarding the specimens that may come 
into their hands, it may result in a valuable collection for the 
museum and in some valuable work along the line of embryonic 



Editorials. 273 

pathology. They arc urged to take notice of this request. A full 
case report accompanying the specimen would be very desirable. 

DISTURBING THE CLINICS. 

A thoughtful, far-seeing individual will not, as the saying is, 
"bite his own nose off to spite his face." The disfigurement of 
the physiognomy far outweighs the passing satisfaction afforded by 
the nip. On the same principle one would hardly expect a body of 
students, preparing to enter the most serious and important of all 
professions, to subvert their own interests by a petty disturbance of 
the clinics. Unfortunately, there is a tendency in that direction. 
In nearly every instance the underlying cause is a desire to create 
fun, to bother the consulting staff, or to get a "good drive" on some- 
one — professor, staff or student on the benches. It is true the 
temptation is often very great; and that it is yielded to is evidence 
that some good-natured student has a mind that perceives quickly 
even though he be a little short on good judgment and kindly con- 
sideration of others. But "to everything there is a season, and a 
time to every purpose/' The object of a clinic is instruction. When 
in progress, it should have the right of way over everything. Re- 
spectful attention on the part of the student is a duty imposed by 
self-interests if by no higher considerations. He cannot afford to 
let pass unheeded the practical knowledge presented. No student 
knows what fact or facts are going to save him in that hour w'hen he 
shall "sweat blood" as it were. As a self-protective measure against 
the time of responsibility that is to come, he must now be ready 
and eager to receive all that is presented. 

But this is a selfish consideration; there are others. The faculty 
in endeavoring to present a good course for value received is 
entitled to cooperation from the students. The professor in charge 
of any clinic, by virtue of maturer years, more extended knowledge, 
and riper experience, has a right to expect a certain deference from 
the untried student. Fellow-students on the benches who realize 
the importance of fullest preparation should be accorded the right 
to listen undisturbed. Patients, too, have rights that are bound to 
be respected, for this is a free country. Aside from the fact that 
if insulted they do not return and thus cut short the clinical supply, 
this aspect of the question suggests another important point: No 
man who practices medicine can afford to treat his patients other 
than with kindly, yet dignified, consideration. The student can well 
begin the development of such a bearing while in school. It will 
mean dollars in his pocket in after years. 

In conclusion, let this be the summary: Stop chewing your 
nose; your face cannot stand the loss. 



274 The Corpuscle. 

OUR JUNIOR COURSE IN PATHOLOGY. 

If the Class of '98 does not know something about pathology, 
it is its own fault, for it has had systematic work under Dr. Le 
Count four times a week during the entire past year. The work 
has been entirely in the laboratory. 

At first, in order to> show the relation the microscopical exami- 
nation of the stained cut section bears to the anatomical diagnosis 
made at the autopsy, the organs were brought from the morgue and 
shown to the students in the laboratory. At the same time, when 
possible, the clinical history of the case was read and each member 
of the class was given a block from one of the organs and was 
requested to write a macroscopical description of the organ from 
which it was taken. The blocks were hardened, impregnated with 
celloiden and cut into sections, and these sections stained and 
mounted, each student doing all this work himself. The members 
of the class exchanged cut sections, so that each procured all the 
specimens examined. Following this, each student read before the 
class the macro- and microscopical description of the organ exam- 
ined by him. An informal discussion was then indulged in, and 
the description freely commented upon and the relation between the 
pathological condition found and the clinical history of the case 
was ascertained. 

The examination of the kidney was then taken up. Each 
member of the class, which, fortunately for them, numbers only 
twenty-nine, received a piece of kidney, twenty-nine kidneys from 
as many different cases being distributed. These were put through 
the routine celloiden method and sections from each examined by 
each member of the class. Full descriptions of the sections were 
placed upon the board to serve as a guide for their study. These 
different specimens of the kidneys, thus obtained, were then classi- 
fied into groups, according to the pathological features exhibited 
by each. At the same time as many facts as were procurable con- 
cerning the macroscopical appearance of each kidney and the clin- 
ical history of the individual from whom that kidney was taken 
were utilized. 

A similar method was employed in a study of the pathology of 
the liver. 

Finally the class studied tumors and in this case each student 
carried through two blocks. In this manner nearly sixty tumors 
were examined by each member of the class. Diagnoses of about 
two-thirds were placed upon the board, accompanied by an enumer- 



Editorials. 275 

ation of the important histological features. The remaining third 
were left to test the students' knowledge gained from the course. 

Along with all this, the class were required to make about 
sixty drawings illustrating the principal pathological features. This 
was done with the object in view to both impress the features 
upon their minds and to make them more thorough in their work. 
It has proved a marked success, and great improvement has been 
noticed in this respect during the last several months, the majority 
of the drawings being excellent. 

We feel that Rush may be very proud of this course in patholo- 
gy. We are not absolutely certain, but, to our knowledge, no other 
medical school in this country gives a better course than this; in 
fact, we do not see how a much better course could be devised in a 
busy college curriculum. We are absolutely sure, however, that 
the vast majority of such courses are far inferior and may be com- 
pared with our sophomore work in that line. The "class of '98" feel 
deeply indebted to Dr. Le Count for the course he has given them, 
and thanks him for the care and attention he has devoted to each 
and every man of it. 



After the May issue, two new men will be elected to the Cor- 
puscle Board, to fill vacancies created by the retiring senior editors. 
Members of the sophomore and freshman classes are eligible. 
Candidates are requested to hand in, to any of the present editors, 
on or before May 5, some of their own written work, either an 
editorial, an essay or an original article. The subjects are left en- 
tirely to the men, and they may draw them from whatever source 
they please; but, of course, they are expected to do the work them- 
selves. The selection will be made impartially and will depend upon 
the merit of the work handed in to us and in part upon the amount 
of interest displayed. We urge as many men as possible to try, 
so that our choice may represent the best literary ability in the 
lower classes. Any one of the present members of the board will be 
most pleased to talk with candidates and to give them any hints or 
suggestions in their power. Successful candidates will be notified 
of their election by mail. 



The annual conversational meeting of the Pathological Society 
of Philadelphia will be held in the upper hall of the College of Phy- 
sicians, northeast corner Thirteenth and Locust streets, on Thurs- 
day, April 22, 1897, at 8:15 p. m. 

Dr. Ludvig Hektoen, Professor of Morbid Anatomy in Rush 



276 The Corpuscie. 

Medical College, will deliver an address, entitled, "Segmentation 
and Fragmentation of the Myocardium." After the meeting a re- 
ception will be tendered Dr. Hektoen at the University Club, 1316 
Walnut street. A cordial invitation is extended to attend the meeting 
and the reception. 

We congratulate the society upon its excellent choice in select- 
ing a speaker. 



The College of Physicians and Surgeons of Chicago has 
recently become the Medical School of the University of Illinois. 



Professor Hamilton has accepted the superintendency of the 
Hospital for the Insane at Elgin. 



COLLEGE NOTES. 



EXAMINATIONS FOR INTERNES IN COOK COUNTY 

HOSPITAL.* 



SURGERY AND EYE AND EAR. 

Pathology and treatment of acute glaucoma. 



Describe the operation of enucleation of the eyeball. 

Diagnose paralytic from concomitant strabismus. 

Give symptoms and treatment of mastoiditis. 
Name the pathologic conditions of the eye that may develop 
in the course of (a) basilar meningitis, (b) diabetes, (c) tabes dorsalis, 
(d) rheumatism, (e) intracranial growth pressing upon the occipital 
lobe of one side. 

6. Middle meningeal artery, (a) Landmarks, (b) How to ligate, 
giving steps of operation. 

7. How would you drain for acute suppuration of the knee- 
joint? 

8. Wound of internal mammary artery, (a) Diagnosis of 
hemorrhage from, (b) Treatment of. 

9. Pott's fracture, (a) What injuries are included in this 
category ? (b) Give the principles which underly the treatment. 

10. Aneurysm, (a) Etiology, (b) Pathology, (c) Classifi- 
cation, (d) Principles of treatment. 

11. Gangrene, (a) name the various causes of. (b) Name 
the clinical varieties of, and indicate treatment of each. 



* Each examination lasted three hours. 



College Notes. 211 

12. Differentiate in parallel columns between syphilis, tuber- 
culosis and carcinoma of the face. 

13. What principles should be observed in doing" an amputa- 
tion? 

14. Differentiate between a dorsal and a thyroid dislocation of 
the hip-joint. 

15. Patient with swelling in abdomen; most prominent in 
upper part of left side; differentiate between (a) pancreatic cyst, (b) 
hydronephrosis, (c) pyonephrosis, (d) gastric dilation, (e) po3t peri- 
toneal lipoma. 

GYNAECOLOGY AND OBSTETRICS. 

i. Give the three most important etiological factors in pelvic 
inflammation in order of frequency. 

2. Give the details of preparation and after treatment of 
laparotomies. 

3. Give the differential diagnosis between acute pyosalpinx 
and appendicitis. 

4. Slide from cervix uteri to identify the pathological condi- 
tion. (One minute given for observation.) 

5. Write on atresia and stenosis of vagina and vulva. 

6. Write on cancer of the cervix uteri. 

7. W r rite on ovarian dermoids. 

8. Write on ectopic gestation. 

9. Write on puerperal eclampsia. 

10. Write on placenta praevia. 

11. Give the symptoms of shortness of the cord. 

12. Give the conjugate circumferences and diameters of the 
pelvic inlet. 

13. Give the differential diagnosis of the various head presen- 
tations. 

14. What are the causes of accidental hemorrhage? 

15. Give the technique of episiotomy, its direction, its axis and 
the tissues severed. 

MEDICINE AND PATHOLOGY. 

i. Differential diagnosis of small-pox. 

2. Characteristics of the blood in (a) chlorosis, (b) per- 
nicious anaemia. 

3. Detail the consequences of arterio-sclerosis as regards fa) 
the heart, (b) the brain. 

4. The gross morbid anatomy of the kidney, in chronic in- 
terstitial nephritis. 



278 The Corpuscle. 

5. Describe the fundamental difference in the manner of 
formation of secondary growths in the malignant tumors and in 
tuberculosis. 

6. The pathology and diagnosis of biliary cirrhosis of the liver. 

7. Differential diagnosis between epidemic cerebro-spinal, 
suppurative and tuberculous meningitis. 

8. Distinguish anatomically and histologically between paren- 
chymatous and fatty degeneration of the myocardium. 

9. Fat embolism. 

10. Pathology and symptoms of amyloid disease. 

11. Characteristics of the urine in (a) acute nephritis, (b) 
chronic interstitial nephritis, (c) diabetes mellitus. 

12. Your conception of the nature of the inflammatory process. 

13. Distinguish between facial paralysis of periphereal and cen- 
tral origin. 

14. Symptomatology and signs of pericarditis. 

15. Describe the pneumococcus of Fraenkel (diplococcus 
lancealatus). 

ANATOMY AND PHYSIOLOGY. 

1. Describe the forms of ossification. 

2. Describe the spermatic cord. 

3. Describe the terminations of the auditory nerve. 

4. What muscles are supplied by (a) musculo-cutaneous 
(brachial), (b) musculo-spiral? 

5. Diagram of Scarpa's triangle and name its contents. 

6. Diagram of inferior carotid triangle. Give contents and 
their relations. 

7. Describe the wrist-joint and give its relations. 

8. Describe the course of transmission of a motor impulse 
from the cortical area to the periphery. 

9. (a) Name the general classification of the chemical bases 
of the animal body, (b) What are their general chemical formulas? 
(c) Name three in each general class. 

10. Give briefly the physiology of the tenth pair of crania 
nerves. 

11. Give the nerve supply of the uterus. 

12. Describe the functions of the liver. 

13. Describe the deep perineal fascia. 

14. What are the factors involved in the lymph circulation? 

15. Describe the left common carotid artery and name its 
branches. 



College Notes. 279 

MATERIA MEDICA, THERAPEUTICS AND CHEMISTRY. 

i. Compare the action on the circulatory system (heart and 
blood vessels) of (a) alcohol, (b) strychnine, (c) digitalis and (d) 
caffeina. 

2. Give definition of (a) decoction, (b) tincture, (c) fluid ex- 
tract, (d) infusion and (e) oleoresin. 

3. What is iodoform? (a) Description and properties, (b) 
Dose, (c) Symptoms and treatment of poisoning. 

4. Describe morphine, quinine, zinc sulphates and dis- 
tinguish between them. 

5. (a) Description and properties of arsenious acid, (b) Dose, 
(c) Official preparations and doses, (d) Antagonists and incompati- 
bilities, (e) Physiological action on the circulatory system. 

6. Name four indications for the use of cathartics. Give 
modus operandi. 

7. Describe the various methods in which mercury may be 
employed in the treatment of syphilis, and write suitable prescrip- 
tions. 

8. By what channels may therapeutic remedies be admin- 
istered? 

9. How would you detect and treat carbolic acid poisoning? 

10. What are the therapeutic indications for granatum, and 
what is the best method of administration? 

11. Give test for indican in urine. When found, what does it 
signify? 

12. Prepare two of the chief compounds of mercury and give 
equations. 

13. Describe the manipulations necessary in testing for 
s/trychnia in the contents of a stomach. 

14. Differentiate chemically between lead acetate and oxalic 
acid. 

15. Give Fehling's quantitative test for sugar in the urine. 
Are there any objections, and if so, state them. 



THE SURGICAL CLINICS. 

The following is a list of the operations or conditions for which 
the operation was made, witnessed in the upper amphitheater of the 
college during the last month: 

March 16 — Professor Senn: Reduction of congenital disloca- 
tion of the hip-joint. Excision of carcinoma of cheek. Plastic 
operation for deformed upper lip. 



280 The Corpuscle. 

March 17 — Professor Etheridge: Trachelorrhophy. Oopho- 
rectomy. 

March 18 — Professor Senn: Amputation through base of 
thigh. Amputation of breast. Excision of carcinoma of nose. Ex- 
cision of powder-pigmented skin from face. Tubercular perineal 
fistula, complicating extensive genital tuberculosis. Talipes equino- 
varus in infant. Tapping and iodoformization of tubercular knee 
joint. 

March 20 — Professor Hamilton: Cirsoid aneurysm of fore- 
head. Sarcoma involving right nasal cavity and frontal sinus. 
Drainage of tubercular hip-joint. Osteomyelitis of carpal bones. 
Fisure of anus. Deflected septum and ulcer of nasal mucous mem- 
brane — correction of deflection and cauterization of ulcer. Phleg- 
mon of inner aspect of foot. 

March 23 — Professor Senn : Excision of lupus patch from an- 
terior aspect of wrist, followed by Thiersch's skin-grafting. Cauteri- 
zation over course of sciatic nerve for sciatica. Removal of tubercu- 
lar lymphatic glands of the neck. Iodoformization of tubercular 
knee and shoulder joints. 

March 24 — Professor Etheridge: Trachelorrhaphy. Peri- 
naeorrhaphy. Oophorectomy. Hysterorrhaphy. 

March 25 — Professor Senn: Excision of large lupus patch, in- 
volving back of hand, fingers and wrist, with restoration by plastic 
procedure, taking skin flap from front of abdomen. Removal of 
chondro-fibroma of parotid gland. Traumatic web-fingers. Re- 
moval of tubercular glands of neck (two cases). Iodoformization of 
tubercular knee and elbow joints. 

March 17 — Professor Hamilton: Herniotomy. Urethrotomy. 
Excision of epithelioma of hand. Excision of cirsoid aneurysm. 
Suppurative osteomyelitis of foot. Old Colles' fracture. 

March 30 — Professor Senn: Tapping and iodoformization of 
tubercular hip-joint. Excision of lupus patch from face. Iodoformi- 
zation of tubercular wrist-joint. Removal of vermiform appendix. 
Rib resection and drainage of pleural cavity for empyema. 

March 31 — Professor Etheridge: Dilatation and curettage of 
uterus. Trachelorrhaphy. Ovariotomy. Hysterorrhaphy. 

April 1 — Professor Senn: Resection of superior maxillary 
bone. Removal of tubercular cervical glands. Skin-grafting. 
Iodoformization of knee-joint. Osteotomy for osteomylitis of tibia. 

April 3 — Professor Hamilton : Varicocele. Secondary ampu- 
tation of thigh. Removal of tubercular cervical glands of both sides. 
Removal of cervical glands of one side. 

April 6 — Professor Senn : (Clinic not held publicly.) 



College Notes. 281 

April 7 — Professor Etheridge : Operation for vaginal cystocele. 
Perinaeorrhaphy. 

April 8 — Professor Senn: Ventral hernia. Resection of 
superior maxillary bone. Pes cavus. Osteomyelitis of humerus. 
Osteomyelitis of tibia. Joint iodoformization. Removal of piece 
of broken knife blade from frontal sinus. Circumcision (two cases). 

April io — Professor Hamilton: Appendicitis. Amputation of 
fingers. Urethral stricture (two cases). Drainage of abscess of 
ankle. Anal fissure — stretching and causterization. Excision of in- 
growing toe nail. 

April 13 — Professor Senn: Amputation through forearm. Re- 
moval of tubercular cervical glands. Osteomyelitis of humerus. 

April 15 — Professor Senn: Iodoformization of knee-joint. 
Iodoformization of hip-joint. Ligation of common carotid for 
aneurysm of ophthalmic. Atypical resection of wrist-joint. High 
amputation through thigh. Curettage of frontal sinuses for tuber- 
culosis. 



COOK COUNTY EXAMINATIONS. 

Examinations for internes in the Cook County Hospital were 
held at the hospital Monday, Tuesday and Wednesday, the fifth, 
sixth and seventh of April. There were five examinations of fifteen 
questions each, as follows: Monday, 9 to 12 o'clock, surgery and 
eye and ear; 2 to 5 o'clock, obstetrics and gynaecology; Tuesday, 
9 to 12 o'clock, medicine and pathology; 2 to 5 o'clock, anatomy 
and physiology; Wednesday, 9 to 12 o'clock, materia medica, thera- 
peutics and chemistry. 

The following is a list of the successful candidates, with the col- 
leges to which they belong and the places which they took: 
Internes: 

P. Bassoe, College of Physicians and Surgeons. 

C. J. Habhegger, Rusih Medical College. 

P. D. Morf, Chicago Medical College. 

E. F. Burton, Rush Medical College. 

S. M. White, Chicago Medical College. 

T. R. Crowder, Rush Medical College. 

N. P. Mills, Rush Medical College. 

Mrs. A. E. Blount, Woman's Medical College. 

H. J. Brugge, Rush Medical College. 

G. R. Fridus, College of Physicians and Surgeons. 

L. F. Schmaus, Rush Medical College. 

H. T. Rickets, Chicago Medical College. 



9 
10 

11 
12 



282 The Corpuscle. 

Alternates : 

i. J. A. Moran, Rush Medical College. 

2. F. J. Kinny, Chicago- Medical College. 

3. R. B. Westnedge, Rush Medical College. 

4. W. B. Whittaker, Rush Medical College. 

5. Miss H. M. Duncan, Woman's Medical College. 

6. P. F. Rogers, Chicago- Medical College. 

The first six internes begin service June first, the second six 
December first of the current year. 

Out of a possibility of 750 points in the examinations the highest 
mark was 553, the twelfth being 486J. 



The baseball team is getting into good condition for the season's 
work. Captain Somers says there is a better lot of material for a 
team this year than there ever has been before. There are several 
good candidates for pitcher, among whom are Phelps, who has 
had a great deal of experience on Nebraska teams ; Gallagher, who 
has played with a Winnipeg team; McDermid, who pitched for 
Drake University; Wellington and Captain Somers, who formerly 
pitched for the Iowa College team. Captain Grasse of the football 
team and Ainslie will be behind the bat. Messrs. Lewis and Schultz 
are candidates for first. Other candidates are Robinson, who played 
with Shattock Military Academy, Myers, Bush, Lowenthal, Cool- 
ing, Stewart; for out-field are Dancer, D. J. Evans, Jones, Foley, 
Smith, McGinley, Ellis, Swan, Young and Sheldon. On account of 
bad weather it has not been possible to play enough outside as yet 
to place the men definitely. 

Manager Hodges has worked under a great many difficulties. 
Nevertheless, he has arranged some very good games. They are 
as follows: , , ; \ \\ ,.,\\:u 

April 10, Oak Park at Oak Park. 

April 19, University of Chicago ait Marshall Field. 

April 24, Bennett Medical College. 
1 April 27, University of Chicago at Marshall Field. 

April 29, Northwestern University at Evanston. 

May 1, Bennett Medical College. 

May 5, Lake Forest University at Lake Forest, 

May 7, University of Wisconsin at Madison. 

May 8, Bankers' Athletic Association at Thirty-fifth and Went- 
worth. 

May 14, University of Wisconsin at Chicago. 

May 15, University of Upper Iowa at Chicago. 



College Notes. 283 

May 19, Lake Forest University at Chicago. 

May 22, Illinois Cycling Club. 

May 29, Oak Park at Oak Park. 

June 2, Upper Iowa University at Fayette, Iowa. 

Dates are pending with Beloit, Champaign, Delafield Military 
Academy, Notre Dame and the leading colleges of Western Iowa. 
A series of practice games is also being arranged. 

Cut this out and paste it on your wall. Attend as many games 
as possible. Take with you a horn and the college colors. What 
the team needs most is the willing support of the student body. Let 
us have a little enthusiasm. 



Recitation Breaks. — -"The prognosis of chronic rheumatic sore 
throat lasts about three months. The pain is apt to come back 
and recur. v — Meachem. 

"A pneumocele is a condition where air is found in the lungs." — 



A Natural Inference. — "Ya-as," said an Indiana citizen, w^. 
home lies in the fertile valley of the "Waybosh," "I happened ter be 
in Charleston when the fust yearthquake cum." 

"What did you do when you felt the trembling?" 

"I tuk thirty grains o' quinene, b'gosh." 



