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Full text of "Journal - American Medical Association"

HANDBOUND 
AT THE 



UNIVERSITY OF 
TORONTO PRESS 



V... 






y 7 




THE JOURNAL 



AMERICAN 



lEDICAL ASSOCIATION. 



CONTAINING 



THE OFFICIAL RECORD OF ITS PROCEEDINGS. 



REPORTS AND PAPERS PRESENTED IN THE SEVERAL SECTIONS. 



Edited for the Association by N. S. Davis, M. D., LL.D. 



"VoX-iTTn^E I. 



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18 8 3. ''t^^^A^ 



xo 



o- 



CHICAGO: 

Printed for the Association by A, G. Newei.i,, 
71 and 73 Randolph Street. 



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" The American Medical Association, though formally accepting and publishing^ 
the reports of the various Standing Committees (and Sections^, holds itself wholly 
irresponsible for the opinions, theories, or criticisms therein contained, except 
otherwise decided by special resolution. ' ' — Transactions, i 85 i . 



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I 



INDEX VOL. I. 



PAGE. 

Aibdominal Surgery, Cases of. 550 

Abortion, Antiseptics after 54 

Abscision, is it Proper?- 298 

Absence of the Spleen 455 

.Acute Goitre 183 

Acute Inflammation of the Lungs in Young 

Children 139 

Acute Peritonitif Following Intestinal Per- 
foration 53 

Addison's Disease 56 

Address on Obstetrics 97 

Address in State Medicine 161 

Address in Surgery and Anatomy 199 

Address of President 12 

Address on Present and Future Tendencies of 

the Profession in the United States 133 

Adhesion of Tongue to Floor of Mouth 210 

Agaricin in Night Sweats 561 

Air in Veins, Death f'om 180 

Air Passages, Foreign Bodies in 422 

Albuminuria 681 

Alcohol, Action of on Heart 307 

Alcohol as a Food, a Medicine, a Poison, and 

a Luxury. Pitzer 127 

Alcohol as a Germicide 411 

Alcohol, a Stimulant or a Paralyzant- 271 

AHmentary Canal in Bronchitis, and Phthisis 84 

Alimentation, Rectal 558 

Aliment Preserved by Salicylic Acid 536 

Allfn, D. P , Antiseptics and Non-Antiseptics 292 
Allport, W. W., Amaurosis from Dental Irri- 
tation 637 

Alum Gargles and the Teeth 215 

Amaurosis from Dental Irritation 637 

Amaurosis from Tumor in Nasal Cavity ijl 

Amenorrhoea, Conception During 622 

American Academy of Medicine 408 457 

Ameiican Dermatological Association 318 

American Uynsecological Society 310 371 

American Medical Diplomas Abroad 408 

American Public Health AssociatioH 319 515 

American Society of Microscopists 153 186 

Ammoniated Chloroform 180 

Ammoniated Mercury Peptone in Syphilis.... 428 

Amputation, Atrophy of Brain after 25 

Amputations and Hot Water 638 

Amputation in Preference to Brisement Force 325 

Anaemia, Arsenic in 178 

AnEBmia and Somnambulism 215 

Anaesthesia in Labor 104 

Anaesthetic, New 675 

Anaesthetics, Deaths from 51 

Anal Erectile Tumor 427 

Anchylosis, Amputation for 325 

Anchylosis of Femur, Operation for 87 

Andrews, E., Medical Lore of Indians 401 

Andrews, E., Restoration of Lost Cheek 20 

Andros, F., Medicine and Surgery of In- 
dians 116, 402 

Animal Rotation 647 

Annual Report of Surgeon General's Office... 625 

Anomaly of the Ureters 678 

Anthrax 336 

Anthrax and Bacteria 67 

Antimony in Skin Diseases 592 

Antiseptics 4ii 

Antiseptics After Labor 54 

Antiseptics in Obstetrics 106 

Antiseptics in Otorrhoea 18 

Antiseptics. Study of. 197 

Antiseptic Surgery 129 

Antiseptics and Non- Antiseptics in Surgery... 292 

Aortic Deficiency, the Pulse in 135 

Apnoea, Resuscitation ia 352 

Applied Anatomy 734 

Arbutin 336 

Arm Presentations 563 

Army Changes 736 

Army, Medical Museum and Library 489 

Arsenic, Diffusion Through the Body after 

Death IT4 

Arsenic in Leucaemia 178 



Arsenite of Bromine in Diabetes 27 

Articular Rheumatism 413, 415 

Ascites, Early Tapping in 289 

Ashford, F. A., Notice of 192 

Asiatic Cholera 350 

Asthma Caused by Nasal Disease 295 

Atkinson, Wm. B., Symptomatology of In- 
fants 268 

Atiee. J. L., Address as President- 12 

Atrophy of Brain after Amputation 25 

Atropine Poisoning 455 

Atwood F.. Notice of. _ 160 



Bache, B. F., Notice of......'. 

Bacilli, the 

Bacilli and Koch 

Bacillus tuberculosis 

Bacillus Tuberculosis in Anal Abscess 

Bacteria 

Baker, C J., Facial Nerve Paralysis of. 

Baldwin, J . F , Costatome in Excision of Rib 

Barker, R. D., Typhlitis 

Barney, John W., Notice of 

Bartlett, J. K., Address on Obstetics 

Battey's Operation „.. 

Bead -Swallowing _ 

Beach, W. M., Milk Sickness..i 

Beef's Blood in Alimentation 

Bell, Cyrus, Notice of 

Bichromate of Potash Poisoning 

Biliary Calculus Occluding the Rectum 

Bicmuth in Foetid Sweating 

Bitters, Hostetter's, 

Bladder, Catheter in 

Bladder, Gas in the 

Bladder, Suture of 

Bland, D. W., Double Dislocation of Hip 

Blankenship, J, P., The Pulse After Hanging 

Blindness in Children. Prevention of 

Block's Thermometer 

Bloodletting 

Bloodletting in Eclampsia and Pneumonia 

Blood Tumor in Labium 

Blood, Transfusion of 

Blut Plattchen 

Boards of Health, Local 

Bodies, Preservation of 

Bontacou R. B., Perineal Urethrotomy for 

Cystitis 

Books, List of 

Books, etc , Received, 32, 127, 158, 191, 222, 

379 

Boothby, E. L., Croup 

Boothby, E. L., Northwestern Association. . . 

Boston Letter 91, 

Bowditch, H. 1., Cremation..- 

Bowel Obstruction -.._-....-. 

Boyd, S. S . Hay Fever 

Brain, Electricity to the 

Brain, Ramrod in _ 

Brain, Sexual Differences in 

Braley, N. W., Notice of. 

Breast Amputation 

Breech Presentations — . - 

Bright's Disease Deafness 

British Medical Association 

Bromide in Diabetes.... 

Bromine, Arsenite of, in Diabetes 

Bronchitis, Alimentary Canal in - 

Brown, Gustavus Sr , Notice of 

Brown, Guslavus Alexander, Notice of 

Brown, Gustavus Richard, Notice of. 

Brown, Wm., Notice of 

Bryce, C. A., Ethical Advertising 

Bufalini Prize 

Bureau of Examination for Degrees™.- 

Bumham, W., Notice of. 

Burg's Thermometer 

Byford, W. H„ Intra Pelvic Inflammation 

Byrd, W. A., Exsection of Both Hip Joints... 
Byrd,W. A., New Anaesthetic 



192 

129 

410 

67 

211 

410 

419 

557 

273 

538 

97 

98 

244 

71 
179 
160 

25 
537 
428 
281 
717 
145 
621 

351 
658 
706 
121 
532 
174 
120 

'°d 
312 

559 



716 

344 i 

332 

379 

489 

568 

146 

631 

534 

118 

309 
520 
366 
564 
387 
95 
426 

27 

84 
600 
602 
601 
602 
540 
183 

67 
191 
121 
225 
237 
675 



Ca;sarean Operation 487 

Calculus Occluding the Rectum 537 

Calculus. Removal of Large Cystic 649 

Calculus, Urethral 145 

Calomel and Digestion 182 

Campbell, H. F., Strictures of CEsophagus... 465 

CannabinumjTannicum 2ie 

Cannabis Indica ; A Valuable Remedy in 

Menorrhagia 51 

Canned Meat Poisoning 535 

Capron, Geo., Notice of 603 

Carbolic Acid, an Antiseptic 129 

Carbo'ic Acid in Rectum, Death from 145 

Carmichael, Geo. F.. Notice of. 224 

Carter, J. M. G.,Trephine in Chronic Pleuritis 24a 

Casebeer, J. H., Pediatric Medicine 327 

Casebeer, J. H.. Pediatric Therapeutics 361 

Caseine in the Urine 426 

Cases for Instruments 214 

Castration for Histeria '. 591 

Castration of Tubercular Testicles 620 

Catalogue of Additions to the Library 718 

Cathartics. Salines 337 

Catheters Broken in Urethra 241, 389, 534 

Catheter, Hydro-aerial 394 

Catheter, Soft Rubber in Bladder.. .T 717 

Caustic Alkali Poi.soning 558 

Cauterizing Ecraseur for Hemorrhoids 397 

Cephalaematoma 550 

Cervix Uteri, Laceration of. 97 

Chambord, Count, Sickness of. 451 

Champaign. Letter on. Dr. J. M. Sims 658 

Cheek, Restoration of 20 

Chemistry, General and Medical 734 

Chevallereau, A.. Sickness o 1 < 

bord 451 

Chicago Letter 90 

Chicago Medical Society 

59, 60, 151, 457, 566, 627, 680 

Chicago Throat and Chest Hospital 660 

Chicago Training School for Nurses 518 

Childhood, Purulent Effusions in 382 

Children, Common Diseases of 384 

Children, Epidemic Jaundice in 321 

Children, Inflammation of Lungs in 139 

Children, Palatable Drugs for 180 

Children, School, Short Sight in 52 

Children, Tobacco Smoking in 24 

Chinese Method of Determining Paternity 487 

Chisolm, J. J., Is Abscision Proper 298 

Chloroform, Ammoniated 180 

Cholera »...« 90, 94 

Cholera, Asiatic 350 

Cholera Congress - 650 

Cholera, Egyptian 309 

Cholera, Pasteur on - 250 

Cholera, Preventive 185 

Cholera, Progress of 122 

Cholera and Yellow Fever 218 

Chylous Ascites 120 

Chylous Urine with Caseine 426 

Cigarette Smoking 85 

Cincinnati Letter 149 

Circumcision, Modem - 87 

Clark, H. W., Major Amputations and Hot 

Water 638 

Clark, A. P., Letter from 433, 545 

Cleansing the Pharynx, Novel Mode of 26 

Clinical Character of Wool Sorters' Disease.. 336 

Clonic Spasms of Uterus 594 

Code Controversy- 430, 436 

Co-existence of Diphtheria and Typhoid 309 

Coffee, EflTects of 177 

Cohen, J. Solis, Tuberculosis of the Larynx... 261 

Collective Investigation Movement 181 

College Appointments 340 

College News 32,96, 159 

Colorado University 183 

Coloring Matters in Urine 294 

Conception During Amenorrhea - 622 

Confiscation of a Medical Journal - 121 

Congenital Ectopia of the Heart 646 



IV 



INDEX. 



PAGE. 

Congress, Medical, Proposed 650 

Connecticut, Coroners and Examiners in 556 

Constant Current on the Brain 534 

Constriction of Pylorus 133 

Consumption, Infection of. 425 

Consumption, Infection 571 

Contract Practice and Ethics 400 

Convulsions, Puerperal 565 

Cooper. C. N., Phantom Tumor 618 

Cooper, Geo. F., Notice of. 224 

Cornwell, H. G., Eye Disease Following 

Brain Disease 267 

Costatome, the 557 

Couvcuse, the 339 

Cowden, J. W., on Perityphlitis 700 

Cox, Christopher C., Notice of 223 

Cox, Edward, Notice of. 256 

Cramp, Writers 335 

Crane, C. H., Notice of. '. 464 

Cremation 568 

Cronin, P. H., Who Does the Stealing ? 434 

Croonian Lectures 253 

Croup, Unity of Diphtheritic and Membrane 330 

Culbertson, H , Correction 352 

Gulbertson, H., Segmental Features of Glau- 
coma 257 

Culbertson, H., Spectacle Frames in Lieu of 

Nose Pieces 381 

Cummings, Silas. Notice of 576 

Cure of Ranula, New Operation for 48 

Curtis, Josiah, Notice of. 223 

Cystieercus in the Vitreous Body 706 

Cysticercus in Eye 121 

Cystitis, Urethrotomy for 196 

Cystotomy in Enlarged Prostate 212 

Cysts, I'arovarian 731 

Dana Anderson .Green, Notice of. 604 

Dangerous Soda Water 121 

Davis, N. S., on Present and Future Tenden- 
cies of Profession in the United States 33 

Davis, N. S., Report on Practice, etc., of Il- 
linois 409 

Davies, D. C., Placenta Praevia 302 

Dawson, J. H., Diffusion of Arsenic after 

Death 115 

Deafness and Bright's Disease 387 

Death from Carbolic Acid in Rectum 145 

Death from Foreign Body in Oesophagus, 

Undetected 621 

Decapitating Instrument ; 456 

Delegates and Members, Annual Meeting in 

1883 724 

Dentition 383 

Denudation of Teeth 633 

Deodorization of Iodoform 397 

DeWolf, O. C, Glyclosuria 577 

Diabetes, Arsenite of Bromine in 27 

Diabetes, Bromide of Potassium in 426 

Diabetes and Fractures 395 

Diabetes, Iodoform in 454 

Diarrhoea, Fatty 28 

Diet, Low, Hygiene of 416 

Digestion and Calomel 182 

Digestion, Hydrochloric Acid in 536 

Digitalis, Poisoning by 648 

Digitalis, Tincture of 121 

Dilatation of Pylorus 23 

Diphtheria 413 

Diphtheria, Bi-chloride in 590 

Diphtheria General Paralysis after 649 

Diptheria with Typhoid 369 

Disease of Kidneys and Stricture 26 

Disease on the Tapis 680 

Disea.ses and Bacilli 67 

Diseases of Children 384 

Disinfectants 211 

Disinfectant, Heat as a 379 

Displacement of Heart 24 

Dissections in London 596 

Doctors'^Model House.; ; 88 

Domain of Sanitary Science 612 

Dougherty, A. N., Notice of 256 

Dover and His Powder 600 

Dramage Tube, New 121 

Drainage of Uterus 183 

Drugs for Children 180 

Dudley, E •', on Immediate Perineorrhaphy 689 

Duhamel, W. J. C , Notice of 288 

Dunglison, R. J., Laws on Practice 505 

Duty of the Hour 385 

Dynamite 351 

Dynamite as a Tonic 179 

Dysentery. Epidemic 413 

Dysmenorrhoea •.••"■.■ '°9 

DyspnCEa, Elastic Respiration for 395 

Ear Disease and the Facial Nerve 418 

Earle, C W.. Cephalsematoma 550 

Early Tapping in Ascites 289 



Early Trephining in Bone Di.^eases 299 

Eclampsia, Bloodletting in 174 

Ectopia of Heart 646 

EniTOKiALS : 

On Change of Publication 28 

Meeting in Cleveland 56 

Do Moral Principles Change? 57 

Bacillus Tuberculosis 57 

Editorial Association 58 

Endowments 58 

Notice 58 

Advertisements 89 

Epidemic Cholera 90 

New Subscribers 90 

Discussions Before Sections 90 

Yellow Fever 122 

Progress of Cholera 122 

Lost Membership 148 

Meeting of British Medical Association 148 

Yellow Fever aud Cholera 148 

Distant Appointment 148 

Necrological Report 149 

Tri-State Medical Society 184 

A Safe Anaesthetic 184 

Cholera 184 

Yellow Fever 184 

Corespondents 184 

Convention of Microscopists 185 

American Association for Science 185 

Back Numbers 185 

Collective Investigation of Diseases 216 

The St. Louis Medical Society 218 

Cholera and Yelfbw Fever 218 

Contract Practice and Ethics 246 

Epidemic Cholera 248 

Letter from Surgeon-General Crane 248 

Yellow Fever 248 

Explanation 275 

Progress of State Medicine and State 

Boards of Health 275 

Progress of Yellow Fever 279 

Small Pox 279 

The American Medical Association 311 

Epidemic Diseases jii 

Cholera 312 

Observations on Management of Enteric 

Fevers, etc., Jas C Wilson 3151 

Tri-State Medical Society 340 

Prevalence of Epidemic and Infectious Dis- 
eases 340 

American Academy of Medicine 370 

Opening of Medical .Schools 370 

Hint to the Dilatory 370 

Sir Wm. McCormac 370 

Contract Practice and Ethics 398 

Progress of Infectious Uiseases 399 

Collective Investigation of Disease 399 

Trained Nurses 430 

Novel Mode of Bleeding 431 

Texas Courier Record 431 

American Public Health Association 431 

An Unhealthy City 431 

Sanitary Condition of Suez Canal 432 

Renal Circulation in Fever 432 

Explanation 456 

Death of Surgeon-General Crane, W H. 

Byford and B McVickar 457 

Medical Department of University of Ver- 
mont 457 

Medical Honors 457 

Death of M. Thullier 457 

Editorial Change 457 

Yellow Fever 457 

American Climatological Association 457 

American Academy of Medicine 488 

The American Medical Museum and Li- 
brary 489 

Specialties and Their Ethical Relations 511 

Explanation 512 

The Pedicle in Ovariotomy 539 

Ethical Advertisements 540 

Medical Advertising 561 

Unity of Diphtheritic and Membrane Croup 562 
British Medical Association and its (ournal 596 

American Public Health Association 597 

American Climatological Association *.. 597 

Notice 597 

Quackery and the Illinois State Board of 

Health 604 

Preparations of the Committee of Arrange- 
ments for the Next Session 633 

American Public Health Association 624 

Ohio State Sanitary Association 656 

Proper Material for Medic;*! Society 65c 

The International Review of Medical and 

Surgical Technics 651 

Collective Investigation ofDisease 679 

Physi.Jogy aud Hygiene in Literary Col- 
leges 679 

Changes in Medical Journals 679 



»T • ^ PAGE. 

Notice, Polyclinic 680 

To Subscribers gSo 

Index Medicus 708 

Investigations, Original, 708 

Number Seven of Journal 710 

Explanations j^o 

Corrections y,^ 

Error Corrected 710 

Ethics and Town Poor. &c 709 

! Effusion of Blood in the Cavity of Retzius 454 

Egyptian Cholera 309 

; Elastic Respiration for Dyspnoea 395 

I Elbow, New Method of Reduction of. 21s 

', Electric Light in Medicine 26 

j Electric Light for Microscopy 89 

I Electric Light in Surgery 130 

! Electricity to the Brain 534 

Elements of Prognoses and Therapeusis of 

Tuberculosis of the Larynx 261 

Eliot, Gustavus, Coroners and Examiners in 

Connecticut 556 

Eutropion, Relieving Irritation in 538 

Epidemic, Peculiar 413, 414 

Epidemic at Pakhoi 558 

Epidemics in Illinois J..... 413 

Erectile Anal Tumor ,', 427 

Erectile Tumor During Pregnancy 394 

Ergot in Labor 104 

Ergotine in Post-partem Hemorrhage 592 

Ergotine in Prolapse of Rectum 145 

Erosion of Teeth 633 

Ergotism, Epidemic of 760 

Erysipelas and Parasites 67 

Ether Habit 537 

Ether, Subcutaneously 88 

Ethical Advertising 540 

Ethicus, Letter by 400 

Ethmoid Cells, Catarrh of. 644 

Etiology of Lenticular Opacity 263 

European Professorships 339 

Every Patient His Own Case-Book 535 

Exchanges 29 

Exchanges and Books 95 

Excision of Rib 557 

Experimental Inquiry into Causes of Varia- 
tions in Pulse-Wave Velocity, Ac 437 

Excision of Both Hip Joints 237 

Extirpation of Larynx 486 

Extraction of Pomade Pot from Rectum 536 

Extra-Uterine Pregnancy 100, 214 

Eye, Cysticercus in 121 

Eye Disease After Brain Disease 267 

Eyes, (The) and Menstruation 144 

Facial Nerve and Ear Disease 418 

Faeces of Starch-Fed Inf.ints 87 

'^arrand, D O. Notice of 254 

Farr's Tablets 163 

Fatty Diarrhoea 28 

Femur, Anchylosis of, Treated by Division of 

Shaft '. 87 

Fever, Puerperal io8 

Fishes, Poisonous 560, 621 

File, C. C. Cholera. 185 

Flint, Austin, Early Tapping in Ascites 289 

Foetid Sweating 428, 576 

Foetus Retained Fifty-Five Years 454 

Forceps 103 

Forceps Labor 562 

Ford. L. Des., Notice of 320 

Foreign Bodies in Air Passages 422 

Foreign Body in Ear, Causing Cerebral Hy- 

peraemia 538 

Foreign Body in (Esophagus, Death from 621 

Foreign Body in the Urethra 52, 54 

Foreign Correspondence 403 

Fourteen Fractures in Same Subject 677 

Fractures and Diabetes 395 

Fractures, Fourteen in Same Subject 677 

Fractures of Long Bones 227 

Fracture of Patella, Treatment of. 677 

Frankel, Eugene, Facial Nerve Paralysis 419 

Franklin, G. S., Hygiene of Low Diet 416 

Fridenberg, E. L., Heat as a Disinfectant 379 

Fuqua W. M., Gastro-Enterotomy for Intesti- 
nal Obstruction 305 

Fu.ssell Edwin, Notice of 255 

Galium Aparine for Ulcers 147 

Garnett, A Y. P., Jaundice Among Children 321 

Gartner's Ducts in Women 622 

Gas in the Bladder 145 

Gastro-Elytrotomy 167, 383 

Gastro-Enterotomy lor Obstruction 305 

Gastroscope 650 

Gastrotomy 131 

Gastrotomy for a Hair Tumor 181 

Germany, Trichina in 509 

Germicides 410 

Germicides, Study of 197 



INDEX. 



PACK. 

Gilman Judson, Notice uf~ 288 

Glandular Hypertrophy 510 

Glaucoma, Segmental Feature of. 257 

Glover, E., Late Resuscitating in Apncea 352 

Glycosuria 577 

Goitre, Acute- 183 

Good, A. H , Dentition 383 

Good Remedies Out of Fashion 337 

Gradle, H., Otorrhoea 18 

Grafting, Sponge - 145 

Granular Lids 54 

Granular Lids, Jequirityin 683 

Gynecological Treatment in Hysteria, Ac 523 

Gynesic Emergencies, Appliances for 238 

Hair Tumor 181 

Hamilton, George, Bloodletting 532 

Hamilton, J. B., Nitro-Glycerine and Dy- 
namite 351 

Hanging, Pulse After 658 

Hard, A., Catheters Broken in Urethra 241 

Hardmau, L. G.. Typhoid Fever 571 

Harris, Alex., Unity of Diphtheritic and 

Membranous Croup 330 

Harvard, Centennial of. 339 

Harvey, Wm., Removal of Remains of. 596 

Haukhurst, D. C, Notice of 254 

Hawley, Geo. B., Notice of 687 

Hay Fever 434, 631 

Hay, W., Moral Insanity 482 

Haynes, T., Notice of. 224 

Health Law in Michigan 95 

Heart, Action of Alcohol on 307 

Heart, Ectopia of 646 

Heart, Traumatie Displacement of. 24 

Heat as a Disinfectant 379 

Heating Surgical Instruments 427 

Hemenway, H . B., Duties of Members ol So- 
cieties 420 

Hemiatrophy, Complete Progressive 178 

Hemorrhage, Post Partwm loi 

Hemorrhage, Post Partum, Ergotin for 592 

Hemorrhoids, Cauterizing Ecraseur for 397 

Herrmann, Friedrich, Jubilee of. 508 

Hernia, Cure of. 141 

Hernia, a Form Liable to be Overlooked 203 

Hernia, Operations, Omentum in 584 

Hernia and Testis in Perineo 367 

Hersom, A. N., Notice of. 687 

Hertzog, W . F., Puerperal Eclampsia 220 

Hip, Double Dislocation of 351 

Hips, Simultaneous Dislocation of Both 193 

Hip Joint Exsection 237 

Hixson C , Hay Fever 434 

Haemophilia 349 

Hollister, J H , Address as Chairman on 

Practice, etc, 65 

Holmes, C. C, Notice of : 254 

Hopper, H.A., Notice of. 362 

Horseflesh Consumed in France 538 

Hostetter's Bitters 281 

Hot Climates, a Peculiar Disease of. 508 

Hot Water and Amputations 638 

Humbert, F., Catarrh of Ethmoid Cells, etc. . 644 

Hydatid Tumor, Rupture of. 248 

Hyde, J. N., Study of Syphilitic and Non- 
Syphilitic Eruptions 353 

Hydro-.^irial Catheter 394 

Hydrochloric Acid in Stomnch Digestion 536 

Hygiene of Low Diet 416 

Hygienic Work 162 

Hypodermics in Piles 245 

Hypodermic Uses of Morphia 27 

Hysteria, Castration for 591 

Hysteria, Gynecological Treatment in 528 

Hystero Epilepsy and Pregnancy 733 

Icthzol 88 

Illinois, Report on Practice, etc., of 409 

Imperforate Urethra 147 

Improvement in Medical Treatment 411 

India, Medical Women for 486 

Indiana, State Medicine in 340 

Indianapolis, Letter from 713 

Indians, Medical Lore of, 116, 401 402 

Index, General to Volumes of Transactions.. 29 

Induction Balance 131 

Infants, Digestion of Starch 86 

Infants, Symptomatology of. 268 

Infantile Paralysis 334 

Infection of Consumption. 425 571 

Influence of Morphinism on Pregnancy 649 

Ingals, E., Serpent Bites 249 

Inguinal Hernia 2<«3 

Inhalations, Mineral Water 339 

Injections Into Optic Nerve 594 

Innominata, Ligature of. 134 

Insanity 161 

Insanity, Increase in United States 668 

Insanity, Moral 482 



PACK. 

nspection. Vessel 595 

nstrumental Cases 214 

nstruments for Collecting Morbific Germs 

Exhaled with the Breath 56 

nstrument for Opening Pelvic Abscesses 518 

nstruments. Heating of. 427 

ntestinal Obstructions, Surgical Treatment 

of 170 

ntoxication. Iodoform 396 

ntra-Abdominal Pathology 131 

ntra-Pelvic Inflammation 225 

ntra-V^esical -Pathology 131 

odine Painting in Variola 593 

odine in Typhoid 412 

odoform. Action of. 594 

odoform, Deodorization of. 397 

odofoim in Diabetes 454 

odoform Intoxication 396 

odoform Plaster 210 

odoform Poisoning 396 

apan, Medical Notes on 21 

arvis, W. C., Tonsillotomy 17 

aundice. Epidemic Among Children 321 

aundice. Obstructive.... 212 

enkine, J. F., Prolapsus Ani 248 

" " Trained Nurses 515 

equirity in Granulated Lids, 54 683 

erome, Jas. H., Notice of. 223 

ohnson, J. B., Letteron St. Louis 658 

ohnson & Wright, Nerve Stretching 508 

ones, C. v.. Notice of. 602 

oumal, Daily Medical 596 

oumalism Devoted to the Promotion and 
Concentration of Medical and Surgical Sci- 
ence 42 

ubileeof F. Hermann , 508 

udicial Council Minutes 50 

Kairine 89 

Keyt, A. T., the Pulse in Aortic Deficiency 135 
Keyt, A. T , Facts and Experiments on Vari- 
ations of Pulse- Wave in Man, and Elimina- 
tion Causes, 437, 605 662 

Keyt, A. T., Corrections by 221 

Kidneys, Operations on the 143 

Koch, and the Bacilli, 67, 129, 166 410 

Koroniko 336 

Labor, Antiseptics After 54 

Labor, Blood Tumor in Labium During 120 

Labor, Ergot and Anaesthesia in 104 

Labor, Means to Shorten 241 

Labor Pain, What Can Be Done to Shorten 521 

Labium, Blood Tumor in 120 

Laceration of Cervix Uteri 97 

Laceration of Perineum 627 

Lambert, S. H. on Haemophilia 349 

Lambert, S. H., Stricture of (Esophagus 632 

Landis, H, G., Post Pastum Polypoid Tu- 
mors 205 

Laparotomy 131 

Larynx, Extirpation of. 486 

Larynx, Tuberculosis ot 261 

Lawton, S. Notice of 352 

Leal, John R , Notice of. 406 

Leaman, H., Amputation of Breast 366 

Leffmaun, H., Duty of the Hour 385 

Lemon Juice and Oysters 210 

Lenticular Opacity 263 

Leprosy and Bacilli 67 

Lucsemia, Arsenic in 178 

Lithophone 707 

Letter from Indianapolis 713 

Letter from Washington 715 

Lyman, Geo. N., on Lithsemia, &C. 692 

Lewis, Emmons, Notice of. 288 

Librarian, Report of 718 

Ligature of lnnomin»toe , 134 

Ligature Tightener 88 

Lightning Stroke, Case of 678 

Liquid Oxygen and Nitrogen.- 487 

Lithsemia, Connection with Tinnitus Aurium 

and Vertigo 692 

Lithaemia, Its Diagnosis, &c 696 

Lithotomy, Supra-Pubic 349 

Liver, Partial Regeneration of 453 

Local Use of Antiseptics After Labor and 

Abortion 54 

London Letter 686 

Long Bones, Fractures of. 229 

Longevity of Savans 576 

Low Diet, Hygiene of 416 

Lung Inflation in Children 139 

Lupus, Scraping and Scarification in 429 

Lythrum Salicaria, Use of. 677 

Maggot Eggs Causing Catarrh of Ethmoid, 

^4c 644 

Male Breast, Milk in 181 

Malposition of a Tooth 680 



PACK. 

Man According to Nature 207 

Manly, Geo.. Consumption Infectious 571 

Mansfelde, A. S. V. Nebraska's Field of Med- 
icine 350 

Manufacturing Chemists 401 

Marcy, H. O. Germicides 197 

Marcy. H. O , Intestinal Obstructions 170 

Marcy, H O., on Journalism Devoted to the 
Promotion and Concentration of Medical 

and Surgical Science 42 

Marcy, H. O , Laws on Practice 505 

Marsh Mallow in Psoriasis 705 

Marcy, H.O., Recent Advances of Sanitary 

Science ^05 

Marcy, H. O., Restoration of Perineum by a 

New Method 477 

Markham, N. C, Rupture of Hydatid Tumor 24S 
Marshall, J. S., Denudation or Erosion of the 

Teeth 63J 

Marshall, J. S., Pyorrhoea Alveolaris 641 

Martin, H. A., An Appliance for GjTiesic 

Emergencies 238 

Mason, Augustus, Notice of 1 191 

Massage. Risks of. 182 

McCulloch, T. C: Bloodletting iu Eclamp- 
sia, Ac 17^ 

McDowell, Geo. M., Notice of. 128 

McGill Medical Skrhool 287 

Mclntire, Chas., Is it Fair? ; 47^ 

Mechanical Nurse 33^ 

Mechanical Remedies in Skin Diseases 75 

Medical Benefit Society 30 

Medical Education and Degrees in England 250 

Members and Delegates 724 

Medical Corps of the Army 71& 

Medical <'orps of the Navy 716 

Medical Brethren Abroad, How they Regard 

Us 710 

Medical Jurisprndence 621 

Medical Legislation 245 

Medical Lore of Indians 401, 402 

Medical Notes on Japan 20 

Medical Profession, Its Political Position 479 

Medical Register of the World 652 

Medical Society Items 158 

Medical Societies Teaching and Licensing .~. 31 

Medical Titles 651 

Medical Societies, < fficers of. 32 

Medical Women for India 486 

Medicine Ac, of Indians 116 

Membership Dues and Subscriptions 29 ' 

Menorrhagia, Cannabis Indica in 51 

Menstruation and the Eyes 144. 

Mercury Bichloride in Diphtheria 590 

Metallotherapy in Hysteria 210 

Method of Relieving Irritation in Entropion... 538 

Michigan State Board of Health 163, 544 

Michigan Medical Law 95 

Micro-Organisms and Disease 493 

Micro- Parasitic Organisms 66 

Microscopic Preparations as Illustrations 596 

Microscopic Work 66 

Microscopy, Electric Light in 89 

Midwifery and Gynecology 591 

Milk, Continuous Flow of 22 

Milk in the Male Breast t8i 

Milk Sickness 71 

Mineral Water Inhalations 339 

Minnesota, State Medicine in 342 

Minutes of the Judicial Council 50 

Minutes of Thirty-Fourth Session : — 

Address of Welcome i 

Committee on Nominations < 2 

Constitutional Amendment 2 

Army Museum and Library 3 

Report on Journal 4-7 

Trustees Appointed 7 

Trained Nurses 8 

Delegates Abroad 8 

Code of Ethics 9 

Treasurer, Report of. 9 

Librarian, Report of 9 

OflTccrs for 1884 10 

Minutes of Section on Children 347 

Minutes of Section on Dental and Oral Sur- 
gery 652 

Minutes of Section on Obstetrics and Women 156 
Minutes of Section on Ophthalmology, &c.... 281 

Minutes of Section on Practice, etc 123 

Minutes of Section on Surgery 189 

Minutes of Section on State Medicine 220 

Mississippi. State Medicine in 342 

Missouri, State Medicine in 340 

Mixen, S. F., Notice of. 406 

Model House....... 88 

Modem Circumcision 87 

Montgomery, Joseph Foutleroy 716 

Bloniimeiit to Pinel 710 



■VI 

I'AGE 

]\Ioiikey, Syphilis in 648 

Monoplegia of Lower Extremities 26 

Monstrosity, 53 122 

Montgomery, Edw., Notice of 548 

TVIoore, R. L., Common Diseases of Children :'t84 

Moral Insanity 482 

Morphia, Uses of Hypodermically 27 

Morphinism on Pregnancy 649 

Morris, John, Means to Shorten Labor 241 

Morris, John, What Can Be Done To Shorten 

Labor Pain 52' 

Morrison, Jas., Notice of. 192 

Mortality of Cities of Europe 121 

Mosher. Jacob S , Notice of 407 

Mothers Milk in Nursing 86 

Mfitoi Localization in Cerebral Cortex 610 

Murray, R. D , Treatment of Yellow Fever 68 

MiiHsey, W. H., Notice of. 405 

M ycetoma of the Foot 244 

Myer, W. H., Notes on Tracheotomy 422 

Myer, W. H,, Punilt-nt Pleuritic Effusi n in 

Childhood 382 

Naphthol, Use of. 309 5°' 

Nasal Disease and Asthma 295 

National Fellow of Medicine 68 

Naval Laboratory 279 

Navy Changes •■ 73^ 

Nebraska's Field of Medicine 390 

Necrology 9^ 

Nephoraphy '34 

Nerve Stretching, 504 597 

Neurological Association 59 

New Anaesthetic 675 

New Blood Corpuscle..., 66 

New Books. 428, 574 • 688 

New Brunswick Medical Society 275 

New Instruments, 130 456 

New Inventions, 89, 121, 518 650 

Newman, S. T., Notice of 128 

Newman, W. G, H., Notice of 603 

New Medical Journal 576 

New Method Reducing the Elbow 215 

New Operation for Cure of Kaniila 48 

New York Code Controversy, 430 436 

Night Sweats, Agaricin in 561 

Nitrate of Silver in the Throat Hnd Nose 265 

Nitrite of Sodium as a Toxic 676 

Nitro-Benzole, Poisoning by. 453 

Nitrogen and Oxygen, Liquid 487 

Nitro-Glycerine. Toxic Properties 0,179 35' 

North Carolina, State Medicine in 341 

Northwestern Inter-State Medical A-socia- 

tion, [91 379 

Novel Mode of Cleansing the Pharynx 26 

Nurse, the Mechanical 339 

Nursing, Mother's Milk in 86 

Nussbaum's Bracelet 335 

Obstetrical Society of Philadelphia, Proceed- 
ings of 732 

Obstetrical Society of Hhilauelphia. 457 562 

Obstetrical and Gynecological Society of 

Washington 514 

Obstetrics, Address on 97 

Obstetrics, Antiseptics in 106 

Obstruction of Bowes 146 

Obstructive Jaundice 212 

Ocular Polyp ■ ; 59' 

OEsophagus, l)eath from Foreign Body in 621 

Qisophagus, Strictures of, 46s 632 

O factory Membrane, Structure of the 178 

Oliver, John B ,Vessel Inspection 595 

■ Oliver's Urinary Test Papers 629 

Omentum in Hernia Operations 584 

Operations on the Kidnevs 143 

Optic Nerve, Injections Into 594 

Opium Poisoning 149 

Orchitis After Typhoid 180 

Otorrhoea Treated With Antiseptics 18 

Ovaries, Extirpation of 732 

Ovariotomy in a Child 244 

Oxygen and Nitrogen, Liquid 487 

Oxytocic Action of Quinine 54 

Packard. J. H , Simultaneous Dislocation of 

Both Hips 193 

Pains of Labor, to Shorten 521 

Pakhoi,an Epidemic at 558 

Palatable Diugs foi Children 180 

Palmer, \. B., Is Alcohol a Stimulant or Par- 
alyzant 271 

Pancreatic Juice, Pure 172 

Panification 594 

Paralysis After Diptheria 641 

Paralysis of Facial Nerve, With Disease of Ear 418 

Paralysis, Infantile 334 

Paris Letter, 219, 43s 571 

Paris Medical Practitioners 222 

. Parish, W. H., Porro Miiller Operation 447 

Parotitis, Epidemic 414 



INDEX. 



Parturition, Death from Air in Veins After... 180 

Pasteur, On Cholera 250 

Patent Medicines in Italy 67 

Patella, Treatment of Fracture of 677 

Patton, A., Inflammation of Lungs in Chil- 
dren r39 

Peck, W. K., Address in Surgery 129 

Peculiar Disease of Hot C imates 508 

Peculiar Epidemic. 413.... 414 

Pediatric Medicine 327 

Pediatric Therapeutics 361 

Peebles, A. D., S'ricture of (E^ophHgus 632 

Pelton, IvOuis F., Notice of. 406 

Pennsylvania and Maryland Union Medical 

Association 320 

Perforation, Peritonitis After ■ 53 

Perineal Laceration 627 

Permeum Restoration by a New Method 477 

Peritonitis After Perforation 53 

Pertussis 413 

I erineorrhaphy. Immediate 689 

Perineum, Two Forms of Rupture of 690 

Perityphlitis 700 

Phantom Tumor 618 

Pharynx, Novel Mode of Cleansing 26 

Philadelphia Letter, 29, 58, 220. 348 512 570 

Phthisis Pulmonalis, etc., Pat ology of 525 

Physiological Action of Iodoform 594 

Physiological Effects of Coffee 177 

Physiology in England 120 

Fierson, Wm., Sr., Notice of 407 

Piles, Hyooderniic Injection for 245 

Placenta Praevia, 109 302 

Placenta, Removal of ;mm^ 592 

Placenta, Retention of 649 

Pneumonia, 413 414 

Pneumonia, Bloodletting in 174 

Poisoning, Atropine 455 

Poisoning by Bichromate of Potash 25 

Poisoning by Canned Meat 535 

Poisoning by Caustic Alkali 558 

I'oisoning by l>igatalis 648 

Poisoning by Iodoform 396 

Poisoning by Nitro Benzole 453 

Poi.soning by Opium 149 

I'oisoning from Snails 678 

Poisoning by Stramonium 22 

Poisoning by Vnnilla fean 621 

Poisonous Fishes, 560 621 

Political Powerlessness of the Profession 213 

Political Position of Medical Profession 479 

' ollak, S., Ocular Polyp 591 

Polyp, Ocular 591 

Pomade Pot in Vagina 647 

Porro-Muller Operation 447 

' orter, Wm , Address by 364 

''ostepileptic Phenomena on Some 428 

Post Partem Hemorrhage loi 

''ost I'artum Polypoid Tumors 205 

Powdered Beef's Blood in Alimentation 179 

Practical Clinical Lessons on Syphilis,etc., F. 

N. Otis 516 

Practice, etc.. Address on 65 

Practice, etc., of Illinois, Report on 409 

Practice, Laws Regulating 505 

Practice, Report on from Kan.sas 587 

Pratt, Foster, Address on State Medicine 161 

I ratt, Foster, Increase of Insanity in United 

States 668 

Pregnancy, Erectile Tumor in 394 

I'regnancy, Extra-Uterine 100, 214 

Pregnancy, Morphinism in 649 

Present and Future Tendencies of the 1 rofes- 

sion. Address on 33 

Preservation of Bodies 559 

■'resident's Address 12 

Presphygmic, Interval 437 

Prevalence of Epidemics in Illinois 413 

Prewitt, T. F., New Operation for Cure of 

Ranula 48 

Prizes 183 

Proceedings of Association of American Ed- 
itors, Record of 49 

Professional Rewards I2t 

Prolapsus Ani 248 

Prolapsus of Rectum and Ergotine 145 

Promotion and Concentration of Medical and 

Surgical Science. Journalism Devoted to... 42 

• rostate. Cystotomy in Enlarged 212 

Psoriasis, Treatment of 245, 530 

Psoriasis Palmaris 705 

Putnam, J. J., on Lithsemia 696 

Puerperal Affections of Mother and Child 147 

I'uerperal Eclnmpsia 220, 565 

Puerperal Septicaemia 107 

puerperal State and Scarlet Fever 337 

pulse After Hanging 658 

pulse in Aortic l>eficiency "... 13s 

Pulse, Sub-Ungueal 620 

Purulent Pleural Effusions 382 

Phylorectomy 131 



I yloru.s. Forcible I'ilitation of 2, 

I'yorrhea Alveo aris [' g ^ 

Quackery, War on g^ 

Questions on Etiology of Lenticular Opacity 26^ 

Quinine, Notes on _ _ _ gf 

Quinine. Oxytocic Action of.. !...."!. !!!.".!!.'..54' 185 

Railway Surgery j 

Raines, Thos. R., Notice of !...."!!!!.'.'.'.'."' ^20 

Ramrod in Brain jjg 

KansohofiT. Jos., Eany Trephining in Bone 

I iseases 

Radical Cure of Certain Forms of Hcri'ia by a 

New Operation j 

Reasons for Mothers' Milk in Nursing"!!!"." 86 

Reclination in Spinal Curvature 181 

Record of Proceedings of Association "of 

American Editors 

Rectal Alimentation !!!!!! Jli 

RectHl Prolapse, Ergotine in ..!!!!.'!!!! ff- 

Rectum Occluded by Biliary Calculus tAl 

Rectum, Pomade Pot in '^g 

Reagan, J. A., Is Quinine an Oxytocic?!'!!! " i8s 
Reality, Mechanism and Diagnostic Signifi- 
cance of Diminution of Retardation of the 

Pulse in Aortic Insufficiency j,- 

Reduction of Luxation of Thumb !! " ilo 

Reece, Madison, Bichloride of Merciii-y iti 

Diphtheria ^ 

Reeves, J. E., Sanitary Science 612 

Reilly, W. E, Cholera „„ 

Remarkable Monstrosity ' „ 

Restoration of Cheek !!!!!!!!!!!!!!!!! 20 

Resuscitation in Apnoea !!!!!!!!!!!!!!!!! 3-2 

Reviews : 
A System of Surgery by Various Authors... 61 

Books and Periodicals Received 62 

Miscellaneous Items g^ 

Nineteenth Annual Report of the 'Alumiii 
Association of the Philadelphia College 

of Pharmacy, 1883 g2 

Sitzungsbericfite der zu PhysiicalVsch-Med- 
icinischen Gesellschaft zu Wurzbure 

1882 ^ ^' g^ 

Treasurer's Report !!!!! g^ 

Necrology f^ 

Relations of Micro-Orgaiiismsto'Di'sease" 
Belheld ' 

Guy's Hospital Reports...........'.'.!!!." 125 

Proceedings of Southern Illinois !Medicai 
Association j^g 

Transactions of Medical Society ijfWest 
Virginia ,^6 

Bacteria, and the Germ Theory of Disease 
Gradle ' J27 

Electricity in Medicine and Surgery "Pit- 
zer ; ,27 

Lessons in Qualitative Chemical Analysis 157 

Report of Health Officer of District of 
Columbia j-g 

The Prevention of Insanity, N. Alleii!!!!!!!!! 251 

Anatomy, by Henry Gray ! 252 

Malarial Poisoning the Cause of !HaEma- 
turia, W O'Daniel 252 

Report of Surgeon-General of the Navy.!!!! 253 

Transactions of State Medical Society of 
Michigan 280 

John, O., Nasal Disease aDd Asthma 295 

Annual Report of U. S. Marine Hospital 
Service ,j . 

Essentials of Bandaging, Berkeley Hill..!!!! 315 

Tabulae Anatomicae Osteological,Von Klein 315 

Pathology and Treatment of Nerve Wealc- 
ness.C L Dunn ,42 

Collective Investigation Record 343 

The Fixitive Power of Traction in Hip Tth- 
G^se 244 

Massage, Its Mode of Application and Ef- 
fects 34^ 

Transactions of College of Physicians of 
Philadelphia, Vol. VI, 1883 .^ 403 

The Essentials of Pathology, D. Tod Gil- 
lian ^22 

Pocket Book of Physical Diagnosis, etc., 
E. T. Bruen ^j-j 

Index Catalogue of Library of Surgeon- 
General's Office, Vol. IV 433 

A Complete Hand-Book of Treatment, etc., 
by W. Aitken ^fij 

Transactions of the Medical and Chirurgi- 
cal Faculty of Maryland 463 

Proceediugs of Connecticut Medical Soci- 
ety 491 

Collective Investigation of Diphtheria, J.J. 
Mulheron 517 

Contagious Diseases of Domestic Animals, 
Investigations by the Department of Ag- 
riculture 517 



INDEX. 



Vlli 



PAGE. 

Transactions of Medical Society of State of 

Pennsylvania 546 

Transactions of New Hampshire Medical 

Society 574 

Pathoiogy, DiagnosisandTreatmentof Dis- 
eases of Women, by G. Hewitt 599 

Transactions of Medical and Chirurgical 

Faculty of Marj-land 630 

Lectures on Orthopcedic Surgery and Dis- 
eases of ihe Joints, by Louis A Sayre, 

M.D 653 

Reports from the Consuls of the United 

States, etc 654 

Minutes of the State Medical Society of Ar- 
kansas 654 

Fifth Annual Report ot the State Board of 

Health of Kentucky 654 

Texas State M.:dical Society, Transactions 

of. 683 

Maine Medical Society,Transactio s of. 684 

Annual Report of U. S. Marine Hospital 

Service 684 

Report of Commissioners of Education, 

1881 685 

U. S. Consular Reports 686 

Rewards, Professional 121 

Rheumatism, Articular 413, 415 

Rheumatism, Treatmentot 704 

Reymond, Prof. Emil DuBois 689 

Reynolds, Edward. Notice of 492 

Reynolds. T. N., Alimentary Canal in Bron- 
chitis etc B4 

Riberi Prize 183 

Rib, Excision of. 557 

Richardson, T. G., Use of Trephine in Trau- 
matic Empyema 46 

Risks of Massage 182 

Robson's Method for Spina Bifida 87 

Rochard, Dr , Shooting of 600 

Rogers, H. R. Cholera 94 

Rook, C W , New Anaesthetic 675 

Rotation, Animal 647 

Ruschenberger, W. S. W., The Naval Labo- 
ratory 279 

Russey, J. W., Contracts and Ethics 400 

Sabin, G. G., Enlarged Tonsils 185 

Salicylate of Bismuth in Typhoid 308 

Salicylic Acid as a Preserver ^36 

Salines, Action of. 337 

Salivary Digestion of Starch by Infants 86 

Sanitary Science Advances 493, 612 

Sanitary Convention in Michigan 660 

Sanitary Report, Con 735 

Savans, Longevity of. 576 

Sayre, L. H., Amputation Below Knee in 
Preference to Biisement Force in Anchylo- 
sis 325 

Scarlet Fever 413 

Scarlet Fever and the Puerperal State 337 

Schenk. John V., Notice of. 408 

Schrock, W. H., Man According to Nature... 207 
Schenck, W. L., Report on Practice, Kansas 587 

Schoolchildren, Short Sight in 52 

Sciatica, and Nerve Stretching 597 

Scientific Duties of Members of Societies 420 

Scrotal Presentation 592 

Sea-Sickness 368 

Segmental Feature of Glaucoma 257 

Seller, Carl, Action of Nitrate of Silver on 

Mucous Membrane of Throat and Nose 265 

Seller, Carl, Pathology of Phthisis Pulmona- 

lis, etc 525 

Serpent Bites 249 

Separation of Symphysis Pubis 120 

Septicaemia Puerperal 107 

Sexual Differences In Brain 309 

Sexual Impotence, VV. A. Hammond 516 

Sheffield, D. A., Therapeutics of Typhoid... 280 
Shoemaker, J. V., Mechanical Remedies in 

Skin Diseases 75 

Shoemaker, J. V., Naphthol 501 

Shooting of Dr. Rochaid 600 

Short Sight in School Children 52 

Sims, James Maricn, Notice of. 659 

Sitnultaneous Dislocation of Hips 193 

Skin Diseases, Mechanical Remedies in 75 

Skin Diseases, Antimony in 592 

Slaughter, A. E., Notice of. 436 

Smith, Q. C, Typhoid 515 

Snails, Poisoning by 678 

Soda Water, Dangerous 121 

Somnambulism and Ansemia 215 



PAGE. 

South Western Wisconsin Medical Associa- 
tion 519 

Spectacle Frames in Lieu of Nose Pieces 381 

Spina Bifida Treated by Robson's Method... 87 

Spinal Curvature, Reclination in 181 

Spiritus Etheris Nitrosi 560 

Spleen, Absence of the 455 

Sponge Grafting 145, 244 

Stair, U P., Is Consumption Infectious 425 

Starch, Digestion of by Infants 86 

State Boards of Health 612 

State Boards of Health. Concerted Action of.. 627 

State Medicine 627 

State Medicine, Address in 161 

State Medicine, Progress of. _ 312 

Sternum, Operations on 134 

Stevenson. Jas S., Notice of. 576 

Stewed Fruit for Gout and Dyspepsia 243 

Stomach. Ulcers of. 215 

Stramonium Poisoning 22 

ftricture and Disease of Kidneys 26 

Strictures of (J2sophagus 465, 632 

Structure of the Olfactory Membrane 178 

Subcutaneous Injection of Ether 88 

Sub Ungueal Pulse 620 

Successful Ciesarean Operation 487 

Suffolk District Medical Society, Mass 542 

Suffolk District Medical Society, Proceedings 

of. 711 

Suppression of Urine for Eighteen Days 560 

Supra-Pubic Lithotomy 649 

Surgical Literature 134 

Surgical Pantagraph 576 

Surgeon General 287 

Surgery 648 

Surgery, Address in 129 

Surgery of Intestinal Obstructions 170 

Suture of the Bladder 621 

Sweating, Excessive of Feet and Hands 245 

Sweating, Foetid 516 

Symphysis Pubis, Separation of 120 

Symphysiotomy 100 

Symptomatology of Infants 268 

Syphilis and Ammoniated Mercury Peptone.. 428 

Syphilis in .-ionkey 648 

Syphilitic and Non Syphilitic Eruptions 353 

Tadlock, A. B., Letter ot 514 

Tapping Early in Ascites 289 

Taylor, J. R., Fractures of Long Bones 229 

Taylor. \Vm. H,, Gastro-Elytrotomy 167 

Teaching and Licensing 31 

Tsal, Norman, Infantile Paralysis 334 

Teeth, and Alum Gargles 215 

Teeth, Erosion of. 633 

Telegraph in Medical Journalism 622 

Temperature Reduction After Spinal Haem- 
orrhage 559 

Tennessee, Transactions of state Society 61 

Testis in Perineo 367 

Therapeutics of Typhoid 280 

Thermometer, Bloch's 121 

Thermometer, Burgs 121 

Thermostat, New 731 

Thomas, J. P , Cases of Abdominal Surgery 550 
Thompson, J L., Questions on Etiology ot 

Lenticular Opacity 263 

Thoracic Duct, Wounds of. 455 

Thumb Luxation, Reduction of. 120 

Thyro-Cricoid Muscle 25 

Title, Medical 651 

Tennitus Aurium 387 

Tinnitus Aurium and Vertigo with Lithicmia 692 

Tobacco Smoking in Children 24 

Tonsillotomy Without Haemorrhage 17 

Tonsils Enlarged Sgi 

Tooth, Malposition of a 680 

Toxic, Nitrite of Sodium as a 676 

Toxic Properties of Nitro-Glycerine 179 

Toxicology 621 

Tracheotomy, Notes on 422 

Trained Nurses 515 

Transactions ot the Society of the State of 

Tennessee 61 

Transposition of Viscera 54 

Traumatic Empyema, Use of Trephine in 46 

Trephine in Chronic Pleuritis 242 

Trephining Early in Bone Disease 299 

Tribulations of a Country Obstetrician 214 

Trichinain Germany 509 

Tri-state Medical Association 364, 376 

Tubercular Testicles, Castration of. 620 

Tuberculosis of Larynx 261 



PAGE. 

Tucker. Geo, G.. Notice of. 407 

Tuckerman, L. B., New Method of Obtain- 
ing Pure Pancreatic Juice 172- 

Tumor of Hair in the Stomach 181 

TurnbuU, L. , Paralysis of Facial Neive with 

Disease of the Ear J 41& 

Turnbull, L., Tinnitus Aurium 387 

Turnipseed, Edw. B., Notice of. 604 

Turpentine in Syphilis, etc 398- 

Two Deaths During the Administration of 

Anaesthetics 51 

Typhlitis with Autopsy 273. 

Typhoid Fever 515, 571 

" " Iodine in 412 

" " Salicylate of Bismuth in 308 

" " Therapeutics of s8o- 

" " With Diphtheria 309 

Ulcers, Gallium Oparine for 147- 

Ulcers of the Stomach ^ 215 

Unity of Diphtheritic and V.embrall. Croup .. 330- 

University of Niagara 310 

Ureters, Anomaly of. 678 

Urethra, Catheters Broken in 241,389, 534 

Urethra, Foreign Body in 52 

Urethra, Imperforate 147 

Urethral Calculus 145 

Urethral Stricture and Disease of Kidneys...- 26- 

Urethrotomy for Cystitis 196 

Urinary Test Papers 622 

Urine, Coloring Matters in 394 

Urine Suppressed in Eighteen Days 560- 

Uterus, Cancer of 732 

Uterus, Candlestick in 591 

Uterus, Clonic Spasms of. 394 

Uterus, Drainage of. 183 

Use of Trephine in Traumatic Empyemia, As- 
sociated Yvfith Fistula 46- 

U S. Army, Changes in 380, 

408, 436, 487, 492, 575, 600, 632, 650, 688- 
U. S. Navy, Changes in... 519, 576, 600, 650, 688 
U. S. Marine Hospital Service, Changes, etc., 
in 160,578, 579- 

Vagina, Pomade Pot in 647 

Vail, A. M., Foetid Sweating 516- 

Vance, R. A., Radical Cure of Hernia 141 

Van Harlingen, A , Psoriasis 530 

Vanilla, Poisoning from 621 

Varicocele, New Operation for , 134 

Variola, Painting with Iodine in 593. 

Vaughan, V. C, Diffusion of Arsenic after 

Death 114 

Vessel Inspection 595 

Victoria Medical School 287 

Virchow^nd His Testimonial 183 

Viscera, Tra.isposition of. 54 

Vivisection in France 28 

Wakefield, H. P., Notice of. 3S2 

Ward, E. B., Manufacturing Chemists 401 

Warder, John A., Notice of. 128 

Washington Letters 656 

Water Cress 336 

Weist, J. R., Omentum in Hernia Operations 584 

What Our Neighbors Think of Us 215 

What to Do First in \ccidents and Emergen- 

ries, C. W. Dulles 517 

What is the Ratiorale of Traction and Coun- 
ter Traction in Hip Disease 344 

Wilbur, H B, Notice of. 254 

Willard, W. T., Notice of. 254 

Wilson, A. H., Form of Inguinal Hernia Lia- 
ble to be Overlooked 203 

Wisconsin State Medical Society 344 

Women, Gartner's Ducts in 622 

Woodman, L. C, Notice of. 519 

Wool-Sorter's Disease 336 

World, Medical Register of. 652 

Worden, A. L , Catheter Broken in Urethra. . 534 

Wounds of Thoracic Duct 455 

Writer's Cramp 335 

Yellow Fever i22, 282 

Yellow Fever, Treatment ot 68 

Young, Noble, Notice of 520 

Zeisel, H., Honors to 296 

Zenner, P., Value of Gynecological Treat- 
ment in Hysteria 523 

Zitzer, John Jacob, Notice of 54& 



CHICAGO: 

Printed for the Association by A. G. Ncwei.l, 

71 and 73 Randolph Street. 



TECE 



0urttal#^mericanB^i^ical^00ociati0tt, 



PUBLISHED WEEKLY. 



Vol. I. 



Saturday, July 14, 1883. 



No. I. 



ORIGINAL ARTICLES. 



MINUTES OF THE AMERICAN MEDICAL ASSOCIA- 
TION AT ITS 34TH ANNUAL SESSION, HELD IN 
CLEVELAND, OHIO, JUNE 5, 6, 7, 8, 1883. 



FIRST DAY— general SESSION. 

Promptly at 10:30 o'clock Dr. X. C. Scott arose 
and said that the time had now arrived for the open- 
ing of the Thirty-Fourth Annual Session of the Ameri- 
can Medical Association, and he took pleasure in 
introducing Right Rev. Richard Gilmour, Bishop of 
Cleveland, who would offer the introductory prayer. 
Bishop Gilmour closed a few preparatory remarks by 
repeating the Lord's Prayer. Dr. Scott then said the 
next thing on the programme was the introduction of 
the president, Dr. Atlee of Pennsylvania, a gentle- 
man so well known that an introduction was merely 
a formality. Dr. Atlee was received with rounds of 
applause. He at once introduced General Ed. S. 
Meyer, of this city, who delivered the following 

.\ddress of welco.me. 

Gentlemen of the American Medic.\l Associa- 
tion : On this beautiful morning, when the vernal air is 
once more redolent of sweetest perfume ; when all 
nature, clad in the newness of life, and, breathing of 
immortality, extends to you her kindliest greeting, 
our people, uniting with your brethern here, bid you 
welcome, most cordial welcome, to our goodly city, 
trusting that your deliberations here may prove as 
profitable to you in the future as they shall be pleas- 
ant and memorable to us. In the presence of this 
vast assemblage of the representati^-e men of your 
high profession in all America, we are profoundly 
impressed with the thought that though other convo- 
cations have been witnessed here from whose delib- 
erations has gone forth that influence which has 
sometimes guided the destinies of State and Nation, 
none, in its sublimity and nobility of its aims, has 
ever transcended that with which we are honored to- 
day. 

In these quiet, peaceful, dignified gatherings, you 
but typify that silent, potent power, which, under- 
lying the philosophy of our institutions, carries us 
irresistibly onward in the great march of progress 
toward a higher and a better civilization, proclaiming 
to the world the truth that the greatest triumphs of 
the Republic are not achieved amid the ravages of 
destnictive war, but follow in the silent train of in- 
tellectual pursuit and research in the realms of science 



and religion, whose paths — ever untrodden by mailed 
hoof — are lined with the most beautiful flowers of 
true happiness and peace. 

Thus, through the agency of your powerful in- 
fluence, you hasten the advent of that day — already 
too long deferred — when from their proud pedestals 
now lining all the endless halls and corridors of his- 
tory, the lightnings of retributive justice shall hurl 
into oblivion the shattered statues of those who, 
arraying man against his brother, have strewn the 
paths, over which they rode rough-shod to fame, with 
the wreck of ruined civilizations; with ravaged and 
devastated homes ; with cnished widows and helpless 
orphans ; with the mangled and broken wrecks of 
once vigorous manhood, and the moldering bones of 
myriads of their fellows. And when shall, instead, 
be enshrined the tme heroes of their day, those who, 
turning war's red sword into the hook and share of 
husbandry, and lending a helping hand to lift poor 
humanity upward and onward, have sought only the 
paths of peaceful progress. 

Thus in the application of your science to the dis- 
charge of the duties of your profession, do you ever 
conserve the vital forces of the r^ce, and re-gather 
and replenish the decaying energies and waning 
strength of those who, weary and discouraged, have 
fallen by the wayside. " 

In this, your ministration, yours is a life of peril, 
exposure, and unrest, and fraught with gravest re- 
sponsibility. For, while in thoughtful study, you 
ascend far above all imagery into the brightest and 
purest realm of science, in practice you are carried 
into the innermost courts of love and tenderest af- 
fection, of suffering and sorrow, of anguish and de- 
spair; often keeping anxious, weary vigil over the 
dying, only to stand at last with your science ex- 
hausted, powerless in the presence of the awful mys- 
teries of death, where but the slightest whisper of 
hope may fill with radiant light the eye already grow- 
ing dim, or thoughtless word from flippant tongue 
rob the poor confiding sufferer of that priceless boon 
which smooths his dying pillow and bids his weary 
soul look trustingly beyond. But equally great with 
its responsibilities are the advantages and opportuni- 
ties of your high calling. The timely voice of your 
warning, emanating from authority so high, must, in 
some mea.sure at least, check the dread course of that 
monster, dissipation, which has wrecked and ruined 
myriads of happy homes, and yet stalks boldly 
abroad — the bane and curse of our civilization. The 
far-reaching influence of your earnest protest must 
prove fruitful in those business and home circles of 
our land, wherein to-day has grown so prevalent the 
false and artificial system of life, whose extravagant 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIATION. 



[July, 



and ruinous demands require that continued fatal 
strain of nerve and brain power, which fills our ceme- 
teries with untimely graves, and renders infirm and 
decrepit thousands upon thousands of men who 
should still be in their prime. 

But due regard for the value of every moment of 
your time, so apparent in the published assignment of 
your labors, precludes further encroachment without 
transcending the limits of propriety. And, there- 
fore, indulging the hope that as you view the beauty 
with which nature and art have combined to crown 
our city, and contemplating the busy throng of her 
thoroughfares, the vast commerce riding her harbor, 
and the hum and clatter of the varied and number- 
less industries of her two hundred thousand people, 
and realize that all this is the growth and product of 
a single generation, you may also learn that her ma- 
terial progress has but kept pace with the hospitality 
of her homes. Again bidding you most cordial wel- 
come, gentlemen, we wish you Godspeed in your 
noble work. 

Vice-Presidents Dr. Eugene Grissom, of North Caro- 
lina; Dr. Alex. J. Stone, of Minnesota, and Dr. H. 
S. Orme, of California; the Permanent Secretary, 
Dr. Wm. B. Atkinson, and the Treasurer, Dr. R. J. 
Dunglison, of Pennsylvania ; the Assistant Secretary, 
Dr. I. N. Himes, of Ohio, and the Librarian, Dr. C. 
H. A. Kleinschmidt, of D. C, were also present. 

Ex-Presidents Dr. S. D. Gross, Pa.; Dr. N. S. 
Davis, 111.; Dr. J. M. Toner, D. C; Dr. T. G. Rich- 
ardson, La.; Dr. W. O. Baldwin, Ala., by invitation, 
were seated upon the platform. 

Dr. X. C. Scott, on behalf of the Committee of 
Arrangements, presented the programme for the en- 
tire session, and announced the invitations which had 
been received and the entertainments which had been 
prepared for those attending the sessions. 

He presented several communications protesting 
against any change in the Code of Ethics, all of which 
were referred to the Judicial Council. 

The President then delivered the annual address. 

On motion of Dr. Jas. M. Keller, of Arkansas, a 
vote of thanks was tendered to Dr. Atlee for his inter- 
esting and able address, and it was referred to the 
Committee of Publication. 

On motion of Dr. Henry Hakes, of Pennsylvania, 
the members of the Ohio State Medical Society were 
invited to seats as members of the Association. 

Dr. J. S. Billings, U. S. Army, presented a com- 
munic;ation from the British Medical Association, ask- 
ing the American Medical As-ociation to cc- operate 
in the work of meteorological observations in their 
relation to the clinical hi.tory of disea;ie. On 
motion, it was referred to the Committee on Atmo;> 
pheric Conditions, of w'.iich D . N. S. Davis is chair- 
man. 

An appeal from Dr. Dwight W. Day, asking a re- 
hearimr, was referred to tne Judicial Cou icil. 

Dr. H. D. Didama, of N -w Y)]k, offered the fol- 
lowing, which, on m >tioi, was laid on the tabl-? until 
the report was made by t lie appropriate committee: 

Whereas, It is all-'mportant that the medical 
profession should be provided with accurate and dis- 
interest jd rei)orts of the variou. moteorclogical con- 



ditions of the most important of the health resorts, 
and thus be enabled to judge for themselves of their 
relative value in the treatment of pulmonary affec- 
tions : therefore, be it 

Resolved, That the American Medical Associa- 
tion, as a body, petition Congress and the Secretary 
of War to authorize the chief signal officer to estab- 
lish a certain additional number of stations for cli- 
matic observations in such localities as have been 
shown to exercise a beneficial influence upon pulmon- 
ary consumption. And be it further 

Resolved, That a committee of five members of 
the regular profession be appointed to agree upon and 
designate such localities, to carry into effect the fore- 
going resolution, and to report the result of their 
labors from year to year to the Association. 

The Permanent Secretary then read the list of del- 
egates and permanent members, as registered. 

On motion of Dr. J. M. Toner, the list as read, 
save any that might be protested against, was adopted. 

On motion, the Association adjourned until Wed- 
nesday, at 9:30 A. M. 

SECOND DAY— GENERAL SESSION. 

The President called the Association to order at 
9:30 A. M. 

Prayer was offered by Rev. Chas. S. Pomeroy, 
D.D., of Cleveland. 

COMMITTEE ON NOMINATIONS. 

The Permanent Secretary called the roll of States, 
and announced the following as composing the Com- 
mittee on Nominations : 

Alabama, W. O. Baldwin ; Arkansas, D. Linthi- 
cum; California, W. F. McNutt ; Colorado, H. K. 
Steele ; Connecticut, T. M. Hills ; Delaware, Wm. 
Marshall; District of Columbia, D. C. Patterson; 
Georgia, E. Foster; Illinois, C. T. Parkes; Indiana, 
H. G. Wood ; Iowa, W. S. Robertson ; Kentucky, 
L. S. McMurtry ; Kansas, W. L. Schenck ; Louisi- 

! ana, J. W. Dupree; Massachusetts, C. A. Savory; 

j Maryland, J. J. Chisolm ; Minnesota, B. H. Miller; 
Michigan, F. K. Owen ; Missouri, F2. H. Gregory ; 
Maine, A. J. Fuller ; Nebra ;ka, V. H. Coffnian ; 
North Carolina, E. G:issom; New Jersey, B. A. 
Watson; New York, H. D. Didama; Ohio, W. M. 
B''ach ; Pennsylvania, Samuel D. Gross ; Rhode 
I land, A. Ballou; S:iuth Carolina, R. A. Kinloch ; 
T-nne.ssee, D. J. Roberts; Texas, H. C. Ghent; 
Virginia, Alex. Harris; Wcist Virginia, J. M. Laz- 
Z' 11; Wisconsin, S. C. Johnson ; U. S. Marine Hosp., 
T. W. Miller; U. S. Army, Jos. R. Smith; U. S. 
Navy, A. L. Gihon ; New Mexico, W. R. Tipton ; 
Dak'jta Ter., A. B. Van Nison. 

CONSTITUTIONAL AMENDMENTS. 

0"i motion of Dr. Foster Pratt, of Michigan, the 
full wing amendment to the by-laws was taken up 
and adopted : 

T.iat Section XIII of By-Law; be, and it is hereby, 
am mdcd so as to read as follows : 

Tnat none but members present shall be elected 
President, Vice-President, Secretary or Treasurer of 
the Association, Chairman or Secretary of Sections. 



iSSsl 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIATION. 



ARMY MEDICAL MUSEUM AND LIBRARY. 

By request of Dr. S. D. Gross, the Permanent Sec- 
retary read the following : 

To THE President of The American Medical 
Association, 

S/r: — The undersigned, members of the medical 
profession, desire to call the attention of the Associa- 
tion to a subject of great importance, as they believe, 
to the profession and to the public welfare. 

There has been formed at Washington, under the 
direction of the Medical Department of the Army, a 
Museum of Military Medicine and Surgery, and in 
connection with this, a Medical Library, each of 
which is believed to be the largest and best of its kind 
in the world. 

The building in which these invaluable collections 
are stored, collections which can never be replaced if 
destroyed, is insecure, not fire-proof, in the midst of 
highly inflammable buildings, and overcrowded. At 
the close of the last session of Congress, too late for 
action, a bill appropriating funds for a fire-proof build- 
ing, of which a copy is appended herewith, was re- 
ported. It appears to the undersigned in the highest 
degree desirable that this bill should become a law at 
the next session of Congress, and to further this end, 
that the physicians of the United States should ex- 
plain to the Senators and members of Congress of the 
Districts and States to which they belong, the great 
importance of these collections of books and speci- 
mens, the propriety of granting the funds necessary 
for their maintenance and preservation, the inexpedi- 
ency of separating them, or removing them from the 
management under which they have been so success- 
fully conducted, and the necessity of a fire-proof j 
building, that they may be handed down safely to 
coming generations. ! 

The library now contains seventy thousand volumes 
and sixty-six thousand pamphlets. The Army Medi- 
cal Museum contains twenty thousand specimens, il- 
lustrating military surgery and medicine. The com- 
munity, and probably many of the profession, are 
hardly aware of the great expansion of medical liter- 
ature within the last thirty or forty years. When one 
of the undersigned drew up the first Report on Med- 
ical Literature, read before the Association at the 
meeting in Baltimore in the year 1848, there were not 
as many as twenty-five medical periodicals published 
in the United States. There are now one hundred 
and seventeen. A similar increase has taken place in 
other countries. When it is remembered that the 
least valuable of these p)eriodicals may contain new 
and valuable facts not to be found elsewhere, and that 
such facts are made accessible to practitioners all over 
the country, by means of the admirable Index Medi- 
ciis, the value of such a storehouse of medical inform- 
ation is sufficiently obvious. It is very important that 
the Museum and the Library should be kept together, 
inasmuch as they mutually illustrate each other to a 
large extent. The building containing both would be 
a great center of attraction for physicians and surgeons 
from every part of the country ; and not this country 
only, but from all civilized regions of the earth. 



During the year 1881, no less than forty thousand 
I persons visited the Museum. 

The formation of this great public library has acted 
as a stimulus to the establishment of medical libraries 
in many other cities — in Philadelphia, New York, 
Worcester, Providence, Baltimore, Buffalo, St. Louis, 
Cincinnati, Brooklyn, and elsewhere. 

As regards the Library, it should be urged that it 
is for the benefit of medical education, and of the 
medical profession throughout the country, which 
means, let it not be forgotten, for the benefit of all 
who come under the treatment of physicians. The 
physicians of the country appeal confidently to the 
General Government to lend its aid in helping on the 
cause in which the common good is so deeply involved. 
An educated and enlightened medical profession 
means a great saving of human life and a great dimi- 
nution of human suffering. To be equal to what 
should be expected of an institution equipped by the 
nation for the needs of the nation, we believe the fol- 
lowing measures should be adopted : 

The Library should receive promptly every medi- 
cal book, journal or pamphlet published in the world, 
for which an annual appropriation of ten thousand 
dollars would be required. 

The Museum should have, in addition, an annual 
appropriation of at least five thousand dollars. 

The funds required for completing the index-cata- 
logue, which is the handle of that great civilizing in- 
strument, the Library, should be promptly provided. 

A fire-proof building of ample dimensions, for the 
proper management and safe preservation of the in- 
estimable treasures already collected, and to increase 
with every succeeding year, should, without delay, be 
furnished by the General Government. 

S. D. Gross, 
Austin Flint, 
O. W. Holmes. 

47th Congress, 2d Session. — H. R. 7681. — Re- 
port No. iggs- — In the House of Representa- 
tives, February 28, 1883. Read twice, committed 
to the Committee of the Whole House on the state 
of the Union, and ordered to be printed. 

Mr. Shallenberger, from the Committee on Pub- 
lic Buildings and Grounds, reported the following bill : 
A Bill authorizing the erection of a fire-proof build- 
ing in the city of Washington, to contain the rec- 
ords, library, and museum of the Army Medical 
Department. 

Be it enacted by the Senate and House of Represent- 
atives of the United States of America, in Congress 
assembled, That the erection of a brick and metal 
fire-proof building, to be used for the safe-keeping of 
the records, library, and museum of the Surgeon- 
General's Office of the United States Army, is hereby 
authorized to be constructed upon the government 
reservation in the vicinity of the National Museum 
and the Smithsonian Institution, on a site to be selected 
by a commission composed of the Architect of the 
Capitol, the Secretary of the Smithsonian Institution, 
and the officer in charge of the State, War, and Navy 
Department building, and in accordance with plans 
and specifications submitted by the Surgeon-General 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIATION. 



[July, 



of the Army and approved by said commission, the 
cost of the building, when completed, not to exceed 
the sum of two hundred thousand dollars ; the build- 
ing to. be erected and the money expended under the 
direction and superintendence of the officer in charge 
of the State, War, and Navy Department building. 

Dr. H. A. Johnson, of Illinois, "offered the follow- 
ing preamble and resolutions, which, on motion, were 
unanimously adopted : 

Whereas, There has been formed in Washington, 
under the direction of the Medical Department of 
the Army, a museum of unrivaled completeness and 
excellence, illustrating military medicine and surgery, 
and a medical library, which is believed to be the 
largest and most valuable in the world, and 

Whereas, It is believed to be of the highest im- 
portance for the promotion of medical science, liter- 
ature and education in this country that these collec- 
tions should be preserved and made and kept as 
complete as possible, and 

Whereas, It is believed that this can be best done 
by keeping them together under the management 
which has already produced such excellent results, 
and by its publications has made them available for 
use throughout the country ; therefore 

Resolved, I. That the American Medical Associ- 
ation respectfully urges upon Congress the importance 
of at once providing a commodious fire-proof building, 
to contain the Army Medical Museum and Library. 

II. That the annual appropriation for this Library 
should be sufficient to enable it to obtain all new 
medical publications of all countries as soon as they 
appear, and also to complete its collection of medical 
books heretofore published, and that for this purpose 
the sum of ten thousand dollars is considered a reason- 
able and proper annual appropriation, and Congress 
is requested to grant that ■ sum in addition to the 
amount required for the Medical Museum. 

III. That it is of the greatest importance that the 
index catalogue of this library, now in course of pub- 
lication, should be issued as rapidly as it can be prop- 
erly prepared for the press, and Congress is urged to 
make the necessary appropriations for this purpose. 

IV. That a special committee of five be appointed, 
of which the president of the Association shall be ex- 
officio chairman, to present this matter to Congress, 
and to call the attention of State medical societies, 
and of all who are interested in the progress of medi- 
cine to the importance of furnishing to members of 
Congress and senators full information as to the value 
of this Museum and Library, and the esteem in which 
they are held by the medical profession of the United 
States. 

ASSOL'IATION journal REPORT OF THE BOARD OF 

TRUSTEES ON THE ESTABLISHMENT OF THE JOURNAL 
OF THE AMERICAN MEDICAL ASSOCIATION. 

Dr. Davis, president of the board, reported as fol- 
lows : 

'■'Resolved, That the interests of the Association 
would be promoted by the publication of its transac- 
tions in a weekly medical journal under its own con- 
trol, instead of in an annual volume, as heretofore. 



provided it could be done without involving pecuni- 
ary embarrassment, or so far engrossing its funds as to 
prevent the annual encouragement of original inves- 
tigations by its ipembers. 

'■'■Resolved, That so much of the report of the com- 
mittee on journalizing the transactions of the Associ- 
ation as relates to the appointment of a board of 
trustees, nine in number, and their duties be, and the 
•same is hereby adopted, and that the president of the 
Association now appoint a special committee of seven 
to recommend to this meeting of the Association the 
names of nine* members for election to constitute said 
board of trustees. 

'■'■Resolved, That the board of trustees so appointed 
be requested as early as possible to agree upon a plan 
of a medical journal, to be called the Journal of 
THE American Medical Association, and to send 
circulars explaining such plan, and asking pledges of 
support by actual subscription, to the members of the 
medical profession throughout the whole country, and 
thereby ascertain as reliably as possible, what degree 
of support the proposed journal can have as a basis for 
commencing its publication. And that said board 
also proceed to ascertain and agree upon the best 
methods of publishing said journal, the best editorial 
services it can secure to take charge of the work, and 
the best plans for its issue. 

'■'Resolved, That said board of trustees be and are 
l^ereby instructed under all " circumstances, in Avhat- 
ever plans or contracts it proposes to adopt, to retain 
the entire control over the use of the advertising, as 
well as of all other pages of the journal that is pro- 
posed to be established, and that said board report in 
full at the next meeting of this Association the plans 
upon which it has been able to agree, together with 
the response of the profession to its circulars asking 
actual subscriptions to the proposed journal, and that 
the constitutional amendments proposed by Dr. Pack- 
ard last year be continued upon the table until the 
report of the board of trustees is received and acted 
upon. 

''Resolved, That the treasurer of this Association is 
hereby authorized to pay out of funds in the treasury 
the necessary expenses of the board of trustees in 
printing and distributing its circulars and in conduct- 
ing its proper correspondence." 

In accordance with the foregoing resolutions adopt- 
ed by the Association at the meeting in St. Paul, June, 
1882, nine members were appointed to constitute a 
board of trustees, consisting of Drs. N. S. Davis, of 
Illinois, E. M. Moore, of New York, J. M. Toner, 
of Washington, H. F. Campbell, of Georgia, John 
H. Packard, of Pennsylvania, L. Connor, of Michi- 
gan, P. O. Hooper, of Arkansas, A. Garcelon, of 
Maine, and L. S. McMurtry, of Kentucky. 

Immediately after the adjournment of the Associa- 
tion, a meeting of the board was held at which a 
majority of the members were present, and an organ- 
ization was effected by the election of N. S. Davis, of 
Chicago, president, and J. H. Packard, of Philadel- 
phia, secretary. The president of the board was in- 
structed to proceed with as little delay as possible to 
the printing of a sufficient number of copies of the 
report of the special committee on the subject of 



t883.] 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIATION. 



journalizing the transactions of the Association made 
to the meeting in St. Paul, and of the resolutions 
adopted by the Association, for the use of each mem- 
ber of the board. Also to devise a plan or programme 
of a weekly journal suitable for the objects of the 
Association, and submit the same by correspondence 
to each member of the board. This was done, and 
a programme for a weekly medical journal containing 
an average of thirty-two double-column pages of 
reading matter was agreed upon, each number to con- 
tain a department for original articles, embracing all 
such papers, addresses, reports, etc., as should be re- 
ferred for publication by the Association, and such 
other original matter of value as might be contributed 
for that purpose ; a department containing an edito- 
rial summary of the progress in the various depart- 
ments of medical science and practice ; an editorial 
department proper, especially devoted to the discus- 
sion of such topics as would be likely to aid in pro- 
moting the interests and efficiency of medical organ- 
izations, both National and State, and would make 
the important objects of such organizations better 
knowTi throughout the whole profession ; a depart- 
ment of correspondence from the more important 
medical centers, both domestic and foreign ; and a de- 
partment for miscellaneous items of intelligence es- 
pecially in relation to the doings of all medical and 
scientific societies in this country, and of such notices- 
of the duties of committees, the presentation of pa- 
pers, the practical working of sections, and the time 
and place of meeting, as will greatly aid in rendering 
all the work of this Association, and indirectly of all 
the State and local associations, more systematic, ef- 
ficient, original, and co-operative ; and consequently 
far more valuable in scientific and practical results. 
Having agreed upon the plan of a journal, the board 
proceeded at once to the printing of 40,000 circular 
letters containing the principal features of the plan 
adopted and the objects to be accomplished, together 
with 40,000 blank pledges of support of such journal 
if published, and the same number of envelopes, di- 
rected, in which to enclose and return the pledge if 
approved and signed by the recipient, to the presi- 
dent of the board. One copy 6f the circular letter ! 
embracing the programme, one pledge, and one di- i 
rected envelope, were enclosed in a i-cent stamped : 
envelope and mailed to members of the profession in 
all the States and Territories of the Union. 

Having very full and recently prepared lists of physi- i 
cians in the States of Pennsylvania, Indiana, Illinois, 
Iowa, Minnesota, Texas, Kansas, Dakota, and West 
Virginia, a larger proportionate number of the circu- 
lars reached the members of the profession in those 
States, than in any of the others. For New York, Con- 
necticut and New Jersey, the volume published in New 
York containing the registration of regular physicians 
in those States was used. For Massachusetts, the offi- 
cial list of members of the State and District medical 
societies was supplied. For Georgia a State gazetteer ; 
was used, while for nearly all the other States, only i 
lists of the members of this and the State medical j 
societies, aided in some instances by the last edition of '■ 
the United Medical Directory. The result was an 
absorption of three-fourths of the 40,000 circulars in 



supplying the fourteen States just named, leaving but 
a limited supply for the other twenty-three States and 
Territories. 

These details in regard to the distribution of circu- 
lars are given, to show, first, that the whole number 
printed was not adequate to supply a full distribution 
in all the States, even if complete lists could have 
been obtained without unreasonable expense and delay ; 
and, second, to explain why a much larger number of 
pledges were returned from some States than others in 
the same general division of the country. A« full 
comparison of the returns from States well supplied 
with circulars, with those from States directly adjoin- 
ing only partially supplied, fully justifies the conclu- 
sion that if all had been as well supplied as the first 
class, the aggregate return would have been increased 
more than twenty-five p)er cent. From the distribu- 
tion actually made, 2,150 answers have been returned. 
Of these, 1 2 were direct expressions of opposition to 
the proposed change in the mode of publishing the 
transactions; 38 were equivocal, while 2,100 were 
unequivocal pledges to sustain the proposed journal, 
either by the prompt payment of annual dues or by 
subscription. The last complete list of those who 
had paid their dues with sufficient regularity to retain 
their membership is in the volume of transactions for 
1 881, and contains about 2,200 names. By compar- 
ing the number of pledges from each State with the 
number of members of the Association resident in 
each, we obtain the following result: Twelve of the 
States have returned 444 more pledges than they had 
paying members, as indicated in the list of 1881. 
The other twenty-five States have returned 468 less 
than the number of members given them in the list 
of 1 88 1. These figures indicate that at least 500 of 
the members of the Association had not taken the 
trouble to make any reply to the circulars received, 
while nearly the same number, who are not mem- 
bers, have pledged support by subscriptions. It is 
fair to presume that those members, who through 
forgetfulness or indifference, have made no reply, 
will nevertheless continue their membership. And 
if so, their names should be added to the pres- 
ent number of pledges, making the aggregate 
over 2,500 as the actual basis of income from mem- 
bership dues and independent subscriptions. This 
would indicate a revenue from membership and sub- 
scriptions of $12,500. As the proposed journal of 
thirty-two double-column pages of reading matter, 
without advertising sheets, can be issued weekly on 
excellent paper and in good style to the extent of 
3,500 copies per week, at an aggregate cost lor 
materials, printing, wrapping and mailing of $8,000 
per annum, there would be left in the treasury only 
$4,500 for editorial work and current expenses of the 
Association. But such a journal reaching members 
of the Association and others in every State and Ter- 
ritory of the Union would constitute one of the best 
mediums for legitimate medical advertising, and under 
reasonably fair business management the net revenue 
from that source would not be less than $5,000 per 
annum. This sum, added to the income from dues 
and subscriptions would cover the cost of publication, 
allowing $6,000 for editorial work of all kinds, and 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIATION. 