At the meeting of the Tri-State Medical Society, held at St. 
Louis, April 7, the honors of the day were accorded to one of the 
representatives from Rush, Dr. E. J. Senn, for the superior excel- 
lency of his paper on "Arthritis as it Occurs in Gonorrheal Subjects.'' 
Dr. Senn's production, which will be published shortly, is the result 
of persistent and scholarly investigation of an all-important subject, 
and, considering the man, his success is not so surprising. It cer- 
tainly is a source of satisfaction and pride to those interested in 
Rush that so many of her graduates are coming deservedly into 
prominence as original scientific investigators. 

The officers of the class of '97 enjoyed the hospitality of the 
graduating class of the Chicago College of Dentistry at their com- 
mencement banquet. The good feeling which is growing up be- 
tween the students of the two departments is a gratifying exception 
to the petty animosity which different departments of a university 
usually show toward one another. 

The seniors are wearing their new pins. The design is very 



The Corpuscle. 

neat and appropriate. Every alumnus of Old Rush should not only 
own but wear one, and he should understand the symbols so thor- 
oughly that he will never be heard, as one senior was, trying to 
explain the significance of the ''brush" engraved upon it. 

At the meeting of the Athletic Board Mr. J. P. Sedgwick was 
chosen to succeed Mr. Hollenbeck as manager of the football team. 
Mr. Hollenbeck has made an efficient and enthusiastic manager. He 
retires with everyone's good-will. 

The appointment of internes to the Presbyterian Hospital, in 
order of places taken, is as follows: E. D. Whiting, W. E. Kaser, 
W. F. C. Heise, J. D. Freeman, G. T. Ayers, G. W. Fox, W. W. 
Meloy and B. D. Black, first alternate. 

Section D in sophmore anatomy is working hard now to 
make up for the vacation which was indulged in a short time ago 
in order to give Doctor Byrnes an opportunity to wrestle with a 
case of chickenpox. 



lviessrs. Ureenebaum and Shultz, of the senior class, have 
received appointments as internes at the Michael Reese Hospital. 

Two Rush men will act as internes at the Alexian Brothers' 
Hospital the coming year — J. E. Moran and F. S. Davidson. 

Edward Bowe and F. J. Sullivan, of the senior class, received 
appointments as internes at St. Joseph's Hospital. 

On account of the snowstorm on the tenth it was necessary to 
postpone the baseball game with Oak Park. 

C. H. Parkes and B. D. Black have received appointments as 
internes at the Augustana Hospital. 

Mr. J. L. Stewart, '99, is acting as clerk at the Detention Hos- 
pital. 

Professor Hektoen will spend the summer in Europe. 



BOOK REVIEWS. 

The Practice of Medicine. A Text-Book for Practitioners and 
Students, With Special Reference to Diagnosis and Treatment. 
By James Tyson, M. D., Professor of Clinical Medicine in the 
University of Pennsylvania and Physician to the Hospital of 
the University, etc. 8vo, 1184 pages, illustrated. Price, 
cloth, $5.50; sheep, $6.50. Philadelphia: P. Blakiston, Son 
& Co. 1896. 

In the preface to this master work on internal medicine the 
author says: "I have no apology to make for preparing this book," 
and it certainly needs none. After nearly thirty years of observation 
at the bedside in private and hospital practice, in the laboratory and 
post-mortem room, Dr. Tyson is preeminently prepared to produce 
a book of value to the medical profession. His long connection with 
the colleges and clinics of Philadelphia has given him a thorough 
realization of the physician's needs in a text-book. For many years 
he was Professor of Pathology in the University of Pennsylvania, 
having entered medicine by that very advantageous route. He has 
long been known as a diligent and painstaking teacher of clinical 
medicine, and this book represents mainly the mature conclusions 
deduced from wide reading, large clinical experience, keen observa- 
tion and mature judgment. 

The treatise is a comprehensive one, embracing all the subjects 
generally found in text-books of general medicine, having added 
thereto a convenient table on acute poisoning. The classification 
is convenient and practical, departing somewhat from most Ameri- 
can authors, and omitting the section on general pathology, so often 
inserted as an introduction. 

The work opens with the section on the infectious diseases, of 
which typhoid fever is first considered in an article of about thirty 
pages. The broad method of treatment is warmly advocated, and its 
technique described. The Widal method of diagnosis is not given, 
however, as would scarcely be expected. The antitoxin treatment 
of diphtheria is not given the recognition that might be expected. 
It is far from warmly advocated and rather timidly recommended. 

In the section on diseases of the digestive system a good account 
is given of the diagnostic technique relative to diseases of the 
stomach. The whole section is of decided value, that part upon ap- 
pendicitis being equaled (by few if any of the American treatises upon 
general medicine. In his treatment of appendicitis we find Dr. Ty- 
son strongly on the side of the surgeon. 

In the early treatment of pneumonia blood letting is strongly 

285 



286 The Corpuscle. 

recommended in robust subjects. Alcoholic stimulants are advised 
for many cases, while digitalis is not very enthusiastically recom- 
mended. 

The following sections on the heart and blood vessels, the blood, 
the thyroid, the urinary organs, constitutional and nervous diseases, 
are well proportioned, and the subjects well treated. The sections 
on the urinary organs and on the nervous system are particularly 
lucid and satisfactory. 

Throughout the work the matter of treatment is considered in 
considerable detail. Both the apothecaries and the metric system 
are given in specifying doses. 

The typographical part of the work is decidedly above the aver- 
age. The print is clear cut and plain and the paper of particularly 
good quality. Italics and bold-faced type are freely used to empha- 
size headings and important points. The index is, however, rather 
incomplete. 

This volume will no doubt take a high place among American 
text-books on general medicine, and will be paid the high compli- 
ment of frequent reference by up-to-date medical men. We can 
honestly and heartily recommend it to every student and practi- 
tioner. 



The Diseases of Infancy and Childhood. For the Use of 
Students and Practitioners of Medicine. By L. Emmett Holt, 
A. M., M. D., Professor of Diseases of Children in the New 
York Polyclinic; Attending Physician to the Child's and the 
Babies' Hospitals, New York, etc. 8vo, 1117 pages, with 
204 illustrations, including seven colored plates. New York: 
D. Appleton & Company. 1897. 

In this excellent work on the diseases of children is added one 
of more than ordinary value to the list of books that should be in a 
place of ready reference for the practitioner and one that will serve 
as an admirable guide to the student of infant life and care. The 
rapid advance that has been made in pediatrics during the last few 
years has been due as much to Professor Holt, perhaps, as to any 
other single worker in this particular line of medicine. He has 
made efficient use of a vast opportunity for observation and study 
of infant disorders during eleven years' continuous hospital service 
among young children. 

The author has "endeavored to give a somewhat full discussion 
of matters which are peculiar to early life, the space allotted to each 
subject being in some degree commensurate with its practical im- 
portance to the physician and student." Discussions belonging 



Book Reviews. 287 

to general medicine and fully treated in works upon that subject 
are intentionally omitted, being- replaced by discussions of sub- 
jects relating to child life alone; and this with great profit to the 
work. Considerable space and careful attention are given to the con- 
sideration of parthological conditions and the description of lesions 
peculiar to very early life, thus adding materially to the value of the 
book, this being a subject heretofore rather scantily dealt with. 

The work is divided into two main parts. 

Part I includes chapters on hygiene and the general care of 
infants and young children, growth and development of the body, 
and the peculiarities of disease in young children. The various 
therapeutic measures useful in early life are grouped and sepa- 
rately discussed, thus aiding the reader who wishes to consult the 
work on these points. Tables of infant weights and measures are 
given, and the general care of premature and delicate children is 
discussed. 

Part II comprises ten sections dealing with the various classes 
of diseases which are to be found in infants and young children. The 
arrangement differs somewhat from that of most writers on the 
subject. Section one deals with diseases of the new born, section 
two with nutrition. Ample space is given in the section on nutri- 
tion to infant feeding. Various tables, formulas and comparisons 
of different foods and methods of feeding are presented, which can- 
not fail to be of much practical value to the consultor. Nearly 
one hundred pages are given to this all-important subject and the 
section is one of great value. Scorbutus and rickets are placed here 
as diseases due to faulty nutrition. 

Section three deals with diseases of the digestive system; sec- 
tion four with the respiratory system; five, with diseases of the cir- 
culatory system; six, of the uro-genital system; seven, the nervous 
system; eight, the blood, lymph nodes and bones; nine, the infectious 
diseases, and ten is a discussion of rheumatism and diabetes mellitus. 
In the chapter on diphtheria, a very interesting article of thirteen 
pages on the antitoxin treatment is found. The technique is fully 
and accurately described; the limitations, the real and alleged dan- 
gers, the results in private and hospital practice and the results as 
modified by the time of injection, the age of the patient and the seat 
of the lesions are all gone into and ably presented. The serum 
treatment is warmly recommended, and is advised in all severe 
cases as soon as a clinical diagnosis is made without waiting for the 
bacteriological confirmation. 

This valuable book should find its way to the shelves of many 
a practitioner and student. It deserves wide recognition. 



Alumni Department. 

JAMES B. HERRICK, A. B., M, D., Editor. 



Membebship in the Alumni Association of Rush Medical College is obtainable 
at any time by graduates of the College, providing they are in good standing in the 
profession, and shall pay the annual dues, $1.00. This fee includes a subscription to 
The Cobpuscle for the current year. This journal is the official organ of the Association 

Dues and all communications relating to the Association should be sent to 

JOHN EDWIN RHODES, M. D., Sec'y and Treas., 34 Washington St., Chicago. 



ALUMNI ASSOCIATION OF RUSH MEDICAL COLLEGE. 

(Medical Department of Lake Forest University). 

Conwiencement Week, Monday, May 24th to Wednesday, May 26th, 

MDCCCXCVII. 

Dear Doctor: — We have arranged the following program for 
commencement week of Rush Medical College, May 24, 25 and 26, 
1897: 

On Monday, May 24, at 10 a. m., there will be a clinic in general 
medicine, by Prof. Henry M. Lyman, in the upper amphitheater of 
the college. 

At 11 a. m., there will be a clinic in gynecology, by Prof. James 
H. Etheridge. 

At 2 p. m., there will be a clinic in skin, venereal and genito- 
urinary diseases, by Prof. James Nevins Hyde. 

At 4 p. m., the class day exercises of the class of 1897 will be 
held in the upper amphitheater of the college. 

On Tuesday at 10 a. m. the annual scientific meeting of the 
association will be held in the upper amphitheater. An unusually 
interesting program has been provided for this meeting. It is as 
follows : 

1. Tumors Arising from Misplaced Supra Renal Tissue 

Dr. Bertram W. Sippy, Chicago 

2. Intra Cellular Irrigation by Associated Hypodermic and En- 

teroclysis Dr. J. R. Burnett, Neenah, Wis. 

3. Is Medical Selection Futile? 

Dr. C. E. Albright, Milwaukee, Wis. 

4. Toxic Correlation Dr. Henry B. Favill, Chicago, 111. 

5. Luschka's Tonsil Dr. A. L. Craig, Aledo, 111. 

6. Leprosy in the Sandwich Islands 

Dr. Jas. Harvey Raymond, Honolulu, H. I. 

At 1 p. m. there will be a demonstration of surgical anatomy 



288 



Alumni Department. 289 

on the cadaver, by Prof. Arthur Dean Bevan, in the dissecting- room. 
The laboratories of chemistry, histology, bacteriology, experimental 
physiology and materia medica will be open, and subjects of special 
interest will be demonstrated. 

At 2 p. m. a surgical clinic will be given by Prof. John B. 
Hamilton. 

In the evening a theater party will be given. This has been 
one of the most enjoyable of the social features of the past three 
years. The alumni will be seated with personal friends, as far as 
possible, and classes will be grouped together. "The Hoosier 
Doctor," by Augustus Thomas, has been selected. It will be given 
at the Grand Opera House. 

Wednesday, 10 a. m., annual business meeting of the associa- 
tion, and election of officers for the ensuing year. 

2 p. m., graduating exercises of the class of 1897 a ^ Central 
Music Hall. 

8 p. m., a reception and the joint banquet of the faculty and 
alumni will be held at the Auditorium Hotel. Addresses are ex- 
pected by Dr. T. C. Clark, Stillwater, Minn., President of the asso- 
ciation, who will preside; Judge T. A. Moran, President Edward 
D wight Eaton of Beloit College, Rev. Jas. G. K. McClure, D. D., 
of Lake Forest, Prof. John M. Dodson, and Dr. E. F. Burton, of 
the class of '97. Music for the occasion will be furnished by the 
Rush College Glee Club and the Mandolin Club. 

The tickets for the theater party have been obtained at the 
reduced rate of one dollar for the best seats. The tickets for the 
banquet are one dollar and fifty cents per plate. 

Those who wish to attend the theater party or the banquet 
should notify the secretary immediately on the inclosed card, as it 
is imperative that the exact number who are to attend should be 
known so that provision may be made for all. 

Those who engage seats or banquet tickets may procure them 
of the Secretary at the college, Monday, May 24, after 9 o'clock, or 
Tuesday before 1 o'clock p. m. 

The dues to the Association of one dollar are now payable. It 
is hoped the amount will be sent the secretary by mail at once or paid 
at commencement time without further notification. 

An excellent program has been provided this year for the 
entertainment of the alumni, and it is hoped many will make a spe- 
cial effort to be present during commencement week. Let us meet 
once more to do honor to "Old Rush." 

John Edwin Rhodes, Secretary and Treasurer. 
' 34 Washington St., Chicago. 



290 The Corpuscle. 

DEATH OF DR. FOX, OF MILWAUKEE. 

Dr. William Fox, '70, one of the best known physicians of 
Milwaukee, died at 11:45 o'clock p. m., March 12, at his residence, 
420 Jackson street, in that city. 

We take the following from the Milwaukee Sentinel: 

Dr. Fox's illness began two years ago when he was attacked 
by nervous prostration. After many months he rallied and was 
again able to be about and even to visit some of his old patients, 
but his health was never restored, and for several weeks past has 
been failing. During the last days of his illness it was several 
times thought that he was at the point of death, but his vigorous 
vitality continued to prolong his life, even after all hope was gone. 

No physician in the city had a larger practice than Dr. Fox, 
and none enjoyed to a greater degree the affection of his patients. 
His kindly character, broad sympathies and sunny disposition al- 
ways made his presence welcome in a sick room, and every patient 
came to have a warm personal attachment for the man. He was 
a general practitioner — one of a class now becoming more and 
more rare — and he was equally successful in all the varied lines of 
medicine and surgery. In his practice he recognized no rank and 
no condition. The rich and the poor were alike to him, when a 
call was made for his professional services, and no one will ever 
know of his generous charities, not alone in the way of 
professional services, but also in other and even more 
substantial ways. The death of no physician in this city w r ill ever 
be more mourned, and more sincerely, than the death of Dr. William 
Fox, for he was not only the trusted physician, but the personal 
friend of all who came to know him. 

William Fox was born in Dane County, Wisconsin, in June, 
1844. He spent his earlier days upon the farm, attending the 
district school during the winter season. At the age of fifteen he 
entered the Sinsinawa Mound Institute, now known as St. Clara's 
Institute, in Grant County. Having acquired all the knowledge 
possible at the institute, he became a student in the State University. 
Next he was a clerk in a drug store in Madison, and while thus en- 
gaged he determined to become a physician. Leaving the store 
in 1866, he returned to his home at Oregon, Dane County, and the 
following year entered Rush Medical College at Chicago as a 
student, being graduated in 1870. On obtaining his degree he was 
appointed on the house staff of the Cook County, Illinois, Hospital. 
This position he filled for one year, and then began practice as a 
physician and surgeon at Janesville. A year later he moved to 
Madison, where he remained for seven years, building up a large 
and lucrative practice. In 1878 he came to Milwaukee, his older 
brother, Dr. Philip Fox, succeeding to his practice in Madison. 
In this city he at once took leading rank in his profession. His 
practice was large and successful and to his untiring work is no 
doubt due the breaking down of his health two years ago. Dr. Fox 
w 7 as a member of the American Medical Association, the State 



Alumni Department. 291 

Medical and many other kindred associations. In 1876 he was a 
delegate to the International Medical Congress, which assembled in 
Philadelphia during the centennial celebration. No two physicians 
in the state are more widely known than Dr. William Fox of this 
city and his brother, Dr. Philip Fox, of Madison. Seven children 
survive him — five sons and two daughters. 



H. G. G. Schmidt, '96, is doing well at San Antonio, Texas. 
P. C. Beaghler, '95, reports success from Middleport, Ohio. 
We have received letters that indicate professional prosperity 
from T. C. Hill, Sweetwater, III, and S. H. Raback, Lyle, Minn. 

K. Hanson, who was obliged to leave college on account of 
pulmonary weakness, reports from the West that he hopes to be 
able to return to Rush in 1899. He feels greatly improved in health. 

W. T. Moffett, class of '95, who located in Blue Mound, 111., was 
married on March 31 to Flora M. Van Cleve, a young lady of that 
place. The Corpuscle extends hearty congratulations to Dr. 
Moffett. 

B. F. Strong, '96, has located at Howard, Kan. He writes 
that his wife, who has been for a long time an invalid, seems in 
general somewhat improved. Those who knew the doctor and 
were aware of his devotion to his estimable wife, will be greatly 
pleased to learn of this, and trust that the improvement may steadily 
continue. 

Dr. E. E. Prescott, '93, while temporarily insane, attempted to 
take his own life on April 16. We are pleased to learn that the 
latest reports indicate an improvement in both his physical and 
mental condition. Dr. Prescott has been in active practice in 
Chicago since his graduation, and has also been in charge of a 
bath establishment on Desplaines street that was formely run by 
his father. 

Dr. James Henry Honan, '95, who has been attending the 
medical department of the University at Berlin, Germany, since 
May last, has successfully passed the examinations for graduation 
and will receive the degree of M. D. from that institution this 
spring. Dr. Flonan has devoted most of his time in Berlin to work 
in the physiological laboratory under Prof. Dubois-Reymond, who 
died recently, and his assistants. He will return in July next. 

Dr. J. R. Barnett has the appointment as assistant superinten- 
dent of the Asylum for the Feeble-Minded at Lincoln, 111. Of Dr. 
Barnett, who is a Rush alumnus, the Lincoln Herald says: "It has 



292 The Corpuscle. 

been known that Dr. J. R. Barnett, of Hartsburg, was practically- 
sure of appointment as assistant superintendent, but we did not men- 
tion it because there was a possibility of change. It is now in order 
to say that this appointment will give great satisfaction in Logan 
County, where the doctor has hosts of friends. He is not only a 
good physician, but a gentleman of ability and character and will be 
found accommodating toward the people and kind to the inmates 
and employes. No better selection could have been made." 




EDWARD JENNER 



The Corpuscle. 

RUSH MEDICAL COLLEGE, CHICAGO, ILL. 
Medical Department Lake Forest University. 



Vol. VI. MAY, 1897. No. 9. 

CLINIC OF PROFESSOR NICHOLAS SENN. 

REPORTED BY C. C. CUMMINGS, MARCH 30, 1897. 

No. 1. — This patient was operated upon in the last clinic for 
tumor of the parotid gland. We had no reason to suspect that it 
was carcinomatous. It was slow in growth and regular in outline, 
showing that it was not malignant. I concluded to remove it by 
enucleation with a considerable portion of the gland itself. I had 
to cut through a thick mantel of gland tissue. It was diagnosti- 
cated as an adenoma and is probably an adeno-fibroma. I ac- 
quainted the patient with the fact that we might injure the facial 
nerve or Stenson's duct in performing the operation. The result 
of the operation shows that the principal branches of the facial 
nerve have escaped. You will, however, see a slight paralysis of 
the muscles of the left upper eyelid when the patient tries to close 
it. Stenson's duct escaped. 

In combating the superficial inflammation, which is slight here, 
we usually use 96 per cent, alcohol compresses. We will take 
at least eight layers of gauze saturated with the alcohol, and over 
this place a layer an inch in thickness of aseptic absorbent cotton, 
to be covered by a perforated rubber or gutta-percha sheet. We 
want the effects of the vapor of the alcohol and not the liquid alco- 
hol, as its local effects are too severe. 

No. 2. — This patient has been operated upon many times for 
tubercular infection of the knee joint. There has been recurrence 
above the knee joint after the resection in the soft tissues, perios- 
teum and bone. I found a large tubercular sinus running up and 
down in these tissues. We laid open, curetted, iodoformized and 
tamponed with iodoform gauze. The wound presents to-day a very 

293 



294 The Corpuscle. 

encouraging appearance in the form of vigorous, quite vascular 
granulations. The ultimate result depends upon preventing 
secondary infection with pus microbes. I shall irrigate with strong 
iodine solution and repack with iodoform gauze saturated with 
the balsam of Peru, a stimulating application. 

No. 3. — A case of recurring appendicitis in the form of a lim- 
ited, circumscribed, plastic peritonitis. The patient has been im- 
proving, and we have delayed operation, watching him for further 
indications. When the inflammation has subsided an operation for 
removal of the diseased tissue will be attended with little risk, be- 
cause the acute symptoms have practically subsided. 

No. 4. — A case of glandular tuberculosis of the neck. 
The disease had resulted in caseation and softening, with successive 
infection of the remaining glands in the direction of the clavicle. 
The specimen furnished a good example of the entire chain of con- 
nected tubercular glands. The connecting lymphatic channels are 
constantly involved in the disease and therefore removal by a clean 
dissection is the only rational treatment in aiming at a radical cure. 

No. 5. — This patient was injected last Thursday for 
tubercular pan-arthritis of the knee joint, a case of primary 
synovial tuberculosis of the joint extending to the capsule, the carti- 
lage and the articular ends of the bones themselves. I had little 
faith that iodoform would yield anything but a temporary result 
preparatory to subsequent operation. We injected three drachms, 
and as a result we had intense local irritation. Temperature was 
101 degrees F. The swelling has increased in size and there is 
more tenderness about the line of the joint. We have thus pro- 
duced an active process which possibly may be of great benefit to 
the patient. We must watch for the ultimate, effects of the inter- 
articular injection. The skin is irritated quite markedly, which I 
have no doubt is the direct result of the use of iodoform. It is one 
form of iodoform intoxication, iodoform dermatitis, as a result of 
absorption into the system, with toxic effects as a secondary mani- 
festation after general absorption has taken place. The patient 
must be dealt with carefully when we come to inject again with 
iodoform. We must remember this in his after-treatment. 