[July, 



leave a balance of $3,500 in the treasury for ordinary 
expenses and such scientific investigations as might be 
deemed proper. These estimated expenses are based 
on actual bids from well-established and responsible 
printing houses, and are for an edition of 1,000 
copies in excess of the number of supposed members 
and subscribers constituting the basis of income. If 
the estimates both for income and expenditures were 
limited to the actual number of direct pledges of sup- 
port, the relative outcome would be the same. But 
as each new member who may come to this meeting 
(and there are a considerable number of new mem- 
bers at each annual meeting), will be entitled to a 
copy of the journal, in addition to the 2,100 pledges 
already on hand, it would not be safe to provide for 
less than 2,500 members and subscribers at once. 
And at least 1,000 extra copies of each issue should 
be printed, first, to supply new members and subscri- 
bers ; and, second, to furnish sample copies and com- 
plete files when broken by accident or miscarriage. 
The circular letter containing the programme and 
blank pledges had been distributed so early in the 
year that much the larger number of the returns had 
been made to the President of the Board before the 
first of January, 1883, and estimates in regard to the 
cost of publication had been obtained from two reli- 
able printing establishments in Washington, three in 
Philadelphia, two in New York and two in Chicago. 
The general results, up to that time, were communi- 
cated by letter to each member of the Board, accom- 
panied by an invitation to meet in Chicago for a full 
consideration of the important matters confided to 
the Board. The meeting was held on the 1 7th of Janu- 
ary, 1883, in the parlor of the Grand Pacific Hotel, 
Chicago, at which time a majority of the members, 
namely, Drs. Toner, of Washington, Packard, of 
Philadelphia, McMurtry, of Louisville, Davis, of Chi- 
cago, and Connor, of Detroit, were present, and full 
letters also from each of the absent members. After 
a careful analysis of the returns containing pledges of 
support, together with the few of an adverse charac- 
ter, the members of the Board voted unanimously in 
favor of recommending the publication of the journal 
as previously proposed, being satisfied that it could 
be done without pecuniary embarrassment to the 
Association. 

Having decided this question, the Board proceeded 
to consider the general plan on which the work could 
be most efficiently conducted, and the most favorable 
place for its publication ; which resulted in the adop- 
tion of the following propositions : 

1. The editor to take direct supervision of the 
whole work, and for business purposes he should 
employ a clerk, competent to assist in all business 
matters, such as keeping books, filing papers, answer- 
ing business letters, etc. 

2. For assistafice in editorial work, he should 
engage an assistant or assistants, specially qualified to 
select and write up the progress being made in all the 
departments of medical science and art, and give to 
each, out of the editorial fund, a fair compensation 
for the work performed. 

He should also, as far as practicable, secure the 
services of reliable correspondents in each of the great 



medical centers of the country, and some of those in 
Europe. 

3. He should establish a direct correspondence 
with the secretaries or proper officers of all the State 
Medical Societies, with a view of obtaining early and 
accurate knowledge of their proceedings. 

4. Through his clerk he should solicit by cir- 
cular letters, etc., advertisements from all medical 
educational institutions and hospitals open for clinical 
instruction, from book publishers, pharmaceutists, 
instrument makers, and all other legitimate business 
interests. But all advertisements oi proprietary , trade 
mark, copyrighted, or patented medicines should be 
excluded. Neither should any advertisements be 
admitted with one or more names of members of the 
profession as indorsers, having their official titles or 
positions attached. 

In other words, no advertisements should be ad- 
mitted which fairly contravene in letter or in spirit 
the principles of the national code of ethics. 

On examining the estimates furnished by respon- 
sible printing houses in the four cities previously 
named, it was found that the most favorable terms 
had been offered by Tucker, Newell & Co., of Chi- 
cago, and the Board decided to recommend the 
acceptance of their terms, and Chicago as the place 
of publication. 

It is thus seen that the Board of Trustees has en- 
deavored to promptly and faithfully comply with the 
instructions given, and execute the work enjoined 
upon it in the resolutions adopted by the Association 
at its annual meeting in St. Paul, June, 1882. 

1. By agreeing upon a plan for the proposed 

JOUNAL OF THE AMERICAN MeDICAL x\sSOCIATION. 

2. By printing and distributing over 40,000 
copies of said plan, accompanied by the necessary 
explanations, and blank pledges asking a return of 
the latter to the President of the Board. 

3. By ascertaining as reliably as possible the cost 
of publishing the journal on the plan agreed to. 

4. By assembling at the proper time and in open 
meeting, carefully canvassing the results, and ar- 
riving unanimously , at the conclusion that the pub- 
lication of the proposed journal, on the general plan 
already stated, could be undertaken not only without 
serious danger of producing any financial embarrass- 
ment, but, on the contrary, with a fair prospect of 
greatly adding to the prosperity of the Association, 
by retaining in active connection with it all who may 
be added from year to year, and by keeping alive a 
very much more active and beneficial intercourse 
with the profession at large. And 

5. By a cordial agreement upon the general 
plan of business management, the most favorable 
place for publishing, and upon the chief editor to take 
charge of the work, providing the Association should 
accept the recommendations and order it to proceed. 

The expenses incurred by the Board for printing, 
stamped envelopes and clerical work in directing and 
mailing the same, aggregate the sum of ;^ 709. 00, ^ 
of which has been paid by the Treasurer of the Asso- 
ciation, and vouchers for which are herewith pre- 
sented. In conclusion, the following resolutions are 
submitted for your consideration and action thereon : 



t883.] 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIATION. 



Resolved, That the report of the Board of Trus- 
tees just read be accepted, and the recommendations 
contained therein concerning the publication of a 
weekly periodical, to be called The Journal of the 
American Medical Association, be, and the same 
are hereby adopted. 

Resolved, That the Board of Trustees are hereby 
instructed to proceed with the publication of The 
Journal of the American Medical Association, 
at as early a day as is practicable, to take the place of 
the annual volume of transactions, and that the duties 
formerly devolved upon the standing Committee of 
Publication be transferred to the Board of Trustees, 
and that the Secretaries of the Association during or 
immediately after each annual session be required to 
transfer to the editor of the Journal the record of 
proceedings, addresses, and all written reports of 
committees and officers, papers and contributions that 
may be referred for publication, either in general 
sessions or in any of the Sections. 

Resolved, That the Treasurer of the Association be, 
and is hereby directed to make such arrangements 
with the Board of Trustees in regard to the collection 
of subscriptions and the disbursement of moneys, as 
may be necessary for facilitating the business of pub- 
lishing a weekly medical journal. But all orders on 
the treasury for disbursements of money in any way 
connected with the publication must be endorsed by 
the President of the Board of Trustees. 

Respectfully submitted, 
N. S. Davis, 
J. M. Toner, 
Leartus Connor, 
Henry F. Campbell, 
Alonzo Garcelon, 
P. O. Hooper, 

L. S. McMuRTRY. 

Dr. Wm. Brodie, of Michigan, moved to accept the 
report, and adopt the resolutions. 

Dr. W. C. Wile, of Connecticut, moved that it be 
printed, and made the order for discussion on Thurs- 
day at lo A. M. This was rejected. 

Dr. Wm. B. Atkinson, of Pennsylvania, expressed 
his gratifif ation at the report, and in order that no 
obstacle might be in the way of the success of the 
journal, voluntarily offered his ser\aces of the past 
year without fee or reward. 

The motion of Dr. Brodie was then adopted, with 
a few dissenting votes. 

D% L. S. McMurtry, of Kentucky, Secretary of the 
B)ad of Trustees, sta<^ed that he had beci instructed 
by the Board to report to the Association that it had 
now selec ted Dr. N. S. Davis, of Chicago, ^s editor- 
in-.-hief" of the Journal. 

D •. Davis then took the floor, and spoke at some 
Icigthwith reference to thep.-ospectsot the Journal, 
the anxiety whi( h it had given him, and asked the 
forbearance of the Association with reference to any 
shortcomings which might appear, and also that the 
members should not expect too much, and should not 
be to strict in their comparison of the Journal with 
the British Medic xl Journal, which had so often been 
held up for a pattern, for it must be remembered that 
the British Medical Journal had been the work of 
years. 



He further announced that he expected to be able 
to issue the first number of the Journal early in July 
next. 

Dr. J. Solis Cohen, of Pennsylvania, moved that 
the Board of Trustees be instnicted, in addition to the 
Journal, to print annually a thin, octavo volume 
containing the minutes of the Association. 

This motion gave rise to discussion, participated in 
by Drs. Hibbard of Indiana, Quimby of New Jersey, 
and Byrd of Illinois, and, on motion of Dr. T. G. 
Richardson of Louisiana, the whole subject was re- 
ferred to the Board of Trustees. 

Dr. L. P. Bush, of Delaware, moved that the Asso- 
ciation, in consideration of the long services already 
rendered, and also the kindness, self-denial, and will- 
ingness to assume the duties of editor-in-chief of the 
new journal, tender a vote of thanks to Dr. N. S. 
Davis. This was unamiously adopted. 

code of ETHICS 

Dr. N. S. Davis said he had been directed by the 
Judicial Council to state that that body assumed all 
responsibility in putting the pledge to support the 
Code of Ethics upon the blanks to be signed by dele- 
gates and permanent members before registering. 

Dr. A. B. Palmer, of Michigan, asked if it was 
meant that, by signing this blank, the signer was to 
sustain the present provisions of the Code, or was to 
sustain the Code, whatever it might be. 

Dr. Davis answered that the Code as it now stands 
was meant, and that if the Association made altera- 
tions, that then the changes would be considered as 
binding. 

TRUSTEES. 

The President announced the following as the 
committee to nominate Trustees in place of those 
whose terms had expired, and to fill the vacancy 
created by the resignation of Dr. Davis : 

Dr. T. G. Richardson, Louisiana. 

Dr. Wm. Brodie, Michigan. 

Dr. J. F. Hibberd, Indiana. 

Dr. W. O. Baldwin, Alabama. 

Dr. X. C. Scott, Ohio. 

Several questions on ethics were presented by tlie 
Chairman of the Committee of Arrangements, and 
referred to the Judicial Council. 

Dr. J. H. HoUister, of Illinois, then delivered the 
address as Chairman of the Section on Practical 
Medicine, etc. 

On motion, this was referred to the Board of Trus- 
tees of the Journal. 

Dr. T. G. Richardson announced that the Commit- 
tee had selected the following to complete the Board 
of Trustees: 

Dr. Alonzo Garcelon, Maine. - 

Dr. P. O. Hooper, Arkansas. 

Dr. L. S. McMurtry, Kentucky. 

Dr. J. H. Hollister, 111. 

Dr. J. K. Bartlett, of Wisconsin, then delivered 
the address as Chairman of the Section on Obstetrics, 
etc. 

On motion, it was referred to the Board of Trustees, 

Dr. J. M. Toner, District of Columbia, presented 
the report on American Medical Necrology. 



8 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIATION. 



[July, 



On motion, it was referred to the Board of Trustees. 
On motion, the Association adjourned to meet on 
Thursday, at 9:30 a. m. 

THIRD DAY— GENERAL SESSION. 

The President called the Association to order at 
9 :3o A. M. 

Prayer was offered by Rev. N. S. Rulison, d.d., 
of Cleveland. 

TIME OF MEETING. 

Dr. J. M. Keller, called up his proposed amend- 
ment to the By-Laws, permitting the holding of the 
annual meetings as late as the first Tuesday of Sep- 
tember, if desirable. 

On the suggestion of the Permanent Secretary, he 
agreed to modify it so as to allow the committee on 
•nominations to select the time as well as the place of 
meeting, and the By-Laws were so amended. 

TOXICAL AGENTS. 

Dr. D. H. Batchelder, of Rhode Island, offered 
the following : 

Whereas, In the opinion of this Association, the 
laws of almost every State are too lax in relation to 
the sale of toxical agents, by which suicidal deaths 
are made easy ; therefore. 

Resolved, That there be appointed by the Presi- 
dent one or more persons or members of each of the 
States, who shall be members of this Association, to 
confer with the legislatures of each of the States, by 
petition or otherwise, for the enactment of more 
stringent laws in relation to the sale of all toxical 
agents. 

After some discussion, on motion the resolution 
was adopted. 

On motion of Dr. Foster Pratt, of Michigan, it 
was 

Resolved, That the labors of Dr. William Parr, of 
England (recently deceased), in the organization, 
classification, and compilation of vital statistics — 
labors begun in 1838, and perseveringly, wisely, and 
ably continued by him for nearly half a century — are 
recognized by the medical profession of the United 
States as an enduring monument to his ability and 
learning as a physician ; as the real incentive to and 
the foundation of our own sanitary work, and as a 
perpetual blessing to present and future generations 
of our universal humanity, entitling his name and 
fame to stand with that of other great men, whose 
genius and labors have resulted in beneficent revolu- 
tions of the medical, surgical, and sanitary thought 
and activities of the civilized world. 

TRAINED NURSES. 

Dr. S. D. Gross offered the following, which on 
motion was adopted : 

Whereas, Good nursing is of paramount impor- 
tance to the comfort of the sick and the restoration 
of their health, and, 

Whereas, The subject is one which strongly ad- 
dresses itself to the common sense and kindly sym- 
pathy of every intelligent member of society ; there- 
fore, 



Resolved, That this Association, fully recognizing 
the importance of the subject, respectfully recom- 
mend the establishment at every county town in our 
States and Territories, of schools or societies for the 
efficient training of nurses, male and female, by lec- 
tures and practical instruction, to be given by com- 
petent medical men, members, if possible, of county 
societies, either gratuitously or at such reasonable 
rates as shall not debar the poor from availing them- 
selves of their benefit. 

Dr. Walter Hay, of Illinois, offered a resolution 
providing for the organization of a special section to 
be devoted to the subject of psychological medicine. 
Laid over for one year, as being an amendment to 
the by-laws. 

atmospheric conditions, etc. 

Dr. N. S. Davis presented the report on Atmos- 
pheric Conditions and their Relations to the Preva- 
lence of Disease. 

The report closed with the following resolutions : 
That the committee be authorized to furnish their 
report for publication as a part of the transactions of 
the Association, and to continue the investigations 
now in progress, with the privilege of drawing upon 
the treasury for so much of the unexpended balance 
of the former appropriation as might be necessary. 
Second, that the thanks of the Association are here- 
by tendered to the Superintendent of the Signal 
Service, General Hazen, for his uniform courtesy and 
favors extended, and that he be requested to continue 
the same as the committee may require. The reso- 
lutions were unanimously adopted. 

The resolutions offered by Dr. Didama in behalf of 
Dr. Tyndale, of New York, at the session on Tues- 
day, were then taken from the table and referred to 
this committee. 

By request of Dr. Davis, Dr. Didama, of New 
York, was added to the Committee on Atmospheric 
and Ozonic Conditions. 

On motion of Dr. Reed, of Iowa, it was 

Resolved, That the sympathy of this Association be 
and is hereby extended to the bereaved wife and 
family of the late Dr. J. C. Hubbard, of Ashtabula, 
Ohio, who was so suddenly snatched from our midst 
while in attendance upon this Association. 

FOREIGN delegates. 

The president appointed the following as delegates 
to foreign organizations : 

G. J. Engelman, Missouri ; W. M. Findley, of 
Pennsylvania ; Walter L. Zeigler, Pennsylvania ; 
M. H. Alter, Pennsylvania; R. B. Cole, California; 
Jos. H. Warren, Massachusetts ; C. H. von Klein, 
Ohio ; W. M. Lawlor, California ; S. C. Martin, 
Massachusetts ; J. C. Hutchinson, New York ; A. M. 
Hawes, Michigan ; Edward Borck, Missouri ; T. F. 
Prewitt, Missouri ; E. P. Allen, Pennsylvania ; H. 
McColl, Michigan ; I. N. Quimby, New Jersey ; S. 
C. Gordon, Maine; Eugene Smith, Michigan; M. 
A. Bogie, Missouri ; G. C. Catlett, Missouri ; 
Edward Warren, Paris, France; S. Strausser, Illi- 
nois ; M. M. Milligan, New Mexico. 



1883.] 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIATION. 



CODE OF ETHICS. / | 

Dr. S. Pollak, of Missouri, presented the following: ! 

The St. Louis Medical Society requested me to ; 
make a motion to the following effect : , 

A code of ethics is considered essential for such I 
an organization as that of the American Medical 
Association, and is equal in importance to the writ- ; 
ten law of a community. Associations, communities, 
can only be ruled by laws which are made for them- 
selves and by themselves. 

But the best laws became oppressive and inoperative, 
when the conditions change which called for their en- 
actment. A revision and change of such laws becomes, 
then, imperative, as is so frequently instanced by the 
changes of the Constitution of the United States, and 
of every State in the Union. Municipal and cor- 
poration charters are changed by the will of the gov- 
erned, who delegate that power to their representa- 
tives. The Code of Ethics has an existence coeval 
with the organization of the American Medical Asso- 
ciation. It was absolutely necessary, then, and it can 
not be entirely dispensed with now. But in thirty- 
four years this country has presented so many phases 
in its development and progress that new laws are 
being constantly enacted, old laws are repealed or 
modified to suit the requirements of the time. 

The Code has accomplished all that it was designed 
it should, but at present many of its features are ob- 
solete, and not adapted to our wants. The necessity 
of an early revision is very apparent, is loudly called 
for in all parts of our land, and it cannot be repressed 
much longer. 

The American Medical Association alone has the 
right and power to order a revision. The other med- 
cal organizations, in affiliation with it, can only re- 
spectfully ask for it, but they cannot legitimately urge 
or effect it. The time has come when this loud, and 
very soon, universal, call should be heeded. The 
excitement and evil consequences of a schism can be 
easily averted now, and harmony and fraternal feel- 
ing may once more be restored among the members 
of the medical profession. Therefore, 

Resolved, i. That the American Medical Associa- 
tion be respectfully requested to appoint a committee 
of one member from each State for the purpose of 
taking into consideration the propriety and advisa- 
bility of a revision of the Code of Ethics of the Ameri- 
can Medical Association, and to report thereon at the 
meeting of 1884. 

Resolved, 2, That the committee be authorized to 
prepare a Code of Ethics, which, in their view, will 
meet the wishes of the profession, and submit the 
same to the meeting of 1884. 

On motion of Dr. D. Leasure, of Minnesota, it 
was laid on the table by a large majority. , 

Dr. Wm. Brodie offered the following : 

Resolved, That all papers to be read before the dif- 
ferent sections should, before such reading, receive the 
approval of the chairman of the same. 

On motion this was laid on the table. 

On motion of Dr. N. S. Davis, Dr. Mark L. 
Nardyz was invited to a seat with the Association. 

Dr. W. F. Peck, of Iowa, then delivered the address 
as Chairman of the Section on Surgery and Anatomy. 



On motion it was referred to the Board of Trustees. 

Dr. Foster Pratt, of Michigan, delivered the ad- 
dress as Chairman of the Section on State Medicine. 

On motion, it was referred to the Board of Trustees. 

The Treasurer presented his report : 

REPORT OF THE TREASURER. 

The Treasurer has the honor to report a balance 
in the treasury at this Hate of $903- 93- There is but 
little of interest to report in regard to the funds of. 
the Association, except, perhaps, the fact that the 
amount — $50 — authorized by this body to be paid 
towards the guarantee fund of the "Index Medicus," 
was materially reduced by the refusal of a portion of 
the amount paid, under authorization of the Associa- 
tion, in 1881, and an unclaimed portion of the 
amount guaranteed in 1882, all of which is respect- 
fully submitted. Richard J. Dunglisox, 

June 5, 1883. Treasurer. 

The Librarian presented his report : 

REPORT OF THE LIBRARIAN OF THE LIBRARY OF THE 
AMERICAN MEDICAL ASSOCIATION. 

Mr. President : I have the honor to submit the 
accompanying catalogue of additions made to this 
library by donations, exchange, and purchase during 
the past year. The catalogue shows • that since the 
last report of my predecessor. Dr. Wm. Lee, there 
have been added 115 distinct titles, exclusive of 
yearly volumes of transactions of societies, reports of 
hospitals, boards of health, and volumes of medical 
journals previously catalogued as such. By this ad- 
dition the library has been increased to 1,817 dis- 
tinct titles, representing about 5,713 volumes, in- 
clusive of pamphlets. 

The donations to this library, as a rule, consisted 
in monographs presented by their authors, the library 
otherwise depending upon its own resources to ob- 
tain periodicals by exchange. 

I respectfully recommend that the home and foreign 
exchanges be continued, and, wherever p)ossible, in- 
creased ; that $200 be placed at the disposal of the 
Librarian, to be expended as heretofore for the pur- 
poses of binding and purchase of periodicals, proceed- 
ings, and transactions to complete sets already in our 

' possession ; also that $50 be again subscribed to the 
Index Medicus under the same conditions as have ob- 

I tained heretofore, in order that the editors and pub- 
lishers of this valuable periodical may again be as- 
sured of the full appreciation of the Association and 

; of its desire to ensure the success of their work. 

In conclusion, I feel it my duty to state that the 
admirable system introduced and perfected by my 
immediate predecessor, Dr. Wm. Lee, has rendered 
my work as librarian, w^hich, without such system, 
would have been difficult and laborious, an easy and 
pleasant task. Respectfully submitted, 

C. H. A. Kleinschmidt, m.d., Librarian. 
3,113 N. St., N. W., Washington, D. C. 

publications. 

The Committee of Publication have the honor to 
present their report for the past year. 

Volume 33 of the Transactions was published and 
issued to the members of the Association early in the 



lO 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIATION. 



[July, 



present year, after the usual delay, which seems to be 
unavoidable in the issue of the annual volumes. The [ 
causes which produced such delay have been alluded 
to in almost every preceding report of the Committee ; 
of Publication, and need not, therefore, be dwelt 
upon at this time. The Committee, with the view of 
publishing the Transactions at as reasonable a rate as ■ 
possible, solicited estimates from the various print- 
ing establishments of Philadelphia, and awarded the 
work to the lowest responsible bidder. The Com- 
mittee have also made arrangements for the print- 
ing of the Index of all the volumes of Transactions, 
in accordance with the instructions of the Association, 
and it is now being printed as rapidly as possible, 
under the supervision of the Permanent Secretary, by 
whom the Index was prepared. The Committee did 
not receive any instructions from the Association as 
to the nuniber of copies to print, or the method of 
its distribution, and they have therefore exercised 
their own discretion in the matter, and have ordered 
1,500 copies, at a cost of about ^500, believing that 
this will be quite as many as the Association will ever 
need for its members. The Committee have not 
thought it desirable that a volume of this kind should 
be distributed in the same way as the annual volume 
of Transactions. There is a large number of mem- 
bers whose direct interest in the Association is but 
transient, as has been exhibited in several annual re- 
ports of the Treasurer, and there is also a large num- 
ber who have but recently become connected with the 
Association, to whom an index would be of but little 
importance, in the absence of all the volumes to which 
such an index is a companion. As a general distribu- 
tion to all past and present members of the Associa- 
tion would be unadvisable and entirely impracticable, 
the Committee would suggest that the price of the In- 
dex be fixed at one dollar a copy, postpaid, to meet 
the outlay for its publication, and the possibility of a 
large number being left on hand unsold. It is prob- 
able that a limited field for the sale of the Index will 
be found also among medical and general libraries. 
The expenses of making its publication known and of 
mailing may be met out of the proceeds of the sale of 
the work. It is estimated that the Index will make a 
volume of about 120 pages. As it is desirable that 
the work, when issued, as it will soon be, should be 
rapidly distributed, the Committee would respectfully 
request the Association to instruct them how to act ; 
and in the absence of any explicit resolution on the 
subject, will accept the simple reception and adoption 
of this Annual Report of the Committee of Publica- 
tion as a sanction of the suggestions contained in it. 

Albert Fricke, 
Chairman Com. of Publication. 
June 5, 1883. 

On motion, these reports were severally accepted 
and referred for publication. 

OFFICERS. 

Dr. Eugene Grissom, Chairman of the Committee 
on Nominations, presented the following report : 
To the President of the American Medical Association : 

The Committee on Nominations respectfully presents 



the following recommendations for officers and mem- 
bers of committees for 1884: 

President — Dr. Austin Flint, Sr., of New York. 

First Vice-President — Dr. R. A. Kinloch, Charles- 
ton, S. C. 

Second Vice-President — Dr. T. B. Lester, Kansas 
City, Mo. 

Third Vice-President— Dr. A. L. Gihon, U. S. 
Navy. 

Fourth Vice-President — Dr. S. C. Gordon, Port- 
land, Maine. 

Treasurer — Dr. R. J. Dunglison, Philadelphia, Pa. 

Librarian — Dr. C. H. A. KJeinschmidt, Washing- 
ton, D. C. 

Place of meeting, 1884, Washington, D. C; time 
of holding meeting, first Tuesday in May. 

Chairman Committee of Arrangements — Dr. A. Y. 
P. Garnett, Washington, D. C. 

Assistant Secretary — Dr. D. W. Prentis, Washing- 
ton, D. C. 

Judicial Council — Dr. F. D. Cunningham, of Vir- 
ginia; H. O. Marcy, Massachusetts ; W. O. Baldwin ; 
Alabama; J. S. Billings, U. S. A.; Truman W. Mil- 
ler, U. S. M. H. S.; Eugene Grissom, North Caro- 
lina; R. N. Todd, Indiana. 

To fill vacancy injudicial Council — for Class 1884 
—Dr. E. W. Clark, Iowa. 

Practice of Medicine — Chairn^an, Dr. John V. Shoe- 
maker, of Pennsylvania; Secretary, Dr. W. C. Wile, 
of Connecticut. 

Obstetrics and Diseases of Women — Chairman, Dr. 
T. A. Reamy, of Ohio; Secretary, Dr. J. T. Jelks, 
of Arkansas. 

Surgery and Anatomy — Chairman, Dr.C. T.Parkes, 
of Illinois; Secretary, Dr. H. O. Walker, of Michigan. 

Ophthalmology, Otology and Laryngology — Chair- 
man, Dr. J. F. Chisolm, of Maryland; Secretary, 
Dr. J. L. Thompson, of Indiana. 

Diseases of Children — Chairman, Dr. Wm. Lee, of 
Maryland; Secretary, Dr. W. R. Tipton, of New 
Mexico. 

Oral and Dental Surgery — Chairman, Dr. T. W. 
Brophy, of Illinois; Secretary, John S. Marshall, of 
Illinois. 

State Medicine — Chairman, Dr. Deering J. Rob- 
erts, of Tennessee; Secretary, Dr. C. W. Franzoni, 
of D. C; Alabama, Jerome Cochran; Arkansas, J. J. 
McAlmont; California, W. F. McNutt; Colorado, 
Chas. Denison; Connecticut, C. W. Chamberlain; 
Dakota Territory, A. B. Van Nelson; Georgia, J. P. 
Logan; Illinois, O. C. DeWolf; Indiana, George 
Sutton ; Iowa, W. S. Robertson ; Kansas, D. W. 
Stormont; Kentucky, J. P. Thompson ; Louisiana, 
I S. C. Chaille; Maine, S. H. Weeks ; Maryland, John 
Morris; Massachusetts, H. I. Bowditch; Michigan, F. 
; K. Owen; Minnesota, C. N. Hewitt; New Mexico, 
! M. M. Milligan; District of Columbia, S. Towns- 
hend; Delaware, L. P. Bush; Oregon, Horace Car- 
penter; Mississippi, H. A. Gantt ; Missouri, Lester 
Hall; Nebraska, L. B. Larsh; New York, E. M. 
Moore; New Jersey, Ezra M. Hunt; North Carolina, 
Jas. McKee; Ohio, T. L. Neal ; Pennsylvania, R. J. 
Dunglison; Rhode Island, C. H. Fisher; Tennessee, 
C. C. Fite; Texas, Thos. D. Wooten ; Vermont, S. 



1883-] 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIATION. 



II 



W. Thayer ; Virginia, J. L. Cabell ; West Virginia, 
Geo. B. Moffet; Wisconsin, J. T. Reeve; U. S. 
Army, J. R. Smith; U. S. Navy, J. M. Brown; U. 
S. M. H. S., H. H. Bailhache; South Carolina, Man- 
ning Simmons. 

Committee on Necrology — Chairman, Dr. J. M. 
Toner, Washington, D. C; Alabama, R. F. Michel; 
Arkansas, Dr. Turner; California, Henry M. Gibbons, 
Jr.; Colorado, Chas. Denison ; Connecticut, C. H. 
Pinney; Dakota Territory, A. B. Van Nelson; Georgia, 
Dr. H. F. Campbell; Illinois, J. H. Chew; Indiana, 
William Lomox; Iowa, S. B. Chase; Kansas, C. V. 
Mottram ; Kentucky, W. S. Reynolds ; Louisiana, 
Earnest Lewis; Maine, A. J. Fuller; Maryland, Chris. 
Johnson ; Massachusetts, J. H. Oilman ; Michigan, 
W. F. Breakey; Minnesota, F. A. Dunsmore; Mis- 
sissippi, Wirt Johnson ; Missouri, H. H. Mudd ; Ne- 
braska, R. C. Moore ; New York, H. D. Didama ; 
New Mexico, W. H. Page ; District of Columbia, 
William Lee ; Delaware, W. Marshall ; New Jersey, 
G. T. Welch ; North Carolina, Hubert Ha}^wood ; 
Ohio, Starling Loving ; Oregon, Dr. H. H. Carpen- 
ter ; Pennsylvania, Frank Woodbury ; Rhode Island, 
W. E. Anthony; Tennessee, J. B. Lindsley; Texas, 
M. D. Knox ; Vermont, O. F. Fassett ; Virginia, L. 
B. Edwards ; West Virginia, W. K. Curtis ; Wiscon- 
sin, E. L. Boothby ; United States Army, W. S. For- 
wood ; United States Navy, A. L. Gihon ; United 
States Marine Hospital Service, Walter Wyman; 
South Carolina, F. P. Porcher. 

On motion of Dr. N. S. Davis, the report was 
imanimously adopted. 

Dr. H. D. Didama then read the following letter 
from Dr. Austin Flint, addressed to him as a member 
of the Committee on Nominations : 

" Circumstances render it necessary for me to return 
early to day, June 7th, to New York. Will you 
kindly express to our brethren, the members of the 
American Medical Association, with my sincere thanks, 
an assurance that I thoroughly appreciate the great 
honor which has been conferred on me. I accept the 
honor, feeling assured that I may confidently expect 
co-operation and indulgence in my efforts to fulfill the 
duties which it involves. ' ' 

On motion, the Association adjourned to meet at 

9 A. M. 

FOURTH DAY— GENERAL SESSION. 
The President called the Association to order at 

9 130 A. M. 

Prayer was offered by Rev. C. T. Collins, of Cleve- 
land. 

The amendments to the Constitution and By-Laws 
as offered last year were then called up. 

The following, offered by Dr. N. S. Smith, Dakota : 
" To provide for the admission to membership of 
two delegates from the Medical Bureau of the United 
States Indian Service, to be nominated by the Surgeon - 
in-Chief of that Bureau, and approved by the Secre- 
tary of the Interior," was, on motion, laid on the 
table. 

The following, offered by Dr. J. M.. Toner, D. C. : 
" That the office of Permanent Secretary be vacated, 



and that the Nominating Committee hereafter annu- 
ally nominate a Secretary who will serve without com- 
pensation," was withdrawn by Dr. Toner. 

The following, offered by Dr. J. H. Sears, Arkan- 
sas: " That the Chairman and Secretary of each Sec- 
tion may add any number of earnest workers to their 
Sections, in addition to those named by the Nomina- 
ting Committee, and that the Librarian be made a 
permanent officer," was, on motion, laid on the table. 

The following amendment to the By-Laws, offered 
by Dr. J. W. Smith, Iowa. : Art. II. Sec. 8. Per- 
manent members : strike out the words ' ' but without 
the right of voting," was, after much discussion, 
on motion, indefinitely postponed by a very large 
majority. 

JUDICIAL COUNCIL 

Dr. N. S. Davis, from the Judicial Council, re- 
ported that the petition of D. W. Day be returned, 
with leave to supplement the paper with a written 
statement of the character of the new evidence he 
proposed to introduce. Further, that in the case of 
D. H. Goodwillie, of New York, the Council de- 
cided that his registration be canceled, and the an- 
nual dues be returned. 

Dr. L. Turnbull, of Pennsylvania, offered a reso- 
lution that the legislature of each State be petitioned 
to pass laws requiring railroad employes to be ex- 
amined regarding their hearing before taking charge 
of any railroad train. On motion it was referred to 
Section on Otology, etc. 

Dr. Foster Pratt presented the following, which 
had been referred to the Association from the Section 
on State Medicine : 

Resolved, That being impressed with the truthful- 
ness and importance of the Memorial of the Parlia- 
mentary Bills Committee of the British Medical As- 
sociation, under date of March 17, 1883, the Ameri- 
can Medical Association urge upon the Congress of 
the United States the subject of competent medical 
and sanitary service, and prop>er provision for its 
maintenance on board all trans-oceanic passenger 
vessels ; and that a committee of five be appointed to 
promote this object, and to report upon the condition 
of the subject at the next session. 

On motion the resolution was adopted. 

The President announced as the committee on the 
above : Drs. A. N. Bell, New York ; A. L. Gihon, 
U. S. N.; H. O. Marcy, Massachusetts; I. N. 
Quimby, New Jersey; Henry H. Smith, Pennsyl- 
vania. 

Dr. A. N. Bell, of New York, offered the following: 

Whereas, The practice prevails of reading papers 
before the several Sections, at the option of their 
authors, without sufficient regard to the special ob- 
jects for which the sections were created ; therefore. 

Resolved, All papers hereafter offered or intended 
to be read before the Association, or any of its Sec- 
tions, except the address of the President and Chair- 
man of the Sections, shall be first referred to the 
Trustees of the Journal for classification and appro- 
priate reference. 

After much discussion, on motion of Dr. D. F. 
Cunningham, of Virginia, the whole subject was laid 
on the table. 



ANNUAL ADDRESS OF THE PRESIDENT. 



[July, 



Dr. W. Brodie offered the following, which was 
adopted by a rising vote : 

Whereas, This Association takes a deep interest in 
the efficiency of the Medical Department of the 
United States Army, and 

Whereas, The late chief of this Department, Sur- 
geon-General Joseph K. Barnes, contributed largely 
to the efficiency of this Department in the work which 
It has been and is doing for medical science and edu- 
cation, therefore 
' Resolved, That this Association receives with pro- 
found ragret information of the death of General 
Barnes, and desires to record its appreciation of the 
great value and importance of the work which he has 
done and enabled others to do for the advancement of 
medical science. 

Resolved, That this Association recognizes the en- 
ergy and ability which characterized the administra- 
tion of General Barnes, and his services in connec- 
tion with the Army Medical Museum and Library, and 
the publication of the Medical and Surgical History 
of the War, and other works of great value to the 
profession. 

Resolved, That a copy of these resolutions be sent 
to the Surgeon-General of the Army. 

Dr. J. M. Keller offered the following, and asked 
that it be referred to the Section on State Medicine, 
which was agreed to : 

Resolved, That in the very near future, if not now, 
cremation will become a sanitary necessity in the 
large cities and populous districts of the country. 

The President appointed as delegates to the Cana- 
dian Medical Association, Drs. W. Brodie and H. O. 
Walker, of Michigan. 

On motion of Dr. J. M. Toner, it was 

Resolved, That we tender a vote of thanks to our 
Secretary and Treasurer for the efficient and satisfac- 
tory manner in which they have discharged their sev- 
eral duties. 

By request of Dr. R. F. Blount, of Illinois, Chair- 
man of Section on Diseases of Children, his address 
was referred to the Board of Trustees without being 
read. 

Dr. I. N. Quimby, New Jersey, offered the follow- 
ing: 

Whereas, We, the delegates of this Association, 
have received at the hands of the citizens of Cleve- 
land the most elegant, cordial and unstinted hospital- 
ity, and 

Whereas, To make mention of all the names of 
the good citizens who have so handsomely entertained 
us, would be unnecessary, yet, at the same time, we 
cannot refrain from expressing our special thanks to 
the physicians of Cleveland for the elegant entertain- 
ment at the Opera House ; also to Mr. and Mrs. 
Stewart Chisolm, A. C. Armstrong, R. R. Herrick, 
W. P. Southworth, Henry A. Stephens, Rev. and 
Mrs. Chas. Pomeroy, Mr. and Mrs. Leggett, W. G. 
Rose, W. B. Hale, W. J. Boardman, E. B. Hale, 
Jesse H. McMath, Jos. Perkins, W. H. Harrison, G. 
E. Herrick. In all the above handsome homes and 
palaces we»were so kindly and cordially received by 
the host and hostess, accompanied in all instances by 
a large number of beautiful and attractive ladies, that 



many of us, we fear, will find it quite difficult to take 
our final departure from the city of Cleveland ; and 
when the unkind and cruel hand of time points to 
the inevitable hour of our leaving, we will feel our- 
selves inclined, like the unfortunate wife of Lot, 
constantly to turn back, to receive once more 
the warm and cordial grasp of the hand in which a 
heart did beat, and hear again those pleasant voices 
which did us kindly greet. But whether we come or 
whether we go, or in whatever country or clime our 
lot may be cast, one thing be assured, that the kind- 
ness and good-will extended to members of our Asso- 
ciation have made an indelible impression, which can 
never be erased or forgotten. 

We also wish to extend our hearty thanks to the 
Cleveland press, especially to the Herald and Leader 
for their energy and enterprise shown in getting such 
extended and accurate daily reports of our proceed- 
ings. It is evident that while these papers live, 
Cleveland will never want for light. Also to Dr. X. 
C. Scott and his colleagues on the Committee of 
Arrangements for their efforts to make this meeting a 
grand success. 

After several efforts to amend this resolution, all 
were negatived, and it was unanimously adopted. 

The Sections reported their minutes, which, with 
the accompanying papers, were referred to the Board 
of Trustees. 

Vice President Dr. E. Grissom having taken the 
chair. Dr. Atlee made some remarks on taking leave 
of the Association as its President. 

Dr. Alonzo Garcelon, of Maine, offered the follow- 
ing, which was unanimously adopted : 

Resolved, That the thanks of this Association be 
extended to J. L. Atlee, the retiring President, for 
the able, dignified, and satisfactory manner in which 
he has presided over the deliberations of the Associa- 
tion, and that he retires with the best wishes of 
every member of this Association for a long continu- 
ance of a life so highly useful not only to the present 
but to all future generations. 

In the absence of the other officers elect. Vice 
President Dr. T. B. Lester, of Missouri, then de- 
clared the Association adjourned, to meet in Wash- 
ington, D. C, on the first Tuesday of May, 1884. 
Wm. B. Atkinson, 

Permanent Secretary. 



ANNUAL ADDRESS 



BY JOHN L. atlee, M. D., OF LANCASTER, PENN., 
president of THE ASSOCIATION. 



Gentlemen of the American Medical Associa- 
tion: Permjt me to express my feelings of gratitude for 
the unexpected honor conferred upon me at the last 
meeting of the Association, and to cherish the hope that 
in fulfilling the duties of this responsible position I 
may be sustained by your cordial co-operation. We 
meet here to engage earnestly in furthering the in- 
terests and objects of the medical profession. We 
have come together from all parts of our broad 
country, charged with these great responsibilities. It 
is fitting to express here deep regret at the absence 



1883.] 



ANNUAL ADDRESS OF THE PRESIDENT. 



13 



from our. councils of delegates from the Medical So- 
ciety of the State of New York. Let us hope that 
this absence may be only temporary, and that at the 
next meeting every State may be represented. 

As specialties are so much in favor at the present time, 
I have thought it well, though far from favoring them 
on ordinary occasions, to bring prominently forward, 
in my address to-day, my own rare specialty, namely, 
the having been a graduate of sixty-three years' 
standing. Instead, therefore, of calling your atten- 
tion to the more strictly scientific subjects that are so 
generally considered upon such an occasion as this, it 
has occurred to me that some reminiscences of my 
early medical life might not be wholly unacceptable, 
or devoid of interest and instruction. 

When I began my medical studies in 181 5, there 
were but few medical colleges in the country — the 
medical department of the University of Pennsyl- 
vania, the College of Physicians and Surgeons of 
New York, and the colleges at Baltimore, Harvard, 
New Haven, and Lexington, Ky. The University 
of Pennsylvania was the leading institution, to which 
students from all parts of the country came. The 
facilities for clinical instruction at the university were 
confined to the Pennsylvania Hospital and the Phila- 
delphia Alms-house ; but of these lectures and the 
distinguished clinical teachers I shall speak again. 
Having no opportunities for studying practical anato- 
my before matriculation at the University of Penn- 
sylvania, I devoted myself more particularly to that 
branch in my first course of lectures, 181 7-18. The 
chair was then filled by Dr. Caspar Wistar, one of 
the most able and accomplished teachers of anatomy 
which this country has produced. His amiable de- 
portment and kind treatment of students made an 
impression upon me which I shall never forget, and 
after the lapse of more than sixty-five years the 
thought of him kindles in my breast emotions of 
genuine pleasure. As I remember him, he was of 
medium stature, apparently about sixty years of age, 
and so impressive w^as his teaching of anatomy, up to 
the time of his death, which occurred very suddenly, 
in January, 181 8, that his words remain with me yet. 
He was certainly a man of great personal magnetism, 
extremely courteous in his manners, and gentle in 
disposition ; he was always ready to converse with 
the students and help them in their difficulties. It 
is no wonder that he was greatly beloved by the 
students. The announcement of his sudden death 
from disease of the heart, on the night after he de- 
livered his last lecture, produced a shock among the 
students that I shall never forget. 

Just here, I may appropriately allude to the foun- 
dation of a social institution, long known in Phila- 
delphia as "the Wistar Parties." Dr. Wistar had 
been in the habit of inviting to his house, on Satur- 
day evening, men of learning and distinction, both 
citizens and strangers. The ability and social quali- 
ties of the. professors of the University of Pennsyl- 
vania and of the eminent medical men of Philadel- 
phia, caused always the presence of a large infusion 
of medical science in the composition of his parties. 
After his death, these gatherings were revived and 
continued by his friends, and they were still known 



as " Wistar parties " in honor of their founder. In 
this way originated the celebrated social gatherings 
which occupied so important a share in the social 
annals of Philadelphia. I remember my gratifica- 
tion when young at meeting some distinguished 
gentleman from abroad, and many no less distin- 
guished from our own country. 

The course of lectures on anatomy, intermpted by 
the death of Dr. Wista^r, was subsequently finished by 
Dr. John Syng Dorsey, a favorite nephew of Dr. Phy- 
sick. He completed the course with credit, and was 
subsequently elected to fill that chair. Unfortunately, 
he also died from a very short illness, after delivering 
his introductory lecture, within a week of the be- 
ginning of the term. It was a great loss to the uni- 
versity, and a very severe blow to Dr. Physick — one 
from which he never recovered. At this period there 
was no American work on anatomy, but about this 
time Dr. Wistar' s Anatomy was published, and adopt- 
ed as a text-book. . It was received with great favor, 
even with enthusiasm, by the students. The assist- 
ants to the professor of anatomy at this period were 
Drs. William E. Horner and Hugh L. Hodge, after- 
ward highly distinguished in their respective branches, 
anatomy and midwifery. 

Dr. John Redmond Coxe was the professor of chem- 
istry in the winter ofi8i7-i8, a grandson of Dr. 
John Redman, one of the leading physicians of Phil- 
adelphia in his day, and first president of the College 
of Physicians. Dr. Coxe had the reputation of being 
one of the most diligent students in Philadelphia. 
He was very careful in his experiments, and in lectur- 
ing was very punctual in filling the whole of the hour 
allotted to him. The chair of midwifery, during my 
first course, was filled by Dr. Thomas C. James, a 
very modest and agreeable gentleman of Quaker ori- 
gin. He had such a sense of delicacy that he could 
not bring himself to lecture on the female organs of 
generation, but entrusted this part of his course to 
Dr. Horner. Although a graduate of the University 
of Pennsylvania, he subsequently became a pupil of 
Dr. Denman, of London, whose work on midwifery, 
together with that of Burns, and Dr. Dewees' trans- 
lation of Baudelocque, constituted the principal w^orks 
on that subject. Dr. James, after Denman, was a 
strong advocate for the short forceps. 

Dr. Nathaniel Chapman, at this time, and for many 
years afterward, filled the chair of the institutes and 
practice of medicine. He was a most eloquent and 
impressive lecturer, and the idol and tried friend and 
benefactor of the student. He was, moreover, a man 
of very marked ability, eloquence, and great social 
qualities. Having to teach the institutes, as well as 
the practice of medicine, it required two courses of 
lectures to complete the subject. The physiology of 
that day was very different from that of the present. 
The microscope had hardly begun to be applied to 
the study of anatomy, and so little did Dr. Chapman 
appreciate it, that it was a standing joke with him to 
quote old Leeuenhoeck as having discovered with his 
microscope "twenty thousand devils playing upon 
the point of a needle," thus foreshadowing, some of 
the most remarkable discoveries of the present day, 
especially disease germs. Professor Chapman was 



14 



ANNUAL ADDRESS OF THE PRESIDENT. 



[July, 



thoroughly posted in the departments which he taught, 
at that time, although they have advanced wonderfully 
since his day. He was a man of very imposing pres- 
ence, rather above the medium height, always neat in 
his dress, perfectly well-bred, and uniformly obliging 
and polite to the students. I believe that he did more 
for the advancement of medicine in his day than any 
other person with whom I was acquainted. He estab- 
lished a school, called Chapman's Institute, for the 
benefit of his private students, of whom he always had 
thirty or forty, and other students who chose to attend. 
The building was in the rear of his house, with a pri- 
vate entrance, and he employed, as teachers of his 
classes, gentlemen who afterward became eminent pro- 
fessors at the university and at the Jefferson Medical 
College, among whom may be mentioned Professor 
William P. Dewees, Hugh L. Hodge, and John K. 
Mitchell. 

Last but not least among the faculty of that day 
was Dr. Philip Syng Physic, the great American, sur- 
geon, who that winter, 1817-1818, delivered his last 
course of lectures on surgery. A pupil of John 
Hunter, he taught the doctrines of that great man. 
As I recall his course of lectures, it seems to me that 
he was one of the most impressive teachers that I have 
ever listened to. Dr. Physick was remarkable for 
great attention to details, and in his operations upon 
the cadaver he carefully observed all the rules for 
operating upon the human body. He also recapitu- 
lated the lecture of the preceding day before going 
on with his subject, by questioning the students who 
occupied the first two rows of seats in the amphi- 
theater. I may refer to one incident which may 
illustrate his method and his carefulness. On one 
occasion he stumped the whole class ; he had been lec- 
turing on lithotomy the preceding day, and he put 
the question to the first student, "What instruments 
should be provided for the operation ?" The answer 
appeared to have been correctly given, but he was 
not-satisfied. The question was repeated to the next 
student, and finally to the whole class with the same 
result. Dr. Physick then said it was "a pin, gentle- 
men, a pin," that was needed to complete the list. 
This showed his precision, and impressed upon us the 
necessity of taking care never to go to an operation 
without the minutest preparation. 

Dr. Physick was a man of medium height, with very 
regular features. His face at that time was pale, as if 
he suffered from delicate health. He was of very 
abstemious habits. I remember on one occasion, at 
a party given at his house, when the servant brought 
in a tray with wine, I was standing beside Dr. Chap- 
man, when I placed my hand upon a decanter, as I 
supposed, of wine ; Dr. Chapman touched my elbow, 
and told me not to take that; I filled the glass from 
another bottle, and afterwards asked the Doctor why 
he had checked me ; he said the first was simply 
colored water that Dr. Physick had provided for his 
own use. 

In speaking of Dr. Physick's teaching, I should 
also say that he always lectured extemporaneously, the 
didactic lectures on inflammation being read by Dr. 
Dorsey, his nephew. Dr. Physick was dignified in 
his deportment, and eminently grave ; we rarely saw 



a smile upon his face. His usual dress in the lecture- 
room was a blue coat with metal buttons, white vest, 
and drab pantaloons. He was remarkably staid and 
reserved in his manner, and was always regarded with 
reverence and great respect by the students. He 
never indulged in any flights of imagination, and was 
purely a practical lecturer who brought his knowl- 
edge from the stores of his large personal experience. 

One of his favorite precepts was to insist upon 
great attention to diet after surgical operations. I 
may mention this anecdote : In one of his lectures 
he spoke of a very important surgical operation, and 
said that there was a necessity for attention to abso- 
lute diet. The next day in recapitulating, he asked 
a student what was meant by absolute diet. The 
student said " Toast or barley water." " Will any 
gentleman tell me what is meant by absolute diet?" 
appealing to the whole class. There was no reply. 
"Water, gentlemen, water." A precept I have 
never forgotten, and which, I think, is not sufificiently 
observed at the present day after important surgical 
operations. 

The clinical teaching of that day was not given at 
the medical college, as it now is, but at the Penn- 
sylvania Hospital, and the Philadelphia alms-house, 
then in the city ; each institution affording an excel- 
lent school of instruction to the students. As the 
clinical hours were the same at both institutions, I 
chose the alms-house as affording a larger field. 

Among the clinical teachers of that day, very few 
were superior to Dr. Joseph Parrish, who had been a 
pupil of Dr. Wistar. He was a man of most amiable 
character, thoroughly devoted to the advancement of 
the profession; having large classes of private stu- 
dents every year, to whom he lectured, and for whom 
he also provided able assistants to aid in teaching. 
One of these was the late Dr. George B. Wood. Dr. 
Parrish was a man of warm sympathies, and he testi- 
fied to his benevolence in the manner in which he 
conducted his clinics. Let me give you an illustra- 
tion. A poor, weather-beaten sailor was brought to 
the alms-house suffering very much from rheumatism. 
Dr. Parrish ordered the man to be clothed in flannel, 
and have a bottle of porter daily. On the next 
clinic day Dr. Parrish, on inquiring, found that 
neither had been attended to. He repeated the 
order, with a mild rebuke to the steward. At the 
next visit, three days afterwards, finding that his 
previous orders had been disobeyed, he called for 
the steward, and remained at the bedside of the 
patient until the order was fulfilled. 

With regard to the treatment of that day, I shall 
say little ; the text-books then studied fairly present 
it to you. Would that I could speak more satisfac- 
torily of the treatment of the insane as I remember 
it. They were generally confined in the basement 
of the alms-house in small cells, some with manacles, 
others with chains ; seldom had they access to fresh 
air, and often they had nothing but loose straw for 
their bedding. This unhappy and inhuman state of 
things continued until Pinel and Esquirol established 
a course of treatment more consistent with the dic- 
tates of science and humanity. In a recent visit to 
the State Lunatic Hospital, at Harrisburg, Pa., of 



1883.] 



ANNUAL ADDRESS OF THE PRESIDENT. 



15 



which I am a trustee, not one of the fonr hundred | 
insane inmates was the subject of mechanical re- ■ 
straint. 

At that time, the resident physicians at the alms- ' 
house were not graduates in medicine, but last-course \ 
students, who fulfilled their duties while preparing for : 
graduation. The requirements for graduation were 
attendance upon two full courses of lectures, of four 
months each, a written thesis on some medical sub- 
ject, attendance at the hospital or almshouse, and an 
oral examination in the presence of the whole faculty. 

Many of the elderly gentlemen present to-day 
must have heard of the much dreaded "green-box." , 
During the time of Drs. Rush and Barton, it was re- 
ported that favoritism was sho^\^l to their respective 
students, and the same was said of the students of Drs. 
Chapman and Dorsey. To obviate this, or the ap- ' 
p)earance of it, a large green screen was placed across 
one corner of the room, having a door behind it, 
through which the candidate entered, and here under- 
went his examination, unknown to any one but the . 
dean of the faculty. This mode of examination was 
adhered to until after the death of Dr. Dorsey, when 
it was optional with the student to go into the green- 
box or present himself openly before the faculty. 
Some ten or twelve candidates had such a terror of 
the green-box that they went to New York, where 
they obtained the degree of M. D. by undergoing an 
examination and paying the graduating fee. 

It was the time of calomel and the lancet. With 
regard to the one, I need not speak; but of the latter 
I feel well assured that the almost total disuse into 
which it has fallen has cost many valuable lives. 
From a very large experience in its use, I am satisfied, 
fully satisfied, that if we depended more ©n the early- 
use of the lancet in the congestive and inflammatory 
states of many diseases, our practice would be more 
successful than it now is. At the present time there 
is too exclusive reliance upon medicines affecting the 
nervous and vascular sj'stems, which act with less 
efficiency and are less prompt. It is, in my opinion, 
a very important subject, and I feel assured that ere 
long the lancet will be more freely used than it is 
now. In the congestive chills preceding inflamma- 
tory diseases, and in the cold stages of intermittents, 
I have frequently broken up the paroxysm, and re- 
lieved the patient by the lancet alone. 

In the class of 181 7-18, there were many men who 
afterwards became distinguished in their respective 
departments. Time will not permit me to enumerate 
them all. 

Among the first was one with whom I was very 
intimate, Dr. George McClellan. A man of great 
natural talent, quick perception, wonderful memory, 
prompt to decide and prompt to act, he made him- 
self, during his pupilage, one of the best anatomists 
in the country, and subsequently brought more talent 
into surgery, than any man I have ever met with. 
During his brief, but brilliant career, he performed 
more surgical operations than any other surgeon in 
Philadelphia, and he undertook to perform, and did 
perform successfully, some operations which were 
considered impracticable by other surgeons. Among 
these was the removal of the parotid gland. It was 



my good fortune to visit with him his first patient the 
day after the operation, and although it was after- 
wards reported that it was not the parotid gland, I 
made a very careful examination of the tumor, and 
of the patient, and was perfectly satisfied of its 
identity. This operation he performed several times 
afterwards, one of them on a young Irishman, where 
Dr. Deal, of Dublin, an eminent surgeon, had 
previously failed. A beautiful illustration of his 
diagnostic ability was shown to me when on a visit to 
Philadelphia. A female infant, about four or five 
months old, whose parents belonged to one of the 
most distinguished families in New York, was 
brought by her father to Philadelphia, to consult the 
oldest leading surgeons of the city, who all pronounced 
the case hopeless. The child had from birth a com- 
plete paralysis of the right arm and hand. As Dr. 
McClellan, at that time, was beginning to acquire 
popularity as a surgeon, the father was persuaded to 
consult him*. Dr. McClellan made a careful ex- 
amination, and found that the clavicle was pressing 
on the brachial plexus of nerves, as it passes over the 
first rib, and that the paralysis was owing to this 
cause. All that he did was to elevate the shoulder 
and the clavicle by mechanical means, and the 
functions of the arm were entirely restored. I saw it 
playing equally well with either arm on the nurse's 
lap. 

Dr. McClellan was of medium size, fair complexion 
and blue eyes. He was very attractive and agreeable 
in his manner, very vivacious, and was called a 
* ' bundle of nerves. ' ' He was very fond of society, 
and a general favorite wherever he was known. 
There was no jealousy in his disposition, and I may 
be permitted to add that he was the only surgeon in 
Philadelphia who congratulated me upon the success 
of my first operation for ovariotomy in 1843, when I 
revived the operation which, after its introduction by 
Ephraim McDowell, had fallen into disuse. He 
sought me at my hotel, when on a visit to the city, 
and gave me a most cordial embrace. 

Dr. McClellan was among the first to suggest and 
urge the establishment of another medical college, in 
Philadelphia, and with the assistance of Dr. Eberle, he 
determined to get a charter from the legislature. 
Dr. Eberle, being a native of Lancaster county, and, 
having practiced both in the city and county for 
several years before his removal to Philadelphia, had 
many friends there, and wrote to them, asking their 
assistance in procuring a charter from the legislature. 
With a view to furthering the cause, a public dinner 
was given to Dr. Eberle by the leading gentlemen of 
Lancaster, and resolutions were then passed instruct- 
ing our representatives at Harrisburg to favor the 
charter. Notwithstanding the opposition which had 
always existed among the friends of the university to 
the establishment of another school, a charter was 
obtained authorizing the trustees of the Jefferson 
College, at Canonsburg, to grant degrees in medicine 
and to locate the school in Philadelphia. Another 
member of the class of 181 7-18, a native of Lancaster, 
and when young a schoolmate of mine, was Dr. John 
Rhea Barton, who began the study of medicine with 
my preceptor. Dr. Samuel Humes, and through the 



i6 



ANNUAL ADDRESS OF THE PRESIDENT. 



LJULY, 



influence of his uncle, Professor Benjamin Smith 
Barton, of the university, was appointed a resident 
pupil at the Pennsylvania Hospital. At that time, I 
believe, the residents were apprenticed for five years. 
Such was the distinction he attained in his position 
that immediately after receiving the degree of Doctor 
of Medicine he was elected one of the attending 
surgeons, an unprecedented event. While in this 
position he acquired the reputation of being one of 
the most dexterous operators in the country. A gen- 
tleman, a physician, who, after graduating here, had 
spent five years in Paris, and who had^ seen Dupuytsen, 
Boyer and Dessault operate, told me that with the 
exception of Dr. Physick, who had been his preceptor, 
he had never seen Dr. Barton equalled as an operator. 
He was ambi-dexterous, ' and instead of changing 
sides in amputations, he would change hands. 

Among my fellow-students in 1 817-18, and fellow- 
graduates in 1820, I should be unmindful of what is 
due to extraordinary merit, were I not to speak of 
one who has done more for American medical jour- 
nalism, than any other physician in the country. I 
allude to the late Dr. Isaac Hays, the editor of the 
American Journal of Medical Sciences, by whose la- 
bors, professional accomplishments, and excellent 
judgment, the leading medical journal of this country 
was established. Having assisted Dr. Chapman in 
editing The Philadelphia Journal of the Medical and 
Physical Sciences, the motto of which was the ill- 
natured quotation from Sidney Smith, " Who reads 
an American book?" Dr. Hays established, in 1827, 
the '■'■ Ainerican Journal of Medical Sciences, ^^ which 
to this' day, both in this country and in Europe, is 
admitted to be, in character and ability, the first. 
Modest and unassuming, he scorned the arts by which 
many seek prominence, and during a long and very 
busy life, sustained the character of a high-toned and 
honorable gentleman. To him are we chiefly indebted 
for the preparation of the Code of Ethics of this As- 
sociation, which some of our physicians, from motives 
we cannot appreciate, would be willing to mutilate or 
destroy. 

To another fellow-graduate I may with great pro- 
priety allude^ — Dr. Samuel Henry Dickson, one of 
the most accomplished scholars, both in medical 
and miscellaneous literature, it was my good fortune 
to know. Having obtained, by his extensive acquire- 
ments, sound judgment and high character, the first 
position in his native city, Charleston, South Caro- 
lina, he was elected Professor of the Theory and Prac- 
tice of Medicine in Jefferson Medical College, where 
he lectured with distinguished ability to the close of 
his life. 

Dr. George B. Wood, known to many of you, was 
graduated at the end of my first course in 181 8. The 
possessor of an ample fortune, he devoted his wealth, 
his untiring industry, and his great acquirements to 
the promotion of sound knowledge, and the welfare 
of the Medical Department of the University of Penn- 
sylvania. 

In the winter of 1819-20, when I attended my sec- 
ond course, a change had taken place in four of the 
chairs at the University. Dr. Physick, in conse- 
quence of the death of Dr. Dorsey, had been elected 



Professor of Anatomy, and Dr. Gibson was brought 
from Baltimore to fill the chair of Surgery. Dr. Coxe 
was taken from the chair of Chemistry to teach Mate- 
ria Medica, and Dr. Robert Hare was appointed to 
teach Chemistry. These changes were not very agree- 
able to those who, like myself, were attending their 
last course, as they took from the chair of Surgery 
that great man. Dr. Physick, and placed him in a posi- 
tion where he had to renew his early studies. It placed 
Dr. Coxe in what might be called his favorite element, 
for there was hardly a single article of the materia 
medica from the time of Hippocrates to that day, that 
he did not notice in his lectures. It was very amus- 
ing to the class, after Dr. Chapman had recommended 
the use of a medicine as emanating from Dr. Physick, 
to hear Dr. Coxe, a day or two afterward, taking es- 
pecial pains to tell us that the remedy had been used 
from the time of Galen or Celsus. Dr. Hare, who 
never failed in an experiment before the class, had 
great hesitation in explaining the rationale, not hav- 
ing the gift of fluent speech. He gave an excellent 
demonstrative course on chemistry, particularly on the 
subjects of heat, magnetism, electricity and galvan- 
ism, which since his day have excited the attention of 
the whole civilized world. Dr. Hare was a large 
man, of great muscular physique, but possessing the 
manners and feelings of a courteous gentleman. 

Dr. Gibson, whom I have referred to as coming 
from Baltimore, where he had acquired great reputa- 
tion as a surgeon, had been a pupil of the celebrated 
Charles Bell, of London. At first, he read his lec- 
tures, which rendered him somewhat unpopular with 
the class, as his predecessor. Dr. Physick, had always 
lectured extemporaneously. Being told of this, it 
was said tljat he afterward committed his lectures to 
memory. 

At the time of my attendance upon lectures, there 
were very few boards of examiners, and the graduat- 
ing classes were generally divided into "quizzing 
clubs ' ' of six students, each of whom took notes at 
the lectures of the different professors. We examined 
each other twice a week on the lectures of the three 
preceding days, and recapitulated on Sunday after- 
noon ; having been told by Dr. Wistar that we could 
not spend Sunday more profitably than in the dissect- 
ing room. So Galen ends his book, De usu Partium 
Corporis Hmnani, by saying, it is an epodos, or a 
song sung standing before the altars of the gods, 
Hyminis deos celebrantes. The result of these fre- 
quent examinations was, that although we had some 
lazy fellows among us, every member of our class re- 
ceived his diploma. 

With the garrulity, and may I not call it, the priv- 
ilege, of your oldest brother, I present you with some 
of the reminiscences of my college life. Before I 
close this address, let me briefly call your attention to 
some other subjects, which, in my opinion, are of 
pressing importance. 

Let me impress upon the mind of every member of 
the profession, the necessity of strict and undivided 
attention to the duties of his high calling. Let no 
outside influence operate to interfere with these duties. 
When you undertake the case of a patient, your whole 
duty belongs to him. The intermission of a single 



1883.] 



TONSILLOTOMY WITHOUT HEMORRHAGE. 



17 



visit, which on your part may have been devoted to 
pleasure, may sacrifice the life of your patient. 

Above all things, ever strive to maintain the honor 
of the profession. Let no selfish or mercenary con- 
sideration deter you from observing the laws laid 
down in our noble Code of Medical Ethics. Culti- 
vate friendly relations with your local medical 
brethren, more particularly the younger; and regulate 
your intercourse with all men in such a way as to cast 
no stain upon the honor of the profession, which is 
in your keeping. 

In my day, previous to the establishment of medi- 
cal societies throughout the country, ard the organ- 
ization of the American Medical Association, and the 
general adoption of the Code of Ethics, I saw many 
disa-strous effects from the want of brotherly consider- 
ation and kindness. The medical men of that day 
were often in difficulties, pitie: ts would be taken 
from one physician to another without ceremony; and 
so great was the jealousy existing between them that 
for more than twenty years after my graduation, it 
was impossible to form a medical society in my 
native city and county, because there were so many 
aspirants for the honors. Here let me speak of some 
of the difficulties I had to encounter in my early pro- 
fessional life. Instead of being taken by the hand by 
the older physicians, every obstacle was thrown in my 
path — consultations were refused, and the treatment 
of my patients unfavorably criticized. 

By the establishment of medical societies, and the 
adoption of the Code of Ethics, a wonderful change 
has been effected. We now feel it our duty to sus- 
tain our younger brethren, to treat them with courtesy 
and kindness, to save them from their errors, and en- 
courage them in all their good work. Had,the adop- 
tion of the Code of Ethics no other result than this, 
it would have been an invaluable blessing to the pro- 
fession. But it has accomplished more. It has put 
the seal of condemnation upon all "isms," and de- 
veloped an esprit de corps that has enlarged the boun- 
daries of our science, and greatly increased the use- 
fiilness and .social standing of the profession. 

Now, gentlemen, being aware that reports and pa- 
pers upon every important topic connected with the 
different departments of medicine will be presented 
by the chairmen of the sections, and by individual 
members, I have not entered upon the discussion of 
any subject, either medical or surgical. 

Our meetings are for the purpose of promoting 
social intercourse, as well as for the advancement of 
medical science ; but we should devote suflRcient time 
to the discussion of the various subjects presented to 
us, and not allow them to be too greatly interfered 
with by social entertainments. 

One word more, and I have done, and I say it 
chiefly as a word of encouragement to the younger 
among you. At the close of a long life, one devoted 
unreservedly to the study and practice of medicine, 
I will say that notwithstanding its uncertainties, its 
fatigues, its anxieties, its bitter disappointments, I am 
^ completely satisfied that in no other career can a man 
more fully accomplish his whole duty to God and to 
his fellow-men ; so that when life here is ended, it can 
truly be said of him, as — be it said with all reverence 



— was said of Him whom we should all imitate, per- 
transivit henefaciendo — he went about doing good. 
Trusting that our proceedings may b? both harmoni- 
ous and profitable to us all ; and thanking you again 
for the honor you have conferred upon me, I sincerely 
hope that the recollections we shall carry home with 
us will be both agreeable and lasting. 



TONSILLOTOMY WITHOUT H.CMORRHAGE. 



BY W. C. JARVIS, M.D., OF NEW YORK. 



[Read to the Section on Ophthalmology, Otology and Laryngology.] 

The question of haemorrhage after the excision of 
enlarged tonsils is still unsettled, and no single 
method for their removal is universally approved. 
Those looking to others for advice as to the dangers 
of the operation, must be bewildered by the extreme 
difference in opinion held by experts on this subject. 
There are those who, advocating the ideas of Schmidt 
and his sympathizers, discourage the use of all sharp 
instruments as dangerous to life ; others, however, 
accepting the views of MacKenzie, insist upon the 
indiscriminate removal of enlarged tonsils by the 
knife. Safety, as we might expect, lies between the 
two extremes. Experience directed my attention to 
a middle course, and results demonstrated its advisa- 
bility. My conclusions, with the reasons for forming 
them, the following cases will briefly explain : 

Case I. A laboring man of powerful build, and 
in the apparent possession of perfect health, consulted 
me on account of eighteen years' discomfort in 
breathing and deglutition. The cause of the diffi- 
culty was an exceedingly enlarged tonsil. Finding 
it impossible on account of its size to ring it with the 
tonsillotome, I procured a piece of perforated sheet 
brass, fenestrated to fit the tonsil. The growth was 
then readily ringed, and I shaved off the projecting 
mass with a guarded bistouri and scissors. Profuse 
haemorrhage followed section of the growth, and a 
persistent oozing of blood continued for more than 
three hours. Our failure to control the haemorrhage 
in spite of the many measures employed was account- 
ed for by the large area of the bleeding surface. The 
pulse became exceedingly weak and signs of serious 
exsanguination occurred, when suddenly and mys- 
teriously the haemorrhage ceased. The critical point 
reached by the loss of much blood in so powerful an 
individual, would, I believe, have been extremely 
serious if not fatal to a person of ordinary strength. 

This history is by no means unique for the litera- 
ture of the subject furnishes abundant evidence of 
similar experiences. The less6n taught was not dis- 
regarded, and I have selected the history of a single 
case as best illustrating its value : 

A patient, aged 26, consulted me for a throat 
trouble. According to her statement she had been 
afflicted for three years with periodical attacks of 
quinsy sore throat. Much annoyance was also caused 
in the intervals between the attacks by the mechan- 
ical interference of enlarged tonsils with respiration 
and deglutition. She consulted a senior surgeon on 
the house staff of Bellevue Hospital, who very prop- 
erly suggested removing the tonsils. I did not learn 



TREATMENT OF OTORRHCEA WITH ANTISEPTIC POWDERS. 



[July, 



why he preferred scissors to the tonsillotome, but 
presume it was on account of the large size of the 
tonsils. He snipped off a portion of one of the 
growths, but the profuse haemorrhage which followed 
prevented immediate removal of more of the mass. 
The first attempt, it seems, discouraged both phy- 
sician and patient, and her request to leave met with 
but slight remonstrance. 

The patient put up with the discomfort caused by the 
growth, until her suffering compelled her to consult a 
physician, who suggested the removal of both tonsils. 

Using a tonsillotome, he skillfully ringed and re- 
moved a small portion of one tonsil, when, according 
to the doctor, blood gushed from the patient's mouth, 
the profuse and continuous haemorrhage being only 
checked by the expenditure of much time and labor. 
The case was then referred to me. I found the pa- 
tient's throat occupied by a remarkably enlarged ton- 
sil. Although the fauces were roomy, but little space 
remained for respiration or food. The growths were 
paler in hue than the surrounding mucous membrane. 
The surface of each tonsil was roughened by numer- 
ous fine indentations. They seemed to indicate that 
the tonsil had undergone an irregular increase, being 
retarded at certain points by the fine strands of firm 
fibro-cellular tissue forming part of its substance. In 
this respect, its appearance was quite different from 
the familiar smooth, glandular, hypertrophied tonsil. 
It had the consistency of cartilage, giving a harsh, 
gritty sensation when pressed upon. I was reminded 
by these peculiarities, of my disagreeable experiences 
with the case already described. Her unfortunate 
history demonstrated the correctness of my observa- 
tion. I hesitated to operate upon the patient by the 
usual method. Mindful of the efficiency of my ecra- 
seur in operating upon vascular tumors of the nares, 
I selected it as for removing the tonsils without. 
The right tonsil was snared with No. 5 piano wire, 
and severed in a line with the pillars of the fauces. 
More than three hours were occupied in its removal, 
and when the divided mass was drawn from the throat, 
not a drop of blood escaped from the wound, nor 
was the saliva even tinged with blood subsequent to 
the operation. The patient declared she suffered no 
pain, and only complained of the operation being 
tedious. She was away from the city for three 
months. On her return, I was unable, by looking 
directly into the throat, to discover a trace of tonsil- 
lar tissue on the side from which the growth was re- 
moved. Absorption had left a sulcus between the 
right faucial pillars. The patient was exhibited to 
the students at the University Medical College, and 
the left tonsil eradicated in the same manner. 

I do not desire to play the part of an alarmist in 
discussing hoemorrhage after tonsillotomy. Neverthe- 
less, I believe the subject demands serious attention, 
in view of the number of deaths recorded as result- 
ing from the use of the knife, taken into considera- 
tion, with the natural hesitancy shown by some phy- 
sicians to publish unfortunate results, which is not a 
mere surmise, but an inference based upon the experi- 
ence of surgeons, communicated in a spirit of confi- 
dence, the question of the possibility of distinguish- 
ing between the hoemorrhagic and non-hcemorrhagic 



tonsil naturally suggests itself. I believe such a dis- 
tinction can be made in many cases by carefully 
comparing the appearance of enlarged tonsils, giving 
diverse results when operated upon. The hard or 
scirrhous tonsil just described, differs in many respects 
from the soft or malachotic gland. The malachotic, 
hypertrophied tonsil has a smooth surface, is often 
lobulated, being soft to the touch, and is usually of 
a light-pink color. The scirrhous hypertrophied tonsil 
has a rough, irregular surface, is exceedingly compact, 
gives a harsh, cartilaginous sensation when touched, 
and has a somber hue. For the removal of the first- 
mentioned variety, I would give preference to the 
tonsillotome. Any haemorrhage occuring while these 
tonsils are excised by the guillotine soon ceases. In 
this respect, they resemble the adenoid hypertrophies 
found in the vault of the pharynx. The scirrhous 
tonsil, on the contrary, bleeds profusely when incised. 
The analogy it bears in this respect to firm fibroid 
tumors is quite striking. My ecraseur offers a safe, 
simple and reliable means for the removal of these 
dangerous tumors. I would discourage the use of all 
sharp instruments in operating upon scirrhous tonsils, 
believing the histories of serious or fatal hoemorrhages 
occur as a result of the indiscriminate use of the 
knife. I would recommend the knife for excising 
the smooth and somewhat compact, enlarged gland 
known as the hyperplastic tonsil. Indeed, a knife 
when it can be safely used, is to be preferred to the 
ecraseur since it expedites the operation and only 
causes momentary pain. The scirrhous tonsil is often 
associated with a syphilitic history. The objection 
raised that the operation is inconvenient on account 
of the large expenditure of time, has been overcome 
by a very simple modification of my ecraseur. I pre- 
sent to your notice this simple method of removing 
enlarged tonsils, as its vSafeness and efficiency have been 
tested upon a number of cases with unvarying success. 
You will find my distinction useful, if carefully studied. 
The discrimination is easily made, and must prove 
valuable as giving confidence to the operator. 



ON THE TREATMENT OF OTORRHCEA WITH ANTI- 
SEPTIC POWDERS. 



BY DR. H. GRADLE. 



Although the antiseptic treatment of purulent in- 
flammation of the middle ear has been introduced 
but some three years, it has now been adopted by al- 
most all, if not all, specialists. Scarcely any number 
of an otological journal can be examined without 
finding some testimony as to its efficacy. But by the 
general practitioner, the method has not yet been 
practiced to any extent; at least, I must infer this 
from my own experience with the patients referred 
to me, and I can find a reason for it in the scant allu- 
sions to it in medical journals. Moreover, all but 
the most recent text-books scarcely mention it. How- 
ever, this article is not merely intended to corrob- 
orate the experience of other specialists, but to de- 
scribe the use of some new substances for this purpose, 
and an improved method of applying them, both of 



1883-] 



TREATMENT OF OTORRHCEA WITH ANTISEPTIC POWDERS. 



19 



which have considerably shortened the time of treat- | 
ment of such cases in my hands. 

The antiseptic treatment appears particularly appli- 
cable in suppurative inflammation of the middle ear. 
For, on account of the anatomy of the cavity, the \ 
treatment can be carried out very conveniently ; while, j 
on the other hand, without it, the conditions are es- j 
pecially favorable for the decomposition of pus. For 1 
we have here a cavity with numerous recesses in which 
the pus can stagnate, where it is kept warm and fluid, 
and where the air can reach it to deposit in it all 
floating germs. In order to counteract these noxious 
influences, the ear, after cleansing, is filled with some 
antiseptic powder and plugged with absorbent cotton. 
The efiicacy of any antiseptic treatment shows itself 
at once in deodorizing the secretion, which in most 
chronic cases, is very fetid. But it would be a de- 
cided mistake to seek the efficacy of an antiseptic 
dressing only in its power to check decomposition of 
the secretions. The real object is to keep out all 
micro-organisms, and the ideal antiseptic is the one 
which can, by its gradual absorption, aid the tissues in 
their struggle against the parasites, which have already 
invaded them. For the researches of Ogston,' and 
later those of Uskoff" and of Orthmann, have estab- 
lished definitely that suppuration, unless produced by 
chemical irritants, is always the result of parasitic 
invasion of the tissues, especially by micrococci. 

The treatment I advocate in this paper I have tested 
in fifty cases of otorrhcea, of which I have a complete 
record, and about the same number of instances of 
which I have no — or, at least, no satisfactory — notes, 
or which are still under treatment. The impressions 
made on my memory by the latter series fully corrob- 
orate what I can learn from my tabulated records. 
The great majority of these cases were treated by in- 
sufflation of powdered boracic acid. Since it is the 
object to bring the powder in contact with the muc- 
ous surface, it is best to begin with cleansing the ear 
thoroughly. A rubber bulb syringe with a very small 
nozzle saves much time and discomfort, when com- 
pared with the use of dry cotton alone for this pur- 
pose, though after syringing I dry the parts with 
absorbent cotton on a probe, or cotton-holder. The 
boracic acid should be as finely pulverized as possible, 
since large crystals may irritate mechanically. With 
this precaution, its application never pains, though it 
may cause some noise in the ear. Since it is the in- 
tention to keep the inflamed surfaces covered with the 
powder, or its concentrated solution, the application 
should be repeated as often as the discharge has car- 
ried off" the excess. Once a day in cases of profuse 
secretion up to once every four or five days, when the 
disease is near its end, has been found satisfactory. 
I have never seen any retention of pus caused by 
even large quantities of the powder. Formerly, I 
have blown the powder into the meatus through a glass 
tube, which is more convenient than the insufflators 
in the market. But, with the object of carrying the 
finely divided powder into all the nooks and corners, I 
have constructed a very simple powder bottle, through 
the cork of which two tubes are passed. One of these, 

1 Vide " Gradle, Bacteria and the Germ Theor>' of Disease." (W. T. 
Keener, 1883.) 



connected with a rubber bulb, terminates in the mid- 
dle of the bottle, with a fine opening. The air, blown 
through, whirls the powder about, and a sufficient 
quantity of this fine dust is carried with the current 
of air through the other tube, which reaches only to 
the lower end of the cork. Slender silver tubes, bent 
properly, can be attached to this outlet in order to 
be passed through a narrow perforation of the mem- 
brana tjnnpani, but if the perforation be not too 
small, it is not necessary to introduce the tube far into 
the meatus. Messrs. Sharp & Smith, of this city, 
have lately put up these powder bottles for me in a 
more elegant and durable shape, and with attachments 
for the nares and larynx. My expectation of reaching 
the diseased surfaces better than formerly with the all- 
penetrating cloud of fine dust poured forth by this 
simple apparatus, has not been disappointed. When 
the eustachian tube is fully pervious, the patient often 
gets a taste of the remedy in the mouth, on blowing 
it into the ear. Since the apparatus is always filled, 
it saves much time in the treatment of a number of 
patients in succession. It is also of decided conven- 
ience for the treatment oC other mucous surfaces ; for 
instance, the nose, or larynx, as well as for the sur- 
gical employment of iodoform. Since I have begun 
using this apparatus, the average time required for the 
cure of otorrhcea by means of boracic acid has been 
decidedly lessened. 

The duration of the treatment of otorrhcea varies 
very much. Among my recorded cases I have suc- 
ceeded three times in arresting a long-standing dis- 
charge by a single application of boracic acid. The 
majority of patients, however, required from five to 
twelve applications, corresponding to eight days to 
three weeks time. A few have dragged along for two 
to four months, but in these instances the treatment 
was sometimes interrupted by irregularity on the part 
of the patient. In all my experience I have only 
seen one case which I had to declare incurable after 
several months treatment. It was a young man, who 
had bilateral otorrhcea since childhood (after scarlet 
fever), with complete loss of the membrane and the 
ossicles in both ears, but with very nearly normal 
hearing power. The very fetid discharge was dimin- 
ished, but could neither be checked entirely nor deodor- 
ized by boracic acid, iodoform, tannic acid, carbolic 
acid, alcohol, or nitrate of silver; but, at that time, 
I did not yet use my present powder blowers. In all 
my instances the effect of boracic acid was notice- 
able on the first application, by lessening the dis- 
charge and generally deodorizing it. I have occa- 
sionally filled the ear with a 4 per cent, solution of 
carbolic acid, when boracic acid failed to disinfect it 
at once. But this smarts slightly, and fluids kept 
permanently in the ear are not as pleasant as dry 
powders. Moreover, with the powder blower I can 
accomplish just as much now with boracic acid as 
with carbolic acid formerly. There are, however, 
cases in which a foul odor persists until the cure, in 
spite of all antiseptic remedies. I never pronounce 
a patient cured until absorbent cotton at the end of a 
probe detects no trace of moisture in the ear. When 
this test is applied, relapses are not common. I have 
altogether known only of two instances, though, 



RESTORATION OF A LOST CHEEK. 



[July, 



possibly, some "may not have come to my knowledge. 
But relapses, improperly so called, or, rather, exacer- 
bations of the disease, occur often, when patients dis- 
continue the treatment prematurely. 

The prognosis in the individual case, as regards the 
duration of treatment, is very uncertain. I know of 
no definite landmarks. Neither the previous dura- 
tion of the disease and the character of the discharge, 
nor the size of the perforation and amount of de- 
struction seem to determine the persistence of the 
purulent inflammation under antiseptic treatment. 
Even the presence of complications, like polypous 
growths or granulating erosions, does not necessarily 
prolong the time of treatment. 

Of other antiseptic agents, iodoform has been much 
lauded by American authors, but much less so by 
European otologists. As long as I contented myself 
with simply filling the meatus with this powder, I 
found it quite unreliable, and never as prompt as 
boracic acid ; but since ^I distribute the powder in 
such a state of fine subdivision over the entire surface, 
by means of the powder blower, its value has become 
more apparent to me. Yet its action is generally not 
as prompt as that of boracic acid, although in some 
few cases I have found it beneficial to substitute 
iodoform for other applications, when the latter had 
ceased to influence the disease very markedly. On 
the whole, I have not found the value of iodoform 
in otorrhoea sufficient to compensate for its odor. 

The enthusiastic praise by Kocher of subnitrate of 
bismuth, as a substitute for iodoform in antiseptic 
surgery, has led me to use it in otorrhoea. Although 
it does not destroy the odor of the discharge as 
promptly as boracic acid, it lessens the secretion in a 
very marked manner. I have, however, employed 
pure bismuth but very few times, because I have 
found it so much more efficacious, when triturated 
with a one per cent, of corrosive sublimate. The addi- 
tion of this powerful antiseptic does not give rise to 
any pain, while its quantity is too slight to endanger 
the patient's health. I have used this mixture now 
in some fifteen instances, with the most gratifying re- 
sults. In three cases the cure was accomplished by a 
single application, while in others, still under treat- 
ment, the influence was manifested by an immediate 
improvement, as compared with the previous effect of 
boracic acid or iodoform. 

The cloud of dust which can be obtained with this 
powder is so much more penetrating than that of 
boracic acid, that this explains in part its superiority 
over the latter agent. Besides, bismuth it is claimed 
by Kocher and other surgeons, diminishes directly 
the secretion of even aseptic wounds, which I can 
confirm from a limited surgical use of the bismuth 
and mercuric chloride mixture. While it might be 
difficult to prove the superiority of this antiseptic 
powder by my limited figures, the prompt effects 
.which I have seen of lessening and deodorizing 
the discharge, and of allaying the pain in the more 
acute instances, have led me to discard all other in- 
sufflations but those of subiiitrate of bismuth, with 
the addition of i per cent, of mercuric chloride. 

I have tried insufflations of calomel a few times 
and found them nearly as efficient as the bismuth 



mixture, but have feared applying it too often on ac- 
count of the personal danger in inhaling the fine 
mercurial dust. 

Not the least advantage of the antiseptic treatment 
of otorrhoea is its effect on polypi. Unless these are 
very large, so as to fill up the cavity and prevent the 
entrance of the powder, or so constricted at the 
pedicle as to render their removal very easy, there is 
not much object in operating upon them. Twice have 
I been able to check the otorrhoea by one or several 
applications of boracic acid, although polypous 
growths were present. The latter atrophied gradu- 
ally afterwards. In another case boracic acid failed 
to accomplish this. The bismuth and corrosive sub- 
limate mixture I have found more efficacious in this 
respect in the two cases which have lately come under 
my treatment. 

Finally, I claim for the antiseptic treatment this 
decided advantage, that the painful, and, indeed, 
dangerous, inflammatory exacerbations and complica- 
tions, which under other treatment, so often annoy 
patient and physician, are never observed with rigid 
antiseptic medication. 

Central Music Hall, Chicago, III. 



RESTORATION OF A LOST CHEEK BY A FLAP FROM 
THE SHOULDER. 



BY EDMUND ANDREWS, M.D., LL.D. 



Professor of Clinical Surgery in Chicago Medical College. 

This operation, so far as I know, is new; at least, 
I find no example of it among the works of reference 
at present accessible to me, and it is of importance as 
showing that for plastic operations on the side of the 
face one may use the shoulder freely as a source of 
flaps. 

Case 11,707, Andrew's Surgical Record, May 18, 
1882. — The patient was a young woman about twenty- 
two years of age. During the previous year she had 
received the discharge of a shot-gun close to her face, 
passing obliquely from the front backward and out- 
ward. The right cheek, from the angle of the mouth 
backward nearly to the ear, was torn away, stripping 
the jaws down to the periosteum. The teeth were not 
injured, but a few scales of bone afterwards exfoliated 
from the side of the body of the lower jaw. The mas- 
seter muscle was injured, but not torn away. At the 
time of the operation the parts were cicatrized, the 
lips were separated widely at the commissure, the 
upper one being adherent to the upper jaw near the 
ala of the nose, and the lower one to the lower max- 
illa an inch below, changing the mouth to a triangu- 
lar opening. The molar teeth were exposed in the 
cavity where the cheek should have been. 

I examined the forearm and the neck with the view 
of transplanting a flap from one of these places, but 
the patient was thin, and it was evident that there 
was not fat enough in either of these locations to sup- 
ply the thick cushion torn from the cheek by the gun. 
Fortunately, the patient had a long and flexible neck, 
and the shoulder was very movable. By experiment, 
I found there was no difficulty in placing the wounded 
spot fairly against the top of the deltoid region by 



1883-] 



MEDICAL PROGRESS. 



flexing the neck to one side, and raising the shoulder 
to meet the spot where the cheek should be ; at the 
same time, there was a tolerably thick cushion of fat 
covering the deltoid muscle. 