No. 6. — An operation for ankylosis of the hip joint in a con- 
tractured condition. We made brisement force under an anaesthetic, 
breaking up firm adhesions, and since last clinic, after removal of 
the fixation dressing, active and passive motion have been made 
and massage over the joint with very marked improvement, as the 
patient will demonstrate in moving the thigh. We have escaped 
the danger of lighting up a new inflammation in the partially 



Clinic: Senn. 295 

ankylosed joint. These movements will be carried out persistently 
until the function of the joint is restored. 

No. 7. — This patient has been under treatment for fracture 
of the clavicle at the junction of the middle with the outer third. 
We removed the dressing yesterday, three weeks after the fracture. 
The fracture is united firmly. The position was so perfect that 
little provisional callus has formed, a proof that the reduction was 
complete and the parts thoroughly immobilized. An extensive field 
of suggillation three weeks after the injury, you observe, is present. 
The discoloration is below the fracture and in the region of the 
tendinous origin of the biceps muscle and the deltoid, the whole 
showing deep seated extravasation of blood. 

The patient will be directed now to rest the arm in a sling for 
one more week. 

No. 8. — Case of a child twenty-two months old. Parents per- 
fectly healthy. The trouble began with a bad cold. The doctor 
pronounced it a case of tonsillitis. At that time a swelling began 
at the angle of the jaw, or just below that point on the right side. 
It really began back of that location, but was reduced in size un- 
der treatment, and later appeared at the place in which it is now 
seen. The discoloration of the surface is attributed to the use of 
ichthyol. The child is now cutting the canine teeth. Its muscles 
are rather flaccid, and the child looks as if it had been very ill, but 
its condition on the whole is rather fair. The lymphatic glands of 
the cervical region are enlarged behind the sterno-cleido-mastoid 
muscle along the posterior border and along the anterior border 
near the sterno-clavicular joint. There is, therefore, very diffuse 
glandular enlargement. The swelling in this case seen in the sub- 
maxillary region, fluctuates. The child presents some appearances 
of rickets. 

The diagnosis is tubercular abscess involving the lymphatic 
glands of the submaxillary region. The sore throat is probably 
accountable for the tubercular infection, because a healthy mucous 
membrane is a good protective against infection with the bacillus of 
tuberculosis. The catarrhal condition, or tonsilitis, is probably the 
exciting cause of the infection. Infection occurred through the 
damaged mucous membrane of the tonsil, a. result quite often seen. 
But this does not appear to be a purely tubercular abscess. It has 
pursued a rather acute course, and the size of this gland is out of all 
proportion to the remaining enlarged glands. This gland has also 
been infected with pus microbes, resulting in a peri-adenitis and 
abscess formation. The abscess is rather around than within the 
gland primarily infected. 



296 The Corpuscle. 

Treatment: We will incise, scrape and iodoformize the abscess 
cavity, but leave the other tubercular glands. The removal of the 
product of mixed infection will have a favorable influence in in- 
hibiting the tubercular process in the remaining glands. 

No. 9. — Case of a child nine months old. Parents Bohemians. 
Has had none of the diseases of childhood. There is one other 
child in the family which is also healthy, age ten. The father died 
five months ago of pulmonary tuberculosis, and the grandfather 
on the paternal side died of the same disease. The child is nursing 
and was perfectly healthy in every way before this trouble began. 
About three months ago the mother noticed that the ankle joint 
seemed loose. About a month after this swelling made its appear- 
ance just above the inner maleolus. One month ago there was a 
swelling upon the left ear, which opened and is discharging a small 
amount of pus at the present time. The swelling upon the left 
leg gradually increased in size. The pulse is very rapid, seemingly 
about 180; the temperature is 100.9 F. Lungs and heart seem to be 
normal. Behind the ear there is quite a swelling, which looks as 
if the mastoid might be involved, and there is a well marked ab- 
scess there. The swelling complained of is on the inner aspect of 
the right leg, over the tibia. The ankle joint is not swollen. The 
swelling is rather soft and fluctuates. 

Diagnosis: Epiphysitis, a rather rare form of osteomyelitis, 
found particularly in young children, and frequently terminating in 
separation of the epiphysis. The joint is not infected, a form of 
osteomyelitis noted for its tendency to circumscription. 

Treatment: Open, remove the infected tissue, disinfect and 
pack. We must be careful of iodoform in young children. The 
post-auricular abscess is the result of a general infection with pus 
microbes. 

No. 10. — A case of tubercular coxitis which we will inject with 
iodoform glycerin emulsion 10 per cent. Formerly we injected this 
joint from behind. But to-day I will make Von Bungner's punc- 
ture. In order to do this, draw a line extending from the upper 
border of the great trochanter to the pubic spine. On this line the 
point of puncture should be made. Search for the inner border of 
the Sartorius muscle. We have the great vessels and the crural 
nerve to avoid. The space in the joint exposed sufficiently is quite 
limited. Accuracy is therefore necessary. At the inner border of 
the Sartorius we make another mark, locating the point where the 
puncture is to be made. The patient must lie upon the back, and 
without tilting of the pelvis. The trochar must be passed directly 
backward. The point of the instrument is now in the neck of the 



Clinic: Senn. 297 

femur; it is in the bone, which is osteoparotic. I withdraw the 
stylet. I hold the canula steady because I wish to make an inter- 
capsular injection. It is a case in which I have reason to believe the 
trouble began in the capsule and extended to the bone and cartilage, 
resulting in a panarthritis. I shall therefore not endeavor to make 
a parenchymatous injection. I feel the canula resting against the 
neck of the femur. I believe we shall be able to inject two drachms. 
It is well to make these inter-articular injections slowly, so as to 
permit the fluid to permeate and go as far as it can in the joint cav- 
ity. We have reached two drachms, quite a large quantity consid- 
ering the nature of the joint affection and probable capacity of the 
cavity of the joint. We withdraw the canula very quickly, displac- 
ing the skin so there will be no chance for the fluid to return 
through the channel made. Make compression over the opening a 
few minutes and then seal with iodoform collodium. The patient 
will be permitted to walk about within three or four days. 

No. ii. — A case of catarrhal appendicitis. In this case there 
has been no great constitutional disturbances, but the patient has 
suffered quite a number of attacks, and there is no telling but what 
any subsequent attack might assume serious aspects. Owing to 
alterations within and around the appendix there might result per- 
foration, gangrene, acute diffuse peritonitis and death. I believe the 
appendix will show slight macroscopical changes. 

We make an incision about half way between the umbilicus and 
the superior spinous process of the ilium, as near as we can di- 
rectly over the affected organ, and parallel with the fibers of the 
external oblique muscle. The patient is quite obese and we have to 
go through a thick layer of adipose tissue, and the external incision 
will be a little longer than usual to expose the muscular layer of 
the abdominal wall more freely. We will begin the incision a little 
above McBurney's point, pass downward and inward parallel to the 
fibers of the external oblique muscle, through the skin and adipose 
tissue. The next cut will expose the fibers of the external oblique. 
I have now reached the external oblique muscle. We arrest hem- 
orrhage at once with haemostatic forceps. The next incision will 
be made directly through the external oblique muscle in the direc- 
tion of its fibers. I cut until I feel a sudden loss of resistance, which 
announces that the muscle has been penetrated. You now see the 
outer border of the rectus muscle. I find my way down to the 
peritoneum by the use of blunt force. The rectus will now be held 
out of the way. I find the fibers of the internal oblique and aim to 
make McBurney's incision. We have separated the fibers of the 
internal oblique by means of the index finger and blunt dissector. 



298 The Corpuscle. 

I now pick up the remaining structures with the dissecting forceps. 
At this stage a little caution is necessary, because sharp-pointed dis- 
secting forceps might grasp with the peritoneum an adjacent bowel, 
which might be nicked in opening the peritoneal cavity. The peri- 
toneal cavity is now open and the omentum at once escapes. We 
now apply haemostatic forceps to the parietal peritoneum so it will 
not get out of reach when we come to close the wound. I usually 
enlarge the incision through the peritoneum by dividing between 
the middle and index fingers. I have an opening two and one-half 
or three inches long. I grasp the peritoneum at different points, so 
it will remain in easy reach when we come to close the wound. The 
first thing I find is the omentum adherent at different points. I 
pull forward the first loop of intestine that presents itself. It is a 
loop of small intestine, which I at once replace and search for the 
caecum, which will serve as a guide to the appendix. I feel the 
affected appendix in the form of a distinct enlargement and firmly 
adherent to the surrounding structures. I show you here now a 
mass nearly as large as a walnut, formed of firm plastic adhesions. 
There can be little doubt that this mass includes the appendix. 
While I had no reason to expect a small abscess, I am not now so 
very sure that it is not present. We will now pack off the perito- 
neal cavity with sterile gauze, so that it will surely be protected. 
I attach haemostatic forceps to the pads used in packing off the sur- 
rounding tissues. In the isolation of this appendix we must be 
extremely careful. I separate the omentum, which was attached to 
the tip of the appendix. By palpating the tube, I find it fluctuated 
very distinctly. There is evidently considerable obliteration of the 
lumen of the appendix on the proximal side. I bring the colon 
forward with the appendix, separate the adhesions, which are quite 
firm, and gradually deliver the inflamed organ. I have torn here an 
adhesion on the upper surface of the caecum, where there is quite 
a remnant of a former attack of inflammation in the form of an en- 
larged gland in which some degeneration has taken place. Here 
is a loop of the ileum from which I must separate the appendix. 
The adhesions are quite firm. I follow the organ and come down 
now to the attachment of the appendix to the caecum, where all of 
the parts are very intimately connected by firm adhesions. I sepa- 
rate these adhesions with blunt instruments, and hold the adhesions 
in haemostatic forceps. The tube looks as though a small perfora- 
tion had existed; certainly, the inflammatory area around the appen- 
dix is well marked. I have isolated the mesentary of the appendix 
and will now transfix and ligate it. This operation shows that you 
cannot depend upon the clinical symptoms in estimating the patho- 



Clinic: Se?in. '^99 

logical conditions present. I transfix the mesentary with very fine 
silk. What I find here around the appendix may contain pus 
microbes, though it does not look like pus. We will treat the case 
as if we had found a small abscess. I can now bring the caecum 
well forward into the wound and I have found the point 'of attach- 
ment. I want to make a sub-serous resection; consequently, I take 
a very small, sharp scalpel, with which I cut through the peritoneum 
only, making a circular incision about half an inch from the 
caecum, and being careful not to penetrate the lumen of the organ. 
Now I reflect the. peritoneum on the csecal side in the form of a cuff. 
I make the cuff about one-half inch long. The appendix usually 
being held well forward by the assistant on the left side, I take a 
fine catgut ligature and apply it to the base of the denuded surface 
close up to the caecum. Before cutting off the appendix, I pack 
the space around so there is no possibility of extravasation of the 
contents of the appendix. I empty the appendix in the upward 
direction, and cut at a safe distance from the ligature. The mucous 
membrane exposed lining the lumen of the stump, I will now cauter- 
ize, and do so with pure carbolic acid, being careful to bring it in 
contact with every nook and corner. With a sponge, wipe off the 
excess of the acid and apply to the stump powdered iodoform, in 
order to favor the mummifying process. I shall sew over the stump, 
either the mesentery or, preferably, the peritoneum. One or two 
stitches in the peritoneum, including the peritoneal cuff, should 
cover the stump completely. The wound will now be closed in the 
usual manner. 

No. 12. — As we have reached the close of the hour, I 
wish to show you very hurriedly a case of empyema, upon which 
we shall operate. The patient is presented by Professor Herrick, 
who made the diagnosis. The empyema followed an attack of 
pneumonia and the patient is in a critical condition. The rapid 
pulse, dry tongue and continuous fever indicated danger from 
progressive sepsis. The heart impulse is very feeble and diffuse. It 
would not be strange if we should find in the immediate vicinity 
of the suppurative process a serous pericarditis, a complication oc- 
casionally present in empyema, more especially the acute form. In 
performing the operation under such unfavorable conditions, the 
patient should be given one-fourth grain of morphia and one or 
two ounces of whisky, per rectum, half an hour before the operation. 
We will administer now only a few whiffs of ether. Exploratory 
puncture was, made in the region of the sixth intercostal space on 
the left side. It is here, where percussion is absolutely dull, com- 
plete absence of resonance, while below there is some resonance, 



300 The Corpuscle. 

showing that the empyema is somewhat circumscribed. I shall, of 
course, make the customary rib resection, removing at least two 
inches of the seventh rib in the axillary line rib, opening the cavity 
and draining it. I make the incision a little curved, with the con- 
vexity directed downward, so as to facilitate the exposure of the 
rib. I now cut through the muscular tissue lying over the rib, so as 
to expose the bone freely. I now isolate the rib with the periosteal 
elevator. In doing this, pay particular attention to the intercostal 
space, where the intercostal artery must be separated from the rib 
with the periosteum. With a strong pair of bone forceps I cut the 
sternal side and now include about three inches. Now elevate and 
I have no difficulty in inserting the forceps to make the second cut 
through the rib on the spinal side. I palpate the pleura. I do not 
think it necessary in this case to make another exploratory puncture. 
I make the incision and immediately plunge in the index finger so 
as to permit the fluid to escape slowly. Pus escapes. I can in 
this way intermit the stream of pus any time, thus securing slow 
evacuations of the pleural contents. Notice now air is entering, with 
an audible sound, showing that pulmonary expansion has ceased. 
There seems to be no great collection of fibrinous material upon the 
pleurae and I will therefore put in two large rubber tubes as a drain. 
Through these tubes mild antiseptic injections will be made for the 
purpose of cleansing the pleural cavity from time to time. The 
tubes will be fastened together with a safety pin and secured on the 
outside. The washing will be postponed until to-morrow. 

(At succeeding clinic, two days later.) — From the pus which 
was taken from the thorax of this- patient we have cultivated a 
growth which is white. I cannot say now whether it is the 
pneumococcus or staphylococcus. Both of them may be found 
growing side by side. The exploratory examination made before 
the last clinic yielded the pneumococcus. 

The temperature now is 102 F. I mistrusted that we should 
find, after the operation, a suppurating focus elsewhere. I sus- 
pected some implication of the pericardium, because the impulse 
was very much diffused. It is not uncommon to find the pericar- 
dium implicated in empyemic processes. The pericardial com- 
plication may not be of the same nature pathologically as the pleural 
affection. A serous synovitis frequently complicates suppurative 
osteomyelitis, so we here find suppurative pleuritis and serous peri- 
carditis occasionally associated. We shall investigate the condi- 
tion of the remaining chest organs very carefully in order to ascer- 
tain the reason why the temperature has not fallen sufficiently after 
the evacuation of such an enormous quantity of pus. There must 



Clinic: Senn. 301 

be trouble somewhere else. (Subsequent investigations revealed 
a streptococcus pneumonia on the opposite side, to which the 
patient succumbed ten days later.) 

The patient remembers distinctly that he was cut, but does not 
remember which hurt him more, the cutting of the skin or the sec- 
tion of the rib. He was given before the operation an ounce of 
whisky, a quarter of a grain of morphine, and then a few whiffs of 
ether. He does not remember much about the operation. 

No. 13. — This man has nasal obstruction of the right 
side of five weeks' standing, with a serous discharge from the corre- 
sponding nostril. A digital examination reveals a tumor in the 
nasal cavity. The anterior antral wall is tender to the touch. We 
entered the antrum of Highmore with a needle and found the bone 
very soft, but no evidence of suppurative disease. We will make 
an exploratory operation, and if necessary remove the tumor. I 
may have to remove the entire upper jaw. I begin the incision well 
out over the malar bone at the inferior margin of the orbit, carry 
it well forward over the cheek and down the right side of the nose. 
I reflect the flap and expose the bone. I see a fungous mass in the 
infraorbital foramen. I remove a portion of the bone and my finger 
is now in the antrum. I feel the fungous mass, and the tumor feels 
much like brain tissue. I have no other alternative but to remove 
the entire superior maxillary bone, as the tumor is of a malignant 
nature. I carry the incision below to the median line, and the final 
incision will split the upper lip in the center. I reflect the flap and 
expose the bone freely. Now, I wish to expose the malar bone a 
little more fully, because it may become necessary to remove the 
upper part of this bone. I see the disease has encroached very 
closely upon the orbit. I follow the orbital margin. The disease 
is spreading most extensively in the direction of the floor of the 
orbit. I will now lift the periosteum from the floor of the orbit, be- 
cause I believe the disease has not as yet reached the orbit. I must 
remove a part of the malar bone, because the disease has extended 
in that direction. I will have to lift up; the ala of the nose and do 
so as far as the septum. It is unfortunate that in antral disease the 
tumor creeps into the adjacent cavities before we have reason to 
suspect it. I make an intranasal exploration to determine the extent 
of the difficulty. I will see if it is safe to preserve the alveolar 
process. I prefer to make the dissection through the connected 
parts of the bone by using the chisel instead of the chain saw, the 
hay saw or any other kind of a saw. I cut through the upper part 
of the malar bone. I will now extract the central incisor. I should 
like to have the patient now in a condition of talking narcosis. When 



302 The Corpuscle. 

we come to the mouth, the work must be done quickly. At present 
we are taking our time. I should like to have the patient "wake 
up" so we can talk to him. I must follow the orbit very closely. 
I divide the nasal process high up because the disease has en- 
croached in that direction. I now cut through the mucous mem- 
brane of the mouth to expose the junction of the maxillary with the 
palate bone and the intermaxillary line. The patient must open 
the mouth widely. I cut now exactly in the median line between 
the superior maxillary and palate bones. We have now made a 
track for the chisel. I will first make the transverse section, and 
now I will drive the chisel from before backward. We have severed 
all bony connections. 

I now take the periosteal elevator and see whether we have 
mobilized the bone sufficiently to lift it from its place. Now you 
see I have to reflect the mucous membrane and periosteum from 
the lower surface of the maxillary. It is during this step of 
the operation that you want to be ready for the final act, for the 
hemorrhage is always profuse during this step of the operation. 
The bone now being completely severed, it will be a very easy 
matter to divide the few connecting parts of soft tissue. It is up in 
the orbital region where I find the conditions most interesting. I 
have divided the bone here very high and yet the disease is very 
close to the orbit. I cut now the Schneiderian membrane, and it is 
just at this angle that I turned out the sarcomatous mass from the 
floor of the orbit. I now have the nasal portion of the tumor which 
I havei removed. I show you now the second branch of the fifth 
nerve, which we can follow back to the base of the skull. You can 
see the foramen where it leaves the skull. Here is the wing of the 
sphenoid and here the opening. We have isolated the whole nerve 
down to the point of its exit from the skull. I cut the nerve 
close to the point of exit from the skull. I could here remove 
Meckel's ganglion without much difficulty. The tumor extends 
down to the alveolar process and it would be useless to attempt to 
preserve it. Sarcoma of the antrum has a tendency to extend to the 
brain and it has shown this inclination in this case. We have in 
this case made a typical resection of the entire upper jaw. We 
should be careful to look around the orbit for additional remnants 
of the disease which might otherwise escape. The anterior wall of 
the antrum in this case had become very thin. This is the opera- 
tion in which a, preliminary tracheotomy is usually made, but this 
really adds to the danger of the operation. I can always get along 
with the patients when they are in a state of talking narcosis. The 
operation should, however, be well planned, especially the final part, 



Clinic: Senn. 303 

where we make dissection of the roof of the mouth and the maxil- 
lary bone, because here the mouth fills with blood very quickly. The 
hemorrhage must be arrested by the tampon immediately after the 
bone is excised. I shall have to scrape away soft sarcoma tissue 
here directly from the base of the skull. I shall then cauterize the 
surface. I find the nasopharynx intact. The doubtful place is at 
the base of the skull. Here I shall apply the actual cautery. I am 
now removing a part of the Schneiderian membrane, and there is a 
little of the nasal process of the superior maxillary bone that I will 
remove. Before cauterizing, I pack the naso-pharynx. I tampon 
with iodoform gauze saturated with compound tincture of benzoin. 
This packing can remain for a week and there will be not the 
slightest odor if left in situ for that length of time. 

I now apply the actual cautery to the base of the skull. After 
suturing of the flap the nasal passage will be tamponed in the same 
manner. 

I am sure we will find this tumor to be a small-celled sarcoma 
when we come to exhibit sections under the microscope a week 
from to-day. 



QUIZ NOTES IN GENERAL MEDICINE— LOCALIZA- 
TION OF BRAIN LESIONS. 

BY J. A. ROBISON, M. D. 

I. The General Symptoms. — The general symptoms which oc- 
cur vary according to the nature of the lesion, and as they are nearly 
all found in all cases of brain disease we will notice briefly their 
differences. 



SYMPTOM. 

Headache. . 



Convulsions. 



Mental 
Condition. 



TUBERCULAR MENINGITIS. CEREBRAL HEMORRHAGE. 



. Continuous and uniform. 
Frowns; hand to head. 
Shrieks. 



. Local or general, mild or 
severe, clonic or tonic; 
death seldom a result; 
local paralysis (motor 
oculi, facial, upper ex- 
tremity or total hemi- 
plegia). Static ataxia. 

.Irascible, peevish, de- 
pressed: stupor, coma. 



Uncertain. In in- 
fants, tossing of 
the head. 



Palsies first, con- 
vulsions later. 
Chorea; athetosis. 



Idiocy and epilepsy 
often, 



Eye Often negative; ptosis; Eyes may look to- 

sometimes dilatation ward side of lesion, 

pupil (oculomotor par- Strabismus, 
alysis); sometimes 
choked disk. 

Vomiting Sudden, propulsive, Not marked. 

quick (base of brain). 

Vertigo Not marked. Not marked. 



CEREBRAL TUMORS. 

Constant; intermittent; 
dull; heavy with acute 
exacerbations; varies 
with location. In infants, 
tossing of head. 

Convulsions frequent; from 
local to general; slight or 
severe; followed by tre- 
mors; death frequent. 



Fretful; irritable; easily 
wearied; require constant 
attention; wants to lie 
down ; may cry or scream 
and may be punished for 
supposed irascible temper. 
Imbecile, maniacal. Older 
children dull, melancholic, 
apathy so marked as to 
neglect the wants of nature 
and restraints of decency. 

Double optic neuritis; optic 
nerve atrophy; 80 per cent 
choked disk. 



Frequent; accompanied or 
not by nausea; irregular 
intervals or continuous, 
with vertigo, movements 
of the head, or headache. 

Frequent, more with tumors 
of posterior fossa, cere- 
bellum, auditory nerve. 



II. Local Symptoms. — Lesions involving the frontal lobes 
upon the base may destroy the olfactory bulb or tract and produce 
anosmia of the same side. Lesions of the other convolutions, ex- 
cept posterior part of third on left side, produce no symptoms, ex- 
cept disturbance of cerebration, emotional or imbecility. Lesions 
of posterior third frontal lobes (in right-handed persons) produce 
ataxic aphasia. In this area is located the memories of the combina- 
tion of the motor acts in the pronunciation of words. Can under- 
stand or write, but not talk. 

Lesions of the anterior and posterior central convolutions and 
paracentral lobule produce disturbances of motion. Lower third of 
anterior central convolution affects face and tongue; middle third, 

304 






Quiz Notes in General Medicine: Robison. 305 

arm; upper third and paracentral lobule, body and leg; movement 
of eyes inferior parietal lobule. Lesions in the motor area anterior 
to fissure of Rolando produce paralysis without anaesthesia; pos- 
terior, with! anaesthesia; or lesions in the parietal lobules may 
produce anaesthesia without paralysis. 

Lesions of the three occipital convolutions and the cuneus pro- 
duce disturbances of vision. Each occipital lobe is in anatomical 
connection with the like-named half of each retina, and hence a 
lesion produces disturbance of vision in the opposite half of both 
visual fields. If lesion is in left half, have no power to read written 
or printed words but can speak. 

Lesions of first and second temporal convolutions disturb hear- 
ing. Irritation, hallucinations of hearing, destruction, deafness. 
Lesion of first convolution on left side produces word deafness — 
amnesic aphasia — cannot understand what is said. 

Lesions of apex of temporo-sphenoidal lobe, disturbance of 
taste and smell (?). 

Lesions of the island of Reil produce disturbance of motion 
of face and arm on opposite side. (If on left side also aphasia.) 
The associating tracts which join the sensory with the motor speech 
centers lie under the island of Reil, and destruction of this tract 
causes paraphasia; patient can recall the desired words, can imitate 
the movements, but, the associating tract being broken, he replaces 
them with other words. 

Lesions of Projection Fibers. — Anterior capsule not known. Pos- 
terior portion capsule: (i) motor tract from lower third of central 
convolutions, which curves over the lenticular nucleus and passes 
down the anterior part of the posterior division of the capsule, enters 
the second quarter of the crus, thence down the medial part of the 
ventral half of the pons, and turning downward ends in the facial 
and hypoglossal nuclei; (2) the motor tract from the other thirds 
of the central region, pyramidal tract; (3) tract lying behind the 
pyramidal tract, conveying sensation; (4) the visual tract; (5) the 
auditory tract which passes through the lower posterior segment of 
the capsule from the auditory nucleus to the temporal lobe. 

III. Aphasia. — 1. Apraxia is the loss of comprehension of 
the nature and uses of objects, and occurs when the destructive 
lesion is in the frontal lobe and destroys the perceptive functions. 

2. Lesions involving the left side of the hemisphere in right- 
handed persons and the right hemisphere in left-handed persons 
often give rise to aphasic symptoms. If the vocal center be injured 
there will be motor aphasia; if the fibers between that center and 
the muscles of articulation are interrupted sub-cortical motor 



306 The Corpuscle. 

aphasia is produced, although the patient may comprehend audible 
sounds. 

3. If the path between the center of comprehension and the 
vocal center is interrupted the power of the vocal utterance of 
thoughts is lost, although the person may repeat words heard and 
perform acts commanded — amnesic aphasia. 

4. If the path between the auditory center and the perceptive 
center be destroyed the patient can hear and repeat words, but can- 
not comprehend them, although he may be able to voluntarily utter 
his own thoughts. This is known as transcortical sensory aphasia. 

5. In like manner, if there is destruction of the auditory per- 
ceptive center itself there will be cortical sensory aphasia, or word 
deafness. The patient hears, but cannot comprehend the words, 
though he can think and speak his thoughts. 

6. In word blindness the eyes may be in perfect condition, and 
yet the patient cannot read — alexia. Again, the arm may be in per- 
fect condition, and yet the patient cannot write — agraphia. The 
center for conception of writing may be in the optic portion of the 
cortex of the occipital lobe or the motor center in the left second 
frontal convolution. 



The Corpuscle. 



EDITOKS. 

T. R. CROWDER, '97, Editor-in-Chief, 

226 South Paulina St., Chicago. 

E. L. McEWEN, '97, Secy and Treas. 

F. E. PIERCE, '98. A. F. STEVENSON, '98. J. P. SEDGWICK, '99. 



Communications relative to advertisements and subscription (Subscription price 
$1.00 per annum) should be addressed to the publisher. Remittances should be made 
by money order, draft or registered letter, payable to "The Corpuscle," and addressed 
to H. G. Cutler, Unity Building, Chicago. 



Ruby Red and Black: Colors of Lake Forest University. Orange: Color of Rush 

Medical College. 



EDWARD JENNER. 

The name of Jenner will forever be honored as the discoverer 
of the means of preventing the most terrible pestilence of modern 
times. It is no exaggeration to speak thus of "the smallpox," if one 
considers the long period it has prevailed, its almost universal 
diffusion over the globe, the number of its victims and the perma- 
nent injury it has inflicted on those whose lives it has spared. 

It is believed that smallpox has existed from the most remote 
ages in China and Hindustan. It is certain that it appeared with 
Mahomet in Arabia in the seventh century. In India, in one year, 
two millions persons died of smallpox. In Iceland, in 1707, 16,000 
persons died of the? scourge. 

Edward Jenner was the third son of an English clergyman, and 
was born in May, 1749, in Berkeley, in Gloucestershire, England. 

A singular fact is here noted — in that Gloucester was a district 
noted for its cows, both in quality and numbers. 

Had he been born in any other county it is very unlikely that 
he would have made his great discovery, for he was a man of 
observation and induction rather than a speculative genius. 
Whether anyone else would have made the same discovery in time 
is immaterial, but the facts from which he started were known for 
a long time. His discovery was one of those open secrets of 

307 



308 The Corpuscle. 

nature which once announced seem so simple that the world 
exclaims, "We knew that all before." 

After the usual school education of a boy in his circumstances 
he was sent to Bristol to be under the care of a Mr. Ludlow, and 
while assisting his teacher he saw a young countrywoman who 
said "she could not take smallpox because she had had cowpox." 
These words, considered by the profession as a popular delusion, 
sank deep into young Jenner's mind, and when he went to London in 
1770 he spoke to the great John Hunter of the possibility of pre- 
venting smallpox by vaccination. "Don't think, but try," was the 
characteristic reply of the great physiologist, who in his youth 
had been assisted by Cullen, and who in his turn befriended Jenner. 

At this time (1773 A. D.) his friend Edward Gardner thus 
describes him: "Rather under middle size, robust, active and well 
formed; particularly neat in his dress, and everything about him 
showed the man intent and serious. 

"He wore his hair done up in a club and under a broad-rimmed 
hat." 

Jenner first told his belief in vaccination to Hunter in 1770, and 
although Hunter mentioned it annually to his class, Jenner pub- 
lished nothing of it until nearly thirty years afterward, having spent 
the whole of that time in rigidly examining the facts of the case 
and experimenting. He resisted all appeals to go to London, and 
Mr. Cline, the celebrated surgeon, told him to come at once, take 
a house in Grosvenor Square, and make £10,000 a year. 

It appears that Jenner had actually spent £6,000 in prosecuting 
his studies. After publishing his discovery, he was at once at- 
tacked by nearly all of his professional brethren, and by some sub- 
jected to the most scathing criticisms and abuse. Some even, like 
a Dr. Pew, attempted to snatch from him the merit of his dis- 
covery by claiming priority, but all to no purpose; his discovery 
was safe, and finally the professional world came to acknowledge 
the immense value to the world of vaccination and to honor its 
discovery. 

Jenner died in 1823, secure in the knowledge that through 
his efforts countless numbers of human lives were to be spared and 
the way opened to the successful treatment of many other 
diseases. E. R. L. 

OUR RECENT SUCCESSES. 

Elsewhere will be found a list of Rush men who have been 
successful in the annual effort to secure hospital positions. Re- 
sults have been eminently satisfactory to all. Rush has certainly 



Editorials. 309 

secured her share, and as much, too, as could reasonable be ex- 
pected of her. For our college is not an infant in size or in years, 
and therefore it is rightfully supposed to be able to gather in a large 
proportion of the plums each year. Great qualifications , awaken 
great expectations, and reputation is frequently measured by the 
manner in which expectancy is satisfied. Nothing can add more 
substantially to the fame of a medical school than the success of its 
graduates in securing hospital positions. 

To what are the recent encouraging results due? Primarily, to 
the superior excellence of the curriculum and training furnished at 
Rush. Well equipped laboratories, strong clinics, and a carefully 
arranged recitation system, are factors especially to be noted; since 
they afford an abundance of practical knowledge, and^ drill the mind 
in theoretical considerations — two important elements in educational 
work. Secondly, much of the recent success has resulted from the 
efficient work done in the Cook County class. Much has been 
said, pro and con, regarding a special quiz for hospital work. There 
are arguments on both sides. This year's results would rather 
favor the pros, for, of the men who took regular work in the 
county class, ninety-three per cent, secured places. The notable 
success in the County Hospital examination of one who was not 
a member of the quiz class is not an argument against such an in- 
stitution, for undoubtedly had he taken the work he would have 
won first place easily. While the "technical" element was notice- 
ably absent in the county questions this year, there is no means of 
telling when it will reappear. Hence the absolute necessity of pre- 
paring both for general and "catch" questions. This is rendered 
possible in a special quiz, but it would not be just or proper to 
burden classes at large with such instruction. Moreover, the 
method of teaching by recitation from standard text-books is 
scarcely excelled. Such a method is essentially routine, systematic, 
logical, and is especially adapted to comply with the natural pro- 
cesses of mental acquisition. Covering an entire subject, it presents 
to the mind a picture of the whole; clear cut, or not, according 
to student's mental capacity, but still an entity made up of con- 
joined parts. Such can hardly be accomplished by lectures, for the 
reason that time is not given to present everything; the resulting 
mental picture is largely an outline that requires filling in. To 
prepare well for a competitive examination it is necessary to go 
over in their entirety all the subjects in a comparatively short time; 
hence, the value of a special quiz class for hospital work. Beyond 
doubt the result of this year's work has vindicated the idea; with- 
out it the percentage success of Rush had been much less. 



310 The Corpuscle. 

A third point should not be forgotten. The class of '97 has 
been distinguished in many ways; more especially, however, in two: 
devilment and intellectual ability. Could the former have been 
eliminated no doubt the hospital attainments would have been 
greater. As it is, it must be conceded that the class contains a large 
proportion of very able men to achieve so much with a dead weight 
dragging at its heels. Their presence and faithful work have made 
it possible for Rush to far outstrip her competitors this year. 

THE MISSIONARY PROPOSITION. 

No doubt nearly all the students who read these lines under- 
stand to what the above title refers. But a few words of explana- 
tion will not be amiss. Dr. Skinner, whom everyone knows as 
an earnest and active Christian worker, is now and has been in 
the past anxious to go to foreign fields as a medical missionary. 
Through stress of hard times the Missionary Boards find them- 
selves unable to send him the coming year. The proposition has 
been made that he be sent by the students of Rush as a representa- 
tive of our college in the missionary field. It is to be hoped that 
the plan can be carried out. Already a large sum has been sub- 
scribed by the students, the respective amounts being retained 
from the breakage fees. We understand the matter has the sanc- 
tion of the members of the faculty, and that, should Dr. Skinner be 
sent, regular reports as to the medical situation in the foreign field 
will be returned. To those who are Christian believers no argu- 
ment in favor ot the proposition is needed; to further it is at once 
a duty and a privilege. To those who are not of such belief the 
high considerations of the civilizing influence of the medical mis- 
sionary among a darkened people, and of the power to alleviate 
human suffering that lies within his power — suffering of which we 
can barely conceive — should make a strong appeal. By all means 
let Dr. Skinner be sent. It will require but a small sum from each — 
not enough to be missed — and no one acquainted with the man 
can say the results will not be commensurate. 



Prof. Lyman, in his lecture of May 8, entertained the senior 
class with a talk on practical points of advice, and to aid the young 
doctor in starting upon his professional career. The talk was 
bountifully illustrated with stories and anecdotes drawn from his 
own rich experience. Every point had a story that exactly fitted 
it. We only regret that we cannot give to our patrons the whole 
talk, verbatim, so that all might enjoy and profit by it. 



Editorials. 311 

The following are some of the points brought out, but they 
lose all their spice in this crude condensation: 

The young doctor does not practice medicine merely for fun, 
but must make his living by it. Only too often the first bill is 
greeted by "Oh, Doctor! I thought you were only practicing on 
me." Without being disagreeable he may have it understood from 
the start that his visits and advice are strictly professional and 
upon a business basis. Bills should be sent in regularly and at 
stated intervals. 

The story of the young doctor who had to give up practice 
in order to sell all the farm produce paid in to him by his agricul- 
tural patients for services rendered conveys a warning to those who 
intend to practice in a country district. Respect their good inten- 
tions but lead your patients into a more "fees-able" way of show- 
ing them. 

Charity has its place. When a person really deserves charity 
then the physician should be the first to respond. Where, however, 
the patient can pay but will not, free service harms both physician 
and recipient. For certificates of birth, death notices, etc., all of 
which consume the physician's valuable time, there should be a 
suitable recompense. Even though small it may pay for a sub- 
scription to one or more medical journals which, otherwise, he 
might not feel he could afford. Small sums mean much to the 
young, struggling practitioner, and he should be protected by suit- 
able laws. 

As a man values himself and his services so is he most often 
valued by those about him. Not conceit or self-love, for these peo- 
ple despise or laugh at, but a certain dignified poise, an earnest and 
thorough examination and a concise recital of, directions for treat- 
ment, all impress the patient and lend the weight to the physician's 
counsels that they deserve. 

In thet sick room the physician should be neat in appearance, 
gentle in manner, and sympathetic. He should always try to be 
on a little higher plane than his patients and never come quite 
down to their level. He should always leave the patient feeling 
much better than when he entered, whether it by drugs or kind 
w^ords. A few simple rules like these bind a doctor's practice to 
him and aids much in increasing it. 



The senior finals are over, and the heart of the examinees are 
glad, though the trials of the examiners are on full blast. Every- 
thing considered, they have been very satisfactory to the students. 
While fair in all particulars, they have not been extremely easy; 



312 The Corpuscle. 

neither have they discouraged by reason of severity. A happy 
medium has been the rule. Several of the faculty have remarked 
upon the superior quality of the papers handed in, among them 
Prof. Bridge, who very agreeably surprised the class by announc- 
ing that the papers of the November examination were superior 
to those of any previous year. From the applause his words evoked 
it might be surmised that they came as soothing balm to spirits 
torn with doubts and fears. 

There is scarcely a subject connected with college work more 
worthy of careful study than that of examinations. How to prepare 
for them, how best to present an answer, what dangers to avoid in 
reading a question and writing its answer, how to concentrate 
thought in the midst of excitement, and many other items demand 
consideration. Much has been said in the columns of the Cor- 
puscle on the subject, and more perhaps is not in order now. We 
have this suggestion, however, for the underclass men who have 
yet many examinations to weather: Make a constant analytical 
study of your own weak points as manifested during the process 
known as an examination. It will pay, psychologically and in 
grades. 



By promptly paying the dues to the Alumni Association or 
by seeding in their subscriptions to the publisher, seniors will 
receive the Corpuscle for the coming year. Every senior will find 
it to his interest to do this, and he should do so early, that he may 
receive the Commencement number. Every graduate wishes some 
reminder of his closing days at college, and should accordingly 
secure the June issue of the Corpuscle. A limited number will be 
printed, so come early and avoid the rush. 

Seniors will also find in the next year's numbers matter of 
interest to them in many respects. An early fulfillment of their 
duty by subscribing will be highly profitable. 

The older alumni as well should see to it that the Corpuscle 
is received by them regularly. It will be the effort of the Board 
next year to furnish a journal equal to that of any other medical 
college and such an one as will be of interest not only to all our 
alumni but to the student as well. 



Next month's issue will contain Prof. B rower's clinic, given 
at the County Asylum at Dunning. This report will be much 
more complete than that given in the April number. 



Editorials. 313 

As mentioned in our last issue, two new editors are to be 
elected after this month's number is out. Several competitive 
articles have been handed in. Sophomores or freshmen who con- 
template making the trial should tender their productions at once 
to some member of the editorial staff. 



The attention of the seniors is called to the list of locations 
published on another page. These are from the office and are 
worthy of investigation. 



COLLEGE NOTES. 



LOCATIONS AND OPENINGS. 

An opening at Thompson, Iowa. Population over 600; one 
other doctor; 14 miles to nearest adjoining town. Rush man 
wanted, Norwegian or German, preferably Norwegian. Address 
for particulars, J. L. Cahill, druggist, Thompson, Iowa. 

Correspondence wished with middle-aged graduate of Rush; 
possessor of good habits and desiring good location. Address M. 
Plank & Co., Hancock, Wis. 

Exceptionally fine opening for bright, tactful, well read young 
man in heart of grazing country of Northwestern Nebraska. Nearest 
doctor 15 miles away and he the only one within 50 miles in 
either direction. Fees high ; board cheap ; plenty of surgery. Cor- 
respond with Fred. Howard, Whitman, Neb. 

Location at Ewen, Mich. Address Gordon Goodwin, that 
place. 

Graduate speaking French can learn of a good location by 
addressing Dr. Lynch, Powers, Mich. 

Good chance for competent young doctor at Cumings, N. Dak., 
in heart of Red River Valley; 8 to 12 miles to nearest doctor. Address 
for particulars concerning free office room, drug stock, etc., M. F. 
Forthum, Cumings, N. Dak. 

Excellent opening for one wanting a country practice. Ad- 
dress B. M. Stephenson, M. D., Kilbourne, 111. 

Two openings. Each would yield enterprising man a living 
the first year, possibly the first month. No capital required; no 
old furniture or good will to buy. Each town growing and sur- 
rounded by good agricultural district. One doctor each place. 
Address B. L. Evans, M. D., Watseka, 111. 

For Sale. — A $3,000 practice at Wakonda, S. Dak. Nearest 
competition 18, 24 and 26 miles. Country old and well settled; 
$500 buys office fixtures, driving outfit and good will. Reasons 
for selling. Dr. F. A. Swezey, '94, Wakonda, S. Dak. 

Good practice to one who will purchase my entire office outfit. 
Address J. H. Hundley, Olney, 111. 

Suitable man wanted to take charge of physical culture work 
in first-class college preparatory school in large city for next year. 

314 



College Notes. 315 



Chance to start a medical practice, as position would introduce him 
to wealthiest clientage in city. Salary would depend on man, but 
would be sufficient to enable him to live respectably while estab- 
lishing practice. Must be able to handle gymnasium floor work, 
elementary military drill, etc. Address Albert & Clark Teachers' 
Agency, Pullman Building, Chicago. 

Physician wishes to sell out; successor to purchase only the 
actual necessities in practice. No opposition. Practice amounts 
to $1,700. German or Irish-American would take well. Address 
T. R. Welsh, M. D., Lyndon, Wis. 

Wanted. — A physician at Sixty-ninth and Wentworth Avenue, 
Chicago. First-class location on a transfer corner. Address 6850 
Wentworth Avenue, City. 

Chance for a fine practice in village of 1,500 inhabitants; county 
seat and in good farming country. One physician in place. Ad- 
dress Excelsior Drug Store, Sauk Rapid, Minn. 

A physician is wanted in a live Wisconsin city. Address P. B. F., 
care of Morrisson, Plummer & Co., 200 Randolph Street, Chicago. 

Good opening for enterprising man. Address Oscar Boyd, 
Pingree, N. Dak. 

For particulars regarding two or three locations for especially 
reliable men, address Dr. B. W. Lashier, Armour, S. Dak. 

For Sale. — A good location in a small town and splendid farm- 
ing country surrounding. Will sell drugs and office fixtures for 
$400. A good place for a young man beginning the practice of 
medicine. All inquiries promptly answered. Address John E. 
Haughey, M. D., Rock City, 111. 

A very desirable country location in a beautiful climate. Ad- 
dress G. A. McDonald, M. D., Sunbright, Tenn. 

For Sale. — On easy payments, a desirable residence and large 
practice of two physicians; established twenty years, in a manu- 
facturing town of 8,000 inhabitants; county seat, three railroads, 
shops, paved streets, electric lights, and wealthy farming commu- 
nity. Good reasons for selling. Address Mrs. E. E. Kranzleiter. 
Bucyrus, Ohio. 

For Sale. — An elegantly furnished office, including good prac- 
tice; established six years; $2,000 in office practice alone besides 
general practice and physician for two corporations; in city of 
6,000 not overcrowded with doctors. All for less than one-half 
cost price of office furnishings and outfit alone. Terms easy. 
Home and Chicago references given. Invoice sent to anyone in- 



316 The Corpuscle. 

terested. Address at once, D. A. Crawford, M. D., Centerville, 
Iowa. 

For Sale. — A $3,500 practice, in a wealthy place, 120 miles 
from Chicago; fees high, collections good, people mostly English. 
Property consists of two large lots, well stocked with choice fruit; 
a good seven-room house, cellar, out-buildings, cistern, wells, large 
barn and office. Will include office furniture, drugs, buggy, team, 
harness and sleigh. Price for all, $2,500. Terms, $1,500 cash; re- 
mainder on time, with a bankable note. Address "No. 97," care 
of Sutliff & Co., Peoria, 111. 