I therefore made the first operation by anaesthetiz- 
ing the patient, and raising a thick oval flap from the 
front of the deltoid two inches wide and two and a 
half inches long, leaving it attached by its upper end 
near the outer extremity of the clavicle. This flap 
was washed in carbolized water, and wrapped in gut- 
ta-percha tissue, and left about a week to recover the 
vigor of its circulation. The patient was again anaes- 
thetized, and the circumference of the cicatrized va- 
cuity in the face and of the flap were well refreshed 
with the scalpel. Bending the neck towards the flap 
and raising the shoulder to meet it, the flap was 
turned up, and without much difficulty stitched into 
its place, with the free end backward toward the ear. 
The head and shoulder were now firmly- plastered to- 
gether by long and broad adhesive straps, passing 
around the head and face and under the axilla, rein- 
forced by bandages crossed and fastened in proper 
places. At the end of another week the union was 
established, and I separated the flap from the shoulder 
and released the head from its confinement. Most of 
the transplanted tissue retained its vitality, but a por- 
tion nearest the mouth sloughed, and eventually came 
away, leaving the flap deficient in size at that part. 
Three weeks after the final separation of the flap from 
the shoulder, I separated the external angles of the 
lips from their abnormal adhesions, placed them to- 
gether so as to make a good commissure, and filled 
the gap between them and the flap by sliding in other 
tissues from above and below. 

A salivary fistula from the duct of Steno still re- 
mained near the ear, which was cured by making a 
free route for the saliva into the mouth, and slid- 
ing a small flap over the external orifice. 

The result of these tedious labors was most excel- 
lent, and the patient recovered a reasonably full and 
rounded cheek, and a comparative comeliness of 
countenance. 

No. 6, 1 6th street, Chicago. 



MEDICAL PROGRESS. 



Medical Notes on Japan. Prof. Ch. Remy 
(^Archives Generales de Medicine. Paris : March, 
1883) gives an mteresting account, the results of 
his observations in Japan, in which he details, first, 
the mode of nourishing and raising children. They 
are nursed by the mother to the age of five and 
six years — artificial nursing is unknown — but in 
the second year they are given also rice, boiled in 
meat juice, fish and eggs. The women bear this pro- 
longed lactation exceedingly well. They are small in 
figure, and their breasts before pregnancy present 
nothing peculiar ; after pregnancy they are capable of 
producing an incredible amount of milk, and patho- 
logical galactorrhoea is quite common. In one case, 
which he saw in hospital, a young woman gave from 
her breasts over twelve and a half pints of milk in a 



' day. Their diet during lactation consists of a con- 
siderable quantity of rice, herbaceous and farinaceous 
vegetables, fish, a great deal of tea, and certain pop- 
ular drugs ; forty or fifty times a day is tea made in a 
Japanese houshold. 

This prolonged lactation may be the cause of the 
small degree of fecundity noticeable in the statistics ; 
the women remain fifteen and seventeen months with- 
out menstruating. There are seldom more than three 
or four children from one mother in the family. The 
children are very healthy looking, and escape the 
gastronomical disorders. Nevertheless the mortality is 
very great, and they succumb principally to chest and 
head troubles. Hydrocephalus is very common, but 
rachitis does not exist in Japan. 

The new-born child is not placed in swaddling- 
clothes; its only bandage is that around the umbili- 
cus, and the children of the poor are frequently al- 
most naked summer and winter. When they are 
dressed they wear robes with very large sleeves, op)en 
in front, and gathered around the waist by a belt, 
leaving naked the upper part of the body and thorax, 
and uncovering the legs in many instances. This is 
a very insufficient protection against the cold, for 
which the houses are poorly provided. The child's 
head is sometimes covered by a little red bonnet, but 
most generally remains uncovered, and is close shaven. 
It is carried on the back of the mother, between the 
folds of her garments, and held in place by a band, 
so that while the lower part of the body receives the 
maternal warmth, the head and suf>erior portion of 
the trunk remain exposed nearly naked to the changes 
of the temperature. It lives in this way, on the back 
of a carrier, almost until" it is large enough to in turn 
take a younger child upon its own back. This mode 
of carrying children sometimes produces deformities, 
and is, therefore, described. The women wear a large 
- sash over their clothing which, after four or five turns 
around the body, is tied in voluminous knot over the 
loins; over the shoulder is placed a loose garment, 
with sleeves, and open in front. The child is placed 
within the folds of this latter; is seated just above 
• the knot of the sash, its legs about the body of the 
; mother, and its belly against her back ; then she folds 
' this garment across her chest. The band which re- 
tains the child in position is made of thick stuff" in 
folds, and so arranged as to pass under the buttocks 
of the child, then diagonally across the chest of the 
mother to the left shoulder, then across the back, and 
under the two arnxs of the child, to pass over the right 
shoulder of the mother, the two extremities being 
knotted together and forming a figure 8 over her 
chest. This frequently results in a lateral depression 
of the sides and a corresponding projection forwards 
of the sternum, which is frequently bent at one of its 
articulations, not at all resembling rachitis, but due 
to the pressure of that part of the bandage which 
passes under the arms and compresses the sides ; in 
most cases, as pressure is relieved and age advances, 
■ the deformity disapf)ears. 

The mode of shaving the head, which is gradually 
allowed to grow hair as a tonsure, exposes the un- 
covered part to the rays of the sun, which are very 
powerful in their heat even in winter. It certainly 



MEDICAL PROGRESS. 



[July, 



is a protection against that dirt which is so often the 
origin of impetiginous eruptions and of glandular en- 
gorgements; in the older children, when the hair is 
allowed to grow more freely, these affections become 
more common. Remarkable for the roundness of their 
faces, their limbs in contrast are very slender, and this 
difference prevails in adult life. 

With the girls, menstruation is established at four- 
teen or fifteen in a perfectly natural manner ; they are 
generally married at a very early age, and thus escape 
those troubles of nutrition and innervation, as chlorosis 
and hysteria. Tuberculosis is hereditary, or acquired, 
affecting all ages. There is a marked want of proper 
exercise. The buildings are not well adapted to keep 
out the cold ; they are heated simply by braziers, and 
the dress is but a poor protection. The chemise is ex- 
tremely rare, a simple piece of stuff being worn around 
the waist and half way down the thighs; buttons 
are unknown, the robe being simply crossed in front, 
leaving uncovered the upper part of the chest, and at 
each movement a part of the legs. The men some- 
times wear cotton drawers. The women, in the coun- 
try, wear a somewhat similar garment ; in the city, 
their legs are naked, a simple linen sock covers the 
foot to the ankle. The air penetrates to the skin 
through the wide sleeves. 

Dr. Baelz, in 1877, discovered a parasite — the Disto- 
ma pulmonale — which makes the periphery of the lungs 
its habitat, forming a cavity connecting with the neigh- 
boring bronchi by minute openings, and producing a 
constant cough and recurring haemoptysis. The egg 
of this parasite is studied quite satisfactorily in the sputa. 
With this haemoptysis the health seems to be well pre- 
served, and there is an absence of thoracic signs cor- 
responding to tuberculosis. The parasite itself has 
been but rarely studied owing to the difficulties of 
making post-mortems, the religious belief of the 
Japanese being strongly opposed to it. Cobbold 
describes it as found in the island of Formosa, under 
the name of Disto?na ringeri. 

Dr. Baelz also describes two parasites peculiar to 
the liver, Distoma endemiciitnhepatis and Distoma in- 
noaiumhepatis. The first occupies the vesicular walls, 
or is free in the biliary canals; it produces inflamma- 
sion, enlargement, cachexia and dropsy. This para- 
site is limited to those regions where the water drank 
passes through the rice fields. The second variety is 
sometimes found in great quantities in the biliary 
passages, but without apparent effect. 

As regards the nervous system, there is a singular 
insensibility to temperature; the courier will travel 
with naked legs at 24° F., while the baths are habitu- 
ally heated to 122° F. There is, also, an apparent 
in.sensibility to pain, which is the result of education, 
a stoical or Spartan philosophy. The Japanese, how- 
ever, have a great tendency to collapse, and it is 
difficult to arouse the nervous system during conval- 
escence. There is a remarkably large'number of blind 
persons in Japan ; the result of hydrocephalus, syph- 
ilis, small-pox, and badly-treated conjunctivitis. One 
common cause of mental derangement is the readi- 
ness in which divorces are obtained, and the women 
subjected to humiliation and reduced to misery. 

The small-pox has made terrible ravages in Japan, 



and vaccination has proved most efficacious. It is 
now obligatory, and the government in 1874 estab- 
lished a vaccine farm, which is carefully supervised. 
In 1824 Von Siebold first practiced this method in 
Japan, in a limited space and at a considerable risk 
to himself, not being supported by the authorities. 
After his departure, the virus was taken from arm to 
arm, lost its efficacy, and fell into disuse. In 1848 
a terrible epidemic ravaged the country, and in 1849 
Mohnike recommenced to vaccinate. He was sup- 
ported by the government, and used fresh lymph 
from Java ; but after his departure the arm to arm 
process was again put into practice, and again all 
confidence was lost. Now, since the appearance of 
the United States squadron under Perry, in the Jap- 
anese waters, the former strict objections to foreign 
customs have been relaxed, and Japanese physicians, 
who have studied with the Dutch, reorganized per- 
manently the system of vaccination. 

A Case of Continuous Flow of Milk. — Dr. 
Gomez Pamo, gives, in the Anales de Cirugia, in La 
Revista de Ciencias Medicas, in Barcelona, the fol- 
lowing : 

A woman, married at sixteen years of age, whose 
menses, established at fourteen years, continued with- 
out interruption until the first month of marriage, 
when she became pregnant. After delivery, lactation 
was established, and continued for twelve months, 
without any appearance of the menses. Becoming 
again pregnant, she weaned her child ; and this re- 
peated '\\.%€d fourteen times, without any complication. 
She nursed each of her fourteen children up to the 
time that she felt herself again pregnant. During her 
pregnancies the flow of milk diminished somewhat, 
bnt never disappeared entirely. Immediately after 
delivery, she gave the breast to the infant. The milk 
was abundant and of good quality. All the children 
were very robust, two of them having been born pre- 
maturely. During all this time, that is, from the first 
month after marriage to the present, seven years after 
the birth' of the last child, the menses have not reap- 
peared. She weaned her last child five years since, 
but the flow of milk has not diminished, in spite of 
all treatment ; it is abundant and of good quality, 
and the breasts have to be drawn frequently to relieve 
the pain caused by tension. 

The woman is robust, muscular, intelligent, of a 
nervous temperament and of a lively character, occu- 
pied in housekeeping. — (^Journal d^ Accouchements.) 
Archives de Tocologie des Maladie des Femmes, 
March, 1883. 

Stramonium Poisoning. — Dr. H. T. O. Morsly, 
the French sanitary physician at Mecca, in the Alger 
Medical for May, describes briefly twelve cases of 
poisoning by the datura stramonium, or, as the Arabs 
call it, tartora. It seems that in Mecca, the grocers 
are also physicians and apothecaries, and that this 
drug is most commonly used as a poison. At the 
time of the pilgrimage to Mecca, when some 100,000 
individuals from all parts of the world crowd into the 
city, the criminal portion of the inhabitants use the 
drug, by enticing the stranger to eat with them ; they 



t883.] 



MEDICAL PROGRESS. 



23 



serve up, cooked with the food, the leaves, root, stem 
or grains of the datura stramonium. When the poi- 
son begins to work, they rob them, and leave them 
in delirium or coma. October 18, 1882, five days 
before the pilgrim celebration. Dr. M. visited the 
Turkish hospital at Mecca, where he found six persons 
from Morocco, completely under the influence of vio- 
lent delirium, and presenting all the s)Tnptoms of in- 
toxication from a stupefying p)oison ; dilatation of the 
pupils ; dryness of the throat and mouth ; involun- 
tary movements of deglutition, and a constant move- 
ment of the jaws ; ardent thirst, with dysphagia ; pulse 
and respiration accelerated ; temperature slightly ele- 
vated; pain in the head, with movements; carphol- 
ogia ; the legs vacillating, bending, and not able to 
support the patient, who appeared to be drunk. The 
voice was hoarse ; sometimes complete aphonia, and 
with one imitating the various cries of animals. The 
movements of the heart were intermittent, sometimes 
suspended, and seemed about t<> bring on the syncope 
which precedes death. 

The next day, he found that six more among the 
pilgrims were attacked ; two of them had to be car- 
ried on litters, while the remaining four walked stag- 
gering along, vociferating unintelligible words. 

Two days after, when visiting these twelve cases of 
poisoning, to whom emetics, cathartics, and strong 
inftisions of coffee had been given, he found them as 
calm as possible ; they had no knowledge of what had 
passed, were very much mystified at finding them- 
selves in a strange place, and at being asked questions 
upon matters concerning which they were entirely ig- 
norant. Several of them still suffered slightly from 
mydriasis. Of 51 cases of poisoning by this drug 
collected in one year at the Bombay Hospital by Dr. 
Girard, only one terminated fatally, and only four 
presented very alarming s}-mptoms. 

Forcible Digital Dilatation of the Fvlorus 
FOR Cicatricial Stenosis. — Prof. P. Loreta, of the 
University of Bologna, has operated successfully on 
two cases, as reported by Dr. A. Hubert (from de 
Med. Bruxells, April, 1883). 

The first case was a guard on the railroad, aged 
forty-seven ; not addicted to excess of any kind. In 
1868 he suffered from disordered digestion, obstinate 
vomiting and epigastric pains. This was relieved by 
the use of the milk cure, but in 1875 ^e suffered from 
haematemesis to such an extent that he was nourished 
for a time entirely by nutritive enemata. Again re- 
lieved, in 1878 he suffered from an intense and fixed 
pain in the epigastric region, \vith incessant vomiting 
of bloody alimentary substances. The diagnosis of 
ulcer of the pylorus was made ; relief came after three 
months' treatment by the milk cure. In 1882, after 
suffering for some time from the old pain, acid eruc- 
tations, pyrosis and vomiting, he entered the hospi- 
tal, and September 13 could no longer retain any- 
thing on the stomach. Milk alone was kept down for 
ten or fifteen minutes, but was then vomited, and the 
patient himself observed an obstacle in the right hyjx)- 
chondriac region, which prevented the passage of 
food. Examination of the abdomen by inspection 
and percussion showed the lower border of the stom- 



ach on a level with the umbilicus, and a diagnosis of 
cicatricial stenosis of the pylonis, the result of ulcer, 
was made. 

September 14, the operation was performed in a 
small room, at the temperature of 77° F., with anti- 
septic precautions. After emptying the stomach by 
the stomach-pump, the surgeon made his incision into 
the walls of the abdomen on the right side, parallel 
with the costal arch, and about a third of an inch 
below, to the length of about six inches. He drew 
the stomach through the wound and opened it. In- 
troducing the index finger of the right hand, he 
found that he could but with great difficulty pass it 
through the pyloric orifice. After much time and 
labor, he forced both index fingers through the open- 
ing, and then practiced forcible dilatation, as is 
done with the anus, until he felt the pylorus yield to 
the pressure. The resistance offered by the pylorus 
seemed to be due to a fibrous hardness, and the mus- 
cular fibers seemed to be considerably hypertrophied. 
He was enabled to separate the two fingers to a dis- 
tance of three inches ; they had been bathed in a 
carbolized solution before their introduction, and on 
removal showed nothing peculiar. He applied the 
silk suture to the stomach, returned it, and closed the 
abdominal wound by the interrupted silver suture, 
using Lister's dressings. The operation took thirty 
minutes to perform. 

The patient suffered no pain, but desired food. 
He was given, besides pieces of ice, the yolk of an 
egg in wine. He had neither fever, hiccough, nau- 
sea or vomiting, but some eructation. The dressings 
were renewed twice. On the sixth day, two of the 
sutures were removed, aTid the wound was found in 
good condition, with, for the greater part, union by 
the first intention. On the eleventh day, the seven 
remaining sutures were removed. Since the opera- 
tion, the patient has never experienced any pain in 
the stomach, except one day after soda biscuit had 
been given to him. His appetite was always good ; 
the third day, he ate some chicken, and drank some 
wine; the sixth day, bread was added, and the eighth 
beefsteak, and from that time on, his daily ration 
comprised beefsteak, two pieces of chicken, bread, 
and a moderate quantity of wine. His cure was com- 
plete on the fifteenth day. Before the operation, Sep- 
tember 12, he weighed 117 lbs. On October 12 he 
weighed 162 lbs. The last news from him, January 
10, was that he continued to enjoy perfect health. 

The second case was that of a young man of eight- 
een. In 1876 he ate immoderately of bread, was 
taken with copious vomitings, and discharged the 
food he had taken, already somewhat altered. The 
following week this was repeated twice, and for two 
years this continued every week. Once only, in 1878, 
a slight haematemesis followed the efforts at vomit- 
ing, and at that time vomiting occurred four or five 
times a week, with obstinate constipation. This con- 
dition of things increased until December 17, 1882, 
when he came under the notice of Prof. Loreta. 
For three years he could take no fruit, as it disturbed 
the stomach. At this time, much emaciated, nearly 
every day, for hours of the ingestion of food, vom- 
iting occurred, leaving him with a ravenous appetite. 



24 



MEDICAL PROGRESS. 



[July, 



It was preceded for two hours by bitter eructations, 
intense thirst, a sense of weight in the epigastrium- 
borborygmus, and vermicular movements in the 
stomach, which commenced at the greater pouch, 
passed to the pyloric portion, were arrested, and re- 
commenced returning to the starting point. On 
physical examination, the stomach, when nearly 
empty, exhibited in profile a tumefaction on a level 
with the costal arch, and corresponding to the infer- 
ior parasternal and mamillary lines, occupying the 
whole of the epigastric region, extending below to 
within two finger breadths of the umbilicus in the 
median line, in the left hypochondriac region, near 
to the mamillary line. When the stomach was filled 
with food, the tumefaction was much greater ; its 
lower limit was increased about an inch. Then the 
vermicular movements extended from the left to the 
right region of the stomach, forming very marked 
protuberances, and evidently arrested for a longer 
time at the right hypochondrium than at the left. 
The median line of the stomach seemed to form a 
furrow which intercepted these protuberances and 
prevented their complete development in that region. 
The diagnosis was made of stenosis of the pylorus due 
to the formation of submucus exudations and accom- 
panied with dilatation of the stomach. 

On December 22, 1882, the operation was per- 
formed with the use of chloroform, and the most 
scrupulous antiseptic precautions. An incision of 
nearly six inches was made through the abdominal 
wall, about an inch and a half below the right costal 
arch, and nearly parallel with it. After carefully 
providing against haemorrhage, the peritoneum was 
cut through, and a search made in the abdominal 
cavity for the pyloric region, which, on account of 
the dilatation of the stomach, had been crowded 
against the vertebral column. Seizing a fold of that 
region with the fingers, it was given to an assistant, 
and an incision made through the wall of the stomach 
nearly six inches, and in a direction oblique to that 
of the wound in the abdomen. Introducing the 
thumb and index finger of the right hand into the 
stomach, two plumb stones were withdrawn, which 
were pressing against the pyloric orifice, the edges of 
which were much thickened, and the orfice narrowed. 
These plum stones, according to the patient, had 
been there for three years. After several attempts, first 
the index finger of the right, then that of the left 
hand, were introduced, and with the use of consid- 
erable force, the orfice was dilated to the extent of 
about two inches, until the fingers felt a peculiar 
crackle from the torn tissue. The walls of this greatly- 
dilated stomach were normal, with a fine healthy rose 
tint. The lips of the wound in the stomach were 
united by eight sutures, and the abdominal cavity 
closed by ten metallic interrupted sutures, while anti- 
septic dressings were applied. 

After the operation, the patient progressed satis- 
factorily ; there was no fever, the number of pulsa- 
tions and of respirations, which were slightly aug- 
mented during the operation soon became normal; on 
the day succeeding the operation, the patient desir- 
ing food was given a pint of milk and a small quantity 
of Qgg beaten up with wine, and he digested this per- 



fectly. The third day he took beef soup, with two 
eggs ; notwithstanding the daily increase of diet, on 
the sixth day his hunger was so great that he was al- 
lowed in addition to eat chicken, and on the eighth 
day he digested readily a beefsteak and some chicken 
with bread, and drank a pint of milk and nearly a 
pint of wine. During the first few days enemata were 
used, producing liquid stools, but they soon became 
of a proper consistency, and passed without the 
aid of medicine. The first dressing was not removed 
until the sixth day. The wound was found in excel- 
lent condition ; on the ninth day the second dressing 
was removed, when the metallic sutures were with- 
drawn, and adhesion was perfect. From this time 
dressings of iodoform were used until the nineteenth 
day, when cicatrization was complete. The thirty- 
fourth day after the operation, the patient was in excel- 
lent health in every respect. 

Displacement of the Heart by Violence, with 
Dislocation of the Clavicle and of three Ribs 
FROM their Cartilages. — September 11, 1882, p. 7 
T. P., get. 19, as injured by the fall of a wall against 
which some iron was stacked ; admitted into Wol- 
verhampton and Staffordshire Hospital, suffering from 
the following injuries: The sternal end of the left 
clavicle was dislocated upwards, forwards and inwards, 
dragging the clavicular portion of the sterno-mastoid 
in front of the sternal portion. The third, fourth, 
and fifth left ribs were separated from their cartil- 
ages, and on the front of the chest their extremities 
formed prominences, over which the skin was tightly 
stretched. The heart was displaced, downwards and 
to the left, and there was a diffused impulse in the 
fifth and sixth spaces external to the nipple. 

The action of the heart was tumultuous, dyspnoea, 
anxious expression, hands and feet cold, trace of al- 
bumen in urine. The clavicle was reduced with ease ; 
ribs partially replaced. Six months later the left 
cavicle was loosely attached to the sternum, and the 
left shoulder had fallen slightly. At the junction of 
the third, fourth and fifth left ribs, with their cartil- 
ages there were palpable prominences. The heart 
was still displaced downwards and towards the left, 
and there was a diffuse cardiac impulse below and 
outside the nipple. The patient had a little pain in 
the region of, the heart, and said that "it catches 
him like a stitch if he walks fast." Exertion caused 
palpitation and dyspnoea, but a distended stomach, 
which at first increased the severity of the chest symp- 
toms, no longer seemed to cause discomfort. — Dr. W. 
H. T. Winter in Dublin Jour. Med. Science, May, 
1883. 

The Effects of Tobacco Smoking in Children. 
— Dr. G. Decaisne, in a paper read before the Paris 
Societe de Medicine Publique, gives observations upon 
thirty-eight children, between nine and fifteen years 
of age, where decided effects were produced in 
twenty-seven. 

Twenty-two had disturbances of the circulation, 
bruit de souffle in the carotids, palpitation of the 
heart, difficulty in digestion, indolent intelligence 
and a decided taste for strong drinks. 



i«83] 



MEDICAL PROGRESS. 



25 



Thirteen had an intermittent pulse. 

Eight showed a notable diminution of blood 
corpuscles. I 

Twelve had frequent attacks of nosebleed. 

Ten were restless in their sleep with nightmares. 

Two showed slight ulcerations of the buccal mem- 
brane, which disappeared promptly on their giving 
up smoking for a few days. 

In one case pulmonary phthisis seemed to have 
resulted from a profound alteration of the blood due 
to the long continued use of tobacco. 

In eleven children who gave up smoking entirely, 
with six these symptoms disappeared in less than six 
months; three still suffered in a minor degree at the 
end of a year. 

He concludes, as the result of his observations col- 
lected through twenty years, that the pernicious 
effects of smoking up)on children are incontestable. 
That it produces intermittence of the pulse, alteration 
of the blood, and the principal symptoms of chloro- 
anaemia, pallor of the countenance, emaciation, bruit 
de souffle in the carotids, palpitation of the heart, 
diminution of the normal quantity of the blood 
corpuscles, and difficulties of digestion. That the 
mental faculties become sluggish, with a fondness for 
strong drinks. That the ordinary treatment for chloro- 
anaemia produces no effect while the habit continues, 
and, finally, that with those children who are without 
organic lesion, all these disorders disappear promptly 
and without leaving any traces behind, when the 
habit is discontinued. — Revue d'' Hygiene, March \ 
20, 1 88 J. 

The Thvro-cricoid Muscle. — This muscle, known 
in our anatomical text books as the crico-thyroid, 
was given the name of thyro-cricoid by J. Casserio to 
accord with its functions, but Santorini (Obs. Anat. 
Sugd., 1739) applied the term crico-thyroid because 
the thyroid cartilage is more moveable than the 
cricoid, and this name has been adhered to down to 
the present day. Its anatomical relations have been 
well studied, but its physiological action has not been 
properly appreciated, if we accept the researches of 
Dr. Martel, as given in the Archives de Physiologic, 
Paris, March 15, 1883. He finds in phonation first 
the action of the thyro-arytenoid muscles in bringing 
the arytenoid cartileges together, the vocal apophyses 
touching each other, and the vocal cords, while ; 
approximating each other, still leaving a fusiform , 
space between them, thus making the thyro-arytenoid 
muscle the preparatory muscle to phonation. Second, | 
in order to produce the sounds of the gamut, a factor I 
must be introduced which will vary at will the length, I 
size and tension of the vocal organ, which he finds in ! 
the thyro-cricoid muscle as the phonator tnuscle par 
excellence. To support this he f)erforms experiments 
which prove conclusively, to his mind, that the 
cricoid alone in the mobile cartilege. He places two 
light pieces of copper, armed with pens for registering 
on the Marez cylinder, one on the middle portion of 
the anterior surface of the thyroid cartilage, and the 
other on the inferior border of the cricoid cartilage, 
and the consequent registration shows that during 
respiration both cartilages, remain motionless; in 



forced respiration, both cartilages become elevated in 
unison ; in phonation the cricoid alone is elevated, 
which becomes more decided as the note is higher in 
pitch. In support of this he cites Songet's experi- 
ments of paralysis of the muscle in question by 
division of the external laryngeal nerve, experiments 
which, repeated by Rochefontaine in the dog,^ave 
produced the same result, i. e., hoarseness of voice, 
which was relieved by using the fingers to replace the 
muscles ; and by bringing the cricoid in closer ap- 
proximation to the thyroid, the animal was enabled 
to make sounds higher in pitch. 

Women suffering from hj-sterical aphonia are 
nearly all affected with paralysis of the thyro-cricoid. 
Its superficial p>osition accounts for its being readily 
influenced when one "catches cold," and for its 
ready response to the use of electricity in relieving 
aphonia. He concludes : 

I St. That the thyro-cricoid muscle is the phonator 
muscle par excellence ; that it is the muscle of the 
singer, of the orator ; that its duty is to regulate, by 
its contraction, the length the size and the tension of 
the membranous stop or pipe. 

2d. That the paralysis of this muscle produces 
aphonia or hoarseness of the voice ; that is to say, an 
impossibility on the part of the patient to emit any 
other than the lowest notes; and that this paralysis is 
characterized by a fusiform appearance of the glottis 
in the efforts at phonation. 

Bi-Chromate of Potash Poisoning. — A young 
man aet. twenty-two swallowed a lump of chrome 
(the purified salt) in the solid form, equal in weight 
to 5ij ; then took a fifteen minutes walk, at the end 
of which time he felt lightness in head ; great heat in 
stomach ; glow of heat all over body, followed by a 
cold sweat ; nausea ; free vomiting ; agonizing pain 
in epigastric region ; giddiness ; specks before the 
eyes and loss of power of the legs (complete power 
in arms) ; intense thirst ; rigors and coldness of the 
whole body. He was taken to hospital, and seen 
within two hours after swallowing the poison. Pupils 
slightly dilated ; face pale and extremely cold ; pulse 
feeble and fluttering ; no vomiting, but intense pain 
over stomach and great depression ; no cramps or 
diarrhoea ; a degree of stupor, but answers questions 
fairly well. Sensibility to touch and pain well- 
marked. 

Treatment. — A full dose of sulphate of zinc ; wash- 
ing out the stomach with tepid water by means of the 
stomach-pump till the fluid was colorless ; subcutane- 
ous injections of 20 m. sulphiu^ic ether. Covered 
with warm blankets ; hot bottles to feet and sides ; 
mustard over stomach. Gave tepid coffee, diluted 
with milk and with a good deal of brown sugar — re- 
jected at once. Then gave milk mixed with lime- 
water, and ten grains of nitrate of bismuth ; this was 
retained. Barley water was given as a drink, and the 
patient was ordered a milk diet with lime-water. He 
took the poison at 5 p. m., and received his medical 
treatment first at 7 p. m. ; slept fairly well that night, 
and in the morning every symptom had disappeared, 
except a slight soreness of the mouth. Perfect recov- 
ery. The fact of having taken food about an hour 
and a half before taking the poison, and of vomiting 



26 



MEDICAL PROGRESS. 



[July, 



part so early, aided materially in bringing about the 
favorable result. The urine was examined with ni- 
trate of silver, acetate of lead and sulphuretted hy- 
drogen, without results. Bichromate of potash af- 
fects workmen engaged in dyeing by acting as a caus- 
tic to slight abrasions of the skin, producing a tough 
slougft, followed by an ulcer with hardened, cup-like 
border. They may gradually extend deeper and 
deeper, until they eat their way into the bone. At- 
tacks of conjunctivitis are also of not uncommon oc- 
currence. 

Brief of notes of Edward Orr Macniven, m.b., 
Glasgow Med. Jour., May, 1883. 

Atrophy of the Brain Following the Ampu- 
tation OF A Limb. — M. Bourdon reports a case to 
the Paris Academy of Medicine {Seance du Mai 5, 
1883), in an old soldier, who at forty years lost his 
left arm, and who died at the age of seventy-three 
from cerebral meningitis. The brain was carefully 
examined, and the results are carefully given, with a 
summary that demonstrates, in addition to six other 
observations by the same reporter, that the amputa- 
tion or arrest of development of a limb, produces 
consecutively an atrophy of the motor zone of the 
brain, both anterior and posterior to the fissure of 
Rolando. It proves, further, that the lesion conse- 
quent upon functional defects, and ordinarily confined 
to the cerebral cortex, can extend secondarily to the 
white substance subjacent to the corpora striata, to 
the optic thalami, and to the lateral portion of the 
medulla. In this case, paralysis of the left leg came 
on gradually in the later years of life, without any 
accompanying cerebral symptoms, which was attribu- 
ted to an extension of the atrophy of the brain, fa- 
vored, perhaps, by the advanced age of the patient, 
as cerebral atrophy is such a common alteration 
among old people. 

An Electric Light for Medical Uses. — Dr. 
Nelot, of Rouen, exhibited before the Academy of 
Medicine, Paris, a so-called photophone constructed 
by M. Trouve, consisting of an electric light enclosed 
in a metal cylinder, between a reflector with condens- 
ing lens, which, being very small and light, can be 
worn on the forehead like the mirror of the laryngo- 
scopist, or fixed upon an upright placed on the table, 
arm of a chair, or other convenient point of steady 
support. The light is very strong, and is dc rived from 
a pile of sup' rsaturated bichromate of potash. It can 
be used for boveral hours without renewal. — -Journal 
de Medicine el de C/iir. Prat, Paris, Mai, 1883. 

The Relations of Monoplegia of the Lower 
Extremities with Lesions of the Paracentral 
Lobule. — Dr. Ballet, in the Archives de Neuralogie 
(June 15, 1883), gives the notes of four cases — the 
first, get 29 years, of a monoplegia of the left leg, of 
three months standing, where the left arm became 
gradually involved, and, on post mortem examina- 
tion, the lesion was found to be on a level with and 
bordering upon the lobule paracentral, consisting of 
a tuberculous infiltration which penetrated the gray 
substance and involved the white matter. One im- 



portant symptom in this case was the absolute integrity 
of general and special sensibility. 

The second, in an old person, was a case of mo- 
noplegia of the left lower leg, with simply a gelatin- 
ous consistence to the paracentral lobule. 

The third, set 27, was monoplegia of the left leg, 
followed by the involving of the left arm, and re- 
sulting in hemiplegia in a case of pulmonary tuber- 
culosis. The lesion here was more extensive, but also 
involved the paracentral lobule. 

The fourth case was one reported by M. Jean, 
March 17, 1882, to the Sve Anatomique : There 
existed monoplegia of the right leg, with as a lesion 
tubercular meningitis, with adhesions to the left para- 
central lobule. 

A Novel Mode of Cleansing the Vault of the 
Pharynx. — Dr. John O. Roe in the Medical Record 
(June 9th) .describes a case of chronic nasal catarrh, 
where the mucous discharge becoming dried down, 
the patient removed the crusts readily with the tip of 
his tongue from the posterior nares and vault of the 
pharynx. If a probe was passed through the nostrils 
to their posterior opening and further, he could throw 
it forward nearly out of the nostrils, by passing his 
long and rather slender tongue up behind the palate 
and out of sight. 

Destructive Disease of the Kidneys Follow- 
ing Urethral Stricture. — Case i : J. B. White, 
set. 26, seen first May 6, 1883, when he suffered from 
retention of the urine. Largest sized catheter that 
could be used was No. 4 English, which evacuated 
between two and three ounces of bloody urine mixed 
with pus. The patient had worked to date, but had 
for months been complaining. The urine was am- 
moniacal with alkaline reaction and highly albu- 
minous. A diagnosis of surgical kidney was made, 
and the patient admitted to the Baltimore City Hos- 
pital. In eighteen hours time he became comatose, 
dying on May 8. The autopsy showed both kidneys 
distended like large bladders filled with fluid; of the 
left nearly all kidney structure proper was absorbed, 
of the right a little more coitical substance remained. 
The ureters were dilated and sacculated, at i)oints 
being fully an inch in diameter ; their openings into 
the bladder were normal. The bladder was contracted 
and its walL very much thickened and rugous, con- 
taining three ounces of bloody urine mixed with pu.-'. 
The prostate gland contained a large abscess (two 
ounces of pus), which led by a sinus to the posterior 
inferior wall of the- bladder, and also by a small 
fistulous canal to the perineal junction of the scrs - 
I tum. The urethra was narrowed to No. 4 Eaglish, 
\ in the lower pari; of the spongy portion. * 

Case 2 : B. M., colored, set. 60, brought t) the 
hospital comatose, April 20, 1883 > ^^^^ two hours 
after admission. No previous history. Ox autopsy, 
kidneys found with capmle adheren*-, larger tnk i 
normal, pelvis and infundibula full of pa.; cor'i'al 
substance had disappeared, and its pla.e wa> fiiled 
by masses of organized lymph, which was also aggre- 
gated in masses throughout the medullary por. ijn. 
The ureters were dilated to four times their normal 



1883.] 



MEDICAL PROGRESS. 



27 



caliber and filled with pus ; walls thickened. Bladder 
small, walls thick and rugous, and filled with pus ; in 
its anterior wall was an opening connected with puru- 
lent reservoirs in the connective tissue of the pelvic, 
scrotal, and perineal regions. Prostate gland en- 
larged ; right lobe occupied by an abscess which com- 
municated with the urethra through the prostatic 
openings. The urethra, in its anterior, two and a 
half inches, was contracted to the degree that only 
the smallest filiform bougie could be passed through ; 
behind the stricture there were three fistulae of small 
size leading outward, and the urethra was much di- 
lated. — Dr J. W. Chambers, in the Medical Chron- 
icle, June 1883 • 

The Arsenite of Bromine and its Use in the 
Treatment of Diabetes Mellitus. — Dr. R. H. 
Gilliford, of Alleghany, Pa. {Medical Record, June 
9th), combines bromine with arsenious acid in the 
proportion of 240 parts by weight of bromine to 99 
part by weight of arsenious acid; the union takes 
place slowly, taking many days to pass into an oily 
liquid, which is soluble in water and alcohol without 
any apparent reaction. If water is added before the 
union is complete, an immediate and rapid reaction 
takes place, with the evolution of considerable heat, 
water is decomposed, and a solution of hydrobromic 
and arsenic acid, with a little free bromine, is formed. 
The complete union, before the addition of water, is 
much less irritating to the stomach. Dr. Theodore 
Clemens, of Frankfort, Germany, has been using 
some compound of bromine and arsenic in the treat- 
ment of diabetes, and has reported great benefit from 
its use. The medical journals have called his remedy- 
bromide of arsenic, but Dr. Gilliford thinks it prob- 
able that it is the arsenite of bromine. 

Its use in the treatment of diabetes millitus has 
been followed by the most marked benefit in every 
case in which it has been prescribed so far, and the 
notes of four cases are given to sustain this statement. 

The Hypodermic Use of Sulphate of Morphine 
— Dr. William H. Coggetall, in the Virginia Medical 
Monthly for June, 1883, gives a very thorough, use- 
ful and practical discussion of the subject. He gives : 

I St. The choice of the instrument, preferring the 
glass-barreled syringe, covered with a fenestrated 
white metal incasement. 

2d. Care to examine the point of the needle before 
using, to see that the steel or aluminum is firmly at- 
tached, it has become pulled off and left in the cellu- 
lar tissues in, at least, one instance. 

3d. The proper cleansing of the instrument after 
use, as tetanus has been induced by a rusty injecting 
needle. He refers to the use of carbolized oil, which 
can be kept in a small vial in the instrument case. 

4th. Mode of preparing the injection. The pre- 
pared tablets are recommended. They are apt to 
become hard with age, and difficult to dissolve, but 
the careful warming of the solution in a silver spoon 
over a lamp, gas jet, or even a lighted match, will 
remedy this. 

5th. By Magendie's solution, which can be kept 
good for months by the addition of one grain of 
salicylic acid, or two drops of pure carbolic acid to 



the ounce of solution. Vidal" recommends the addi- 
tion of twice as much chloral by weight as there is 
morphia, and claims that this mixture prevents the 
growth of confirvae and increases the power of quiet- 
ing pain. 

6th. The dose he gives is from one-eighth to one- 
third of a grain, and considers one-eighth quite large 
enough for an initial dose, save in exceptional cases. 

7th. The combination of morphia with atropia, 
one grain of atropia sulphate to one ounce of Mag- 
endie, increases the hypnotic effect, prolongs and 
augments the power of quieting pain, diminishes the 
constipating effect, and diminishes the gastric desturb- 
ance and nervous prostration, but both do produce 
dysuria. 

8th. That the use of the injection as near the 
seat of pain as possible, hastens the immediate effect 
is considered probable, but that it is due more to the 
influence of the food acting upon the part than to the 
alkaloid ; that before the local sedative caused by the 
presence of the fluid wears off", the general effect of 
the morphia is felt and thus the impression is kept up. 

9th. Is there any difference as to the locality where 
the injection is applied in hastening the general ab*- 
sorption? He cites Kane to the effect that " absorb- 
tion from the groin and inner side of the arm 
rank first in p)oint of rapidity ; fore -arm next, and 
the thick tissues of the back last. ' ' 

loth. The relative innocuousness of deep and 
shallow injections. The only care necessary to secure 
its effects is to make it sub cutaneous. If in the skin 
itself phlegmasige are sure to follow. There are cases 
who cannot receive an injection into the cellular tissue 
without its being followed by an abscess. 

nth. The necessity in some cases of producing 
local anaesthesia by the use of the ether spray, or of 
ice and salt. 

1 2th. The relief of the urticaria, which sometimes 
follows injections, by fomentations of warm water 
and vinegar. The administration of potassium bro- 
mide just before the injection has sometimes prevented 
this annoying symptom. 

The writer finds the thin, dark-complexioned mem- 
bers of the Southern or Semitic race require more 
morphia than the Anglo-Saxon. He gives the follow- 
ing description of venous absorption : First, a peculiar 
metallic taste in the mouth, with an aching of every 
carious tooth in the head, a most intense irritation 
and prickling all over the body and a dark-red suffu- 
sion, extreme swelling of the subcutaneous tissues, 
especially of the hands and face, increased heart's 
action, head-throbbing, followed by congestive cep- 
halalgia, which, just before the cranial vessels appear 
about to burst, begins to abate and the symptoms sub- 
side. In two cases he treated, the first, a man, by 
stripping him to the waist, and dashing cold water 
over the head aud spinal column ; the second, a 
woman, he treated by diff"usible stimuli. He finds 
that a sharp pain felt on making the puncture, is in- 
dicative of injury to a vein. 

Of the propriety of its use in albuminuria, he cites 
Loomis, Edes and Bartholow in its favor ; and Loomis 
as considering that the salt counteracts the effect of 
the uraemic poison on the nerve centers, producing 



28 



EDITORIAL 



[July, 



extreme diaphoresis and facilitating the action of 
diuretics and cathartics, thereby becoming a powerful 
eliminative agent. Administered just before the com- 
mencement of the inhalation of chloroform, it nota- 
bly diminishes the irritation of the air passages, and 
the narcosis is prolonged with a smaller quantity of 
the anaesthetic, while the protracted vomiting and 
general depression of the vital powers, sometimes 
occurring as sequelge, are very materially decreased. 

In this connection, the editor of the Planet (May 
15, 1883) insists upon the importance of rubbing in 
the solution ; that is, after the needle has been with- 
drawn a small white lump is left, which should be 
rubbed out by degrees by gentle massage over it and 
in its immediate neighborhood, for ten or fifteen 
minutes, which he claims, adds to the rapidity of ab- 
sorbtion and prevents scars and markings. 