Three Thousand Dollar Practice For Sale. — Best location in 
Cleveland, Ohio. Office of four rooms, on Euclid Avenue, ele- 
gantly furnished, lighted by electricity, equipped with electric bells, 
steam heat and every modern convenience. Work confined to 
chronic diseases, nearly all done in office. Do not average more 
than one call a day out in town. Night calls less frequent than 
once a month.. Office hours, six per day. Sundays, 10 to 12 only. 
Collected last year (1896) over $3,000 cash, being about 80 per 
cent, of work done. Books, receipt stubs, etc., open for inspec- 
tion. Business can be doubled by energetic man. Present in- 
cumbent cannot stand the confinement of an office, because of 
ill health, and wants to go West and "rough it." Hardly able to 
attend to work demanded for past six months. Will sell office 
fixtures, good will, etc., for $600, Will introduce purchaser for one 
month, represent him as partner if desirable, and permit use of 
name in connection with business for one year. Only those hav- 
ing the cash to put up need answer. Will give every opportunity 
for thorough investigation, but will not sell "on time." Address 
"Doctor," per Z. D. Patterson, 170 Superior Street, Cleveland, Ohio. 



HOSPITAL APPOINTMENTS. 

The following is a complete list, so far as we can learn, of 
'97 men who have secured hospital positions. A few facts are 
added showing the relative success of Rush students: 
Cook County Hospital — C. J. Habbegger, E. F. Burton, T. R. 

Crowder, N. P. Mills, H. J. Brugge, L. F. Schmauss. Six 

places out of a possible twelve. 
Presbyterian Hospital — E. D. Whiting, W. E. Kaser, W. F. C. Heise, 

G. W. Fox, J. D. Freeman, G. F. Ayers, W. W. Meloy. All 

places filled by Rush men. 
St. Luke's Hospital — L. B. Fales, H. W. Manning. Two places out 

of three. 



College Notes. 317 



Alexian Brothers' Hospital — J. E. Moran, F. S. Davidson, G. F. 

Connell, '96. All places filled by Rush men. 
Illinois Eye and Ear Infirmary — W. R. Murray, George Ainsley. 

Two places out of three. 
St. Elizabeth's Hospital— F. C. Gorman, A. E. Price, W. F. Jacobs, 

M. U. Chesire. Four places out of five. 
St. Joseph's Hospital — E. Bowe, F. J. Sullivan. All places to Rush 

men. 
Michael Reese Hospital — E. C. Greenebaum, F. L. Strauss. Two 

places out of three. 
Augustana Hospital — C. H. Parkes, B. D. Black. All places filled. 
Norwegian Lutheran Tabetha Hospital — E. L. Brimi. One place out 

of two. 

It is not intended in the above list to present the names in 
the order of their entrance into the respective hospitals. No men- 
tion of alternates is made, since their positions are seldom active. 
It should be stated, however^ that in the county examination three 
Rush men secured places as alternates out of a possible six: J. E. 
Moran, R. B. Westnidge and W. B. Whitteker. The following 
short summary will be of interest: 

Total number of active positions open, 42. 

Total number secured by Rush men, 31, or 74 per cent. 

Total number of active positions decided by competitive ex- 
amination, 32. 

Total number of competitive positions secured by our men, 
23, or 72 per cent. 

Per cent, of positions secured by Rush men, not including 
Presbyterian Hospital, 64. 

We are unable to state the number of men from each school 
who presented themselves at the examinations; nor can we give 
the total number in the graduating classes of the various schools 
concerned in the examinations. As to the first, we believe the 
number of Rush men competing was not in proportion to size of the 
graduating class. On the whole it may be said, without fear of 
contradiction, that our college this year has done well beyond 
compare in placing internes. 



An exceedingly pleasant entertainment and reception was 
given by the underclass women at the Women's Medical School 
the evening of May 1, in honor of the outgoing seniors. The erst- 
while "plain and unadorned" halls were beautified by the rare 
touch of the florist's hand, and the odor of the drug room from 
below and the bone room from above was lost in the exquisite 



318 The Corpuscle. 

fragrance of cut flowers. Preliminary to the social features of the 
evening an entertaining program was presented in the lower lecture 
room. Solos, vocal and instrumental, male and female, were given 
and received well merited encores from the appreciative audience. 
The coup de maitre of the evening, however, was the presentation 
by the Realistic Reading Club of several well-known pieces. These 
renditions, which were highly artistic in their way, included "Maud 
Mueller," in an original hay-making act; "Barbara Fritchie," with 
thrilling pyrotechnic additions; "Soliloquy of Hamlet," with tragic 
scalpel ending showing women's rapid action in surgical emer- 
gencies; "Witches of Macbeth," in their three-hands-around caul- 
dron act with patent medicine termination; "Daisy's Faith," by a 
hopeful prodigy — very realistic; a musical number by the Dunner- 
blitzen orchestra on kazoos and banjos, with bone accompaniment; 
and "Young Lochinvar," by the long and short artists, with assist- 
ance of a hobby-horse. This portion of the program was cer- 
tainly affecting. Few there were not moved to tears — by hearty, 
almost painful laughter. Light and elegant refreshments were after- 
ward served in the upper lecture room. The entire evening was 
one combined success and reflected great credit upon the workers 
in charge. Especially to be congratulated were those concerned 
in carrying out the "Realistic Reading Club" feature, not only 
for the success of the main parts, but for the splendid manage- 
ment of the intermediate and minor portions, thus making the 
whole perfect in every detail. 

A "loud" feature of the evening — not scheduled — was the giv- 
ing of class yells. It is a mistake to think a woman's voice is 
adapted for talking only. Some of these were so excellent that 
we give them: 

N U! N U! We are fine! 

Medics! Medics! Ninety-nine! 
To this the freshmen — class of 1900 — respond: 

M! D! C, C, C, C! 

W! M! C, C, C, C! 

Fin-de-siecle! Fin-de-siecle! 

N! U! See? 



Recitation Breaks (Sophomore Anatomy). — Question: Where is 
the deep origin of the fourth nerve? Answer: In the foramen of 
Winslow. — Dern. 

Question: What is the average length of the oesophagus? 
Answer: About two feet and a half. — Abraham. 



College Notes. 319 

Question: How long is the membranous portion of the 
urethra? Answer: About five or six inches. — Hegler. 

Dr. . — Question: How long is the trachea — about nine 

inches? Yes. 

Pros. Senn and Brower will attend the international med- 
ical meeting at Moscow in August. Professor Senn will deliver 
an address at the meeting. 

The J. W. Freer prizes have been announced. First place is 
given the essay by A. E. Price, on "Neurotic Atrophy of Bone;" 
the second to J. E. Luckey's production on "Subcutaneous Injuries 
of Soft Parts." 

Prof. Bridge, fresh from the coast, greeted the senior class, 
May 8, with encouraging words of compliment for the work they 
had done. It was heard with regret by all that the Doctor cannot be 
present at Commencement. 

Profs. Senn, Ethridge, Bridge, Ingals, Bevan, Hyde and Hek- 
toen attended the Medical Congress at Washington, May 3 to 7. 

At the meeting of the Association of American Physicians, 
held in Washington May 3 to 7, Prof. Hektoen was elected to mem- 
bership in the society. This association is limited to a membership 
of 100 and Prof. Hektoen was elected over a long list of waiting 
applicants. Prof. Bridge and Prof. Lyman are members of this 
association. 

Prof. Ingals will represent the American Climatological As- 
sociation at the meeting of the British Medical Association, which 
meets in Montreal, August 31. 

Dr. Salisbury was called to Storey, Wis., April 27, by a tele- 
gram announcing the violent death of his father at a railroad 
crossing. 

We regret to learn that Mr. Gould, whose health has been 
failing for some time, is now confined to his bed, so serious has 
his condition become. 

T. R. Crowder, ye editor-in-chief, has gone to Sullivan, Ind., 
to secure a much needed rest before taking up his arduous duties 
at the County Hospital. In his absence we beg our readers to 
overlook any shortcomings in the May Corpuscle. 

N. P. Mills will take charge of a doctor's practice in Mich- 
igan for a few months. The aroma of the pine woods will have 
fortified him against the subtle microbe when he returns next fall 
to begin the interne work at the County. 

Manning will spend the month of May in his Kansas home, 
resting up for St. Luke's. Fales will recuperate in Wisconsin. 



BOOK REVIEWS. 

Lectures on the Treatment of Fibroid Tumors of the Uterus, 
Medical, Electrical and Surgical. By Franklin H. Martin, 
M. D., Professor of Gynecology in the Post-Graduate Medical 
School of Chicago; Surgeon to the Woman's Hospital of 
Chicago; Gynecologist to the Chicago Charity Hospital and 
the Post-Graduate Hospital, etc., etc. 174 pages. Price, 
cloth, $1.00 net. Chicago: The W. T. Keener Co. 1897. 

Dr. Martin has for the last ten years devoted a large part of 
his professional time to the study of the subject which forms the 
title of this book. He has had large experience in the Chicago 
clinics and hospital practice, and in these lectures has given to the 
profession a little book of decided value. He is not radical in 
recommending surgical treatment, as is the case with so many 
gynecologists of the present day. 

The medical side of the question receives full and careful treat- 
ment. Considerable stress is put upon the use of electricity in 
selected cases and the technique is carefully and accurately given, 
as are also the indications and contraindications for its use. 

The author's operation of vaginal ligation of the broad liga- 
ment is minutely and clearly described. Its employment is highly 
recommended for many cases where certain named conditions pre- 
vail. Case reports and statistics are given in connection with the 
consideration of this operation and the article is a very interest- 
ing one. Dr. Martin's theory of the action of ligating the broad 
ligament is that it influences the growth of the tumor, not only 
by cutting off the blood supply, thus decreasing its nutrition, but 
also by interfering with the nerve supply of the uterus a trophic 
influence is exerted resulting in a decrease of the size of the fibroid. 

The book contains ten lectures, as follows: I, Anatomy; 
Varieties; Etiology. II, Symptoms; Diagnosis. Ill, Treatment 
— General Consideration — Medical. IV, Ergot. V, Electricity. VI, 
Surgical Environments; Preparation and After Treatment of 
Patients, etc. VII, the author's Operation of Vaginal Ligation 
of the Broad Ligaments, and other minor operations. VIII, Re- 
moval of the Uterine Appendages. IX, Vaginal Hysterectomy. 
X, Abdominal Hysterectomy. 



320 



jRlumni Department. 

JAMES B. HERRICK, A. B., M, D., Editor. 



Membership in the Alumni Association of Rush Medical College is obtainable 
at any time by graduates of the College, providing they are in good standing in the 
profession, and shall pay the annual dues, SI. 00. This fee includes a subscription to 
The Corpuscle for the current year. This journal is the official organ of the Association 

Dues and all communications relating to the Association should be sent to 

JOHN EDWIN RHODES, M. D., Sec'y and Treas., 34 Washington St., Chicago. 



AU REVOIR. 

It is with a feeling of discomfort that with this issue we are 
obliged to chronicle the withdrawal from immediate duties con- 
nected^ therewith, one of the junior editors of The Journal, Dr. 
E. M. Eckard. For a year or more we have found the Doctor a 
most hearty and efficient co-worker, and we are sincerely sorry 
now to lose him from daily association. But what is our loss is 
the gain of the great sanitarium at Alma, Michigan, to which in- 
stitution he goes from this point, and in which he will occupy 
the position of house physician. Having a penchant for diseases 
of the nervous system especially, he has made them a more or 
less constant study, and will find in his new field of labor abundant 
opportunity to exercise that taste amongst the most elegant sur- 
roundings and with a select and most agreeable class of persons. 
Dr. Eckard has built up a most enviable reputation while a resi- 
dent of this city and our regret at his departure is only alleviated 
by considerations of the wider, more agreeable and more influ- 
ential sphere in which his talents will find exercise. — Peoria Medical 
Journal. 

F. A. Guthrie, '96, was in the city recently for a few days. 
He is at Aledo, 111., and is associated with Dr. J. M. Wallace, a 
practitioner of twenty years' experience. Reports plenty of work 
and is doing well. 

Dr. F. W. Miller, '94, is in the city taking a post-graduate 
course at the Eye and Ear Infirmary. Dr. Miller, after graduating, 
served as interne in the Presbyterian Hospital, and then began 
active practice at Red Oak, Iowa. He is doing well and likes 
his work. Is married and has a daughter four months old. Will 
be present at the banquet. 

321 



322 The Corpuscle. 

We are daily receiving word from graduates of their inten- 
tion to be present during Commencement week. Of course all 
alumni in Chicago and vicinity will attend the various exercises. 
Many from long distances are planning to be here. 

Dr. J. R. Currens, '78, writes from Two Rivers, Wisconsin: 
"I shall certainly make a strong effort to be present at the Com- 
mencement." 

J. W. Chamberlin, '82, writes from St. Paul that while he 
hopes to be with us he may be in the East, and "shall miss hear- 
ing my good friend Clark 'orate.' I shall be with you in spirit, 
however. Wishing for an abundance of good cheer for you all, I am 
"Yours for old Rush, 

"J- W. Chamberlin, '82." 

From Jefferson, Wisconsin, come annual dues to the treas- 
urer from G. L. Smith and J. A. Muenich. Dr. Muenich is a 
graduate of 1879. He writes that he is getting old enough to 
desire an assistant or partner. Any member of the senior class 
desiring to learn more fully the particulars can write Dr. Muenich 
or see the editor of this department, or the secretary of the Alumni 
Association. 

S. K. Hissom, '96, is at Wheeling, W. Va. He plans to spend 
his summer in Berlin in medical study. 




FRANK J. GOULD. 



The Corpuscle. 

RUSH MEDICAL COLLEGE, CHICAGO, ILL. 
Medical Department Lake Forest University. 



Vol. VI. JUNE, 1897. No. 10. 

FRANK J. GOULD— 1874— 1897. 

A form was missed from the Commencement stage by the 
older graduates this year, for the first time in over twenty years. 
Just before Commencement week death came to the faithful clerk 
of the college, Frank J. Gould, and thus terminated twenty-three 
years of faithful and exceptionally valuable service. The funeral, 
which occurred on Sunday, May 23, at 2 p. m., was attended by 
a large body of the Senior class, in cap and gown, who marched 
as an escort in double line on either side of the hearse, from Mr. 
Gould's home in the Laboratory building to the Church of the 
Epiphany, where the services were held, the rector, Dr. Theodore 
N. Morrison, officiating. The pall-bearers, all members of the fac- 
ulty and also former students of the college during Mr. Gould's 
clerkship, were Drs. Salisbury, Kauffmann, Weaver, Linnell, 
Shaw and Olney. The Senior Class met on Saturday, passed suit- 
able resolutions of respect and condolence, and voted to send a 
magnificent floral tribute representing the college pin. 

Mr. Gould was born at Ann Arbor, Mich., November 8, 1844, 
and was married, in Chicago, to Miss Isabella Parker, of Rochester, 
N. Y., August 4, 1873. Shortly after his birth his parents moved 
to Cooperstown, N. Y., where he was educated. In i860, at the 
age of 16, he went to California, and when the War of the Rebellion 
broke out enlisted, August 26, 1861, in Company E, First Regiment 
California Volunteers. 

At the expiration of his term of service in 1864 he reen- 
listed and was finally discharged in December, 1866. He came to 
Chicago in 1867 and was in the employ of Bullock Brothers, the 
well-known and fashionable retail dealers in boots and shoes on 
State Street, until the fall of 1874, when he accepted the position 



324 The Corpuscle. 

as clerk in Rush Medical College, in whose faculty his brother- 
in-law, the distinguished Professor Moses Gunn, occupied the chair 
of Surgery. In this position he continued without interruption 
until his death, being absent from his post never more than a few 
days, during the summer vacation, until the sudden inception of 
his fatal illness. 

In December, 1894, while apparently in his usual health, he 
was seized with a coughing spell shortly after retiring one evening, 
and with it a pulmonary hemorrhage. Examination of the chest 
and sputum next day discovered distinct evidences of incipient 
tuberculosis. Mr. Gould was at once given leave of absence by 
the faculty and ordered to El Paso, Texas, where he placed himself 
under the care of Dr. W. N. Vilas, Rush, class of '80. He remained 
here until May, 1896, returning to Chicago, however, for the Com- 
mencement season in May, 1895, and for a month at the beginning 
of the session of 1895-96. By May 1, 1896, he had improved so 
greatly during his sixteen months' absence that he deemed him- 
self able to resume his work and residence in Chicago, and, against 
the advice of his physicians, determined to remain here. He was 
obliged to give up his work about April I, and, failing rapidly, 
died May 20, at his home in the Laboratory building. One brother 
survives him, Fletcher A. Gould, of Holcomb, N. Y., one sister, 
Mrs. Moses A. Gunn, of Chicago. Mr. Gould leaves a wife and 
three daughters, Misses Alice, Daisy and Algenia Gould. 

"Frank," as the Rush graduates will always remember and 
speak of him, was in many respects remarkably well qualified for 
the work of his position. He looked after the multifarious details 
of the college books, students' records, etc., with exceptional care 
and accuracy. As a custodian of the college building and prop- 
erty, his close watchfulness and excellent judgment are largely 
responsible for the excellent condition in which they have been 
kept. As the members of the faculty, who in earlier years looked 
after many of the details of the college government, became more 
and more engrossed in other duties, Mr. Gould came to have charge 
of many matters which are usually intrusted only to a member of 
the faculty. All these he managed with excellent judgment and 
tact. But the faculty for which he was especially noteworthy, and 
which was of great value to the college, was his remarkable mem- 
ory for names and faces. Seldom did an alumnus, who had grad- 
uated during his term of service, no matter of how many years' 
standing, return to the institution, that Frank did not at once 
address him by name, and talk to him familiarly of his fellow class- 
mates, and of some notable incidents of his college days. He left 



Valedictory Address. 825 

the college after such an interview with a feeling that someone, at 
least, connected with his Alma Mater, remembered and preserved 
an interest in him, and his loyalty and enthusiasm for "old Rush" 
received a new impetus. To an institution whose growth and 
prosperity is so largely dependent on the enthusiastic, hearty sup- 
port of its alumni, such a service as this can hardly be overestimated. 
As these old graduates come back to the college in the future 
they will miss nothing more than the familiar face and hearty 
greeting of "Frank." 

The faculty, at a meeting held May 21, and the Alumni Asso- 
ciation, at its annual meeting, passed suitable resolutions of regret 
and respect, copies of which were ordered engrossed for presenta- 
tion to the family. J. M. D. 



VALEDICTORY ADDRESS. 



BY WM. H. MALEY. 

God's greatest handiwork, the human mind, rejoices in a uni- 
versal enlightenment, the human heart in a universal sympathy, 
the human soul seeks comfort in a universal hope. 

The physician as a sociologist has no grander moment than 
the present. He it is who enters the home, catches the throb of its 
heart, and by touch and glance reads the pulse of humanity. 

Humanity is the watchword that unites nation to nation. 
Armed with it the physician becomes a power before which crumble 
the walls of China and opens the way into the jungles of Africa. 
It knows no barriers. The noblest of earth may stoop to wash 
the beggar's sores, or to breathe a word of comfort to the fallen, and 
be thereby exalted. 

The medical profession is in need of philanthropic men who 
will stimulate the intellectual faculties; men who, by living above 
the common level, exalt and dignify human life; men who would 
have opportunity for helpfulness. 

The hour has come when our nation's welfare depends not so 
much on shot and shell as on the disposition of mind and heart; 
bonds of love bind more firmly than bands of steel. 

The science of Bacteriology has opened a new field for the 
physician. He knows the ravages of deadly germs. His duty is 
to educate the people, to teach them of the dangers, and to give 
them a knowledge of the true source of disease. When the mind 
is free judgment may be exercised in the prevention of disease, and 
prophylaxis will find its place. We must show the necessity of 



326 The Corpuscle. 

purging the tenement house and the sweat shop, of relieving suf- 
fering in crowded garrets, of that cleanliness which is next to 
godliness. A few simple laws of hygiene and health, a few simple 
rules for the first aid to the injured, can be readily taught. 

There is a prevalence of ignorance and mistaken ideas of 
economy in the administration of municipal affairs. In the selec- 
tion of officials the welfare of the people demands men of science; 
men who by preparation through a course of study have become 
thoroughly qualified to meet the problems and emergencies aris- 
ing; men who will provide intelligent sanitation and quarantine; 
men who will remind architects and builders of the importance 
of light and ventilation in the construction of schools and public 
buildings. The wise man knows that the health of a nation depends 
largely upon the health of her children. 

The physician as a sociologist should study man mentally, 
morally and physically. The criminal suffering from a disease or 
deformity of the brain is to be treated and educated, not punished 
and condemned. Much of that we call crime is really disease. 

Physicians, awake to the responsibility of your profession! 
Your power for good is unlimited. The ideal physician approaches 
nearer to the hearts of the people than anyone else. In sorrow 
and trouble his presence is a source of comfort. His words are 
cherished in the memory, and at the moment when the gates of 
death are opening to receive that which is mortal, the faithful 
physician is found by the bedside in the humblest cottage and the 
grandest palace. His is a mission of charity and mercy. His life 
has been "dedicated to the quest of knowledge that may relieve 
suffering and prolong life." 

To-day we are carried back to that bright autumn morning 
when about to leave our boyhood home. Filled with thoughts 
of the past and anticipations of the future, we were enchanted by 
a music that no man can name. To-day its silvery echo repeats 
the sacred words: "No human heart has e'er gone wrong to whom 
was told, 'Good-bye, God bless you.' " 

Fathers, mothers, sisters, brothers and friends, you are entitled 
to much of the credit of this day's work. Hours have lengthened 
into days, days into months, and months stretched out into years. 
During all this time you have patiently watched and waited, but 
you never despaired. You have been the fountain that supplied 
our daily wants. Many a father whose head is now bowed with 
age has labored early and late that his son might complete this 
course. Many a mother's temples have whitened and her eyes 
dimmed with endless toil and midnight prayers that her son might 



Valedictory Address. 327 

honorably accomplish this day. In behalf of the class of '97 let 
me assure you that we are conscious of our great indebtedness. 
We can never fully repay you, but our lives and actions may testify 
to the gratitude our words cannot express. 

In the sunset of your life, when your blood grows thin and 
your hearts are weak and slow, may your days be gladdened and 
your years prolonged. May the achievements of a dutiful son 
fill your souls with peace and joy. 

For the opportunities we have received from the noble founders 
and trustees of old Rush in days that are gone, we proclaim our 
sincere gratitude. 

To our honorable faculty, instructors and preceptors, we owe 
a debt of gratitude that words cannot portray. 

Pausing for a moment on the threshold of our college home, 
our hearts are filled with the blended light of retrospection and 
hope. You, as guardians of a sacred trust, have spared no pains 
in perfecting us for the great battlefield of life. You have been 
truly consecrated to your high calling. Your noble example and 
influence have left an indelible imprint on our hearts. We realize 
that it has required more than ordinary efforts for you to equip 
and maintain one of the foremost institutions of the day. You 
have made the name of Rush honored in every land. You have 
filled her chairs with the shining stars of modern science. Some 
are grand men with furrowed brows and whitened locks; some are 
yet destined to be the light of future generations. 

Gentlemen, you have erected an educational monument whose 
principles will withstand the wrecks of time. As the years roll 
by, may the winters of your life be as full of blossoms as the beau- 
tiful spring. May you reap the golden harvest of a well-spent 
life. And, at last, when you have cast your anchor on the silent 
deeps beyond, may a grateful people remember the motive of 
your lives. "Pro scientia et humanitate." 

Fellow classmates, there are but few brighter days in the 
student's life than that which crowns his scholastic labors and bids 
him go forth from his alma mater to engage in the great conflict 
of life. In the midst of this delight there is an undercurrent of 
sadness — we must separate! What better wish can we utter than 
the simple words, fare well? 

If we knew the secret of words we would beg of you to be 
faithful to the high aims and destinies of our alma mater. Let 
us not sink into that miserable existence where all is forgotten 
but the profit of the hour. May your life's aim be an ideal, which, 
molding character and shaping destiny, will blend into harmony 



328 The Corpuscle. 

all other true ideals. May we be ever mindful that all we possess 
is qualified by what we are. That the persevering man of correct 
habits will achieve more than he who has only brilliant achievements. 
May yours be the honors that rest upon the head of the one whose 
existence has made the world brighter and better. 

May we realize that there is something ennobling in our pro- 
fession. When the voice of humanity calls, let us be "semper 
paratus." Then with all the grandeur of meaning of our chosen 
motto let us proceed "nee temere nee timide." 






CLASS HISTORY. 

BY J. E. JOHNSON. 

Members of the Faculty, Fellow Students, Classmates, Ladies and 

Gentlemen : 

The time has come when we must look backward upon, instead 
of forward to, our medical course. For three years we have worked 
side by side, tasted of the bitter and sweet, experienced the pleasures 
and the hardships of a medical education. The years of our sojourn 
are ended; what we have gained, what perchance we have lost, 
must now be recorded, somewhat of the Past, somewhat of the 
Present, somewhat, it may be, of the Future, and the work of the 
historian shall have been accomplished. 

With a holy awe and bated breath we stepped for the first 
time within these halls. Softly we trod as we realized about us 
the scene of many a life's tragedy — the field of bold and brilliant 
achievements without number. The weird legends and fantastic 
tales of life at Rush passed before our eyes in panorama. Surely 
our Mecca had been reached and we would worship here. 

The amphitheater was crowded to listen to the opening lecture 
of the session. We were there, of course, in all the glory of ex- 
pectancy, but what to expect we did not know; whether it was to 
be a feline vivisection or a lecture on the compatibility of science 
and religion we had to conjecture. With the first warwhoop from 
the front row "Sitting Bull" started to his feet and "King John's" 
hair did appear all the more fretful; a conglomeration of hands, 
feet and pants' buttons approached with startling rapidity. Reach- 
ing the "Perch" the form disappeared — an oppressive silence, a 
sickening "thud," and the "middler" had paid for his seat in the 
front row. With the entrance of the faculty and orator of the 
evening, peace was restored. We drank in the learned address 



Class History. 329 

in a most becoming style, looked wise and said nothing. It is 
not required of a man that he flount his ignorance. Herein lay 
the strength of '"97;" when we did not know a thing we had 
enough "gray horse sense" to keep still, and our "gray horse sense" 
has carried us through. 

The following day we sat in the lecture room to hear our 
first lecture. The room had a sanctimonious air, and one might 
have imagined himself in a church instead of a medical lecture room. 
Strangers we were in those days and stood upon our dignity. 
The ceremony and formality which characterized the first few days 
were short-lived, however. It was not long before we knew each 
other with a painful familiarity. "Passing up" was undoubtedly 
a nice bit of civil engineering at which we were soon adept. For 
a time the professors were objects of great sanctity and reverence, 
but this, too, had to undergo transformation with the evolution 
of the class. In short, we were soon shockingly at home. 

In October of that year we held our first class meeting for 
the election of officers, with the result as follows: 

President — J. E. Luckey. 
Vice-President Sec. A — F. E. Bigelow. 
Vice-President Sec. B— G. S. Hall. 
Vice-President Sec. C — John Martin. 
Vice-President Sec. D — E. D. Whiting. 
Secretary and Treasurer — F. F. Bowman. 
Corresponding Secretary — E. F. Burton. 
Chorister — G. W. Shirk. 

A constitution was formed, presented and adopted, and has 
never been heard of since. 

Fall emerged rapidly into winter. At this time the second 
edition of the college manual, the "Pulse," was being compiled by 
the class of '96. President Luckey was authorized to appoint a 
corps of editors to represent the class of '97. In this publication 
he appointed J. E. Johnson, chairman; T. C. Crowder, F. T. Fried- 
burg and A. B. Montgomery. 

It became our painful duty in April, 1895, to call together 
the class to take action upon the death of one of our classmates. 
A. M. Semple had passed away with that quickness which reminds 
us ever of the uncertainty of things mortal. Away from home, 
friends and all the endearments of his nativity, he passed into the 
beyond. W. H. Wardle and G. S. Hamilton were delegated to 
accompany the remains to his home at Poynette, Wis., and con- 



330 The Corpuscle. 

vey to the bereaved family the resolutions and testimonials of 
regret and sympathy from his classmates at Rush. 

Our "D. J." year had slipped away and we stood at last face 
to face with the final examinations. The word "final" has a 
blood-curdling significance to the "D. J." mind, and we were no 
exception. Many a time since, however, have we begrudged those 
balmy spring days spent sweating over books, and hours of repose 
lost or distorted by painful images of "flunks." But soon all was 
over and we scattered in as many directions for the summer months. 

The middle year opened auspiciously — this year reputed to 
be the crucial one of the course. The sense that we were no longer 
"D. J." rested heavily upon our shoulders — evidenced by the con- 
descending, patronizing glances impartially bestowed upon the 
Freshmen. "D. J.'s" no more, every vestige of our former state 
had disappeared save one — our reputation, that hardest of all things 
to shake, that easiest of all things to lose. "The largest and rough- 
est class that ever graced the benches;" so read our pedigree. 
We were deemed an unwieldy mob, impulsive, irresponsible, un- 
moved by reason or eloquence, stolid and emotionless as the Ameri- 
can aborigine. What we said "went" with Seniors and "D. J." 
alike, and for a while we thought what we said "went" with the 
faculty. We passed up before, during and after lectures; broke 
seats and windows at our pleasure, and as recreation ejected ob- 
noxious personages from our lectures. This was the class of '97 
in her middle year. 

In October we held the annual class election. Mr. M. R. 
Stewart was elected President; Fred. Barrett, C. E. Judd, A. H. 
McCreight and N. M. Whitehill, Vice-Presidents of their respective 
sections. 

Secretary and Treasurer — G. L. McDermott. 

Corresponding Secretary — T. A. Kreuser. 

Chorister — F. F. Bowman. 

It being customary for the Middle Class to publish the 
annual, the matter came up early in the session. The preceding 
spring we had elected an editorial board who should have the 
publication in charge. We were waited upon, however, by mem- 
bers of the Senior Class and informed that the "Pulse" of the 
preceding year had not been a success financially; that they still 
had a large number of copies on hand, subscribed for, to be sure, 
but unredeemed, which circumstance was directly accountable for 
the existing shortage. In accordance with our proverbial mag- 
nanimity we decided, therefore, not to put a "Pulse" upon 
the market that year, thus giving them an opportunity to dispose 



Class History. 331 

of their stock and relieve their financial embarrassment, which they 
eventually did. 

This bit of philanthropy was not sufficient to redeem 97 in 
the eyes of our worthy faculty. Like Banquo's ghost, "we would 
not down," and patience at length ceased to be a virtue. An edict 
went forth, "Passing up and all disorderly conduct must be stopped." 
Thus spoke the "powers that be." Adventuresome ever, we de- 
termined to test the validity of this new principle in our medical 
world. Being no respecter of persons, we tackled everything in 
sight. Seniors and "D. J." alike were hurried over the benches 
with more celerity than gentleness. We awaited the result. It 
came in the form of a suspension of two of our classmen. Thus 
was initiated a conflict noted more for the anarchistic sentiments 
expressed and newspaper notoriety acquired than for any good 
resulting. 

Both instructors and students were free in airing their opinions. 
We even received a formal introduction to ourselves in class assem- 
bled. Some extracts from our personality as depicted to us at 
that time may not be amiss. "Individually, we were gentlemen; 
collectively, a mob;" "as such we were killing certain members of 
the faculty by inches." Our conduct was breaking their hearts, 
prematurely silvering their hair and bleaching their hirsute ap- 
pendages. The rugged, ruddy and robust specimens of manhood 
who daily lectured to us w r ere surely not the victims of our mob 
violence. "Individually, we were brave enough," we were informed; 
but "collectively, moral cowards;" all of which complimentary sal- 
lies we accepted with cherubic grace. For many days sulphurous 
oratory riddled the atmosphere. We threatened to leave the school 
as a body if our classmates were not at once reinstated — more bloody 
flags, more stilettos, more oratory — at last silence. In course 
of time our classmates returned, the normal routine of work again 
obtained, and we were good the rest of the year, with "passing 
up" at a premium. 

The year wore on — fall into winter, winter into spring. Our 
time was about equally divided between the Laboratory and monthlv 
examinations. One of the faculty, I recall, was a firm believer in 
the retentive ability of the human mind — did not believe in 
"cramming" for an examination; it was no test of knowledge; 
wanted to find out how much we had "digested and absorbed" 
from his lectures and recitations, and, accordingly, "sprung" an 
examination. The result was so satisfactory that he never tried 
it again. We had digested and absorbed enough, to be sure, but 
things digested and absorbed are, as a rule, difficult of regurgitation. 



332 The Corpuscle. 

The middle year, with all its trials and calamities, came to an 
end as kind Providence had ordained. Some of us remained for 
the purpose of study and individual research, but the majority 
sped homeward, tired of microbes, medicines and microscopes. 

The present session opened on the 29th of September last. 
Most of the class reported for duty. Financial reasons, breakage 
fees, et cetera, caused some to absent themselves, but this was 
more than made up for by the fact that many of the men came back 
"double." "It is not well that man be alone" (especially in Chi- 
cago). Many from other colleges matriculated for the Senior year, 
thus giving the class of '97 the largest enrollment of any in the his- 
tory of the college. 

In October the annual official election was held, the officers 
for the Senior year being duly elected as follows: 

President — W. F. Stokes. 

Vice-President Sec. A — H. O. Caswell. 

Vice-President Sec. B — R. W. Hogeboom. 

Vice-President Sec. C — J. C. Powers. 

Vice-President Sec. D — L. W. Toles. 

Recording Secretary — C. F. Clayton. 

Corresponding Secretary — M. U. Chesire. 

Treasurer — W. G. Hatch. 

Valedictorian — W. H. Maley. 

Historian — J. E. Johnson. 

Poet— G. L. McDermott. 

Essayist — S. E. Findley. 

Chaplain — W. H. Folsom. 

Prophet — W. C. Rucker. 

Chorister — C. C. Cummings. 

Sergeant-at-Arms — W. W. Groves. 

The Executive Committee consisted of A. E. Smolt, chairman; 
Fred. Barrett, M. M. Loomis, H. G. Rheinhardt, H. W. Wardle. 

The fall witnessed the defeat of our "would-be" rival upon 
the gridiron. Verily is our cup full to overflowing. Confident and 
never dreaming of else than victory, with streamers flying and 
the cry of "5 to 1 on the P. and S." ringing in their ears, they 
came upon the field only to go down a few moments later before 
the "Sons of Rush." The class of '97 has made up the greater 
part of this year's team, as she has that of the two preceding years. 
Smolt, Barrett, Loomis, Tisdale, Ainslee and Freeman have set 
the precedent and won the first laurels for their alma mater. May 
this precedent never be clouded. Rush must stand as indisputably 
first upon the athletic field as she does in the intellectual world. 



Class History. 333 

The members of the class honored with positions on the 
editorial staff of the Corpuscle were: J. E. Luckey and E. D. 
Whiting, appointed during the Freshman year; F. C. Crowder, 
Fred. Barrett, E. L. McEwen, appointed in our Middle year. Under 
their able management the Corpuscle has appeared month by month, 
reflecting credit upon the editors and the college. 

The winter has come and gone uneventfully. Spring has 
brought, at last, to the time where we must leave the routine 
of college life and its associations. '97 has maintained the standard 
of "Old Rush" in all of the competitive examinations of the city, 
securing in the Cook County competition as many positions as 
all other medical schools combined. '97 has secured first places 
in the St. Joseph, St. Elizabeth, Alexian, Augustina and Michael 
Reese Hospitals, and now our work is done. We mourn for our 
fellow students in the loss they and the college must sustain at 
our departure. We would it were not so. The college may have 
lost considerable since our arrival, but that is not a circumstance 
to our departure. 

The routine of work has not permitted our instructors to realize 
the tremendous gap which the class of '97 fills, or to give one 
thought as to who shall occupy the places of trust and honor soon 
to be vacant. 

Who will demonstrate the dignity and beauty of the human 
form when George Sherman Watson Hamilton has turned to 
greener fields? Who, I ask of you, shall lead Futurity into the 
realm of the splint and bandage, when King John has hied him 
away? 

Who will sketch Dr. Hindes' clinic when Ayres no longer 
wields the pen? Who will demonstrate the ancient art of expectora- 
tion when Hunt returns to Oak Park? Will you not miss McKee's 
timid appeal, "A little louder, please," and Bill Nye's timely sug- 
gestions from the Perch? Think well, Mr. Faculty, ere you pen 
diplomas for these celebrities of '97. 

I have no apologies for '97. None are necessary. The force 
and snap, which have characterized it from its conception and 
christened it the roughest and most boisterous of many a year, 
are but the criterion of the energy which shall later lend shape and 
form to our professional careers. For our shortcomings we beg 
your charity; for our virtues, your appreciation. Our ambition 
shall be to gain to ourselves that highest of all appellations, that 
of the scholar and the gentleman, while our future careers shall 
be governed by that calm conservatism, yet firm determination 
embodied in our motto, "Nee temere nee timide." 



334 The Corpuscle. 

ALONG LIFE'S PATH. 

CLASS POEM, BY GEORGE LAWRENCE McDERMOTT, 

The great Architect in the beginning, 
Many long years ago, 
Took from the dust of the earth a part; 
Fashioned it well with superior art, 
Modeled it after His own kind heart, 
And was pleased that it should be so. 

Then He breathed on this work of His hand, 
And a nation took birth from His breath; 
And, behold, the human race had begun 
Treading their ways, as, one by one, 
They reach at last their setting sun, 
And sink to rest in death. 

But scarce good Father Time 

The counting of the years began, 

When there was noticed a little fleck, 

Just a microscopical speck, 

Not what could be called a defect, 

In this temple of life called Man. 

Just as a tiny seedling 
Of some vile and vicious weed, 
Cast by chance into a fair bower, 
There to grow, and hour by hour 
Usurp the strength of some fair flower, 
Till it sinks like a broken reed. 

And we find this little defect, 

This lack of resistance so-called, 

Has been handed along 

Through the world's tireless throng, 

A natural legacy to weak and to strong, 

And by it we'ere often appalled. 

But it seems that from the beginning 

Man was born to mourn. 

He starts in this life amid roses fair, 

Soon he encounters the world's trying care; 

For the roses all fade, and then, lying bare, 

He finds that proverbial thorn. 

Look at the honest farmer, 

A strong and rugged man, 

Passes two-thirds of his days in health, 

And, just as he has acquired a little wealth, 

Disease comes along with its fiendish stealth, 

And places him under its ban. 



Along Life's Path. 335 

So, as the ages rolled on, 

And the nations advanced apace, 

There arose in the minds 

Of those more refined 

The thought that they the cords might unbind 

That fettered the human race. 

For they knew, or at least they thought, 

There certainly was a cause 

For all the ills and pain of man; 

Making him weary of life's brief span; 

There must be a source from whence this began, 

According to nature's laws. 

And so they studied on, 

The knowledge of man to enhance, 

And each one added some golden thought 

(Though costing a life's study 'twere cheaply bought); 

For without this knowledge we are naught 

But helpless victims of chance. 

And the work of those fathers of old 
Was the very foundation stone 
On which was erected a monument grand, 
Destined throughout all ages to stand, 
Looked to with pride in every land 
Where the civilized banner has flown. 

For on it in letters so deep 

That time will never efface 

Are written the names and mottoes of those 

Who have triply earned that sweet repose 

That comes to the man whose life doth close 

As a benefactor of all his race. 

And we, to whom it is given 

To relieve suffering and prolong life, 

Should work like those who have gone before, 

Till time, with visage grim and hoar, 

Shall turn the last of life's pages o'er, 

And we, too, shall sink in the strife. 



THE DUTY OF THE ALUMNI TO THE COLLEGE. 

president t. c. clark's address, 
(prepared for banquet may 26, 1897). 

Fellow Alumni and Invited Guests: 

It is my pleasure and privilege to greet you on this anniver- 
sary occasion, and bid you welcome; to usher in the courses 
of the intellectual feast, which is to follow the physical which we 
have just enjoyed, and if I do not credit to my position, ascribe 
it not to lack of inclination to serve you well, but rather to my 
poor wit, which will not enable me to do it better. 

Another year has rolled around, and from North, South, East 
and West the Rush Alumnus has come on eager feet — or a free 
pass — to enjoy and assist in the exercises of Commencement 
week. 

Having been present at the latest accouchement of his alma 
mater; having seen the babe or babes, for it proved to be a mul- 
tiple birth, properly clothed in cap and gown, he is here in full 
force to-night to give a royal welcome to the latest addition to 
our number, and to grasp the hands of old-time friends and class- 
mates. 

Happy is the hour when care and labor can be thrust aside, and 
joy and laughter and kindly greetings take their place, and it is 
for this purpose that we are met here to-night. 

Not for this place and hour are the learned dissertation and 
discussion, nor even the recital of the latest achievements in our 
beloved art; but while friend greets friend and memory recalls 
the names and deeds of those whose faces we shall see no more, 
in sweet communion we may live over the days and incidents of 
"Auld Lang Syne." 

It was my first thought to refer somewhat to the past achieve- 
ments of "Old Rush," and to the noble band of teachers, who for 
over half a century have held aloft the blazing torch of scientific 
truth and inquiry, to illuminate the pathway and guide the feet 
of those who have sought her halls of learning; but reference to 
the records of preceding meetings of this Association, and to 
the publications of the students, informed me that this had been 
done, more fully and in an abler manner than I might hope to 
set them forth. 

It occurred to me, therefore, to present to you some thoughts 
with reference to the relation of the Alumni to an institution to 

336 



The Duty of the Alumni to the College. 337 

which each one is so deeply indebted, and to whose welfare, pros- 
perity and reputation every Alumnus might well be proud to feel 
that he had contributed in some slight degree. 

It has been demonstrated that the trustees and faculty have 
been fully alive to the necessity of keeping pace with the progress 
and development of professional thought and achievement, and 
the requirements of advanced legislation. 

A lengthened and broadened course of study, increased equip- 
ment, a portion of which will ever stand as a memorial of the un- 
selfish devotion of the teaching faculty, a general movement all 
along the line has resulted in placing Rush Medical College in 
the very fore front of the exponents of advanced medical education 
in this country, commanding the respect and recognition of sim- 
ilar institutions abroad, and, of necessity, in graduating this year 
the best class that ever left her halls. 

This latter statement you have heard before, and I have heard 
it intimated that it is a stock phrase used to tickle the vanity of 
this class; but, fellow Alumni, when, in this age of discovery and 
scientific research, this or any other college fails to make it true, it 
has reached the high-water mark of its existence, and degeneration 
must necessarily follow. 

So long as "Old Rush" is dominated by the spirit which has 
characterized her past, so long may this be truthfully said of each 
succeeding class. 

This leads me to ask, are all the obligations on the side of 
the college? 

With the trustees and faculty ever striving to improve the 
facilities and to raise the standard of instruction, is the obligation 
and duty of the student and Alumnus discharged when the fees 
are paid, the required examination passed, and the coveted sheep- 
skin obtained? 

Does all relation between Alumnus and alma mater cease 
with the acquirement of the parchment setting forth under seal, and 
with an imposing array of signatures, that the possessor is duly 
qualified to practice the arts of medicine and surgery? 

Too often, I grant, this is the case, in so far as any apparent 
interest in the welfare of his Alma Mater is manifested by the recent 
graduate. 

The Alumni Association is unattended, its official organ un- 
subscribed for, no periodical visit made to the college to keep in 
touch with its advancing position and purposes, and to contribute 
to its success; but the late enthusiastic son disappears in the mist 
of obscurity, until, perchance, from out the darkness comes some 
Macedonian cry for assistance or counsel. 



338 The Corpuscle. 

It is a fact that the standing of a physician in the community 
in which he elects to practice his profession is largely determined 
by the character and prestige of the college from which he gradu- 
ates, and to hold the diploma of a recognized first-class college 
is the passport to many a desirable professional and official position. 