Vivisection at the College of France. — The 
Gazette Hebdotnadaire (Paris) of June i, 1883, gives 
us the following account of an interesting little epi- 
sode which occurred, May 22, in the amphitheater of 
Brown-Sequard at theCoUege of France : 

Towards the end of his spring course, M. Brown- 
Sequard had commenced a series of experimental 
lessons to demonstrate some new facts of which he 
had previously spoken, that a general analgesia, with- 
out loss of tactile sensibility, could be produced by 
irritating the laryngeal mucous membrane with car- 
bonic acid or with the vapors of chloroform, taking, 
at the same time, precautions to prevent the entrance 
of these substances into the lungs. He was preparing 
to examine the sensibility in a little monkey, which 
had been subjected to a similar experiment three 
days previously ; but a few moments before the lesson 
he was about to cut the suture of a wound near the 
larynx, when a young woman gave him a blow with 
her parasol on the fingers. She was requested to re- 
tire but refused, declaring that in virtue of the law 
of Grammont, she had the right to prevent all 
cruelty against an animal in a public place. The 
professor having recommenced his operation, the 
woman attempted to strike him again, but this time 
her parasol was taken from her before the blow was 
struck. A police officer was called, and she was taken 
before the magistrate, where a complaint was entered 
against her by two witnesses. She said that M. 
Brown-Sequard desired to cut the vocal cords to pre- 
vent the fearful cries of the poor beast. He would 
have been careful not to perform such an operation, 
as they were necessary to give him proper assurance 
of the pre '.ence of sensibility in the monkey, which 
did not c] y, notwithstanding the return of that sense. 
The question to be determined was to learn if the 
analgesia produced by the carbonic acid, which in 
this monkey had continued for twenty-four hours 
after the irritation of the laryngeal mucous membrane 
— still continued after the lapse of three days — sensi- 
bility had returned. This incident had its counter- 
part, for the following week M. Brown-Sequard took 
for the subject of his lesson, the usefulness of vivisec- 
tions. The amphitheater was too small to hold his 
audience, and he received no other interruptions than 
repeated applause and marked proofs of the most 
lively sympathy. 



A Case of Fatty Diarrhcea. — We extract the fol- 
lowing from an article by Dr. Algeron Wolverton, 
in Canada Med. and Surg. Jour, for June : 

Mrs. G., set. 43, multipara — addicted to alcohol- 
ism — has a bloated, puffy, appearance but gradually 
losing flesh, complained of occasional diarrhoea. 
Oct. 10, diarrhoea very troublesome, four or five 
evacuations daily, and quite as many more during 
the night — said she passed a " yellow scum," which 
came away from her with a " gush of wind," just be- 
fore her bowels were going to be moved, and which 
she stated floated like " grease" on what she passed 
in the chamber-pot. Oct. 11, the doctor saw a 
most noisome-smelling mixture, a yellowish, greasy 
looking substance, very much resembling melted bees- 
wax, occupying half the fluid contents of the chamber- 
pot. When first passsed it was semi-fluid, but speedily 
became firmer and more consistent, and appeared in 
irregular-sized cakes, about a quarter of an inch in 
thickness, always preceded the foecal evacuations and 
was accompanied with a considerable discharge of 
flatus ; the total quantity passed in the twenty-four 
hours would, at least, reach ten or twelve ounces. 

The total duration of this diarrhoea could not have 
been longer than ten or twelve days. Fat cells were 
found under the microscope. Mrs. G. lost weight 
rapidly, with nearly total loss of appetite, but gained 
five pounds the week after its disappearance. No great 
pain, some uneasiness* and tenderness or pressure in 
the gastric region. Liver and spleen not perceptibly 
enlarged. Urine free from albumen or sugar. Dis- 
taste and repugnance for fats during the diarrhoea, 
and never fond of fatty kinds of food. No treatment. 



EDITORIAL. 



THE CHANGE. 



At the recent meeting of the American Medical As- 
sociation in Cleveland, it was decided with much 
unanimity to commejice the* publication of the pro- 
ceedings and papers of the Association, in a weekly 
medical journal under its own control, instead of in 
a volume of Transactions, as heretofore. The basis 
on which this change has been made, and the general 
mode of business management, are plainly indicated 
in the report of the Board of Trustees, which is given 
in full as a part of the record of proceedings, consti- 
tuting the first article in the present number of the 
Journal. As the subject has been before the Associ- 
ation and reported on three years in succession, it is 
not necessary at present to discuss further the ques- 
tions as to the advantages or disadvantages to result 
from such change. The important step has been 
taken, and this, the first number of the new form of 
publication, is before its readers. It contains the 
minutes or full record of proceedings of the general 
sessions of the Association during the recent annual 
meeting in Cleveland ; the annual address of the late 
President, Dr. John L. Atlee, and a fair variety of 
other matter of interest to the profession generally. 
Of course, we have not yet had time to secure the 



i883.] 



PHILADELPHIA LETTER. 



-9 



necessary regular correspondents for manning all de- 
partments properly, and with that regularity which is 
desirable for the highest degree of efficiency. But 
we shall spare neither time nor labor to complete such 
arrangements as will make the Journal an efficient rep- 
resentative of the scientific, social, and ethical interests 
of the whole profession. Thirty-two pages of reading 
matter each week will make two large-sized volumes 
for the year. We shall consequently need many orig- 
inal papers and communications beside those coming . 
through the National Association, and we specially 
invite favors in this direction, from those who read 
papers before State and local societies in all parts of 
the country. To our confreres of the medical press 
from whom we have received so many kind and com- 
plimentary notices, we return thanks, with a cordial 
proffer of the right hand of fellowship, and of our 
best endeavors to promote the common welfare of all. 



Exchanges. — It is understood that nearly all the 
editors and publishers of medical periodicals in this 
country have been sending a copy of their respective 
publications to the Library of the American Medical 
Association, in the Smithsonian Institute at Washing- 
ton, in exchange for the annual volume of Transac- 
tions. We earnestly desire that they should continue 
to send an exchange copy directly to the Library, and 
so many as are willing to furnish a duplicate copy, will 
bestow a special favor by sending it to the office of 
the publication of the Journal, 65 Randolph street, 
Chicago, Illinois. The principal reason for desiring 
a copy of all exchange journals continued at the Lib- 
rary in Washington, is, that they will there be readily 
accessible to Dr. Wm. Lee, of that city, who has 
charge of the department of this journal relating to 
medical progress.. 



Membership Dues and Subscriptions. — All mem- 
bers of the American Medical Association should pay 
the annual membership fee of five dollars to the Treas- 
urer of the Association, R. J. Dunglison, m.d., P. O. 
Box 2386, Philadelphia, Pa.," the same as heretofore ; 
and all who do so will receive the Journal of the As- 
sociation without ftirther trouble on their part. Those 
who wish to subscribe for the Journal of the Associa- 
tion, and are not members, can send the five dollars, 
with their post-office address, directly to the "Jour- 
nal of the American Medical Association, 65 Ran- 
dolph street, Chicago, 111. ' ' These rules apply equally 
to all those who have heretofore signed pledges of sup- 
port and returned the same to the president of the 
Board of Trustees. 



A Fitting Appointment. — As predicted in the 
letter of our Philadelphia correspondent. Dr. Theo- 
phalus Parvin, of Indianapolis, has been appointed 
to the chair of Obstetrics in the Jefferson Medical 
College, made vacant by the resignation of Prof. 
W^allace. Probably no more fitting appointment has 
been made in a medical college for many years ; and 
we congratulate heartily all the parties concerned. 



A General Index. — We are informed, officially, 
that a general index of the Transactions of the Asso- 
ciation from the date of its organization to the pres- 
ent time, embracing the whole series of thirty-three 
volumes, has been prepared by the Permanent Secre- 
tary, and is now in press. It will be ready for distri- 
bution at an early day, and all who wish to secure a 
copy should send one dollar to the Treasurer, Dr. 
Richard J. Dunglison, P. O. Box 2386, Philadelphia, 
without delay. With a full index, the value of the 
past series of volumes will be increased fourfold. 



DOMESTIC CORRESPONDENCE. 



PHILADELPHIA LETTER. 



(for the journal of the AMERICAN MEDICAL ASSO- 
CIATION.) 

One of the principal topics of conversation in 
medical circles here is the new Journal of the 
A.MERiCAN JilEDicAL ASSOCIATION. Its importance 
to the profession is appreciated, and the idea that 
founded it, is considered an advanced one, both as 
regards medical journalism and scientific medical lit- 
erature. A medical journal that shall be truly repre- 
sentative is needed. And by representative I mean a 
journal national in character. Such a journal, if the 
standard of excellence is maintained, will do much 
to elevate medical journalism by its competition with 
the periodical medical literature of the day. Although 
occupying a province j^eculiarly its owm, the bounds 
of a journal of this character must, of necessity,, 
overlap somewhat that of medical journalism at large. 

Professor Ellerslie Wallace, who for so many years 
has occupied the chair of obstetrics at the Jefferson 
Medical College, has resigned, and the question who 
will be appointed to fill the vacancy is exciting no 
little interest. The chair is an important one, and 
the college national in character ; therefore the trus- 
tees are looking for a man with a national reputation 
to fill it. Naturally they turn to the West which has 
already furnished a Gross and a Bartholow to the 
Jefferson, and to her sister college, the University of 
Pennsylvania, an eminent professor of chemistry ; 
and, probably, before this goes to press. Prof. 
Theophilus Parvin, of Indianapolis, will be selected 
to take the chair. Professor Wallace was more than 
usually gifted as a medical teacher, and his forcible 
lectures have left their impression on a whole race of 
medical men, and it is a pleasure to know that a man 
of talent fully equal will succeed him. 

A clinical conversational meeting of the Philadel- 
phia County Medical Society was held at the hall, 
June 20, at 8 o'clock p. .m. 

Dr. O. H. AUis made some remarks on the diag- 
nosis and treatment of fractures of the neck of the 
femur in elderly persons. He referred specially to 
the importance of age in making a diagnosis. He 
said that persons over sixty years of age rarely have 
dislocation, and if persons of this age fall and can- 
not rise, the reason most likely will be a fracture of 
the neck of the femur, probably intercapsular. It is 
his opinion that persons of seventy years of age, or 
over, never have a dislocation of the hip, but the 



3° 



PHILADELPHIA LETTER. 



[July, 



injury will, in every case, be found to be fracture of 
the neck of the femur. In the diagnosis he makes a 
point concerning the fascia lata. On the uninjured 
side it effectually covers the parts ; but on the injured 
side the hand may be passed down and the head of 
the bone handled. This, with the usual signs, should 
be sufficient to complete the diagnosis without much 
manipulation or attempt to get crepitus. All attempts 
to obtain crepitus he strongly condemns. 

The question, what kind of a cure can be expected, 
he answered by saying that a bony union cannot be 
hoped for. The first thing that happens in a case of 
fracture is constitutional disturbance. This may be 
very severe, and- death may result from it. But as 
soon as this disturbance is over, if the patient sur- 
vives, he should be got out of bed. These cases oc- 
curring in old people cannot stay in bed. They are 
apt to develop bed-sores ; and they will die of the 
bed-sores. Therefore get them up on the third or 
fourth day. Never think about the kind of union 
you are to obtain. Treat the case as if there was no 
fracture whatever. 

Dr. J. M. Barton said that he had been in the 
habit of treating his cases in the manner described, 
but thinks the present impression of the surgical 
world is to keep fractures of this kind at rest in bed, 
and even with splints. The question of treatment 
has a bearing from a medico-legal standpoint, and, 
as this is the opinion of so many lights in the profes- 
sion, it is a question whether we are not legally re- 
sponsible if we do not follow it. He does not expect 
to get bony union, but expects ligamentous union 
as short as possible. His personal belief in the mat- 
ter is with Dr. Allis. 

Dr. Hearn puts on extension in treating this class | 
of fractures, as it gives patients great comfort, but 
thinks in very old cases Dr. Allis' plan is preferable. 

Dr. Addinell Hewson said that he had in his pos- 
session a specimen of bony union in intercapsular 
fracture formerly belonging to his father. His father 
treated the case by supporting the limb with pillows, 
bending the knee so as to bring the fragments of the 
bone in juxtaposition. The use of Smith's splint, 
Dr. Hewson said, has cured a number of cases in his 
hands. The treatment should be used early in the 
case. He has never had as good results from exten- 
sion and counter-extension as from Smith's splint. 

Prof. William H. Pancoast fully agreed with Dr. 
Allis, about the mistake of too much manipulation 
for the purpose of exciting crepitus. Owing to the 
anatomy of the hip joint, the capsular ligament cov- 
ering the whole of the neck of the femur in front, 
and only the upper half posteriorly, a fracture may be 
partly within and partly without the ligament. And 
as every filament of union is of value to the fracture, 
too much rough handling to establish crepitus might 
tear off some ligamentious connection. As one can- 
not tell exactly the character of the fracture, it is 
best to treat it as an intercapsular fracture, so as to 
give the greatest benefit of treatment. It is a good 
cure if short ligamentous union can be secured. 

He can understand how a good result can be pro- 
duced by Smith's splint. As for himself he has been 
in the habit for some years of treating this fracture 



in a triple inclined plane. It is the Charlestown re- 
clining chair, which can be fixed at any comfortable 
angle by a rachet attached to the side. 

Dr. Allis asked how soon the patients were put in 
the chair, to which Prof. Pancoast replied, at once, 
and they sleep in the chair, which, if it is found nec- 
essary, may be extended into a comfortable bed. In 
some hospital cases, however, from nervousness due 
to shock, they had to be placed in bed to rest a 
day or two. He uses, with the triple inclined plane, 
a splint, or pillow, on the outer aspect of the thigh, 
and a broad leather strap and pad around the pelvis. 

Dr. Allis said that he has had as perfect results 
without splints as with them. One case, 80 years 
old, is now walking without difficulty with the aid 
of a cane. As there is so little chance for motion 
between the fragments in a fracture of this kind he 
sees no necessity for splints. One patient was brought 
to the Jefferson Hospital who had been lying for 
nearly a week fairly macerating in her own urine 
which had soaked the bed. She had frightful bed- 
sores, in the treatment of which she was shifted back 
and forth from bed to bed. Only the bed-sores were 
treated. The patient finally left the hospital, and 
subsequently died of some other affection. Post 
mortem in this case showed the parts closely dove- 
tailed together in spite of the motion from the shift- 
ing which she had undergone. 

Dr. Pancoast said further, at the request of the 
society, and spoke of the fact that fractures of the 
neck of the femur are more common in aged people, 
owing to the more rectangular relation of head and 
neck and shaft, and increased fragility or brittleness 
of the bones ; except the epipheal fracture of the 
very young. He was opposed to the horizontal po- 
sition in the treatment of this fracture, as anatomic- 
ally he considered it the most unfavorable. In the 
horizontal position of the body the external rotators 
at the hip have the most power, and naturally evert 
the thigh as is shown by the eversion of the foot, 
which, at the most distant part of the lower limb, 
marks like an index the amount of rotation made by 
the leg. 

Dr. Barton then exhibited a patient suffering from 
phthisis, in whom great improvement followed am- 
putation, on account of necroses of carpal and meta- 
carpal bones. After the amputation the temperature 
immediately went down, the night sweats disappeared, 
the appetite returned, and the patient gained ten 
pounds in flesh. Most of the constitutional disturb- 
ance was regarded as from the lung affection, but the 
result showed the hand to be the cause in great meas- 
ure. It is a question whether the phthisis was not 
caused by the diseased bone. 

Other things of interest have been said and done 
in this great medical center during the past month, 
but space will not permit a further account. 

Philadelphia, June 23, 1883. J. V. S. 



Washington, D. C, July 2, 1883. 
Dear Sir : Allow me to suggest to you that, with 
the inauguration of the medical journal, which is 
to be the organ of the American Medical Association, 



1883.] 



MEDICAL SOCIETY ITEMS. 



31 



you open yonr columns for the discussion of a scheme 
which shall have for its object the establishment of a 
Medical Benefit Society. We have plenty of time 
between now and the next annual meeting of the As- 
sociation at Washington, in May, 1884, to ascertain 
how far such a scheme would be supported, and in 
what shape it would be best to put it, in order to 
bring it properly before the Association. 

That there is a great need for such a society every 
medical practitioner, of any length of service, will 
readily acknowledge, and, while we see aid societies 
and insurance companies working successfully around 
us for special purposes and for the general public, we 
cannot but think it more than feasible in its execu- 
tion, and that the American Medical Association as 
it stands to-day could best foster and . insure a wide- 
spread support and sphere of usefulness to such a 
project. 

You have an illustrious precedent in the British 
Medical journal, which is proposing a similar society, 
and whose published articles on this subject have sug- 
gested this communication. The English society for 
the relief of widows and orphans of medical men, as 
reported in that journal for May 26, shows that out 
of a membership of only 370, nearly $15,000 had 
l)een distributed in grants in one year, and that the 
exp)enses for the year had amounted to about $900. 

I have no form of organization to propose, not 
being sufficiently acquainted with such bodies, and, 
for that reason, would like to know them better and 
to hear a proper discussion of the subject. 

Yours respectfully, M. D. 



MEDICAL SOCIETY ITEMS. 



MEDICAL TEACHING AND LICENSING TO PRACTICE. 



At the meeting of the Chicago Medical Society, 
held May 7, 1883, Dr. Ephraim I ngals offered the fol- 
lowing resolution : 

' ' Resolved, That the public good would be pro- 
moted by the establishment of a State Board of Med- 
ical Examiners, such Board to be entirely separate 
and independent of all medical colleges, to have the 
exclusive right to grant license to practice medicine 
in the State of Illinois, leaving to medical colleges 
their function of teaching and conferring degrees, 
but obliging all who in future desire to enter upon 
practice, and who have not already received license 
to do so, to go before such Board to prove their fit- 
jiess ; and that .said Board be reo;'^red carefully to 
examine all applicants as to their'^vf^xal, literary and 
medical attainments, aiid only to confer a license on 
those who are well qualified in all these respects." 

It was seconded by Dr. R. E. Starkweather, who 
indorsed it, and stated further, that he believed a 
preliminary examination of students should be car- 
ried out by a State Board, and that the colleges 
should graduate a less number than they do. He 
hoped the colleges in this State would be the pioneers 
in this preliminary examination. 

Dr. J. H. Hollister stated that some phases of this 



subject had interested him for years. Improvement, 
however, is being made gradually in educating students. 
With reference to elevating the standard of education 
for students before entering college, he, personally, 
was disinterested, but thought there should be some 
common standard by which students in all medical 
colleges in the State should be measured and exam- 
ined. An Examining Board might be selected from 
the Illinois State Medical Society, or be appointed by 
the Governor. But the apf)ointment should be given 
to those who are faithful to their profession, and should 
be regarded as of great value and involving a high 
degree of responsibility. 

Dr. J. G. Kiernan said he had been a medical 
journalist for some time, and in that capacity was 
obliged to revise a large number of communications 
from physicians. Many times the sf>elling was poor, 
and he gave an instance in which a New York grad- 
uate spelled the word Emulsion, thus: "Amulsen." 
He thought students graduated too hurriedly. 

Dr. S. Strausser thought a higher standard than 
the present one should be established, and cited in- 
stances where diplomas had been easily obtained, and 
those possessing them were illiterate and unrefined. 

Dr. C. W. Purdy spoke of the merits a man must 
possess before graduating at the Queen's University, 
Ontario. In Canada there is a medical council that 
appoints an examining medical board, and a student 
is obliged to pass this board before entering a medi- 
cal college, and there required to study four years 
before graduating. He favored a higher degree of 
literary attainment here, and also the resolution be- 
fore the meeting. 

Dr. R. Park said every physician should be re- 
quired to become a licentiate, and pass an executive 
or State medical board. The colleges were not 
thorough enough here, and he would like to see a 
medical department attached to a State University, 
but doubted if ever this would be supported by the 
State. 

Dr. G. C. Paoli detailed the methods of medical 
education in Stockholm, Sweden, which consists of 
three different degrees, and the applicants for the de- 
gree of M. D. is required to write a thesis in the Latin 
language, and discuss the points contained therein 
in the s^ame language in the presence of the faculty. 
In the degree of Master of Surgery the candidate 
must be equally as well informed. 

Dr. J. H. Etheridge thought the sample letler con- 
tained in the written report of the last quarterly meet- 
ing of the Illinois State Board of Htal'.h (as rfad) 
could not emanate from a graduate of any college in 
this city. 

Others parti( ipated in the discussion, and upon a 
vote being taken, the resolution was unanimously 
adopted. 

D-. Ipgals then offered the following : 

'■'■Resolved, That a committee of three be appointed 
by the chair to represent the Chicago Meajcal So- 
ciety, and tt~a^ they b» instnictcd to confer .with the 
Illinois State Board of Health, relating to statements 
contained in the proceedings of its last meeting ; and 
that this society respectfully requests said Board to 
communicate to our committee any facts in tlie pos- 



32 



MISCELLANY. 



[July, 1883. 



session of the Board that will enable the committee 
to prepare its report for the society." 

Which was also unanimoasly adopted, and Drs. 
E. Ingals, R. G. Bogue, A. H. Foster were appointed 
the committee. 



The annual meeting of the Ontario Medical Asso- 
ciation was held at Toronto June 6th and 7th. The 
officers for the ensuing year are: President, Dr. W. 
Clark, Toronto; Vice-presidents, Drs. Worthington, 
of Clinton, Philip, of Brantford, McGill, of Doborne, 
and Richardson, of Toronto; Recording Secretary, 
Dr. White, of Toronto; Treasurer, Dr. Graham, of 
Toronto ; Corresponding Secretaries, Drs. Graham, of 
Brussels, Mackay, of Woodstock, L H. Cameron, of 
Toronto, Aylesworth, of Collingwood. 

The next meeting will be held at Hamilton, next 
June. 

The eighth annual session of the Medical Society of 
Arkansas was held at Little Rock May 30 and 31. The 
officers for the ensuing year are: President, J. M. 
Keller, of Garland county; Vice-presidents, Geo. 
Hudson, of Onachite county; J. M. Carrigan, of 
Hempstead county ; J. F. Blackburn, of Franklin 
county ; D. S. Mills, of Jefferson county ; Secretary, 
L. T. Gibson, of Pulaski county; Treasurer, A. L. 
Breysacher, of Pulaski county ; Librarian, John 
Waters, of Pulaski county. 

Little Rock will be the next place of meeting. 



The annual meeting of the Medical Society of 
New Jersey was held June 12th and 13th, at Atlantic 
City. The attendance was unusually large. For the 
ensuing year the following officers were elected: 
President, Stephen Wicks of Orange; Vice-Presidents, 
P. C. Barker, of Morristown, Joseph Parrish, of 
Burlington, and C. J. Kipp, of Newark ; Correspond- 
ing Secretary, Wm. Elmer, Jr., of Trenton; Record- 
ing Secretary, Wm. Pierson, of Orange; Treasurer, 
W. W. L. Phillips, of Trenton. 

The next place of meeting is to be Cape May. 



The ninth annual meeting of the American Neuro- 
logical Association was held in New York, June 20, 
21 and 22. The following new members were elect- 
ed : Dr. L. Weber, of New York ; Dr. G. S. Walton, 
of Boston, and Dr. J. T. Eskridge, of Philadelphia. 

The officers elected for the ensuing year are : Pres- 
ident, Dr. Isaac Ott, of Easton, Pennsylvania ; Vice- 
President, Dr. W. R. Birdsall, of New York ; Secre- 
tary and Treasurer, Dr. R. W. Amidon, of New 
York. 

The Iowa State Medical Society held its 
thirty-fourth annual meeting at Council Bluffs, 
May 1 6th and 17th. Fifty new members were 
admitted. The officers for the ensuing year are: 
President, S. R. Robinson, of West Union ; Vice- 
presidents, H. C. Huntsman of Oskaloosa and D. W. 
Crouse of Waterloo ; Secretary, A. A. Deering, of 
Boone ; Treasurer, G. R. Skinner, of Cedar Rapids. 

Des Moines is to be the next place of 'meeting. 



The National Society of Microscopists will con- 
vene in Chicago in August. Committees from the 
Illinois State Microscopical Society, Academy of Sci- 
ences, and Chicago Medical Society have been ap- 
pointed to co-operate in welcoming the former, and 
otherwise making this, their first meeting here, pleas- 
ant, interesting and instructive. 



I 



The officers of the Maine Medical Association for 
the ensuing year are : Pre.sident, O. A. How, 
Lewiston ; Vice-presidents, L. W. Pendleton, Port- 
land; D. E. Maroton, Monmouth; Corresponding 
Secretary, J. O. Webster, Augusta. 



The Chicago Medical Society has 220 resident 
members, twenty delegates from which attended the re- 
cent meeting of the American Medical Association 
in Cleveland, besides some twelve others from Chicago 
who are permanent members. 



MISCELLANY. 



COLLEGE NEWS. 



At the close of the last academic year of Johns 
Hopkins University, it was announced that the hos- 
pital was nearly ready to open. One feature of the 
building is unique : It is so arranged that the grad- 
uating class of the medical college may be lodged in 
the building. The last year will be almost wholly 
devoted to clinical work. 

Drs. Remsen and Martin, who are now Professors 
of Chemistry and Biology in the University, are made 
Professors of Chemistry and Physiology, respectively, 
in the medical faculty. Dr. Billings, of the army, 
has been tendered the chair of hygiene. It is, how- 
ever, somewhat doubtful whether he can accept a full 
professorship and still retain his position in the army. 

Medical Department University of Nashville 
AND Vanderbilt UNIVERSITY. — At the faculty meet- 
ing of May 19, the following changes were made : 
Prof. Van S. Lindsley, to the chair of Diseases of the 
Eye and Ear ; Dr. O. H. Menees, as Professor of 
Anatomy ; Dr. C. S. Briggs, to the chair of Surgical 
AnatQmy and Operative Surgery ; Dr. C. L. Ives, as 
Demonstrator of Anatomy. — Nashville Jour. Med. 
and Surg., June. 

McGiLL College of Canada. — Dr. J. F. Shep- 
ard has been appointed to the chair of Anatomy made 
vacant by the dea^^^ of Prof. Scott. 

The Long Island College Hospital held its 
annual commencement on June 19, graduating fifty- 
one students. 



BOOKS RECEIVED. 



On the Relation of Micro-Organisms to Disease. 
By W. T. Belfield. 

Bacteria and the Germ Theory of Disease. 
Gradle. 



By H. 



THIE 



|0urnal#^mcrican3IeMcal^000ciati0tt. 

EDITED FOR THE ASSOCIATION BY N. S. DAVIS. 

PUBLISHED WEEKLY. 



Vol. I. 



Saturday, July 21, 1883. 



No. 



2. 



ORIGINAL ARTICLES. 



ADDRESS ON THE PRESENT STATUS AND FUTURE 

TENDENCIES OF THE MEDICAL PROFESSION 

IN THE UNITED STATES, DELIVERED AT 

THE ANNUAL MEETING OF THE AMERICAN 

ASSOCIATION OF MEDICAL EDITORS 

IN CLEVELAND, JUNE 5, 1883, 



BY N. S. DAVIS, M. D. , LL.D., PRESIDENT OF THE ASSO- 
CIATION. 



Gextlemex: — I have promised to occupy your 
attention on this occasion, in considering the present 
status, and future tendencies of the medical profession 
in the United States. There is probably no more 
difficult problem than that involved in the question, 
as to the real status and tendencies of the times in 
which we live ; and especially in reference to com- 
munities or classes of communities of which we consti- 
tute a part. An intelligent mind furnished with all 
the facts of the past history of a people, or of a pro- 
fession, does not find it difficult to trace the various 
influences and measures which have contributed to 
their development and progress up to a given period 
in the past. But our minds are so liable to be in- 
fluenced by such part of the events transpiring in the 
present as are most nearly related to our own interests, 
that we find great difficulty in comprehending with 
equal clearner.s all the influences at work around us, 
and consequently cannot judge correctly of their future 
tendencies. So true is this that if we study the past 
history of our race, we shall find but few, even of those 
most eminent as statesmen, clearly comprehending 
either the full bearing of the measures they advocated 
or the tendency of the time in which they lived. And 
a large part of the legislation which is done, through 
all forms of government, is based upon only a partial 
comprehension of the existing evils to be remedied, 
or of the benefits to be obtained, and if carried into 
effect with still less comprehension of the effects of 
those laws upon the future interests of society. And 
what is true in regard to legislative bodies and states- 
men, is equally true in regard to any particular pro- 
fession or subordinate class of people. For instance, 
at the present time, in relation to our own profession, 
it is apparent upon almost every page of our medical lit- 
erature, and from the discussions in every medical so- 
ciety, that many things exist which are far from being 
.satisfactory either as it regards its legal standing and 



educational progress, or the results of strictly profes- 
sional investigation. And yet, in the midst of all 
the complaints, how few are the instances in which 
even an attempt is made to point out clearly any 
remedies for the evils complained of that would not 
in their practical operation either develop other evils 
of equal magnitude, or utterly fail to accomplish the 
purposes for which they were designed. Very much 
has been said during the last quarter of a century in 
regard to the imperfections and inadequacy of our 
system of medical education ; and yet how few have 
even attempted to solve the question as to why the 
present inadequacy exists, or to point out clearly the 
way for its improvement. For the purpose of study- 
ing the important subject before us I shall on this 
occasion ask your attention first to the question, what 
constitutes the status of a profession. The word 
status is used simply to imply the present state of be- 
ing, or the present condition as a whole. But, to 
comprehend the actual conditions and relations of 
any large class in society as a whole, it is necessary 
to analyze the interests of that body of men, and 
look at each factor in its separate relations, and then 
when they are united we will see more clearly and 
distinctly the actual conditions and relations of the 
whole. For our purposes it is sufficient to consider 
the status of the profession, as comprehending its 
social relations, its ethical spirit or morale, its co- 
operative or society organizations, its educational in- 
stitutions, its legal relations and its scientific activity 
or spirit of investigation. In regard to the first of 
these I know of no reasonable ground of complaint. 
In this country the social standing of the members of 
our profession is ever)^vhere precisely what the edu- 
cation and qualities of the individual member make 
them. There are yet no Such established ranks, 
grades, or casts of society in this country as to dis- 
tinctly assign the members of any profession or call- 
ing to a special social standing. And, everywhere, 
both in the city and country, the enlightened and 
gentlemanly physician is not only a welcome visitor 
at the fireside, and around the bed of sickness in all 
grades of human society from the highest officer of 
the land to the lowest, — from the most wealthy 
to the beggar, — but he is also freely received 
and awarded as high a seat of honor in all social 
assemblies, whether merely social, literary, scientific 
or otherwise, as the members of any other class in 
the community. In the rural districts, outside of 
large cities, the intelligent, educated practitioner of 
medicine is in most instances emphatically a leader 
of society, and is often looked up to, not only as a 
leader in social affairs, but as an adviser in reference 



34 



PRESENT STATUS OF THE MEDICAL PROFESSION. 



[July, 



to all the educational, literary, and hygienic interests 
of the district in which he lives. The ignorant and 
the vulgar, however, who may have obtained in some 
way the title of "doctor," and admission to the ranks 
of the profession will not find the mere name of 
doctor to carry him into social life, or to give him a 
rank beyond that which his education,' habits and 
manners entitle him. 

In regard to the ethical spirit and moral tone of 
the profession in this country, I think it is not only 
equal to that of the members of the same profession 
in any of the other civilized countries of the world, 
but in many respects, it may be regarded as superior. 
Receiving but little protection or fostering care from 
legislation, often times, in fact, being obliged to main- 
tain their professional relations, and standing in spite 
of adverse laws ; it is probable that another equally 
numerous class of men cannot be found, who more 
rigidly and tenaciously adhere to those rules of an 
ethical nature, which are calculated to protect and 
sustain each other on the one hand, and still more 
effectually to protect the interests and welfare of their 
patients, upon the other, than is done by the profes- 
sion in this country; The rule to strictiy avoid 
divulging the secrets derived from confidential inter- 
course with families and individual patients, the dis- 
position as a general rule, of course, admitting of 
some exceptions, to foster and protect the interests of 
each other as members of the same profession, exist 
in a very marked and gratifying degreee, througout 
almost our entire country. I will go further than 
this, in expressing the opinion that throughout the 
entire ranks of the regular profession of medicine, 
there is that high moral or ethical tone, which, not 
only nominally frowns upon and discourages all im- 
moral practices, or the encouragement of those crimi- 
nal proceedings that grow out of the vicious conduct 
of members of the general community, bnt which 
really exerts a more powerfully restraining influence 
than any code of penal legislation could effect. In 
regard to the associate or society interests of the pro- 
fession, there are a number of questions of great im- 
portance to its future welfare. And these questions, 
like those pertaining to the educational standing, can- 
not be fully appreciated in their present relations, or 
in their future tendencies without a retrospective 
study of the influences and forces which have brought 
society organizations into existence, and which have 
given them their present degree of development, ft 
is hardly a century since medical societies, assuming 
the shape of permanent organizations, first came into 
existence. In our country it is less than one hundred 
and fifty years since the first limited and incipient 
organizations of the kind were brought into existence. 
The first state medical society organization, of which 
we have any account, is that of the Medical Society 
of the State of New Jersey in 1760. Some local or- 
ganizations in cities had existed, prior to this. A 
few of these survived, and maintained their organiza- 
tions through the "War for Independence," and a 
few were organized anew during the first twenty 
years after that war. But soon after the commence- 
ment of the present century, the work of organizing 
medical societies on a permanent basis in several of 



the original thirteen States of this Union was com- 
menced and carried forward with considerable degree 
of rapidity. The most complete, perhaps, of these 
organizations, was that which was effected in New 
York State, largely under the guidance of Drs. John 
Stearns, of Saratoga, Alexander Sheldon, of Mont- 
gomery, and Asa Fitch, of Washington counties. The 
two first named were also members of the legislature 
of the State of New York, and in their work of de- 
vising a complete system of medical organization for 
that State, and procuring its adoption by the legisla- 
ture, they were greatly aided by the Hon. Samuel W. 
Van Ess. The act of incorporation which embraced 
the organization of a State Medical Society, with 
auxiliary county societies in every county in the 
state, conferring both upon the state and county 
societies the duty of appointing boards of censors for 
the examination of candidates for admission into the 
profession, was passed by the Legislature of that state 
in April, 1806. Legally organized medical societies 
were formed in other states with such a degree of 
rapidity, that all the original thirteen states, except 
Pennsylvania, Virginia, and North Carolina, had 
more or less complete state and county organizations 
before the end of the next twenty-five years. And as 
new states were added from time to time, state and 
local medical societies were organized in them, ac- 
companied usually by legislation, intended not to 
protect the profession, but to prevent the imposition 
upon the community practiced by ignorant and un- 
skillful pretenders, in nearly all of the then existing 
States of the Union.. A careful study of the laws 
which were enacted during all that period, embracing 
the first thirty years of the present century will show 
that while the legislative bodies were influenced al- 
most solely by two leading motives, one to protect 
the people from the effects of ignorance and imposi- 
tion, and the other to encourage genuine medical 
education as a means of benefitting the people at.^ 
large, the physicians themselves were animated by an 
earnest desire to carry into effect the laws enacted 
for those purposes, and by two other leading motives. 
The first, and perhaps most powerful was the desire 
for mutual improvement in professional knowledge 
and practical skill. The second, a desire for more 
extended mutual acquaintance and personal inter- 
course. 

These organizations produced all the beneficial 
effects that had been expected from them, and per- 
haps in no country at any period of time, has a more 
rapid degree of progress been made in the educa- 
tional, social, and practical interests of a profession 
than topk place during the first quarter of the present 
century in our own country. And nearly, or quite 
all the laws that had been enacted, either for incor- 
porating medical societies, or defining what should 
constitute a proper education, also included provisions 
against irregular practice. As might have been an- 
ticipated in a free country where the utmost liberty 
is enjoyed for the pursuits of man, and for exercising 
choice individually in every relation and aspect of 
society, and where all legislative bodies are made 
elective by direct votes of the people, it did not re- 
quire more than one or two decades of the existence 



1883.] 



PRESENT STATUS OF THE MEDICAL PROFESSION. 



35 



of the restraints that had been thrown upon the I 
practice of imposition and every variety of ignorance, 
to devv lop combinations of those who were thus 
placed under disabilities, for the purpose of aiding 
each other in influencing the legislatures, or rather in 
influencing the voters, who were required to elect 
annually, members of the various legislative bodies. 
And, as in almost every age of tbe world, the cry of 
liberty, of individual freedom, of the right of every 
man to judge and act for himself, has exercised a ' 
charming influence over the masses of mankind, so, ; 
in the brief period intervening between 1820 and 
1840, the rise and spread of what was known at that 
p)eriod of time as "Thompsonianism," (now Eclecti- 
cism,) in medicine, the advocates of which were soon 
recruited by the followers of Hahnemann, and all the 
various forms of imposition, by diligently urging upon 
the various legislative bodies and upon the people the , 
idea that all the legal restraints which had been en- i 
acted solely for the protection of the people were 
only calculated to interfere with individual freedom 
of opinion and choice and to make the practice of ; 
legitimate medicine, a monopoly found little difficulty 
in securing the election of legislators, who succeeded 
in repealing almost all the clauses in the various laws 
and charters, that had exercised any restraint upon 
unlicensed practice. And, in proportion as this was 
done, more or less discouragement appears to have 
been felt by the supporters of medical organizations. 
The societies were less actively supported, and in 
many instances during the succeeding ten or fifteen 
years became practically absolete. So marked was 
this decline that from 1845 to 1850, instead of there 1 
being active working society organizations in nearly ! 
alt of the states then existing in the union, sustained ' 
by large numbers of county and city medical societies, j 
two-thirds of those previously organized had either | 
discontinued stated meetings or held them with so j 
small an attendance as to give them but little influence j 
upon the profession at large. Should I stop here the 
impression would be made that the profession lost 
interest in the medical organizations simply because 
the laws had been so altered as to leave them without 
any exclusive privileges in regard to practice. This, 
however, while it had its influence was by no means 
the chief reason for this decline in the spirit of medi- 
cal organization. As I have already remarked, in 
the granting of charters and enactment of laws, in 
almost every instance the legislative bodies had con- 
ferred upon the medical societies the power and en- 
joined the duty of their appointing and maintaining 
''Boards of Censors" for the special work of examin- 
ing and determining the qualifications of applicants 
for admission into the profession. In all these in- 
stances a fee was charged for the examination and 
license. And, at the commencement of these organ- 
izations, during the first decade of the present cen- 
tury, almost the entire body of men who entered the 
profession annually entered through examination by 
some one of these "Boards of Censors." Conse- 
quently the fees derived from these examinations 
constituted to a very large degree the fund relied 
upon for defraying the expenses of the organizations, 
and the publication of their transactions. And, 



with few exceptions, in granti.ig charters for medical 
schools in the different states, these schools were also 
endowed with the privilege of examining and grant- 
ing diplomas to such of their students as complied 
with certain regulations, and these diplomas became 
equally a license to practice. While from 1800 to 
1806 there were only three medical schools in active 
operation in the then existing states, namely : one in 
Philadelphia, one in New York, and one in Boston, 
the entire number of students in these schools did 
not exceed, annually, three hundred, and of these 
not more than fifteen annually received diplomas as 
college graduates. But so rapid was the multiplica- 
tion of colleges, and so much was the student drawn 
from the office of the private preceptor to the college 
halls that before the middle of the century (1850), 
more than forty medical schools had been established, 
and the number of students annually attending was 
over 4,500, and the number of graduates thirteen 
hundred. This rapid transference of the application 
for legal admission into the profession from the cen- 
sors of the several societies. State and local, to the 
medical schqols exerted a powerful influence, coinci- 
dently, with the other influences that I have already 
indicated in causing such societies to decline in their 
efficiency and activity throughout nearly the entire 
country. Where they maintained an existence the mem- 
bers attending were comparatively few. In the great 
State of New York, for instance, it was rare that more 
than from forty to fifty members gathered at the 
regular annual meetings of the State society. 

The rapid multiplication of medical schools during 
the period to which I have alluded, and the transfer- 
ence of applications, for admission to the profession, 
from the medical organizations to the colleges, thus 
practically making the college diploma the chief and 
popular evidence of education and admission to the 
profession, had not only caused a decline of the in- 
terest manifested in the medical societies, but it had 
also exerted a very material bearing upon the organi- 
zation of the colleges themselves, by placing a direct 
barrier in the way of allowing their competition and 
rivalry to be based entirely upon the question of 
which should present the most perfect and extended 
facilities for acquiring an education, in the form of 
another question, which experience has shown to be 
far more powerful in its influence, both upon the 
students and the colleges, namely, at which college 
can the student obtain his diploma that is to be his 
license to enter the profession, with the least expendi- 
ture of time and money? The influence that this 
question had upon the schools, as they multiplied, is 
seen by a glance at the organization and requirements 
of the first colleges established in the country, and 
comparing them with the organization and require- 
ments for a diploma fifty years subsequently, when 
the numbers had increased from two to between forty 
and fifty. The first college organization in the col- 
onies of which the Pennsylvania University is still 
the representative, required for admission a full and 
fair standard of general education, including a know- 
ledge of the classics, Greek and Latin, and all that 
was then known of the natural and physical sciences, 
and although the field of medical knowledge at that 



36 



PRESENT STATUS OF THE MEDICAL PROFESSION. 



[July. 



time was hardly more than one-third of what it is at 
present, the college term was made full six months of 
the year, and the student was required to attend 
faithfully from two to three full years to ob- 
tain the primary or bachelor's degree, and could 
not obtain the title of "Doctor of Medicine" 
until he added from one to two years more — 
making a curriculum of study, period of time 
to carry it out, and period of active teaching in 
the college, hardly inferior to that which i is de- 
manded at the present time by, perhaps, half a 
dozen of the most advanced colleges in the country. 
But just so fast as colleges were multiplied, either in 
the same city or in neighboring cities, and the advan- 
tages of college instruction became more and more 
apparent, and the influence of medical society organ- 
izations, and the demand for higher education, just 
in the same proportion, was there a steady contrac- 
tion of the annual college term, a diminution of pre- 
liminary requirements needed to enter college until 
at the end of the period we have under consideration, 
between 1840 and 1850, among all the forty or more 
colleges then existing, not one of them required of 
the student any standard of preliminary education, 
and the longest lecture terms were embraced in six- 
teen weeks of the year, while in several of them it 
was reduced to thirteen weeks, in which the student 
was to go over the whole field of medical science. 
The influence of this question as to where the student 
could get his diploma with the least expenditure of 
time and money, instead of where he could obtain 
the highest degree of medical education within a 
limited time, in deteriorating the educational stand- 
ard of the profession, was so prominent as to attract 
the attention of many of the most eminent men in 
the profession at that period of time. Consequently it 
became a subject of active discussion in the medical 
society of South Carolina in 1835 J ^^^ only a little 
later in the medical society of Ohio, and frequently 
in the medical journals of that period. Some of the 
most vivid pictures of the evil effects that had been 
produced, are to be found in the writings of that 
eminent man of the Mississippi Valley, Dr. Daniel 
Drake. About the same time the subject engaged 
the active attention of the medical society of New 
York, in which it received the full consideration of a 
special committee consisting of Drs. J. R. Manly, 
J. B. Beck, and John McCall, a trio of noble men, 
whose report in the transactions of that society may 
still be referred to with profit. 