Frequently I have been told by agents of the leading insurance 
companies of this country that their companies are always pleased 
to secure graduates of Rush as medical examiners. 

In the Northwest, to be a graduate of Rush is almost synony- 
mous with being a successful practitioner and excelling in sur- 
gery. Thus we see that the influence of our alma mater goes 
with us, and her reputation and achievements are reflected in 
our success, however poorly we may requite her. 

I do not wish to intimate that any Alumnus of this college 
fails in his respect and love for her, for I firmly believe that no 
medical college in this country possesses in a fuller degree the 
love and admiration of its Alumni, for its historic past, and for 
the noble men who have made it great, than Rush Medical Col- 
lege. I do believe, however, that as a body the Alumni have not 
lived up to the full measure, not only of their duty, but also of 
their privilege, in striving to repay in a measure the debt which 
they owe individually and collectively to the men who have so 
faithfully and unselfishly labored to build up an institution which 
should endow them with, and support them by, the prestige of a 
great name. 

However, much has been accomplished in the last few years. 

Under the faithful and enthusiastic labors of the present effi- 
cient Secretary and his co-laborers, this Association has been largely 
increased in membership and in interest. 

The movements instituted among the undergraduates looking 
toward a closer union and a more intimate association and ac- 
quaintance during their college life give promise of a deeper and 
more active interest in the welfare of the college by the Alumni 
of the future. 

It is a trite saying that "in union there is strength," but it 
is one worthy of the serious consideration of this Association. 

The Alumni of Rush Medical College are possessed of the 
elements of strength, power and reputation which, if focused upon 
the common purpose of advancing the interests of the college, can 
be made to materially aid in the efforts of the trustees and faculty 
to make her the foremost medical college of the country. 

Every Alumnus of the college should become a member of 
this Association and attend its meetings as frequently as possible. 



Unveiling Portrait of the Late William B. Ogden. 339 

Every graduate should contribute to the support of the Corpuscle, 
a periodical which is not only creditable to the undergraduates 
who edit it, but to the medical profession as well. 

The students that we take into our offices to prepare for 
Rush should be selected with reference to the advanced standard 
of educational requirements. 

As suggested in the Corpuscle, a medical library might be 
established through the contributions of the Alumni. 

The sacrifices of the faculty in providing a splendidly equipped 
laboratory, through their personal contributions, might be emu- 
lated by the Alumni, by endowing a fellowship for the purpose 
of original investigation; and last, but not least, it is to be hoped 
that Providence may smile so bountifully upon us that some of 
our number may be moved to endow our beloved mater with 
some of our worldly goods, so that the good which we would 
do shall live after us, through her efforts. 

I fear, fellow Alumni, that to you, especially, who have just 
finished with quiz, lecture and examination, these observations 
may have proved tiresome, but it is upon you particularly, as 
you stand upon the threshold of your career, that I wish to im- 
press forcibly the fact that the success which you are so ardently 
looking forward to in your professional career, if attained, must 
come through the training received at your alma mater, and the 
prestige of her achievements and name, and to her are due the 
love, devotion and sacrifice of a true son to a true mother. 



THE UNVEILING OF THE PORTRAIT OF THE LATE 
WILLIAM B. OGDEN. 

BY PRESIDENT E. L. HOLMES. 

Mr. President, Members of the Class of 1897, Ladies and Gentlemen: 
I wish to read the following communication: 
"The accompanying portrait of the late William B. Ogden 
is presented to the President and trustees of Rush Medical College 
in loving memory of Mr. Ogden, by a member of his family. 
Chicago, April, 1897." 

For the trustees and faculty of Rush Medical College it is 
my duty to express to the donor sincere thanks for this lifelike 
portrait of a remarkable man. Were it not for the fact that the 
ceremony of unveiling this portrait had been placed in the 
order of exercises of this your class day, I believe scarcely a mem- 



340 The Corpuscle. 

ber of the class of 1897 could inform us who Mr. Ogden was, or 
why his portrait should have a place in this hall. 

Mr. Ogden was one of the incorporators of this college; the 
first President of its Board of Trustees (from 1843 to 1872), and 
the first Mayor of the City of Chicago. He came here in 1835, 
when there was a population of only 1,500. The place in many 
portions was a veritable swamp. (There was not a single rail- 
road in the State.) At first the town had no drainage and no sup- 
ply of water except what was brought in barrels from the river 
or the lake. 

With the fine qualities of industry, indomitable courage, great 
capacity for business and unbounded faith in the future greatness 
of Chicago, Mr. Ogden sought his fortune here with the spirit if 
not with the letter of your class motto — Nee temere, nee timide — 
Not rashly, not timidly. He was animated with public spirit and 
became identified with the beginning of numerous and extensive 
enterprises. In spite of obstacles and serious, though temporary, 
embarrassments, he accumulated great wealth, and happily con- 
tinued, as he ever had been, very generous and charitable. When 
I came to Chicago many years ago he was its foremost citizen. 

You know as well as I can tell you the importance of the 
qualities I have mentioned in Mr. Ogden's character. I desire 
to bring to your thought, with emphasis, two more qualities of 
utmost consequence to you as physicians. I had the fortune to 
enjoy a slight social and professional acquaintance with Mr. Og- 
den, and discovered that he was genial and affable in no ordinary 
degree. Your success will depend in no small measure on this — 
whether you will be genial with true dignity or repellent in your 
manners. 

I discovered, also, more especially through admiring friends, 
that Mr. Ogden could easily lay aside the cares and perplexities 
of business and place himself on the plane of little children. He 
seemed ever to possess the heartfelt desire to make children happy. 
It is no trivial thing, let me tell you, for a physician to keep 
near his heart the desire to add to the happiness of any child 
that may come within his influence. 

Gentlemen, imitate Mr. Ogden in these good qualities. You 
will thereby smooth in a degree your path to success, and will 
ever be thankful for this simple ceremony in the exercises of your 
class day. 



The Corpuscle. 



EDITORS. 

A. F. STEVENSON, Jr., A. B., Editor-in-Chief, 

535 Washington Boul., Chicago. 

F. E. PIERCE, B. S., Secy, and Treas. 
P. SEDGWICK, B. S. N. W. JUDD, A. B. P. A. WAKEFIELD 



Communications relative to advertisements and subscriptions ($1.00 yearly to 
undergraduates) should be addressed to the publisher. Remittances should be made 
by money order, draft or registered letter, payable to "The Corpuscle," and addressed 
to H. G. Cutler, Unity Building, Chicago. 



Ruby Red and Black: Colors of Lake Forest University. Orange: Color of Rush 

Medical College. 



RETIRING EDITORS. 

The retirement of Drs. T. R. Crowder and E. L. McEwen 
from the Corpuscle board leaves a gap in its ranks which is greatly 
felt by those who remain. The Corpuscle, like all enterprises 
during the past few years, has suffered from the effects of the 
hard times. Largely, however, through the devotion and labor 
of these two men, the Corpuscle has weathered the storm, and 
now seems to be entering upon a new career even brighter 
than the past. The knowledge of this is their only recompense. 

The board feels that it has secured two very capable new men 
to help carry on the good work, and takes great pleasure in an- 
nouncing as successful candidates for the editorial staff Messrs. 
N. W. Judd and P. A. Wakefield, both of the class of '99. 

We beg your good will and leniency until we shall have 
worked into the harness and learned to pull together, and your 
cooperation, that the Corpuscle may be a fit representative of 
both the college and the Alumni Association. 

OMISSIONS. 

We regret exceedingly that, through lack of space, much will 
have to be left out that should be put into this number, viz., half- 
tones of the retiring editors, and of Dr. C. T. Lesan's "autograph" 
chair; also a report of Dr. B rower's clinic at Dunning; of Dr. 

341 



342 The Corpuscle. 

Ingall's lecture to the Senior Class, etc., all of which will be printed 
at the first opportunity. It is particularly to be regretted that the 
Doctorate Sermon by President Eaton of Beloit cannot be ob- 
tained. We append Mr. Eaton's letter: 

My Dear Sir: — I regret to say that my doctorate address 
exists only in the form of notes, which could not be used by anyone 
but myself, and which I can hardly command the time to reduce 
into form suitable for printing. I greatly enjoyed sharing the 
exercises of the college, and was much interested in what I saw 
of the dignity and strength of the personality of both faculty and 
graduating class. 

Very sincerely yours, 

Edward D. Eaton. 

CLASS DAY NUMBER. 

The request of a number of the graduating class set into 
action a half formulated scheme of the board to make the June 
issue a class day number, and in it to publish a few of the more 
serious efforts of their elected representatives. At certain of the 
Eastern colleges it is customary to have all the class day speeches 
collected together in pamphlet form and a copy sent to each mem- 
ber of the class by the class Secretary. It makes a very pleasing 
souvenir and one which furnishes much pleasure in later years. 
In lieu of such a custom in Rush and such a close class organization 
we offer this June number of the Corpuscle as a very humble 
substitute, and only hope that in years to come it may serve to 
recall to some of the "Great, the Only Class, the 'Class of '97,' " a 
few pleasant memories of the joyous, boisterous years spent at 
"Old Rush." 

FACULTY AND ALUMNI BANQUET. 

The "Joint Banquet of the Faculty and Alumni of Rush Med- 
ical College," was a great success, some five hundred doctors assist- 
ing in the clearing off of the festive board. The banquet hall of 
the Auditorium Hotel was filled to overflowing and all seemed to 
be having a good time. After the reception in the parlors all, by 
a rising vote, adjourned to the banquet hall, where the usual order 
prevailed. 

In the absence of President Clark at a meeting of military 
surgeons at Columbus, Vice-President BoufBeur presided and acted 
as toastmaster. In his opening remarks Dr. Bouffieur spoke of 
the close relations between the Alumnus and his alma mater. Each 
has responsibilities and duties toward the other. It is for the alma 
mater to keep Rush abreast of the times and in the front rank of 



Editorials. 343 

medical colleges. The Alumnus should keep alive his interest in 
his alma mater; should return to the banquets; should aid it by 
word and deed. Rush is proud of her Alumni, for they number 
in the thousands and are scattered everywhere throughout America. 
They can be found in nearly every town. 

Dr. Bouffleur spoke, also, of Mother Rush's decidedly multiple 
gestation this year, her largest and latest litter — two hundred and 
sixty — delivered in a live state, and all seemed already able to take 
care of themselves. The young graduate, he concluded, reminded 
him more of a new-born prairie chicken than a human infant, for 
he could not remain helpless, but is immediately thrown upon his 
own resources. 

The toast of E. F. Burton, M. D., '97, "Neonanti," was char- 
acterized by the usual point and vein of humor peculiar to Dr. B. 
He spoke of the large number in Mother Rush's class of 1897, call- 
ing forth repeated applause. His apt references to the "slight 
mortality;" Miss R.'s characterization of the class as "the biggest, 
brightest and meanest class that ever entered Rush;" Dr. H.'s 
prescription of mercurial ointment for the soles of a foot long since 
amputated; Prof. S.'s offer to Greece in retreat; the ovary that 
was not removed in Dr. E.'s clinic, and the "one per cent, a 
month" charged by Mother Rush, simply for the privilege of look- 
ing after the finances of '97, were presented in so apropos a man- 
ner that no offense could be taken, though the truths went straight 
home. Among other things, he said, "Every man may be said 
to be born twice, once when he comes into the world an infant, 
and again when he is born into his life profession. This latter 
birth is his own choosing. We of '97 chose Rush as our second 
mother, and in her bosom, for three years, we have been nour- 
ished, until to-day we go forth her child, in truth and name. Her 
care we will constantly bear in memory, and, ever remembering 
the lessons she has taught us, stand for progress and advance. 
We will soon come to our majority. Some of us may come to 
greatness, but many of us will have only common experiences. 
Let us impart to young men who in later years shall stand where 
we do to-day our experience, and be true preceptors to them. 
Than to-day, there shall then come a prouder day, when we see 
the boy whom we have trained and guided through our alma mater 
where we now stand. In no way can we do ourselves more honor, 
nor the profession greater service." 

The Rev. Jas. G. K. McClure responded to the toast, "Pro- 
fessional Fraternity." 

He expressed great pleasure in being present and being able 



344 The Corpuscle. 

to meet with those who had done so much for the medical pro- 
fession, and who would do so much in the future. 

A few of the many good points of the toast were the following: 
He divided the professions into three classes: Those of Law, Medi- 
cine and Theology, though nowadays there are so many so-called pro- 
fessions, such as teaching, architecture, dentistry, music, etc., mak- 
ing a total of sixteen. Of all the classes the teachers number the 
most; second comes medicine, third law, and fourth theology. 

Medicine has stood for all that is noble and good from the 
time of Hippocrates down to the present day. He said that the 
so-called three professions have a fraternal relation which began 
with Moses. They depend on one another. The lawyer and the 
theologian need the doctor, and vice versa. He wished, how- 
ever, that the medical profession would take the ministers' views 
as graciously as members of the law and theology were accustomed 
to accept the views of the physician. The great quesion was, could 
the relation be sustained? Endowed colleges for each were neces- 
sary. 

We should always value a full mind — the large mind which 
is able to comprehend and make full analyses. All truth is one 
truth, and may all who go out aim to have a full mind. He hoped 
that every man present might magnify his profession in some way, 
and held, as a great success, those who would find and consider 
material and out of it force their way to the front. Men should 
look upon their lives as a service to humanity. 

He concluded by wishing that the professional fraternity might 
ever continue, and that hand to hand and heart to heart they 
might continue to do good work, and to finally grasp hands in 
that place where love is the fulfilling of the law. 

Judge T. A. Moran could not be present. His toast, "The 
Medical Profession from a Lawyer's Standpoint," was ably re- 
sponded to by Judge R. S. Tuthill. The medical profession, he 
said, he considered one of the noblest that fell to man ? s lot. The 
destruction of pain, the saving of life, the care and consideration 
of everyone except himself, called for an immense amount of 
power, of labor and endurance upon the part of the physician. 
Money compensation could not adequately repay him for his serv- 
ices, but his greatest reward must rest in the consciousness of a 
duty nobly discharged. 

Law and medicine often meet in court, and there law often 
has to blush for medicine. Someone, he added, has said that there 
are three kinds of lies — the ordinary lie, the damned lie, and the 
medical expert. This last, he said, is a disgrace to the profession. 



Editorials. 34o 

The fault, however, lies in the fact that the laws on expert tes- 
timony are not well enough denned. The expert should be just 
as independent as the judge himself. His fee should be liberal 
and as certain as the judge's, and should be entirely independent 
of the nature of the testimony given. In conclusion, he said: 
"Gentlemen, make it your duty to see that in the future the pro- 
fession is not thus lowered in the esteem of the people." 

In response to the toast, "The Faculty," Prof. J. M. Dodson 
expressed the profound appreciation of the faculty to the Alumni 
in their loyalty to the college by coming back each year and mak- 
ing the Commencement such a success. An institution, especially 
one which is not endowed, depends for strength upon its Alumni. 
He spoke of the great changes which have been made in med- 
ical education, of the increasing demands for special courses and 
original research work, and of the need of a new building to 
meet them. Larger hospital facilities are also needed, all of 
which means more money. Such an institution should be endowed. 
The needs of to-day require more than the student can afford 
to pay, and he hoped that some of those who were blessed with 
all the world's needs would recognize the importance of the needed 
support. 

Two suggestions were offered by which the Alumni and college 
might be brought into a closer relationship: 

i. That in the near future the Alumni Association as a body 
might be represented in the Board of Trustees, which would tend 
to draw the two bodies closer together. 

2. That the Alumni Association should establish a fellow- 
ship, and thus furnish a means for carrying on original research 
in some special line. 

"Old Rush in Sixty-eight" was responded to by one of the 
class of '68, F. C. Henrotin, M. D., who drew an interesting word 
picture of the vicissitudes of the early days of Rush and the later 
and more prosperous years, during which the last members of the 
faculty of 1868 have retired. The last lecture of Dr. Brainard, 
the work of Prof. Fox, the more recent death of Dr. Parks, and 
other references to men known and loved by the older classes, were 
appropriately touched upon as instancing the peculiarly aggressive 
spirit of the Rush faculty then and to-day — the spirit of determina- 
tion to win. 

The last toast of the evening, "Some Family Physicians," was 
given by President Edward Dwight Eaton, of Beloit College. His 
was a plea for the old family physician. Amidst the great tendency 
toward specializing of the present day, there seems to be great dan- 



346 The Corpuscle. 

ger of losing him. He contrasted the stern doctor with cold, Grecian 
features, who comes into the patient's room, examines the patient 
and always seems to reach the same conclusion — patient is bilious 
and needs calomel — with the true family physician. The one with 
gentle, kindly ways, who is a member of the family, and who, in 
righting with death, would risk his own life. How loved. How 
respected. Long may it be before the type of "Family Physician" 
disappears. 

Dr. Vaughn, of the graduating class, entertained the guests 
with several whistling solos during the evening. His rendering of 
"Listen to the Mocking Bird" was especially enthusiastically re- 
ceived. 



The Corpuscle would be pleased to receive, at any time, com- 
munications from members of our Alumni or from undergraduates, 
concerning any matter which they wished to bring before the stu- 
dent body or the Alumni, or any matter which they might feel to 
be of interest to the readers of the Corpuscle. 

We will be glad to give space to all deserving communications 
of this nature. The journal is published for the Alumni and the 
students and its aim is to give them such news as will be of interest 
to them, so that any having such news will please send same to 
the Corpuscle. 



COLLEGE NOTES. 



Cards are out announcing- the marriage of "Warren David Cal- 
vin, M. D., '96, to Jessie Lorena Carrithers, M. D., on Thursday, 
June the tenth, 1897, at Toluca, 111. At home after July 1, at 57 
West Wayne Street, Ft. Wayne, Ind." As an editor of the Cor- 
puscle in '95, Dr. Calvin has already had some experience in med- 
ical enterprises. The Corpuscle extends the doctors its most hearty 
congratulations. 

The Corpuscle has also received the announcement of the mar- 
riage of Dr. Chas. F. Clayton, '97, to Miss Annie M. Weller, Tues- 
day, June 1. The bridal couple will be "At Home" Wednesdays 
in June, at 4145 Central street, Rogers Park, 111. It sends them its 
best wishes. 

His friends were very pleased to see Dr. Le Count again able 
to be about the Laboratory. Dr. Le Count has been suffering with 
a severely sprained knee, which threatened to lay him off for sev- 
eral months. His splendid physical condition, however, allowed 
him to recover in the exceptionally short time of two weeks. 

Drs. C. J. Habhegger, E. F. Burton and T. R. Crowder, Rush's 
representatives in the first six at the Cook County Hospital, have 
started in on their work and are rooming together. 

Dr. E. D. Whiting, '97, has been obliged to lay off from his 
duties at the Presbyterian Hospital for a few days, on account of a 
bad attack of pleurisy. 

The following recent graduates of '97 are studying here this 
summer and expect to spend another year at Rush in study and 
review: Drs. P. E. Somers, T. A. Page, H. Klein, and the "Fellows," 
Drs. E. L. McEwen and J. W. Ellis. 

G. W. Shirk, '97, and J. G. Meachem competed for interneships 
at the Chicago Polyclinic Hospital and were successful. 

H. J. Brugge has taken charge of a doctor's practice out West 
for six months, until his term at the Cook County Hospital shall 
begin. 

L. F. Schmauss has charge of a doctor's practice in this city, 
waiting for his interneship at the "County" to begin. 

H. T. Craigin, '99, is working in a hospital at Butte, Mont., dur- 
ing the summer. 

Prof. A. C. Cotton left for Europe, Saturday, May 5, on the 
Holland-American line. On his way east he stopped at Philadel- 

347 



348 * The Corpuscle. 

phia to attend the meeting of the American Medical Association 
and also to read a paper before it on "Milk Analysis." While abroad 
he will read several papers; one at the International Congress of 
Medicine at Moscow, on "The Egg as a Food for Infants;" another 
before L'Academie d' Hygiene in Paris, on "The Dressing of 
Infants." The rest of his time Prof. Cotton will spend principally 
in Berlin and Vienna. He returns about the last of September, 
stopping at London on his way home. 

The following graduates from out of the city participated in 
the annual reception and banquet: 

P. J. Creel, '93, Angola, Ind. 

W. A. Chamberlain, '82, St. Charles, Minn. 

J. Muncey, '63, Jesup, Iowa. 

E. B. McAllister, '94, Terre Haute, Ind. 
C. L. Wendt, '95, Canton, S. D. 

F. R. Warren, '96, Otis, Md. 

E. A. Minnick, '95, Bradford, 111. 
T. P. Stanton, '79, Chariton, Iowa. 
J. F. Gsell, '95, Richmond, Kan. 
E. J. Cole, '89, Woodbine, Iowa. 
J. Masswan, '67, Austin, 111. 
W. R. Patton, '62, Charleston, 111. 

0. E. Youngquist, '92, Escanaba, Mich. 
J. R. Barnett, '66, Neenah, Wis. 

J. M. Finney, '94, Clintonville, Wis. 

C. M. Dolph, '88, Pleasant Lake, Ind. 

M. Collins, '91, Oxford, Sumner Co., Kan. 

B. S. Hunt, '94, Winchester, Ind. 
T. C. Clark, '81, Stillwater, Minn. 
J. E. Porter, '95, Shannon, 111. 

L. J. Daniells, '96, Milwaukee, Wis. 

J. P. Doolittle, '88, 664 First street, Independence, Iowa. 

1. B. Washburn, '61, Rensselaer, Ind. 
J. P. Goddard, '88, Austin, 111. 

H. A. Winter, '73, Saybrook, 111. 

W. F. Burres, '82, Sidney, 111. 

J. N. Rutledge, '86, Elgin, 111. 

J. E. Brock, '90, Coal City, 111. 

E. M. Anderson, '95, Stoughton, Wis. 

C. E. Albright, ^y, Milwaukee, Wis., New Insurance building. 
J. E. Cox, '96, Belle Plaine, la. 

H. N. McKenzie, '74, Elwood, la. 
P. R. Fox, '90, Madison, Wis. 



College Notes. 349 

J. M. Carney, '79, Milwaukee, Wis. 
F. J. Perry, '92, Ft. Atkinson, Wis. 
J. J. Bonon, '96, Elgin, 111. 
F. E. Shagkett, 94, Brannon, Wis. 
F. M. Elliott, '69, Aurora, 111. 