It was the renewal of the discussion of this subject 
in the meetings of the "New York State Medical 
Society" in 1844-5, ^^^^^ ^ed to the assembling of a 
convention with which you are all familiar, in the 
city of New York, in May, 1846, which convention, 
though composed of only a little more than seventy 
delegates, nevertheless represented a majority of the 
States in the Union, and took all the necessary pre- 
liminary measures such as the appointment of com- 
mittees, and the laying out of a full scheme for a 
permanent national organization, which had its com- 
pletion in the establishment of the American Medi- 
cal Association at an adjourned meeting in Philadel- 
phia the following year. 



The completion of the organization of the Ameri- 
can Medical Association in 1847 on a representative 
basis, with the permanently organized State and local 
medical societies for its chief constituency, thereby 
inviting delegates from the various medical societies 
and organized institutions in medicine throughout 
the whole United States, very speedily developed so 
active a spirit for reviving old State and local socie- 
ties, and the organization of new ones where none 
had before existed, that in less than twenty years 
there was hardly a State or Territory in our widely 
extended country that had not its medical societies 
again in more or less active operation. 

The active interest in medical organizations thus 
rekindled has been maintained to the present time, 
and by holding the meetings of the national organi- 
zation in various parts of the country from under the 
shade of the monument on Bunker Hill at the east, 
to the borders of the "Golden Gate" upon the Pa- 
cific ; from the beautiful city upon the upper Missis- 
sippi almost upon the hydrographical axis of this 
great continent, to the Crescent City resting upon 
the Gulf, the members of the profession have been 
made socially acquainted with each other, geographi- 
cally acquainted with every part of our country, un- 
til a spirit of just emulation, professional pride, and 
what is still more valuable, a spirit of investigation 
and zeal for the advancement of medical science 
throughout all ranks of the profession has reached a 
point higher than it has before attained at any period 
of time, and perhaps higher than it has attained in 
any country by means of purely voluntary organiza- 
tions without the support of law. If I were to stop 
at this point the impression would be left that the 
present status of our professional organizations is, in 
a high degree, satisfactory. And so far as regards 
their social influence upon the profession, and the 
promotion of intercourse and acquaintance of the 
members in one section of the country with those of 
another, they are fulfilling their purpose as well as 
could be desired. But they are nevertheless defective, 
both in regard to the completeness and extent of the 
organizations, and in their practical working as pro- 
fessional and scientific bodies. For, while it is true, as I 
have before stated, that almost every State and Ter- 
ritory, and a large proportion of the counties and 
districts have organized medical societies more or 
less active in their work, yet these organizations em- 
brace only a part, and in some instances only a minor 
part of those recognized as educated practitioners 
in their various States and localities. It would be 
productive of great good if methods could be devised 
by which these organizations would be made to em- 
brace more nearly the entire body of practitioners in 
every locality where they exist. It would not only 
enhance their value by the acquaintance of their 
members, but it would bring about a more united 
and harmonious condition of the profession in every 
State, so that the voice of the profession, as indicated 
by the action of these organizations, would have 
greatly increased force, both upon the profession 
itself, upon the community in general, and especially 
upon the legislative bodies, in any direction in which 
laws were desirable for the protection of the public 



1883.] 



PRESENT STATUS OF THE MEDICAL PROFESSION. 



37 



health, or for the promotion of scientific investiga- 
tions. Another defect is the want of sufficient 
method in the mode of cultivating the scientific in- 
terests of these associations. 

Almost universally, up to within the last four or 
five years, reliance has been placed upon the recep- 
tion at the various meetings of reports from commit- 
tees generally appointed to report upon particular 
topics, or particular branches of medicine, and upon 
volunteer communications. Very little attention has 
been given to the planning of definite lines of inquiry, 
either by individuals, to be carried on in original in- 
vestigations, or by the cooperation of many members 
of the society in different places keeping records of 
facts arising under their observation coincidently 
with records derived from other scientific sources, ; 
and the report of these facts annually to such com- ' 
mittees as would give them the necessary analysis, i 
comparison, and deduction. And, yet, this is the | 
only way by which the data can be obtained for real i 
advancement in several of the most important depart- 
ments of medical science. Papers that are presented , 
by individuals, embodying cases coming under per- 
sonal observation, and the results of personal experi- I 
ence are valuable. The reports of committees ap- ! 
pointed to report, for instance, upon a department of '. 
medical science, whether it be in surgery, practical 
medicine, or materia-medica, are also of more or less 
value. But, as experience has shown, they are ne- 
cessarily made up largely, by compilations of facts : 
already in the medical periodicals, or if derived di- 
rectly from correspondence with practioners, they 
are given without the coincident knowledge of the 
topography and meteorological conditions, or of those 
circumstances which must necessarily go with the ' 
facts in relation to the prevalence of disease, to en- i 
able us to compare results in one locality with those | 
in another. j 

It is this want of definite, well-devised plans of \ 
original investigation and inquiry on the one hand, 
and of well planned cooperative observations on the 
other, that has led many of the wisest and most 
learned among us, to think that all our medical or- 
ganizations, whether State or national, amount to I 
little more than a means of making professional ac- 
quaintance, enjoying annual seasons of social inter- 
course with each other, highly gratifying in their na- 
ture, but accomplishing little in the advancement of i 
medical science. There is another element, also, 
which has been developed during the rapid revival of 
medical organizations throughout the country, which 
begins to develop effects clearly to be distinguished. 
I allude to the rapid increase of specialties in medi- 
cine. At the time of the organization of the Amer- i 
ican Medical Association in 1846-7, the number of! 
specialties in the profession was very limited. They 
have always existed in some degree ; but they existed I 
up to that time almost entirely as a natural outgrowth i 
in particular individuals from the circumstances that 
surrounded them ; and, it was exceedingly rare in this : 
country, and comparatively so in Europe, that indi- 
viduals, at the commencement of their professional ; 
career, entered at once upon a special field of prac- \ 
tice. Much less was it at all common for those com- | 



mencing the study of medicine to carry on their 
studies with the idea of simply qualifying themselves 
for the practice of such particular branch of it as 
might be thought most available. 

But, with the rapid multiplication of medical 
schools, to which I have already alluded; with the 
equally rapid transference of the functions that had 
hitherto been performed by independent boards of 
examiners to the medical colleges, by making the col- 
lege diploma the license to practice, there came 
rapidly into exi.stence the idea of pursuing limited 
fields of study, and still more limited fields of prac- 
tice. And from the general division that had long 
existed, and necessarily must exist, of general prac- 
tioners, surgeons and obstetricians, we began to 
have those who limited themselves to the study and the 
practice of special departments, until in the brief 
period of less than fifty years we have specialties for 
almost every part or region of the human body. Just 
in proportion as these special interests were developed^ 
there became manifest a restless desire for privileges 
to advertise these specialties more liberally than the 
general "code of ethics" which had been adopted 
by the American Medical Association, would per- 
mit. And it was in reference to this subject that our 
national medical organization developed its first 
controversies in regard to the provisions of that code. 
And all who can recall the earlier years of the Associ- 
ation, will remember the warm and sometimes excit- 
ing debates that sprang up at different meetings, and 
the persistent efforts of those who had taken up spe- 
cial lines of practice, to make such alterations in the 
code as would give them greater privilege of adver- 
tising. It was not until at the meeting of 1869, after 
the subject, which had been referred to a well selected 
committee, had been considered during a whole year 
and reported upon — the report ending in a definite 
series of resolutions defining the relations of special- 
ties in this particular, and also the relations to general 
practice, which was adopted by so unanimous a vote 
of the Association that the efforts in that direction 
were set at rest. And although all effort in that di- 
rection ceased to be manifested in the meetings of 
the Association, there was still a manifest disposition 
growing out of similar influences to bring about, un- 
der other names, some alterations in the code ; and 
which resulted a few years later in its being referred 
to the judicial council with instructions to give it a 
careful revision. This was done and the report from 
that council, after consulting with large numbers of 
leading members of the profession as to any altera- 
tions that could be suggested, distinctly recommended 
that the code be allowed to remain unchanged; which 
report of the council was sustained by a unanimous 
vote of the Association. 

In proportion as it became evident that no conces- 
sions in this direction could be obtained through the 
national organization, it also became apparent th'at 
these restless classes were taking less interest in the 
general organization, and inclining to the formation 
of societies of their own. This disintegrating in- 
fluence has continued to increase until we have gen- 
eral and local organizations, distinct from either the 
State or national societies, representing not only ev- 



38 



PRESENT STATUS OE THE MEDICAL PROFESSION. 



[July, 



ery specialty worthy of mention, but also some hav- 
ing no well defined purpose. And instead of those 
who are engaged in the various special departments 
coming up annually to the one great national body 
and thereby maintaining their intercourse, identifying 
their interests with the interests of the whole profes- 
sion, and carrying on their special work as sections 
of the general organization, they have become, in a 
great degree, separated into distinct and independent 
organizations. And their publications instead of 
constituting a part of the transactions of the national 
association and of the State societies, have come to 
constitute volumes by themselves. We have thus 
lost in some measure the unity of our professional 
organization, and in the same proportion we have 
come to perceive clearly the existence of diverse, if 
not directly antagonistic interests. So much so, in- 
deed, that it has become quite common to hear the 
interests of the general practitioner and the wants of 
the specialist spoken of as essentially distinct. And 
a large proportion of the people have come to regard 
in nearly the same light, the different special forms 
of practice and the different systems or sects in med- 
icine, thereby directly helping to obscure in the pub- 
lic mind the line of distinction between the great 
body of supporters of scientific medicine and the 
various factions, isms, and excresences that hang 
upon its skirts. I must not be understood as being 
opposed to the practice of special departments in our 
profession. On the contrary they grow naturally out 
of the extent of the field of medicine, the wants of 
society, the limited duration of human life, and the 
limited extent to which human acquirements can be 
attained. But while this is all true, there is still 
plainly visible a tendency to excess in the develop- 
ment of special departments entirely beyond any 
wants of society, or any necessities in the field of 
medical inquiry, and it is the excess to which I call 
attention. It is perfectly compatible with the high- 
est development of specialties that they be founded 
upon a full general field of education, and be allowed 
to develop in the individual after he enters upon his 
field of practice in accordance with his own special 
tastes and of the circumstances that surround him in 
that field. This is equally compatible with the main- 
tenance of the general integrity and unity of the 
profession, not only in its feelings of interest, but in 
all its organization. And the subject is worthy of 
the most careful consideration, especially of those 
who are connected more or less with the medical 
press of the country, who by controlling the reading 
matter will thereby influence very much the. opinions, 
and consequently the progress of the further organi- 
zations of the profession. All who are thus engaged 
should study carefully the past progress and the 
present influences which are at work, and while en- 
* couraging all legitimate branches of inquiry and of 
practice, they should repress with equal care the 
excesses, and the tendency to make these excesses 
disintegrative influences instead of elements co-oper- 
ating with that harmonious unity which constitutes 
strength. 

Tkese defects in our organizations, namely the ten- 
dency to disintegrate through special interests and in- 



fluences on the one hand, the absence of clear, defi- 
nite, well-considered plans or lines of inquiry and 
schemes of original investigation on the other, can all 
be remedied if their extent is fully appreciated and 
the medical press will exert its legitimate influence in 
keeping both the extent of the defects and a temper- 
ate consideration of the best means for remedying 
them, steadily before the minds of their readers. So 
far as regards advancement in the line of co-opera- 
tive observations and carefully planned lines of inves- 
tigation, the American Medical Association has 
already made a beginning. During the last four 
years there has been steadily developing under the 
guidance of a standing committee, furnished with a 
small appropriation of funds, coincident observations 
and records in regard to appreciable meteorological 
conditions, including the ozonic and oxydizing 
agents of the atmosphere, and during the last year, 
including also the organic constituents, in direct con- 
nection with coincident observations and records in re- 
gard to attacks of acute diseases. And the progress 
made thus far, as will appear from the report of that 
committee during the present session of the Associa- 
tion, will give full promise of most valuable results. 
But such inquiries should be greatly extended and in 
some instances, should bring into co-operative action 
both national and State organizations. 

But I must hasten from the consideration of this, 
subject to a few further thoughts in regard to the edu- 
cational status of the profession. From what I have 
already said in regard to the organization of schools, 
it will be seen that we have undergone in this coun- 
try a complete revolution, in the mode of educating 
members of the profession during the last one hun- 
dred years. Prior to and extending into the first 
quarter of the present century, the young man in- 
tending to become amemberof the profession, sought 
the office of some practitioner generally above medi- 
ocrity in his attainments and reputation, and became 
indentured for a term of years as a regular appren- 
ticed student of medicine. And as a general rule, 
the student thus indentured was expected to continue 
in the employ of his preceptor, a period of from four 
to seven years , during which he gained his medical 
knowledge by the study of the preceptor's library, 
aided by the direct personal instruction of the pre- 
ceptor himself, with such other limited means of illus- 
tration as could be commanded in the office of the 
ordinary practitioner. When he had passed to the 
last one or two years of his indenture period of study,, 
and had mastered so far as he was capable, from his 
own efforts, and from the personal teaching of his 
preceptor, the more elementary branches of medicine, 
he was allowed to do minor work in surgery, pre- 
scribing for and dressing office patients, occasionally 
to visit the sick, frequently with his preceptor, and 
thus became familiar with disease clinically. The 
student thus served a direct apprenticeship in study 
and to some extent in practice, usually entering upon 
his field by himself, simply on the authority of a let- 
ter of recommendation and certificate of acquire- 
ments given him by his preceptor. It is in this way, 
that some of the most renowned men whose names ap- 
pear upon the pages of medical literature gained 



1883.] 



PRESENT STATUS OF THE MEDICAL PROFESSION. 



39 



their education. It is true, at that period of time, it 
was generally thought necessary that a young man ap- 
plying for admission to a preceptor's office should 
have a fair general education. Many of the best 
teachers would not take students until they had more 
or less of a classical education. Some were taken 
for long periods, seven years for example, and were 
required to devote the first two years of the seven to 
the study of the general branches of science as a 
preparation for taking up those of medicine proper. 
But as the field of medical knowledge was rapidly ex- 
tending at that period of time, especially in the de- 
partment of anatomy, physiology, organic chemistry, 
etc. , the means for their successful study and illustra- 
tion, could not be well provided in the office of a 
private preceptor. It was this that first suggested the 
idea of establishing separate rooms, and gathenng 
means for illustrating those departments needing 
further illustration, in classes. And in the cities and 
large towns there came thus to be special classes of 
students, and special rooms in which to receive such 
parts of their instruction as needed illustration. And 
from this it was an easy step to the organization of a 
medical school by the union of several preceptors in 
the same enterprise. The medical schools coming 
into existence through such influences, as was the case 
both in Europe and in this country, their purpose 
was not to give a complete education, but to review 
the different fields of study, more especially for the 
purpose of teaching that department in each field, 
requiring special illustration. Hence the first idea of 
a medical college was not an institution for giving a 
student his full education, but simply to supplement 
the knowledge and education that he was still sup- 
posed to get in the office of his preceptor. And it 
only requires a glance at the history and progress of 
the first schools in America, which were organized in 
Philadelphia, New York and Boston, to see this rela- 
tion fully presented, both, in the organization of the 
schools, and in the arguments and circulars that were 
used for attracting the attention of the profession to 
them. Hence, the medical school in its organization 
•differed from the schools to teach other sciences, in 
being organized only to occupy a part of each year ; 
the student being supposed to get all the details of i 
his professional knowledge still in the office and 
library of his preceptor. The student while going 
to the college for more perfect knowledge in particu- 
lar departments of study, still relied upon the certifi- 
cate of his preceptor as his warrant for entering upon 
practice. Starting at this point as institutions only for 
supplementing the instruction of the private precep- 
tor, to occupy only a limited portion of each year, ■ 
they still in their incipient beginnings, insisted that a ' 
student to be admitted to these schools, should have 
a broad preliminary education. 

Now, during the next forty years the schools rapid- 
ly multiplied — causing an active rivalry in competing 
for patronage as indicated simply by the. number of ' 
students in attendance, regardless of the standards of 
attainment either in general or professional knowledge 
— until instead of suppiementiug the work of the 
private preceptor they came to occupy practically the 
whole field of professional education, as I have already j 



, shown while speaking of the early progress of medical 
organizations. In the same connection I also pointed 
out clearly ^ow it came that while the colleges were 
rapidly absorbing the whole work of professionally 
educating the student, their annual college terms were 
steadily shortening and their standards of require- 
ment lowering instead of increasing both, pari pasu, 
with the increase in the extent of their work, and the 
rapidly extending boundaries of medical science. I 
have shown that this anomaly in educational progress 
was so plainly the result of investing the college 
diploma with the attributes of a license to practice, 
while the colleges were at the same time dependent 
entirely upon the income from students for their sup- 
port, that the agitation for a remedy led directly to 
the establishment of the American Medical Associa- 
tion, and through it, to the general revival of medical 
society organizations throughout the whole country, 
most of which are purely voluntary organizations hav- 
ing no legal status. It has appeared from the same 
review of the past, that during the first twenty-five 
years of our national existence, laws were enacted in 
nearly all the then existing States designed to protect 
the p)eople from the impositions of ignorant and de- 
signing men claiming power to heal the sick, by pro- 
hibiting unlicensed practice, etc.; but which were 
nearly all repealed or so amended as to render them 
inoperative during the next thirty years by means of 
the popular prejudicies and false representations at- 
tendant upon the rise and spread of Thompsonianism 
and homoeopathy ; the one playing upon the mind of 
the masses with all the power of bold and ignorant 
empiricism, and the other captivating the credulous 
tendencies of the more fashionable circles by a mys- 
tic transendentalism inclosed in sugar pellets. The 
first has died a natural death, leaving a sickly off- 
spring bearing the name of eclectics, while the 
second, like some medicines, retains its name as a 
"trade mark," and its organization for political in- 
fluence, while its once transcendental vagaries have 
long since practically ceased to exert an influence over 
the treatment of disease. It will be seen from the 
foregoing brief glances at the past, that the profession 
in this country has already passed through three dis- 
tinct epochs or stages of progress, and is now enter- 
ing upon the fourth. The first may be called the 
period of apprenticeship in education and the in- 
cipient organization of medical societies and medical 
colleges, with laws founded solely on the idea of pro- 
tecting the community on the one hand, and of 
fostering education on the other. The second was 
the period of transition, during which medical col- 
leges were most rapidly multiplied and the education 
of medical students was transferred from the private 
preceptors to the schools, carrying with it substan- 
tially the substitution of the college diploma for the 
license of the independent examining boards, and in 
its latter part distinguished by the advent of Thomp- 
sonianismi and homoeopathy, as organized forces 
widely diverse in their characteristics, but united in 
their work of denouncing regular medicine and in 
procuring the repeal of nearly all the legal restrictions 
placed upon the unlicensed prai;^ice of medicine. 
The third period extending from 1845 ^^ ^870 is one 



40 



PRESENT STATUS OF THE MEDICAL PROFESSION. 



[July, 



in which the profession finding its educational inter- 
ests practically transferred to forty or fifty colleges 
acting under charters obtained from separate legisla- 
tive bodies, each dependent for support on the num- 
ber of students it could attract ; its legally organized 
societies deprived of nearly all that was valuable in 
the previously existing laws, sought protection for it- 
self by a more extended combination of interests, 
and a more general union and harmony of action in 
the foundation and development of a national organi- 
zation which, by its representative character, should 
give emphasis and force to its recommendations ; and 
by equally fostering a more complete voluntary or- 
ganization of the profession in every State, county 
and city in the whole country. 

During all these periods the different departments 
of medical science had been rapidly advancing, and 
entirely new departments were being added ; and 
during the latter, especially, the division of the gen- 
eral practical departments into limited fields of prac- 
tice called specialties, took place almost as rapidly as 
the increase in the number ot medical schools. The 
great defect in the practical working of this third 
epoch of our history, which may be properly called 
the period of voluntary organization and national 
union without the support of legal forms or legisla- 
tive enactments, was the absence of any adequate 
medium through which the voice of the great central 
and representative body could be readily and reliably 
transmitted, either to the profession at large, to its 
organized constituents in the several State and local 
societies, or even to its own members. Meeting once 
a year, anS depending mainly on general reports and 
volunteer papers for its scientific interest, and on the 
voluntary publication of abstracts of its proceedings 
once in the general medical press and th§ scanty dis- 
tribution of its annual volume of transactions, for its 
moral or ethical and educational influences, it is not 
surprising that it should have failed to accomplish all 
that its more earnest supporters had hoped. And 
yet the careful student of history will be surprised to 
find that, with all these defects, the united organiza- 
tions, State and national, have still exerted a great 
influence in devising and enforcing a uniform and 
high standard of ethics; in greatly increasing the 
general spirit of investigation; in pushing the demand 
for a higher standard of education so far as to induce 
a considerable number of the best class of medical 
colleges, especially those constituting departments of 
well established universities, to actually adopt a more 
systematic and comprehensive system of instruction, 
in spite of the strong opposing forces of a pecuniary 
nature, and the length of time they have not only 
maintained, but steadily increased their number and 
influence. 

Having fairly entered upon the fourth era of our 
professional history our present status may be briefly 
expressed in the following propositions or general 
statements : First, the profession consists of an im- 
portant, I may say essential, class of human so- 
ciety, numbering 60,000 or 70,000 persons, more or 
less educated, and engaged in the noble work of alle- 
viating human suffering, by fostering every sanitary 
measure calculated to prevent disease, and culling 



from every field of nature the means for combatting 
disease when not prevented, and as a whole animated 
by a high moral tone, and an active spirit of social 
and scientific progress. Second, this great class of 
society is pervaded and unified by voluntary society 
organizations for the mutual improvement of its 
members and the advancement of all its important 
interests, in a very large proportion of the cities, 
counties, and States, all centering in one representa- 
tive national organization — the American Medical 
Association — constituting the frame-work of an or- 
ganization, which, if completed by the filling of its 
gaps and the extension of its membership, and voiced 
by an efficient and frequent medium of communica- 
tion, both with its own membership and with the pro- 
fession at home and abroad, would in its influence 
be well-nigh irresistible. And yet for the want of this 
filling up of the ranks and the absence of the medium 
for efficiently voicing its doings and utterances its in- 
fluence is not only limited, but the disintegrating 
forces I have already pointed out, are making visible 
progress. Third, not only is the education of the 
profession in the hands of 60 or 70 independent 
medical schools, but the influence of their rivalry is 
still perverted by the recognition of their diplomas 
as equivalent to a license to practice. And while a 
few have yielded to the demand for more extended 
college courses, graded curriculums with annual ex- 
amination in progress, far the larger number still ad- 
here to four and five months repetitional courses of 
instruction annually, with only the one examination 
at the close, and while making a show of enlarge- 
ment by preliminary lectures and short spring courses 
which the students may attend or not as they please,, 
each carefully avoids any positive increase in the 
actual requirements for graduation through fear that 
its rivals will not do the same. Fourth, the long ab- 
sence of any adequate laws for protecting the people 
from the impositions of ignorant and unprincipled 
medical pretenders, and the increased attention given 
to the sanitary interests of communities, have again 
awakened the attention of legislative bodies and are 
developing a strong tendency to once more enter 
upon the enactment of laws for enforcing sanitary 
improvements on the one hand, and the ensuring of a 
higher standard of attainments on the part of those 
who shall be permitted to enter upon the practice of 
medicine, on the other. This tendency is manifested 
in the establishment of national and State boards of 
health, and in legislative acts for regulating the prac- 
tice of medicine in several of the States. It is this 
revival of legislative tendencies which constitutes one 
of the most interesting features in the present status 
of our profession^ and is rapidly developing changes 
of the highest importance both to the profession and 
to the people. And on the final outcome of these 
changes will depend the status of the profession for 
the next fifty years. The fact that the great ^advance- 
ment in all departments of medical science and prac- 
tice, and the complete transferrence of the work of j 
education from the preceptor's office to the schools,, 
is imperiously demanding a corresponding advance 
in grading and extending the curriculums, and adding" I 
to the actual requirements of those institutions, is I 



1883.] 



PRESENT STATUS OF THE MEDICAL PROFESSION. 



41 



clearly perceived both by the profession and the 
j)eople. That the highest interests of human society 
require the adoption and enforcement of such regu- 
lations as will ultimately insure a fair standard of edu- 
cation and mental discipline before entering upon the 
study of medicine, and more efficient methods of en- 
forcing a fair standard of professional attainment be- 
fore receiving a license to practice, is equally appar- 
ent to all. 

To attain these important ends is pre-eminently the 
■work of the present epoch of our history. To accom- 
plish this work in its fullness four things are necessary : 
First, a legal and reasonably uniform definition of 
what shall constitute the minimum amount of general 
education that shall be required to fit the student to 
enter upon the broad and intricate field of medical 
studies. Second, a similar legal definition of what 
shall constitute the minimum amount of time required 
for strictly professional studies, how much of it must 
be spent in medical colleges and hospitals, and the 
minimum standard of professional attainment to be 
required as a condition for receiving a license to 
practice. Third, the establishment in each State of 
a competent, reasonably stable, and impartial tribunal 
which shall determine by actual examinations and 
other proper tests, when these standards, both of pre- 
liminary and professional attainments have been com- 
plied with ; and a certificate from which, shall be nec- 
essary before commencing medical study, and license 
before admission to practice any department of medi- 
cine. Fourth, the steady increase, both in filling up, ex- 
tending, harmonizing the society organizations of the 
whole country by which they shall more fully bind all 
together in one representative national organization, 
thereby preserving the high moral tone so long em- 
bodied in our national code of ethics, facilitating co- 
operative investigations in the advancement of scien- 
tific knowledge and that frequent intercourse which 
breaks our local prejudices, broadens our patriotism, 
enlarges the field of our mental vision and makes us 
happier individuals and more skillful physicians. To 
accomplish the first three of these objects requires 
the most considerate and wisely planned legislation 
in each of the States in this great Union. And the 
time has fully come when those I more esi^ecially ad- 
dress on this occasion connected with the medical 
press should enter carefully upon a temperate, candid, 
and liberal discussion of these important topics. Let 
us avoid all personalities and local prejudices, by so 
studying the history of the past that we realize the 
important historic truth, that all great changes in 
human progress, whether forward or backward, are 
the result of laws and forces that govern alike the 
workings of the human mind and the evolutions of 
human society. Then we shall more readily look 
beyond the motives of individuals to the social fac- 
tors which may have occasioned the motives to exist. 
I am not sure but the time is already at hand when 
the American Medical Association should appoint a 
well-chosen committee, charged with the duty of de- 
vising some uniform scheme or plan of legal methods 
for making the definitions and establishing the exam- 
ining tribunals to which I have just alluded, that they 
might be submitted to the several State societies, and 



when well matured, by them submitted to the several 
State legislatures. Such a course started now coinci- 
dent with the revival of the disjxjsition to legislate 
on medical matters, and pursued with both wisdom 
and patience, might result in the more speedy adop- 
tion of judicious and reasonably uniform laws in rela- 
tion to the important subjects of medical education 
and practice throughout the whole country, than many 
of us would expect. But whether speedy or slow, it 
would be doing our legitimate part of a work de- 
manded by the highest interests of human society. 
For want of such timely action and discussion, 
already we see several imperfect and incongruous 
enactments, establishing State boards to grant licenses 
to practice, not founded on any defined standard of 
attainments, either literary or medical, but on the 
presentation of a diploma granted by some incorpor- 
ated medical school or college, whether labeled with 
■ some special trade-mark or not, and without any ad- 
equate means of determining whether the diploma 
was granted simply on the reception of a specified 
sum of money without the recipient ever having seen 
the inside of the college granting it, or after an at- 
tendance during the ordinary term of a nine months' 
gestation and the form of an examination. Conse- 
quently we see all sorts of medical pretenders, and 
young men and women in all stages of education, 
equally clothed with a legal license to practice by the 
very board which had been created for the purpose of 
elevating the standard of medical attainments for the 
benefit of the country at large. But the absurdities 
of this well intended, though unwisely devised legis- 
tion do not stop here. No sooner does the State 
Board fairly begin to clothe the offshoots of every 
pathy and ism — that hang as excrescenses upon the 
skirts of true medical science, with formal legal 
license to practice medicine, than certain other restless 
disintegrating elements inside of the profession, be- 
gin to put in the plausible plea that whatever the law 
licenses the profession should recognize, by changing 
some of its most sacred ethical rules, and open the 
way for the educated physician to meet on a common 
platform, the mountebank clothed in Indian costume 
and blowing the fame of his herbs on a tin horn 
through the streets, or the scion of transcendentalism 
labeled with a trade-mark indcating the universality 
of the law of similars; thereby speedily mak- 
ing the sickroom again the scene of collisions and 
quarrels, as disgraceful as any described by a Stearns 
or a Drake half a century since. It may be neces- 
sary, however, that some of these glaringly absurd 
results of incongruous acts of legislation should be 
experienced as stepping-stones to something better. 
For there are many restless, disturbing elements in all 
classes of society which can only be controlled by 
allowing them to practically feel the evils of their 
schemes. But the accomplishment of the fourth ob- 
ject I have named rests not on legislative enactments, 
but upon the action of the profession alone. I allude 
to the maintenance, extension, and ultimate comple- 
tion of our local, state and national organizations, 
under one harmonious and co-operative system which 
shall continue to unify, elevate and advance all the 
social, ethical and scientific interests of the pro- 



42 



MEDICAL AND SURGICAL JOURNALISM. 



[July, 



fession ; and consequently promote in the high- 
est degree the welfare of all classes in the com- 
munity. Does the profession at this time contain 
those elements of wisdom, moderation and perse- 
verance, necessary for effectually opposing all the 
disintegrating and iconoclastic elements that I 
have pointed out in the earlier part of this ad- 
dress, and steadily advancing on every line. State 
and national, until the victory is sure? Or shall the 
work of disintegration, so boldly begun in New York, 
extend its baneful influence until social anarchy again 
holds sway over the whole profession ? These ques- 
tions are worthy of the most careful consideration of 
every friend of medical science and progress. After 
almost half a century of active mingling with my 
professional brethren in every part of our great coun- 
try, and a careful study of its history, with all the 
elements and forces calculated to influence its prog- 
ress in the midst of our free political forms of gov- 
ernment, I am satisfied that the first of these ques- 
tions can be answered in the affirmative and the sec- 
ond in the negative. Measures are already rapidly 
maturing which will render the present social upheav- 
als and imperfect attempts at legislation only the pre- 
cursors of an awakening to wiser and more active 
work in the right direction, and consequently of hast- 
ening results of the most beneficial character. 
With a platform which requires us to study man in all 
his aspects of health and disease, and to seek reme- 
dies for his relief in every field of nature aided by 
every human science, to apply them on any principle 
and in any quantity that an enlightened judgement 
may dictate as mo.st beneficial to our patients, and to 
cordially extend the right hand of fellowship to all 
who rally upon it under the banner with the single 
inscription "Doctor of Medicine" — but to sternly 
discard all who would mar the significance and beauty 
of that inscription by qualifying it with the addition 
of an ic, or ism, or pathy — our noble profession will 
continue to uphold its own dignity and honor, and to 
extend more and yet more its blessings alike to the 
rich and the poor, the learned and unlearned, as long 
as disease and death continue to afflict the great fam- 
ily of man. 



JOURNALISM DEVOTED TO THE PROMOTION AND 

CONCENTRATION OF MEDICAL AND 

SURGICAL SCIENCE. 



BY HENRY O. MARCY, A. M., M. D. 



Read to the American Association of Medical Editors, June 5th, 1883. 

It is scarcely more than two decades since the late 
surgeon George A. Otis, whose great work, " The 
Surgical History of the War of the Rebellion," has 
won for its author imperishable honor, advised us as 
his pupil even at the beginning of medical study, to 
devote a certain portion of each day in the discharge 
of the duties of curator of a natural history collec- 
tion. 

This he did with the statement that the medical 
man needed a side issue for his superfluous energies. 



The late Dr. A. A. Gould, of Boston, who was one 
of the wisest clinical instructors, it has been our for- 
tune to meet and ever in demand at the bed-side of 
the rich and the poor alike, found time in the midst 
of his busy career to give attention to natural science, 
with certain branches of which his name will ever be 
connected as one of the brightest stars in the galaxy 
of American scientists. Our venerable friend Dr. 
D. H. Storer, of Boston, now in his eightieth year 
and still mentally the peer of the best, has had a 
clinical career of over half a century, which challenge's 
comparison with any of this generation, and yet, he 
has written four large volumes upon the fishes of 
Massachusetts, a standard work, and of a classical 
value second only to that of the great Agassiz him- 
self 

Little more than a century ago the illustrious Hal- 
ler was professor of botany, physiology, anatomy, ob- 
stetrics and surgery, a whole medical faculty himself, 
and yet devoted some hours daily to the writing of 
his Bibliotheke of Medicine. What does the lesson 
of these periods and lines teach? Not only a super- 
ior ability, wisdom, knowledge and judgment, but as 
we all know as compared with the requirements of to- 
day, that the rapid advances of the cycling years have 
brought with them new demands, new fields of inves- 
tigation and an unexampled progress. 

The border lines of our knowledge have steadily 
and rapidly widened, until the devotee of the science 
of medicine, no matter how diligent and learned, 
ceases to hope for more than a general knowledge of 
its diversified factors and confines himself with ambi- 
tious purpose to some one or more of its subdi- 
visions. 

The Darwinian doctrine of development holds 
good in the evolution of all the sciences, to which 
medicine is no exception, and the specialist of to-day 
in law, in theology, in natural sciences in their mani- 
fold application to the arts, as well as in medicine, is 
the legitimate fruitage of the age in which we live. 
From this standpoint it is well briefly to review the 
literature of medicine. Thanks to the one man of 
America, the par-excellence specialist above all others 
in this bibliothecal field of labor in his generation. 
Dr. Billings, of Washington, this is comparatively an 
easy task. We turn with ever increasing admiration to 
the ponderous folios of Haller, of Margagni, of Sy- 
denham, of Harvey, of Hunter and others of the old 
masters, men who laid deep the foundations of medi- 
cal lore, whose observations have long ago been ap- 
propriated to the current stock which finds place in 
every text book of to-day. 

Individuality is thus early lost for the most part in 
the ever-turning Kaleidoscopic pattern, the old facts 
are re-arranged, old grists re-ground in new mills and 
the product stamped "patent" until it is a wise 
father who knoweth his own mental progeny. From 
Dr. Billings' most interesting and instructive address 
delivered before the International Medical Congress 
in London, 1881, we learn that it is usually estimated 
that about one-thirtieth part of the whole mass of the 
world's literature belongs to medicine and its allied 
sciencies. Thus it appears that our medical literature 
now forms a little over one hundred and twenty 



^»33-l 



MEDICAL AND SURGICAL JOURNALISM. 



43 



thousand volumes, properly so-called, and about twice 
that number of pamphlets, and that this accumulation 
is still increasing at the rate of about fifteen hundred 
volumes and twenty-five hundred pamphlets yearly. 
There are, by estimate, about two hundred thousand 
trained medical practitioners scattered over the earth, 
and one-half of the number belong to America and 
Great Britain and her colonies ; of these about one in 
twenty are producers or contributors to medical litera- 
ture. 

The special characteristics of the literature of the 
present day are largely due to journals and transac- 
tions, and this is particularly tnie in medicine. Our 
periodicals contain the most recent observations, the 
most original matter, and are the truest representa- 
tions of the living thought of the day, and of the tasks 
and wants of the great mass of the medical profession, 
a large part of whom, in fact, read very little else. 
They form about one-half of the current medical 
literature, and in the year 1879 amounted to 655 
volumes, of which the United States produced 156 ; 
Germany, 129; France, 122; Great Britnin, 54; 
Italy, 65 ; and Spain 24. This is exclusive of journ- 
als of pharmacy, dentistry, etc. , and of journals de- 
voted to medical sects and isms. It will be seen that 
at present more of this class of literature appears in 
the English language than in any other, and that the 
number of journal contributions is greatest in the 
United States. A marked increa.se has occurred in 
the literature of hygiene during the last two years, 
and this especially in England, France, Germany and 
the United States. The literature of diseases of the 
nervous system, of opthalmology, otology, derma- 
tology and gynseology is also increasing more rap- 
idly than that of the more general branches. 

The increase in both the amount and value of the 
literature of the several specialties in medicine is 
readily seen by a comparison of recent catalogue and 
bibliographies with those of twenty or thirty years 
ago, and this increase still continues at a greater rate 
than prevails in the more general branches. There 
are great differences of opinion as to the relative value 
of this increase and as to its future effect upon the 
profession, but there can be no doubt as to the fact. 
There must be specialties and specialists in medicine, 
and the results will be both good and evil ; but the 
evils fall largely upon those specialists who have an 
insufficient general education ; who attempt to con- 
struct the pyramid of their knowledge with the small 
end as a foundation. It has been said by Dr. Hodgen 
that "in medicine a specialist should be a skilled 
physician and something more, but that he is often 
something else — and something less." 

"It is by the labor of specialists that many of the 
new channels for thought and research have been 
opened, and if the flood has sometimes seemed to 
spread too far, and to lose itself in shallow and sandy 
places, it has nevertheless tended to fertilize them in 
the end." In pursuance of the thought of journal- 
ism and its influence upon special departments of our 
science, I quote from tables given by Dr. Billings, 
showing the number of volumes of medical journals 
and transactions published during the years 1879 ^^^ 
1880. 



Table I. 



Subjects. 



General and Mis- 
cellaneou s 
PracticalMedi- 
cine 



Journals and 
Transactions. 



Journals 

Transactions 



Journals 

Transactions . . 



Anatomy, Physi. 
ology. Morph- 
ology, Biology. 



Diseases of Nerv- 
ous System and 

Insanity Journals 

Transactions . . . 

Surgery Journals 

Transactions . . . 

Ophthalmology. Journals 

Transactions . . . 

Skin Diseases . . Journals 

Transactions. . . 

Otology [Journals 

jTransactions.. . 
Gynecology and' 

Obstetries Journals 

Transactions 

Hygi en e and 

Jurisprudence. Journals , 

Transactions . . . 
Pharmacy and 
MedicalChem- 

istry Journals 

Transactions 

Dentistry Journals 

Transactions 

Homoeopathy. . . Journals 

Transactions 

Eclectic, Botanic 
Physico-Medi-I 

cal I Journals 

'Transactions 

Popular Adver- 
tising Mineral 

Waters [Journals 

'Transactions 

Veterinary Journals 

Transactions 

Laryngology Journals' 

Transactions 

Total Journals 

Transactions 



Total. 



United . 

States. 



GreatBritain 
and her 
Colonies. 



1879. 1880. I 1879. 1 1880. i 1879.1 18 



336 
169 



335 
151 



635 
215 



680 
184 



26 .26 



163 
69 



Thus we have many workers in many fields 
of labor. Something of the astonishing magnitude 
of the result accomplished is apparent as we turn the 
closely-printed pages of the Index Medicus in its 
monthly visitation to our tables. This latest outcome 
of specialistic journalism is the greatest marvel of 
them all. He who has or thinks he has a new inspir- 
ation will do well to examine carefully its pages and 
see if his own thoughts have not been better expressed 
by another, and thus save himself the mortification 
and chagrin of being shown up by some merciless 
reviewer as having purloined the original observations 
of Dr. Smith, or mutilated the wiser teachings of Mr. 
Jones. He who seeks to know further than that which 
has been written will do well to consult the already 
published two volumes of the catalogue of the library 
of surgeon general's office — quarto volumes in double 
columns of fine type, each containing nearly one 
thousand pages, and yet, in the alphabetical arrange- 
ment, not through "C." This gives assurance of its 
value to the medical student when finished ; a work 
which cannot be over-estimated by our profession, 
and, in its completion by authority of congress, every 
medical man should have an active interest. From 
it, although not a complete index of all that has been 
written, we gather some idea of the accumulated lore 
of the world's work in our especial field of labor. 



44 



MEDICAL AND SURGICAL JOURNALISM. 



[July, 



Table II. 



Subjects. 



Total. 



United 

States. 



Great Brit- 
ain and 
Colonies. 



1879. I 1880. 18 



Anatomy and 
Phy.siology . . . 



Pathology . 



Practice of Med- 
icine 



Diseases of Ner- 
vous System. . 



Surgery 

Ophthalmology 

Otology 

Skin Diseases . . 

Veneral 

Gynsecology . . . . 

Obstetrics 

Hygiene 

Jurisprudence . 



General and Mis- 
cellaneous . . . . 



Total by Coun- 
tries 



Books 

Theses 

Jour. Articles.. . 

Books 

Theses 

Jour. Articles. .. 

Books 

Theses 

Jour. Articles. .. 

Books 

Theses 

Jour. Articles. .. 

Books 

Theses 

Jour. Articles. .. 

Books 

Theses 

Jour. Articles. . . 

Books 

Theses 

Jour. Articles. .. 

Books 

Theses 

Jour. Articles. . . 

Books 

Theses 

Jour. Articles. .. 

Books 

Theses 

Jour. Articles. .. 

Books 

Theses 

Jour. Articles. . . 

Books 

Theses. 

Jour. Articles.. . 

Books 

Theses 

Jour. Articles. . . 



172 

29 

1371 



372 
257 
5799 

135 
63 
1761 
13s 
i6s 
3477 
60 

44 
992 



313 
33 
22 

441 

35 

19 

399 

47 

44 

1130 

45 

37 

1270 

178 



15 



106 

30 

1329 

16 

9 
202 

264 
235 
4716 

144 

59 

1667 

150 

161 

3087 

64 

34 
1007 

23 

9 

535 

44 

24 

547 
29 

19 

348 

SO 

27 

1132 
52 
49 

1114 

247 

16 

1061 

30 



7 

162 

2 

32 

52 

1454 

38 

406 



187 

3 

114 

3 

63 

I 

76 



364 
6 



435 
62 



177 

3 



19 
157 

25 
39 



1154 1085 
32 19 



410 
27 

823 
15 

228 
9 

185 
9 

95 



342 
5 



115 
4 



368 ' 726 



Books 382 

Theses 29 

Jour. Articles. .. ; 1799 



Books 

Theses 

Jour. Articles. 