C. E. Hemingway, '96, Oak Park, 111. 
J. J. Pattee, '95, South Bend, Ind. 

O. P. McNair, '92, Batavia, 111. 
R. M. Malster, '94, Omaha, Neb. 
J.L. Gardner, '83, Steward, 111. 
Guido Ranniger, '90, Naperville, 111. 

D. H. Bowen, '76, Waukon, la. 
J. L. Fleck, '95, Brodhead, Wis. 
H. B. Beegle, '96, Blue Island, 111. 
T. N. Bone, ? 66, Loda, 111. 

C. R. Galloway, '92, Libertyville, 111. 

S. B. Sims, '84, Frankfort, Md. 

R. E. Gray, '96, Garden City, Kan. 

T. Sprague, Sheffield, 111. 

J. L. Taylor, '94, Libertyville, 111. 

U. T. Green, '80, Albion, Ind. 

U. C. Snodgrass, '96, Kenton, Ohio. 

E. N. Clark, '71, Grinnell, la. 

E. D. Howland, Lockport, 111. 

F. J. O'Shay, '89, Braidwood, 111. 
Wm. Kennedy, '81, Leland, 111. 
H. A. Linser, '95, Roanoke, 111. 
F. W. Wilcox, '86, Minonk, 111. 
E. A. Fox, '95, Brooklyn, Wis. 

T. Fitzgibbon, '82, Milwaukee, Wis. 
L. Thexton, '91, Aurora, 111. 
C F. Moore, '88, Shabbona, 111. 
J. S. Kauffman, '75, Blue Island, 111. 
W. D. Brodie, '96, Union Mills, Ind. 

The new catalogue, the 55th Annual Announcement, contains 
the names of 699 students. The following is a synopsis of the 
degrees held: M. D., 72; A. B., 23; B. S., 18; Ph. G., 15; Ph. B., 6; 
B. L., 2; V. S., 2; D. D. S, 2; A. M, 1. 



350 The Corpuscle. 

Student Meyer: — I — I — I would limp also. — "Fliegende Blat- 
ter." 

An Opportunity. — Twin Bridges, Mont., June 5, 1897. 
To the Dean of Rush Medical College, Chicago: 

Dear Doctor: — I am an old physician of thirty-five years' prac- 
tice, and have arrived at that age when old men need rest and quiet, 
and I am in search of a young physician to take my place. I 
want one thoroughly competent, of good moral character, and one 
that will be able to pass examination before our State Medical 
Board, which meets in October and April of each year. Would 
turn over my practice to him or would pay him reasonable wages 
for the first year, provided I got a man to suit. Would like him 
to come, if possible, by the first or twentieth of July. If you know 
of such a man, will you put me in correspondence with him, and 
greatly oblige, 

Yours fraternally, 

D. W. Pease, M. D. 






rllumni Department. 

JAMES B. HERRICK, A. B., M, D., Editor. 



Membership in the Alumni Association of Rush Medical College is obtainable 
at any time by graduates of the College, providing they are in good standing in the 
profession, and shall pay the annual dues, $1.50. This fee includes a subscription to 
The Corpuscle for the current year. This journal is the official organ of the Association. 

Dues and all communications relating to the Association should be sent to 

JOHN EDWIN RHODES, M. D., Sec'y and Treas., 34 Washington St., Chicago 



NOTICE TO THE ALUMNI, 



Your subscription to The Corpuscle expired with 
the May number. The present number is sent to re- 
mind you of that fact and it will be discontinued here- 
after. Those who have not paid their dues for the 
present year are requested to send the amount, One 
Dollar and Fifty Cents (see proceedings of Alumni 
meeting in another column), as soon as possible, to the 
Secretary. Upon your prompt attention to this matter 
will depend, in large measure, the prosperity of The 
Corpuscle. 

We all appreciate our journal and we must not 
allow its progress to be impeded in any way. We 
appeal, therefore, to your loyalty to it and our alma 
mater for your hearty co-operation. 

We sincerely trust that old subscribers will not 
allow their names to drop from our list and the Asso- 
ciation. The three numbers following cannot be passed 
over by those who wish to remain in touch with old 
and sturdy Rush and her graduates scattered over the 
world. A special effort is now being made to make 
the Alumni Department of The Corpuscle more com- 
plete than ever. 

Kindly send in your fees at once that your sub- 
scription year may conform to the college year — June 
to May inclusive. 

JOHN EDWIN RHODES, 
34 Washington St. Secretary and Treasurer. 

35i 



352 The Corpuscle. 

THE ANNUAL MEETING OF THE ALUMNI ASSOCIATION OF RUSH 
MEDICAL COLLEGE, MAY 26, 1897, AT IO O'CLOCK. 

The meeting was called to order by First Vice-President Dr. 
A. I. Bouffleur. The minutes of last meeting were read and ap- 
proved. The report of the Secretary and Treasurer was then read 
by Dr. Rhodes, was received and ordered placed on file. Dr. 
John M. Dodson then read the report on Necrology. 

A motion was made, and carried by a rising vote, that a com- 
mittee be appointed to draw suitable resolutions with reference 
to the death of Mr. Frank J. Gould, clerk of the college. Drs. 
Westcott, Sippy and Washburn were appointed on such committee. 
A motion was made and carried that these resolutions, when pre- 
pared, be suitably engrossed and presented to the family of Mr. 
Gould. 

The following named gentlemen were appointed a committee 
for the nomination of officers for the ensuing year: 
Dr. Reynolds, '51. Dr. Dodson, '82. 

Dr. Washburn, '61. Dr. Wescott, '83. 

Dr. Munsey, '63. Dr. Evans, '86. 

Dr. E. N. Bone, '65. Dr. Noble, '90. 

Dr. Henrotin, '68. Dr. Parker, '91. 

Dr. T. Sprague, '70. Dr. Glaser, '92. 

Dr. E. W. Clark, '71. Dr. Ullerick, '93. 

Dr. Jacob May, '76. Dr. Fleck, '95. 

Dr. W. T. Green, '80. Dr. Rogers, '96. 

The committee reported the following list of officers, who, on 
motion, were elected: 

President, J. R. Barnett, '68, Neenah, Wis. 

First Vice-President, S. G. West, '90, Chicago. 

Second Vice-President,W. T. Green, '80, Albion, Mich. 

Secretary and Treasurer, John Edwin Rhodes, '86, Chicago. 

Necrologist, C. A. Ullerick, '93, Chicago. 

Alumni Editor, James B. Herrick, '88, Chicago. 

Subsequently, the following gentlemen were appointed the 
Executive Committee by the President: Dr. Bouffleur, Chairman, 
C. D. Wescott and John Edwin Rhodes. 

It was moved and carried that the class of 1897 be elected 
to membership and entitled to same on payment of annual dues. 

The following amendment to the by-laws was adopted: "The 
dues of the Association shall be one dollar and fifty cents per 
annum." 

Dr. Dodson remarked informally that he would like to see 



Alumni Department. 353 

the Alumni brought into closer alliance with the college by an 
an election of an Alumnus to the Board of Trustees ; also that 
sometime in the future a fellowship be established by the Alumni 
which would yield the sum of about $400 per annum. 

On motion the meeting of the Association adjourned. 

RESOLUTIONS IN MEMORY OF MR. GOULD. 

At the annual meeting of the Alumni Association of Rush 
Medical College, the following resolutions relative to the death 
of Frank Jordon Gould were unanimously adopted: 

Whereas, It has pleased the Great Architect of the Universe 
to remove by death Frank Jordon Gould, clerk of Rush Medical 
College; therefore, be it 

Resolved, That we, the members of the Alumni Association 
of Rush Medical College, do hereby acknowledge his many acts 
of kindness and express our appreciation of his personal integrity, 
that earned for him the high esteem in which he was universally 
held by the students and Alumni of the college. 

Resolved, That we tender to his family our deepest sym- 
pathy in their affliction. 

Resolved, That these resolutions be published in the Cor- 
puscle and a copy of them be transmitted to the family of the 
deceased as a token of our respect for him. 

C. D. Wescott, \ 

Bertram W. Sippy, > Committee. 

I. B. Washburn, ) 

for old-time students. 
Old students of '47 and '48 will be glad to read the following: 
Stevens Point, Wis., May 22, 1897. 
John E. Rhodes, M. D., Chicago, 111.: 

Dear Sir: — My daughter answered your card of invitation to 
the banquet of the Alumni of "Old Rush." I now write to send 
regrets that I will not be able to be with you. I first attended 
lectures at Rush in 1847-48. At this time the matchless Brainard 
was at the head of the school. His lectures were classical, the 
right word was always at hand, and never an extra word. No 
student failed to give the closest attention during his lectures. In 
those old times, fifty years ago, long before the microscope had 
revealed the wonders of the infinitesimal world, he impressed on 
the student with great earnestness the necessity of absolute clean- 
liness in all surgical proceedings. 
Sincerely yours, 

John Phillips. 



354 The Corpuscle. 

WHY DR. MURPHY DIDN'T COME. 

The following letters from Dr. T. C. Murphy, '68, with the 
newspaper clipping, are self-explanatory. We trust the doctor has 
fully recovered. 

Manito, 111., May 12, 1897. 
John E. Rhodes, M. D., Chicago, 111. 

Dear Doctor: — Please send me a program. I cannot find 
the one sent me some time ago. Now I am between two fires. 
I want to attend the state meeting and also our Alumni meeting, 
but I don't see how I can attend both. So I think I had better 
show my loyalty to Grand Old Rush (copyright applied for) first — 
don't you? It is my opinion now that you will see me at Prof. 
Lyman's clinic about 9:45 a. m., Monday. 
I am very truly yours, 

. T. C. Murphy, 1868. 

Manito, 111., May 22, 1897. 
Dr. John Edwin Rhodes, Chicago, 111. 

Dear Doctor: — I regret that I will not be able to leave home, 
I am about the sorest doctor in the state just now. 

Yours truly, 

(Per Maggie) T. C. Murphy, M. D. 

From the Manito Register: "Dr. Murphy had quite a disas- 
trous runaway this (Thursday) morning. When passing the resi- 
dence of D. P. Black, the horse became frightened, tipped the 
buggy over, throwing the doctor and Harry out, and bruising them 
considerably. The buggy was completely demoralized." 

Born: A son, to Dr. and Mrs. W. L. Thompson, Bayard, Iowa, 
May 23, 1897. 

'86 — Dr. Chas. W. Fisk is located at Downs, Okla., and w r rites: 
"I am glad to know that old Rush is still ahead and likely to re- 
main so." 

'88 — Dr. E. J. Harvard is attending to a thriving practice at 
Corydon, Iowa. 

J. H. Gregory, '96, is at Cave in Rock, 111. With his brother, 
also a graduate of Rush, he is securing his share of the practice in 
that neighborhood. 

W. H. Lewis, '95, made a brief call on us the other day. He 
is pleasantly located and has no complaint to make as regards 
business. 

Arthur M. Dwight, '96, is at Salt Lake City, Utah, holding an 
interneship in St. Mark's Hospital, a well-equipped and modern 
institution. ' ! 



Alumni Department. 355 

L. D. Ray, ^7, of Blakesburg, Iowa, was prevented from being 
present during Commencement week by the serious illness of his 
wife. He writes: "Remember me to my classmates of 1886-87, and 
tell them I am still in the swim." 

Dr. A. L. Craig, who was to have read a paper on Luschka's 
tonsil at the Alumni meeting, was prevented from so doing by 
important and critical cases. The paper will appear in our next 
issue. 

The following clipping is from the Wheeling (W. Va.) Reg- 
ister. Dr. Hissom, of '96, has been doing unusually well, and is 
planning to spend some years abroad, with the purpose of taking 
a degree in medicine from a German University: 

Dr. Hissom, of the Island, one of our youngest physicians, 
faced four prominent physicians of the city on the witness stand 
and proved that he understands his business. The case was tried 
before Squire Thompson Thursday afternoon, and medical terms 
filled the air and kept the attorneys on both sides guessing how 
to remember such words long enough for cross-examination. Dr. 
Hissom sued a Mr. Wilson for a bill for professional services. Mr. 
Wilson obtained the services of four physicians as experts, and 
tried, by their testimony, to prove that the doctor did not prescribe 
for the correct disease. The doctor took the stand and proved 
beyond a doubt that he was right and understands his profession. 
A verdict was returned for the full amount. Attorneys Mabon and 
McLaughlin represented the plaintiff. 



OUR EXCHANGE TABLE. 

Minneapolis is having an epidemic of typhoid fever. The 
health commissioner claims that many of the cases are only grippe 
simulating typhoid. 

The Woman's Medical College of the New York Infirmary 
has received two legacies of $25,000 and $30,000 toward a fund for 
securing them a $250,000 college building. 

Dr. Ira Van Gieson, of the Pathological Laboratory of the 
New York State Hospital for the Insane, is advocating the doc- 
trine that insanity is due to toxic substances in the cerebral circu- 
lation. 

Philadelphia doctors are thought by some politicians of that 
city to be hypercritical because they object to the building of a 
new hospital in a swamp estimated to be worth $80,000, but for 
which $200,000 is asked. 

The coming meeting of the British Medical Association at 
Montreal, from August 30 to September 4, promises to be an enjoy- 
able affair to all who attend. American physicians must not for- 
get that it is, however, a family affair, in which we of the States are 
to take no active part. More than a hint to this effect has already 
been given. A few prominent medical men from our country are 
to be invited guests, but all others are expected to keep away. 
One of the public addresses will be made by a Parisian doctor 
as a compliment to the French-Canadians. The membership of the 
association is said to be 19,000. — American Medico-Surgical Bul- 
letin. 

Never perform an operation without examining the urine for 
sugar, no matter what its specific gravity may be. If glycosuria 
exists antiseptic precautions should be redoubled, but the condition 
does not contraindicate necessary surgical interference. 

So impressed is the Legislature of Norway and Sweden, not 
only with the advantages but with the public duty of vaccination, 
that before a couple can be legally married certificates must be 
produced showing that both bride and groom have been satisfac- 
torily vaccinated. Perhaps it is argued that immunity from small- 
pox is hereditary! 

Dr. Whitney of Boston, according to the Boston Medical and 
Surgical Journal, says you cannot make an absolute identification, 
and say this is human blood, but you can say this is consistent 

356 



Our Exchange Table. 357 

with human blood. This is an important admission, in view of 
the evidence sometimes given respecting such marks in criminal 
cases. 

Emperor William of Germany, while on a hunting expedition, 
came across a camp of lepers that had been driven from their 
homes. On addressing the governor of the province concerning 
such cruelty, he learned that there was no law in Germany dealing 
with lepers or leprosy. The Emperor now proposes to have an 
asylum for them and to have proper laws framed for their care 
and protection. 

POISONOUS EFFECTS OF BROMIDES. 

At the annual meeting of the Association of American Physi- 
cians Dr. Weir Mitchell read a paper on this subject. It has long 
been recognized that the bromides may increase the unpleasant 
after-effects of epileptic fits, especially the irritability of tem- 
per. This will in some cases be accompanied by ptosis and 
feebleness of the limbs, not rarely more marked upon one side than 
upon the other — just like some drunkards who can recognize that 
they are distinctly "drunker in one leg than in the other" — feeble- 
ness and dullness so marked at times as to amount to partial im- 
becility. This was the condition in a girl of seventeen, whose 
father, an apothecary, on the principle, "if a little helps much will 
cure," had been giving her 150 grains of potassium bromide a 
day. The fits stopped, the child nearly did the same, lying for 
days in a state of imbecile collapse, but recovered rapidly when the 
drug was stopped. In two children, each of whom 100 grains of 
lithium bromide was given by mistake, a similar though milder 
condition developed. There were curious disturbances of memory, 
and they were quite unable to walk, the left leg being worse than 
the right. In many cases the author had seen melancholia and 
mental depression, even to suicide, produced by the continued use 
of bromides. 

SALICYLATE OF STRONTIUM. 

Clinical observations show that in doses of five grains its anti- 
septic properties are most energetic. Doses of from ten to fifteen 
grains in gouty and rheumatic subjects give the same results as 
other salicylate preparations, but its superiority lies in the fact 
that it does not interfere with the stomach ; it is therefore especially 
indicated in digestive troubles, in chronic rheumatism or gout. 

It is; interesting to note that cycling sometimes has the effect 



358 The Corpuscle. 

of reducing the weight of the fleshy person and increasing that 
of the thin one. This may be explained by Murchison's observa- 
tion that "excessive leanness, as well as excessive corpulence, is 
often caused by inaction of the liver, and the stimulus of regular 
exercise, setting the function of that organ right, causes the disap- 
pearance of what was only a symptom." 



THE RED BLOOD CORPUSCLE. 

Of the red blood corpuscle Dr. W. S. Thorne, in Pacific Med- 
ical Journal, says: "The basis of microscopical research in med- 
ical jurisprudence is a very minute object. Its size appears to vary 
with the number of the observers, the different races from which 
it is obtained, and its size is not uniform even in the same individ- 
ual, and in certain diseases that are prevalent and common to 
the human family its size is variously modified. Prof. Gram, who 
has given much personal attention to the subject of measurement 
of the red blood corpuscle, and who has also carefully studied 
the literature of the subject, finds, according to the investigations 
of others, that the size varies, the diameter increasing in passing 
from southern to northern climes. Bizzozero gives the average 
of the Italian red blood corpuscle as 7.0 to 7.5 m.m. Malassez, 
whose measurements refer to France, states that 7.5 m.m. to 7.6 
m.m. is the average diameter. In Germany 7.8 is taken as the 
average, while Loocke, who writes of the measurements made of 
the blood corpuscles of the Norwegians, gives 8.5 m.m. as the 
average. Gram gives exact measurements in some of which the 
corpuscles measured 9.3 m.m. In young children a longer diam- 
eter and greater variation are met, some measurements reaching 
as high as 10.3 m.m. My friend, Prof. George O. Mitchell, of the 
San Francisco Microscopical Society, who has made some inter- 
esting measurements of the blood of man and of different animals, 
says that in his comparison of the blood of the same animal he 
expects a variation of 3 m.m. His average of the human cor- 
puscle is from 8.22 m.m. to 7.98. Prof. Ewell from 9.98 to 5.03. 
Prof. Treadwell of Boston, with a 1 -25-inch objective and a 
Jackson eye-piece micrometer, from 5.763 to 9.394. So we per- 
ceive that between the maximum and minimum range, even by 
the most reliable observers, there is a broad disparity of size 
which constantly varies with the observer. Nevertheless, it has 
been quite satisfactorily established that the difference in the meas- 
urement of a series of corpuscles by experts using high powers 
may not vary more than i-ioo,oooth to 1- 150,000th of an inch. 



Our Exchange Table. 359 

But it must be borne in mind that not infrequently corpuscles 
from the same blood vary in size and even in different portions of the 
same slide. This variation is a diminution or contraction, thus 
bringing- it nearer the blood of lower animals, which is an im- 
portant fact in medico-legal inquiries, so that human blood may 
thus be confounded with that of an animal having markedly smaller 
corpuscles, but never the reverse." 

The author also states that: 

"In a paper on 'Blood and Blood Stains/ by Prof. Clark Bell, 
read before the Medico-Legal Society, the consensus of opinion 
favored the following propositions: ist. That there is no great 
difficulty in distinguishing between human blood and that of birds, 
fishes and amphibia generally. 2d. That by careful and compe- 
tent observers, with instruments of high power, a reliable dis- 
crimination could be made between human blood and the blood 
of mammals, when the size of the red blood corpuscles was much 
smaller than those of man, notably the ox, the horse, the goat, 
the sheep and the pig. 3d. That the blood of the dog, the rab- 
bit and the guinea pig so nearly resembles human blood in the 
size of the red corpuscles that it was exceedingly difficult, if not 
impossible, to distinguish between them, and divided opinions upon 
this subject exist among the observers, Profs. Reese, Forman, 
Reyburn and others claiming that by the employment of high pow- 
ers up to 10,000 diameters, the difference of diameter becomes so 
great when thus magnified as to make it apparent in all mammals 
except the guinea pig, while Prof. Ewell and others deny that 
the results of their investigations are such as to make it certain 
and absolute when in doubtful cases human life is at stake. From 
a careful and unbiased examination of the present state of micro- 
scopical science, in relation to the examination of blood and blood 
stains in criminal cases, the dictum of Prof. Wormly in his mas- 
terly treatise is the most consistent and conservative, and should 
guide the judicial mind in its deliberations upon the subject, viz.: 
'That the microscope may enable us to determine with great 
certainty that a given blood is not that of a certain animal and is 
consistent with the blood of man, but in no instance does it in 
itself enable us to say that the blood is really human, or indicate 
from what particular species or animal it was obtained.' " 



360 The Corpuscle. 

THE GENERAL PRACTITIONER. 

He must not walk his rounds for fear his patients think him poor, 

And dearly do they love to see a carriage at their door; 

And if the horse is fat, "He must have little work to do," 

And if he's lean the reason is, "He starves the poor old screw." 

Should he call upon his patients every day when they are ill, 

His motive plainly is, "To raise a great big doctor's bill." 

If he visits them less frequently — thus less'ning their expense — 

The chances are he'll be accused of willful negligence. 

He must work all day and half the night and never say he's tired, 

For the public look upon him simply as a servant hired. 

And should he take a holiday, he'll find when he comes back 

Some patients have resented it by giving him "the sack." 

Concerning money, he must seem indifferent to be, 

And folks will think he practices for pure philanthropy; 

When we hear him boasting of the guineas that he earns, 

We wonder if they all appear in his income tax returns. 

About his own afflictions he must never say a word; 

The notion of a doctor being ill is so absurd! 

And when, perhaps, from overwork, he's laid upon the shelf, 

His sympathizing patients say: "Physician, heal thyself." 

— The London Lancet. 



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