1643 

743 

20169 



377 

63 

2116 

1596 

746 

[9587 



173 

2 


239 

2 


72 


167 


94 


96 


349 


476 


310 


339 


4781 


4904 



416 j 239 

7 i 6 

430 ' 216 

80 I 29 



44 
46 
200 



18 

170 
2 

27 

51 

918 
30 

.303 

23 

706 
7 



lOI 

4 



195 

48 

237 

I 

103 

52 

274 

259 

3443 



If this be the exponent of the result already at- 
tained, and this the rate of accumulation going on, 
what will the next century produce, and when will 
the subdivision of medical specialism end ? 

Infrequent vibrations are independent sounds, in- 
crease the rapidity, and we produce the musical note 
which, under skillful manipulation, becomes the 
smoothly flowing cadence which may blend into the 
harmony of a grand symphony. 

Selfishness, as usually understood, narrows the 
sphere of a man's action to the gratification of his 
personal ends, widen the thought to that which is for 
the real best good of the individual in the highest 
sense, and we verily become our brother's helper, do- 
ing away, as no longer needful, with bolts and bars, 
police courts, jails, prisons, armies, and navies, yea, 
even with our churches, except there to congregate for 
rejoicing, for self is swallowed up in the greater good. 
In this seeming diversity there is a unity of purpose 
of power and of result. In the enthusiasm of the 
young convert we are wont to exclaim, "I am of Paul, 
I of Apollos." In the wider truth we are led to see 
that these are only ways of individual working, and 
that the great end to be attained is the same. 

Pure science is unadulterated truth, and he who 
seeks it for its own sake and the good which it may 



bring, is enlisted in a common cause with one watch- 
word under the same banner. But, says the objector, 
medicine is not a science, at the best it is but an im- 
perfectly understood art. Mathematics pure and 
simple is accepted as an exponent of science, "for 
figures cannot lie." Is not our profession builded 
upon objective factors, and may these not be com- 
bined with results as clear, as definite, as demonstra- 
tive as figures? Facts, not representatives imaginary, 
are our factors, integers of no doubtful meaning, and 
he who contributes to their nimiber makes the world 
his debtor. / 

Last year members of this Association visited the 
seemingly boundless prairies of the great Northwest, 
a terra incognita of a few years ago, roamed over by 
the wild Indian and the buffalo. Energetic compan- 
ies were pushing the iron track in various directions 
out into the vast expanse without a .single settlement 
as an objective point, or for miles and miles the up- 
curling smoke to mark the site of a single frontier 
cabin. When asked the purpose and object of this 
great expenditure and the hope of recompense, the 
cheerful reply always was given : "We are the devel- 
opers of this vast country ; these lands are waiting 
to yield harvests unhoped for by the Eastern farmer, 
and the poor, over-worked, half-starved of other 
continents will yet bless our efforts." This we call 
the energy, the push of the nineteenth century, 
which marks its deeds in monuments of useful labor. 

A few years since, and the physician who used the 
microscope was supposed to be dabbling in the aesthet- 
ics of his calling; what could be the practical out- 
come of this painstaking, time-consuming at best mi- 
nutiae of labor? The realms of the infinite are beneath 
as well as above the natural ken of mankind. By the 
aid of this little instrument, from a knowledge of ulti- 
mate structure, there has been cleared up many a 
doubtful acceptation of function — yea, even the very 
basis of modern physiology established. From the 
standpoint of such observation a Virchow revolution- 
ized all our ideas of pathology. 

Tyndall and Pasteur showed that the ever-prevail- 
ing dust contained the particular causes of fermenta- 
tion which were again demonstrated by careful micro- 
scopic observation to be dependent upon vegetable 
plants, so minute as heretofore to have escaped espe- 
cial notice. It remained for the genius of a Lister 
to demonstrate that from the rapid development of 
such germs arose in large degree the danger to 
wounds. 

By the avoidance of the dangers which such knowl- 
edge taught, untold numbers of lives have already 
been saved, and there is being elaborated a system of 
wound treatment based upon fundamental factors of 
truth, more sure and certain than the wildest dreams 
and fancies of the alchemist of old who concocted 
his healing balsams at the midnight hour under the 
divine influence of the stars. The same line of in- 
vestigation applied to disease clears up the mysteries 
attendant upon the group of so-called contagious dis- 
eases and demonstrates, in many, an entity sui-generis. 
There is a particular something which from individ- 
ual to individual breeds true and gives certain object- 
ive symptoms, and to these have been given definite 



i883.] 



MEDICAL AND SURGICAL JOURNALISM. 



45 



names. Although daily widening, the border lines of 
our knowledge in these directions are easily reached, 
and the outlook would seem to indicate that much 
which had been considered settled will be revolution- 
ized and the facts re-arranged, so that in the near future 
a large part of so-called medicine will be rewritten. 
Accept the demonstrations already made and grant 
the inferences therefrom to be correctly drawn, the 
science of medicine and surgery will be greatly sim- 
plified and its practical application many fold in- 
creased for good. 

Volumes have been written and the best labor of 
many lives has been spent in the study of the repro- 
ductive processes of man and animals. A whole sys- 
tem of classification has developed therefrom, yet the 
observations thus made were tniths only in part which 
4ed on this account to many erroneous conclusions ; 
while from a broader study and deeper knowledge it 
remained for an Ercolani to demonstrate a single and 
universal fundamental law of physiological modality. 

In the not remote past. Panacea has had a longer 
train of enthusiastic followers than her sister Hygeia. 
Now sanitary science, although scarcely popularized, 
very properly is taking its position in the front rank 
of all the means to be employed in the lessening of 
suffering and the prolongation of life. As in surgery 
so here, inscribed upon the key-stone of its great 
arch is the one word clean. 

Cleanliness is next to godliness, and filthiness is , 
the great physical sin. But in this realm, also, as in | 
all others of science, order is being restored out of 
chaos and once having obtained the key the hierogly- 
phics of nature are translated with no uncertain mean- 
ing, and the simplicity and unity of the divine plan 
appears. To noxious gases no longer do we attril)ute 
the chief dangers arising from decomposition, but 
the rather thereby do we know that myriads of min- 
ute microscopic organisms have been preying upon 
and taking to pieces the waste albuminous products 
of life, again to restore them to a condition for higher 
utilization. 

Thus the never ending cycle of life goes on, noth- 
ing wasted nothing lost, and as the infraction of the 
law of gravitation brings with it its penalty, so the 
excess of waste, over repair, and the devitalization of 
tissue which must ensue, render man the easy prey to 
agencies ordinarily invisible which stand ever ready 
to take to pieces his higher organization and refit it 
for new and perhaps better use. 

The beginnings of knowledge are ever involved in 
mystery and doubt. The seeker is led into diversi- 
fied and seeming labyrinthian paths, but like the 
labyrinth of old he who holds the key may safely 
tread its mazes and understand its plan. While we 
rejoice in that to which our profession has already 
attained, we look with longing eyes to the victories 
of the near future. To the better accomplishment 
of this, we welcome the open fields of subdivided \ 
duties and specialistic labor. We rejoice in the ac- - 
tivity of united efforts to make of greatest avail these 
results by combining into societies and the publica- 
tion of such observations in journals devoted to spe- 
cial interests. 



grand national association at whose birthday fest we 
are here assembled. May the Journal, which this 
meeting sanctions and to which this year gives chris- 
tening, as the Association itself has been, be a devel- 
oper of special labor. Like the States to which we 
swear fealty and whose organization we here repre- 
sent, may the special fields of labor be carefully cul- 
tured, and like the grand old union which we ever 
delight to honor, the new Journal be in the broad- 
est sense the representative of the progress of the di- 
vine art of healing. 

We should give encouragement to such publica- 
tions, should teach the rank and file of our profession 
who in a certain sense must ever be general practition- 
ers not to seek in other fields — as natural science or 
politics — an escape- valve for extra energy, but let 
each physician select some subdivision of his work 
where he may find, and if possible widen the bound- 
ary knowledge of his calling. Let him select the 
publication devoted to his field of special labor, con- 
tribute to its columns his own observations and up- 
hold with generous sympathy every effort of real 
progress. 

Last week Dr. Oliver Wendell Holmes, in his ad- 
dress of welcome to the clergy and laity at their 
grand annual festivity, referring to the theological 
dissentions that have from time to time arisen in the 
church, says: " Now it has been one of the flock that 
has got his foot on the lowermost of the five bars of 
the sheep-fold and the bell-wethers ring in a council 
to pull him back if they can or push him over if they 
must. Now it has been to examine a leaky creed and 
determine whether or not the hole could be stopped 
by the proper use of that famous plastic material 
known as tneological soft solder." 

Doctors may take warning from clerical antag- 
onisms, for the hard spelter which our New York 
friends have recently been using in their attempts at 
patching the heel of the old craft have only opened 
up new leaks, and awakes the satirical criticism, " Be- 
hold how these brethren love one another." May 
the time soon conie when we shall not broaden our 
phylacteries, but recognize only one law — the divine 
code of human brotherhood. Then, instead of antag- 
onisms there will be developed yet more fully a gen- 
erous rivalry for good. 

We all possess diversity of gifts, but should be act- 
uated and guided by one spirit. The cavalry shall 
not say to the infantry "You are too slow for our 
purpose," the infantry shill not say to the artillery 
" You are too heavy and cumbersome in your outfit," 
but all with one accord as members of the grand 
army strive to accomplish the work set before it. 
With this end attained, under the clear light of sci- 
entific truth, the isms which smack of ignorance will 
cease to exist, new fields of labor, more attractive be- 
cause nearer to the great source of truth, will open and 
there will yet arise a more noble emulation for the still 
greater advancement of a united and harmonious 
profession. 



In this spirit we welcome the new departure of our i 



The annual meeting of the American Public 
Health Association takes place in Detroit November 
The session will probably co"'.tin::e four days. 



46 



THE USE OF THE TREPHINE. 



[July, 



THE USE OF THE TREPHINE IN TRAUMATIC EMPY- 
EMA ASSOCIATED WITH FISTULA. 



BY T. G. RICHARDSON, M.D., PROFESSOR OF SURGERY 
IN THE MEDICAL DEPARTMENT OF THE UNIVERSITY 
OF LOUISIANA, NEW ORLEANS. 



[Read before the American Surgical Association at its late annual meeting 
in Cincinnati, May 31st, 1883.] 

Chronic suppurative pleuritis with an imperfect 
fistulous outlet, either external or bronchial, is not 
an uncommon result of gun-shot or other penetrating 
wounds of the thoracic cavity; and it is no secret 
that the resources of surgery have not heretofore 
offered much encouragement to the unfortunate suf- 
ferers. In the majority of such cases there is con- 
traction or sinking in of the injured side, a constant 
discharge of fetid pus, persistent cough, irritative or 
septic fevers, and more or less rapid exhaustion of 
strength, terminating usually in death within a few 
months, or a year or two at the farthest. 

Two main difficulties are encountered in the treat- 
ment of such cases: ist, imperfect drainage, upon the 
correction of which the life of the patient depends ; 
and, 2nd, permanent separation of the lung from the 
chest-wall by contraction of the organized exudative 
membrane upon the surface of the former. It is to 
these two points alone that I shall call attention in 
this brief contribution. 

ist. The serious obstacle to drainage in these cases 
is not the ordinary stenosis to which nearly all sinuses 
in the soft parts are liable, but approximation of 
the ribs, consequent upon the sinking or falling in 
of the chest-wall. Owing to the shortness and greater 
degree of fixedness of the first four or five ribs, very 
close approach of their adjacent borders is seldom 
seen except in quite young subjects. The same is 
true of the entire series near the spine in consequence 
of their close attachment to the vertebrae. But in 
other situations where greater latitude of motion 
exists, more especially along the lateral planes of the 
thorax below the fifth and sixth ribs, it is not rare, in 
the class of cases now under consideration, to find the 
adjacent edges closely applied, and sometimes even 
slightly imbricated. Under these circumstances it 
is impossible by any ordinary means to preserve sat- 
isfactory drainage by an opening, however extensive 
it may have been made, in an intercostal space. 
Tolerably strong silver caAulae have been indented 
by the approaching bones, and rubber tubing is fre- 
quently worse than useless. The result is entrance of 
air, decomposition of the pus, septic or irritative 
fever, and death more or less rapid as the disease 
may assume the former or the latter character. 

2. The condition resulting from compression of 
the lung by inflammatory membrane, and consequent 
inability of the organ to expand to its original dimen- 
sions, is not necessarily fatal or altogether irremediable. 
Pyogenic sacs when freely drained, and at the same 
time protected from dessication, more especially if 
kept moist by antiseptic fluid or vapor, do not usually 
give rise to pyaemia or even to irritative fever. They are 
certainly sources of great discomfort and sometimes 
grievous annoyance to patients, but fortunately in 



the class of cases here referred to, they are frequently 
obliterated by the operation employed for overcom- 
ing the obstacle to drainage, as I hope to be able 
presently to show. 

Seeing, then, that the great danger in these cases 
depends mainly upon imperfect drainage, it is to 
the best method of correcting this difficulty that our 
efforts should be directed. The impracticability of se- 
curing a sufficiently free opening through one or more 
of the intercostal spaces, especially along the lateral 
and lower parts of the thoracic wall, has already 
been mentioned ; and I may here add, that in this 
respect counter-openings, necessary as they often are, 
have no advantage over the original outlets. Under 
these circumstances, the surgeon's only resort is re- 
moval of a portion of one or more ribs. This 
may be accomplished by one or other of the ordinary ' 
methods of bone-resection, but, in my judgment, 
much more readily, and in most cases, with equally 
good results, by the use of a large trephine. 

The idea of "trepanning" the thorax is not new. 
The operation is said to have been proposed by Hip- 
pocrates, and, in more modern times, has been 
modified by Reybard and adopted by Recamier, 
Trousseau and others in idiopathic empyema.^ This 
consisted, however, in simply perforating a rib and 
inserting a canula, the greatest care being taken to 
prevent the ingress of air. 

Lossen, of Heidelberg, ascribes the first suggestion 
of resection of the ribs, for what he terms retro-costal 
abscess, to Roser in 1859, and states that this surgeon 
performed the first operation of the kind in 1865, 
with the effect of curing his patient in fourteen days. 
He (Lossen) adds that in 1869 Simon excised a por- 
tion of the sixth rib in a case of empyema with fistula 
for the purpose of permanently enlarging the canal. 
The cavity ultimately closed, the favorable result be- 
ing due in the opinion of the operator, to sinking in 
of the resected rib.^ 

Dr. Schneider, of Konigsburg, in 1877, in a case 
of pleuritic suppuration, resulting from a gun-shot 
wound involving the third rib, removed from the sec- 
ond rib a section two inches in length, from the 
fourth, 3.8 inches, from the fifth. 3.8 inches, from 
sixth, 4.4 inches, and from the clavicle, 1.5 inches, 
by which means the chest-wall was allowed to sink in 
and obliterate the pleural cavity.'' 

It will thus be seen that the benefits derived from 
resection are threefold : i. Unobstructed drainage; 

2, free space for the application of antiseptics; and, 

3, shrinkage of the chest-wall. In a large number of 
cases, more especially those in which the collection of 
pus is confined to the lower and lateral regions of the 
thorax, the mobility of the ribs, the flexibility of the 
long costal cartilages, and the yielding nature of the 
diaphragm permit the closing of quite large retro- 
costal cavities without any assistance at the hands of 
the surgeon other than may be necessary for drainage 
and asepsis. In such cases a large opening at the site 
of the fistula, or, if needs be, at a more dependent 



1 Traits de Pathologie Externe Par. Aug. Vidal (de Casses) Tome 
IVme. 

2 London Medical Record. — Am. Journal Med. Sciences, July, 1878. 
3 Op. cit. 



1883.] 



THE USE OF THE TREPHINE. 



47 



point, is all that is required. For this purpose the 
application of a trephine having a sufficiently large 
crown to embrace the entire breadth of a rib, com- 
mends itself as the readiest and safest method, and 
does not hinder subsequent resection of adjacent ribs, 
if such procedure should become necessary. 

So far as I have been able to investigate the ques- ! 
tion of priority, this operation originated in New Or- I 
leans, and is almost peculiar to this city where it has i 
been frequently performed within the past twenty ] 
years, and with increasing favor. Indeed, since it is ' 
no longer a rarity, those who resort to it seldom keep 
records of their cases. This is greatly to be re- 
gretted, and I am obliged to confess that I am myself i 
probably more at fault than anyone else. But though 
defective in histories of individual cases, I trust that | 
my presentation of the subject may not be discredited ; 
or its importance underrated. To the late Professor j 
Warren Stone, Sr. m.d., is due the credit of having 
first performed this or any other method of resection , 
of the ribs for empyema, as the following history will, 
I think, clearly prove:* 

Case, Charles W., set. 17 years, was stabbed in the 
back with a large pocket-knife, in the hands of one 
of his college-mates, at a well-known institution in ] 
North Carolina, November 19, i860. The wound 
penetrated the eight thoracic cavity about two inches 
from the spine, between the fifth and sixth ribs. 
Pleuro-pneumonia was the result, and very soon offen- 
sive pus, mixed with grumous blood, began to dis- 
charge from the opening. After several weeks con- 
finement to bed the patient rallied, and was taken to 
Paris the following summer. There he was placed 
under the professional care of MM. Velpeau, Mais- 
sonneuve and Nelaton, who attempted unsuccessfully 
to dilate the fistula and keep the cavity cleansed. No 
benefit having resulted after several weeks treatment, 
no operation proposed, and no encouragement to re- 
main longer having been given, the patient was car- 
ried to his home in Mobile, Alabama, with every ex- 
pectation of an early death. 

A fatal result not having occurred, he was brought 
by his parents to New Orleans the following February, 
1862, and admitted into the private infirmary, of 
which Professor Stone and I then had charge. At 
this time he was emaciated to an extreme degree, 
racked by cough and thoroughly exhausted by irrita- 
tive fever and hectic. The right chest was somewhat 
contracted, and from a small fistulous opening at the 
site of the wound fetid pus was slowly exuding. Not- 
withstanding the nearness of the wound to the spine, 
in which situation the ribs are naturally so nearly fixed 
in their position that only the slightest movement can 
be effected, the two adjacent bones had become so 
nearly approximated that a No. 8 bougie could hardly 
be passed between. A careful examination disclosed 
a considerable collection of fluid in the pleural cavity. 



* Since this paper was read my attention has been called by Professor 
S. W. Gross, M.D., to an article in the British Medical Journal of Jan- 
uary 2ist, i860, entitled " Case of Traumatic Empyema of sixteen months 
standing with Fistula, treated successfully. By Albert G. Walter, Surgeon, 
Pittsburg, Pennsylvania, United States." The case was a knife-wound, 
resulting in retro-costal abscess which opened spontaneously. December 
8, 1857, one inch ot the eighth rib was removed with bone-pliers. To se- 
cure better drainage two inches of the eighth and nineth ribs were removed 
in like manner February ii, 1858, followed by injections of tincture of 
iodine. On January i, 1859, patient was reported entirely well. 



To get rid of the latter, establish free drainage and 
render the walls of the sac aseptic, were clearly indi- 
cated, but how to accomplish these ends after the 
signal failure of the three most noted surgeons of 
France was not so distinctly perceived. The problem 
was solved, however, by my distinguished colleague, 
when, after contemplating the situation for a few mo- 
ments, he turned to me and asked what would be the 
objection to enlarging the fistula by a trephine applied 
to the rib below. The proposition met with a hearty 
approval, and was immediately carried into execution. 
But the removal of the disc of bone involving the 
whole breadth of the rib did not complete the opera- 
tion. In consequence of the densely thickened pleura 
the cavity was still unopened. To divide this freely, 
despite the possible wounding of the intercostal artery, 
was the work of a moment, when out gushed an im- 
mense stream of pus, so disgusting and overpowering 
in its odor as almost to drive everyone from the room. 
After fifteen or twenty ounces of this had escaped, 
and the flow in a measure ceased, the cavity was 
washed with a tepid solution of chlorinated soda, and 
a small roller bandage thrust into the opening to serve 
both as lint and plug. No haemorrhage followed the 
operation, and I have since then been convinced by 
additional experience that in such cases the intercostal 
artery in the immediate vicinity of the fistula is ob- 
literated by contraction of the fibrinous deposit. The 
plug was subsequently removed twice a day, and the 
oavity freely injected with the antiseptic fluid. The 
patient's health began to improve immediately, and 
in less than six weeks he was upon his feet and able to 
go unaccompanied wherever he desired. In the mean- 
time the sac was undergoing steady diminution in 
size, partly by expansion of the lung, but principally 
by subsidence of the chest- wall, and we indulged the 
hope that it would ultimately become entirely obliter- 
ated, but in this we were disappointed. 

For reasons not necessary to mention, the patient 
left the city soon afterward, and the following year, 
1863, was sent to Europe, where he was advised to 
continue the treatment begun at New Orleans. In 
1866, I met him in Paris, and was much gratified to 
find him in the enjoyment of a fair state of general 
health, notwithstanding the annoyance of daily em- 
ptying and disinfecting the sac. I measured the lat- 
ter, and found it capable of holding six ounces, and 
learned that the secretion amounted to four ounces 
daily. The ribs upon the affected side were more con- 
siderably depressed, but tTie respiratory murmur could 
be distinctly heard in front. 

Mr. W. returned to Mobile in 1868, where he re- 
mained until 1880, and is now living in New York. 
His health is feeble, but he is able to attend to all the 
ordinary duties of life without special distress. In a 
recent letter he informs me that the cavity has under- 
gone no material change since 1866 ; that it still mea- 
sures six inches in capacity, and secretes from two to 
three ounces of pus daily. The opening is nearly an 
inch in diameter. 

Considering that the operation was original in its 
conception and performance," and resulted in the pre- 

5 I am confident that Professor Stone had never heard of the sugges- 
tion of Roser, nor of the op jr.ation of Walter's, mentioned in a preceding 
foot-note. 



48 



A NEW OPERATION FOR THE CURE OF RANULA. 



[July, 



sf^rvation of a valuable life, it may seem invidious to 
criticize it, but one cannot now shut his eyes to the fact 
that if two or three ribs below the one which was tre- 
phined had been subsequently resected, the prob- 
ability is that complete obliteration of the sac would 
have occurred. 

In connection with the preceding case, which I 
have deemed of sufficient interest to report in detail, 
I take the liberty of mentioning briefly another which 
came under my care only a few weeks later. 

Case II. Captain H., of the Confederate States 
Army, entered the infirmary March 15, 1862, suffer- 
ing with empyema, resulting from a gun-shot wound 
received two or three months before. A small fistu- 
lous opening existed between the seventh and eighth 
ribs, an inch or more beyond their cartilages, but was 
not large enough to keep the cavity drained, nor could 
it be sufficiently dilated for this purpose in conse- 
quence of the nearness of the two adjacent ribs. Act- 
ing upon the experience I had already gained in the 
preceding case, I applied a large trephine to the 
eighth rib, immediately below the fistula, divided the 
thickened pleura, and thus discharged a large collec- 
tion of fetid pus. The cavity was thoroughly cleansed 
by a weak solution of chlorinated soda, and a plug 
consisting of a small roller bandage pressed into the 
opening. The patient was sufficiently recovered to 
leave for his home in Texas a week or ten days after- 
wards with directions to continue the antiseptic in- 
jections until the cavity closed. I heard nothing from 
him for three years, when he presented himself at my 
office to show me the result. The side of the chest 
was somewhat contracted, but not enough to cause 
marked deformity ; the opening was closed by a firm 
cicatrix, and the respiratory murmur could be heard 
everywhere within a short distance of this point. He 
informed me that complete closure occurred a few 
weeks after he left the Infirmary, and that since then 
the wound had given him no trouble whatever. From 
recent accounts Captain H. is still alive, actively en- 
gaged in business, and in the enjoyment of most ex- 
cellent health. 

Complete recovery in this case was evidently due 
to the fact that the empyema was localized opposite 
the most moveable part of the thoracic walls. The 
sinking in of the latter was sufficient to meet the par- 
tially expanded lung, and the cavity being kept per- 
fectly drained, obliteration was complete. 

Since the last mentioned case, which occurred 
twenty years ago, several of similar character have 
been admitted into my wards in the Charity Hospital, 
and have invariably undergone the same treatment, 
but owing to the restlessness and nomadic habits of 
the patients it is impossible to state with any assurance 
of accuracy what have been the ultimate results. In 
every case, however, up to the time of their leaving 
the hospital there were good reasons for a favorable 
prognosis. As one of these cases presented an excep- 
tional complication it is worthy of special mention. 

Case. — M. Barry, aet. 27 years, came under my 
care in December, 1881. He had been shot from 
behind through the right lung a year previously, the 
ball emerging at the seventh intercostal space in 
front, a little in rear of the junction of the adjacent 



ribs with their cartilages. A low form of pleuro- 
pneumonia followed, accompanied by a free dis- 
charge of offensive pus from the two external open- 
ings, and expectoration of similar fluid from the lung. 
After a protracted illness, during which the right side 
of the chest became greatly contracted below, the wound 
of entrance closed entirely, and, in consequence of the 
approximation of the ribs, the opening of exit was 
reduced to the size of a No. 2 bougie. When I first 
saw him, he was suffering from irritative force and 
hectic, coughing up large quantities of foetid pus, and 
so reduced in strength that he could scarcely bear to 
be propped up in bed for examination. I succeeded, 
however, in determining the presence of air and pus 
in the plexural sac, a tolerably free communication 
between the latter and the bronchial passages, and a 
small fistulous opening in the seventh intercostal 
space. 

A few days after the diagnosis was completed, and 
in the presence of the medical class of the University 
of Louisiana, I made an incision downward from the 
fistula across the eighth rib, applied the largest 
trephine to the latter, and 'then, with a bistoury, 
divided an unusually den.sely thickened pleura. Im- 
mediately air rushed into the cavity with a deep gurg- 
ling noise, and the next instant rushed out again 
bringing with it a large quantity of stinking pus which 
bespattered everyone around, and filled the amphithe- 
ater with its nauseous odor. At the same time, and, 
doubtless, in consequence of the ingress of cool air 
into the cavity, 'a violent cough occurred, accom- 
panied by a shower of the same fowl fluid mixed with 
blood, much to the chagrin of the assistants, who had 
moved out of range of the opening in the side. It 
was altogether a most disgusting affair. However, 
not to be tedious, after the escape of more than a 
pint of pus, and when the cough and agitation had sub- 
sided, warm carbolized water was gently injected by 
means of a rubber bulb syringe, care being taken not 
to disturb the sac, and thus force the fluid into the 
bronchial passages. 

I need not enter into the details of the subsequent 
treatment, farther than to say that the injection was 
repeated twice a day, the opening being in the mean- 
time plugged with a small roller bandage. The patient 
rallied rapidly. In a week all communication be- 
tween the suppurating cavity and the air-passages 
was closed, and in about six weeks from the time of 
the operation, the cavity was so nearly obliterated 
that the patient thought it unnecessary to remain 
longer in hospital, and insisted upon being dis- 
charged. I have good reason to believe that entire 
recovery was completed soon afterwards. 



A NEW OPERATION FOR THE CURE OF RANULA. 



WITH REPORT OF A CASE. BY T. F. PREWITT, M.D. 
ST. LOUIS., MO. 



Read to the Section on Surgery and Anatomy. 

I do not propose to go into the literature of ranula ; 
its mode of development, the special strictures in- 
volved, or a consideration of the differential diag- 



1883.] 



ASSOCIATION OF AMERICAN MEDICAL EDITORS. 



49 



nosis, but to call attention to a method of dealing 
with those cases that obstinately resist the ordinary 
methods of treatment, and which, so far as I am 
aware, has never been resorted to heretofore. 

The methods recommended and practiced by sur- 
geons at this day, consist either of the introduction 
ofaseton, injections into the sac, or partial exci- 
sions of it. 

Of these, almost all modern surgeons give prefer- 
ence to excisions of a portion of the sac — total 
excision being impracticable. 

I have no experience with the seton, or injections, 
having practiced partial excisions in the cases that 
have fallen under my care, and always with satis- 
factory results. Having met with a case of double 
ranula recently, in which this measure, followed by 
persistent catheterization failed, it occurred to me 
that I might, by a plastic operation, secure a perma- 
nently patulous orifice. 

Geo. McG — n, aet. 15, was brought to me May 6, 
1882, by his brother-in-law — himself an intelligent 
physician, with a swelling under the left lower max- 
illa, nearly as large as a goose-egg. It fluctuated free- 
ly, some portions of it seeming hard, however, and 
projected also into the mouth under the tongue, though 
the swelling here was not very great. A diagnosis of 
ranula was made, and a portion of the cyst wall in 
the floor of the mouth excised. A quantity of clear, 
transparent mucoid fluid escaped, spurting out several 
feet as the cyst was incised. 

In the course of two or three weeks this had con- 
tracted, and threatened to close, and catheterization 
was resorted to. 

In the meantime, a ranula had appeared under the 
tongue upon the right side, with translucent, bluish, 
thin walls, but not projecting beneath the jaw. This 
also was treated by excision of a portion of the cyst 
wall. 

In July the young man ceased to present himself; 
the orifice closed, the sacs rapidly filled, and Dr. L. 
again brought him to me in an alarming state from 
threatened suffocation. Both ranulae were swollen 
and painful. Upon the left side the swelling ex- 
tended well down towards the clavicle and sternum, 
and across the trachea in front. Upon the right side 
the ranula, was greatly swollen, meeting with that 
upon the left side under the chin, in a continuous 
swelling, from the angle of the jaw upon one side 
around to the opposite angle. Both inspiration and 
expiration were obstructed — the young man was 
flushed and feverish. From the rapidity of the oc- 
currence of the symptoms, and their increasing gravity, 
it seemed as though tracheotomy might become ne- 
cessary. 

I incised the cysts freely, permitting the free escape 
of the accummulated fluids, and directed hot fomen- 
tations to be persistently applied. This gave speedy 
relief to all the urgent symptoms. 

As contraction took place, I again resorted to 
catheterization, with the view of preventing reclosure. 
This was persevered in for two or three months, and 
was more effectual upon the left side, for the reason 
that the bougie, a soft conical rubber about 15 French, 
could be passed down for two inches and could be 



felt below the margin of the jaw. Upon the right 
side a probe only could be used, and when its use was 
intermitted for a few days, it would close completely. 
I determined, therefore, to make a permanent open- 
ing by a plastic operation on that side. Carefully 
dissecting off" the mucous membrance of the mouth over 
the cyst, denuding a surface as large as a nickel, I 
then incised the cyst-waJl, turned it over, and tacked 
its free edge to the border of the mucous membrane 
of the mouth with fine silk sutures, thus, as it were, 
binding the opening in the cyst with mucous mem- 
brane, and interposing an effectual safeguard against 
its closure. 

Union by first intention took place, the stitches 
were removed upon the third day, and an orifice was 
secured that has remained patulous to this time. 

This was in November last. The young man be- 
came irregular in his attendance, and finally ceased 
to present himself to have the left side catheterized. 
On the I St of April he came to me with considerable 
accumulation on the left side, and the orifice closed. 
I repeated the operation on that side, with a like for- 
tunate result, and now, two months after the last oper- 
ation, the openings are equally patulous upon the right 
side and upon the left, and he has no trouble what- 
ever from re-accumulation of the flnid. 



RECORD OF PROCEEDINGS OF THE ANNUAL MEET- 
ING OF THE ASSOCIATION OF AMERICAN 
MEDICAL EDITORS IN CLEVE- 
LAND, JUNE 5, 1883. 



President N. S. Davis called the meeting to order 
in Case Hall, Cleveland, Ohio, Tuesday even- 
ing, June 5, at 7:30 p.m. Dr. John V. Shoe- 
maker, the Secretary, read the minutes of the previ- 
ous meeting, which were adopted. The following 
members and the journals which they represent were 
then registered by the Secretary : 

Dr. N. S. Davis, Chicago, 111.; Dr. W. C. Glas- 
gow, Sf. Louis Courier of Medicine, St. Louis. Mo.; 
Dr. A. N. Bell, Sanitarian, New York; Dr. C. H. 
Hughes, Alienist and Neurologist, St. Louis, Mo.; 
Dr. A. B. Palmer, The Physician and Surgeon, Ann 
Arbor, Mich.; Dr. C. B. Stemen, Fort Wayne Jour- 
nal of Medical Science, Fort Wayne, Ind. ; Dr. John 
V. Shoemaker, Tlie Medical Bulletin, Philadelphia, 
Pa.; Dr. Frank Woodbury, Medical Times, Philadel- 
phia, Pa.; Dr. H. O. Marcy, Tlie Anatomical and 
Surgical Annals, Boston, Mass.; Dr. Thos. J. Galla- 
gher, Pittsburgh Medical J^ournal, Pittsburgh, Pa.; 
Dr. L. S. McMurtry, Louisville Medical News, Louis- 
ville, Ky.; Dr. W. M. Carpenter, Medical Record, 
New York; Dr. H. H. Mudd, Weekly Medical Re- 
view, St. Louis, Mo.; Dr. Leartus Connor, Detroit 
Lancet, Detroit, Mich.; Dr. W. C. Wile, Netv En- 
gland Medical Monthly, Sandy Hook, Conn.; Dr. 
Wm. Brodie, Therapeutic Gazette, Detroit, Mich.; 
Dr. Deenng Roberts, Southern Practitioner, Nash- 
ville, Tenn. 

On motion, the President appointed a committee to 
select officers for next year. Drs. Wm. Brodie, A. B. 
Palmer and L. S. McMurtry, the committee, reported 
the following: President — Dr. Leartus Connor ; Vice- 



so 



MINUTES OF THE JUDICIAL COUNCIL. 



[July, 



President — Dr. Thos. J. Gallagher; Secretary — Dr. 
John V. Shoemaker. 

On motion, the Secretary was instructed to cast tHe 
ballot, and he announced the ofificers already report- 
ed by the committee. 

The time having arrived for the President's annual 
address, Dr. N. S. Davis then spoke on the "Present 
Status and Tendency of the 'Medical Profession and 
of Medical Journalism in this Country." At the 
conclusion of his remarks, Dr. Davis stated that the 
Association had concluded to include the two meet- 
ings already announced upon this occasion, and the 
next address in order would be by Dr. H. O. Marcy, 
of Boston, Mass. Dr. Marcy, upon being intro- 
duced, spoke upon " Journalism Devoted to the Pro- 
motion and Concentration of Medical and Surgical 
Science in Special Departments." 

On motion, the thanks of the Society were returned 
to Drs. N. S. Davis and H. O. Marcy for their admir- 
able and instructive productions, with the request 
that they be furnished to the editor of the Journal of 
THE American Medical Association — should it be 
established — for publication. 

Dr. Deering Roberts presented the following reso- 
lution : 

Resolved, That this Association recommend Dr. N. 
S. Davis, of Chicago, to the American Medical As- 
sociation, as being the most suitable editor for the 
Journal which they shortly propose publishing. 

The resolution was unanimously carried. 
' On motion, the Secretary was instructed to arrange 
a suitable programme at the next place of meeting, 
Washington, D. C, in 1884. 

John V. Shoemaker, Secretary. 



MINUTES OF THE JUDICIAL COUNCIL OF THE 
AMERICAN MEDICAL SOCIETY. 



Cleveland, Ohio, June 5, 1883. 

The Judicial Council met in the private office of 
Dr. X. C. Scott at 10 o'clock a.m. in accordance 
with the adjournment of last year. 

Present — Doctors J. S. Billings, J. M. Brown, 
Wm. Brodie, N. S. Davis, N. C. Husted, Wm. Lee, 
D. A. Linthicum, J. C. Reeves, M. Sexton, A. B. 
Sloan, X. C. Scott, J. M. Toner, J. H. Warren, J. 
K. Bartlett. 

• The first business in order, election of officers for 
the year, resulted in the choice of N. S. Davis, Presi- 
dent; J. K. Bartlett, Secretary. 

No papers having been referred, and there being 
no unfinished business from last year, the Council 
then adjourned, to meet the next morning at nine 
o'clock. 

Wednesday, June 6. — Council convened at 9 a.m. 
Papers from several State and local Medical Societies 
which had been referred, and which reaffirmed adher- 
ence to the Code of Ethics, were read, and ordered 
to be placed upon file. 

A petition from Dr. D. W. Day had also been 
referred, asking for a rehearing in his case, which was 
adjudicated last year. After examination of the papers, . 
the following was unanimously adopted : 

Resolved, That the petition of Dr. D. W. Day be 



returned, with leave granted to accompany said peti- 
tion by a written statement of the character of the new 
evidence which he proposes to introduce, and that 
any action in the case be deferred until the opening 
of the session of next year, on account of the impos- 
sibility of notifying all parties concerned during the 
present session. 

In the case of Dr. E. P. Cook, who, before signing 
the certificate of application, erased the clause which 
had been in.serted by the Secretary of the Association 
as a substitute for the registry book formerly used. 
The Council was of the opinion that Dr. Cook mis- 
understood the import of this addition, and Dr. Davis 
was requested to explain the subject to the Associa- 
tion, which was done by a verbal report. 

A letter from Dr. D. H. Goodwillie, of New York 
to the Chairman of the Committee of Arrangements, 
which had been referred to the Council, was read and 
laid upon the table. Council then adjourned to meet 
at 9 o'clock A. M. of the next day. 

Thursday, June 7. Council met according to 
adjournment. A protest against the registration of 
Dr. D. H. Goodwillie, signed by two delegates from 
the New York Academy of Medicine, and which had 
been referred to the Council, was read, and the letter 
of Dr. Goodwillie taken from the table ; after a full 
consideration of the subject, it was unanimously 

Resolved, '-That the evidence before us in the case 
of Dr. D. H. Goodwillie is sufficient for adjudica- 
tion ; " also, 

Resolved, "That decision in this case be deferred 
until the next Council session, and that the Secretary 
be directed to notify Dr. Goodwillie that these papers 
are before us, and will be acted upon at the session of 
the Council on Friday morning at 9 o'clock. 

Three letters from individual members of the Asso- 
ciation which had been referred, were read, and 
ordered to be placed upon file. The Council then 
adjourned, to meet at 9 o'clock on Friday morning. 

Friday, June 8. Council assembled at 9 A. M. 
The unfinished business of the preceding day was re- 
sumed. The letter written by Dr. Goodwillie was 
read while he was present, as also the protests against 
his registration ; he was asked if the letter fully and 
correctly expressed his present opinion, and replied 
that it did. After his withdrawal, the Council 
unanimously 

Resolved, "That in the case of Dr. D. H. Good- 
willie, who signed under protest the clause printed 
upon the registration blanks, which declared adher- 
ence to the Constitution, Bylaws, etc., of the Asso- 
ciation, his registration be cancelled, and the 
annual dues paid by him be returned." 

There being no farther business, the Council ad- 
journed, to meet at 10 o'clock a. m. on the first day 
of the session of the Association at Washington, D. 

C, May, 1883. J. K. Bartlett, 

Secretary of Judicial Council. 

members of judicial council. 

1884.— Wm. Brodie, Mich; R. B.Cole, Cal.; H. 

D. Holton, Vt.; D. A. Linthicum, Ark.; A. B. 
Sloan, Mo.; J. M. Toner, D. C; E. W. Clark, Iowa. 

1885.— J. M. B-owr, U. S. A.; N. S. Davis, 111.; 



ySS3.-\ 



MEDICAL PROGRESS. 



51 



N. C. Husted, N. Y.; Wm. Lee, Md.; J. C. Reeves, 
W. Va.; X. C. Scott, Ohio; M. Sexton, Ind. 

1886.— W. O. Baldwin, Ala.; J- S. Billings, U. S. 
N.; F. D. Cunningham, Iowa.; E. Grissom, N. C; 
H. O. Marcy, Mass.; N. W. Miller, Marine Hosp.; 
R. N. Todd, Ind. 



MEDICAL PROGRESS. 



Two Deaths during the Administration of 
Anaesthetics. — Mr. J. H. Lee Macintire, Medical 
Superintendent, Bristol Royal Infirmary, writes: 

" H. C, male, aged 54, was admitted to the Bris- 
tol Royal Infirmary, December 30, 1881, suffering 
from a strangulated inguinal hernia of sixty-four hours' 
standing. He had vomited almost incessantly from 
the first, and for the last twelve hours the vomited 
matter had been fgecal. On admission his tongue was 
moist, his pulse weak but regular, and his aspect 
somewhat pinched. Chloroform was adminis- 
tered preparatory to an attempt at reduction by taxis, 
and everything went on well for the first minute and 
a half, a little over one drachm being inhaled, and 
this amount was divided into three parts. He then 
commenced to struggle a little, and his pulse was 
noticed to have improved, when he was seen to be 
about to vomit. The vomited matter measured almost 
a pint, and was stercoraceous and very fluid. Loud 
tracheal rales were now heard, and the breathing for 
the first time became embarrassed. He was imme- 
diately turned over, when nearly two quarts of fluid 
were ejected. His pupils were now widely dilated, 
his pulse failed, and he became cyanosed. Artificial 
respiration, inversion, cold affusion, and dragging for- 
ward of the tongue were at once tried ; air entered 
the lungs freely, there were no tracheal rales, and the 
pupils became contracted. He now vomited again, 
or, rather, some more fluid poured out of his mouth. 
Attempts to resuscitate him were persisted in for over 
twenty minutes, but without avail. From the first 
arrest of pulse and respiration, neither heart-beat nor 
voluntary attempt at respiration was noticed. The 
first vomit occupied about a minute. T\\eJ>(?sf mortem 
examination showed the heart healthy, aorta slightly 
atheromatous, kidneys granular, and a small quantity 
of food, which appeared to be partly digested milk, 
and which was about as large as a pea, was lodged 
just below the rima glottidis. 

M. T., female, aged 45, who had been in the ward 
some days with an abdominal tumor, was, on April 
19, 1883, examined under the influence of an anaes- 
thetic mixture consisting of one part or chloroform to 
three parts of ether. She was known to have chronic 
bronchitis, and was suspected of phthisis at the right 
apex. She had taken some beef-tea and &gg a short 
time before the examination. She took the anaes- 
thetic very well, becoming unconscious in three min- 
utes, and remaining so for ten, when her breathing was 
noticed to be growing shallow, but her pulse, color, 
and pupils remained unaltered. She took three res- • 
pirations, each more shallow than its predecessor, and 
gave signs of being about to vomit. She was just 
about to be turned over on her left side, when her 



breathing stopped, whilst her heart could still be seen 
acting. Her pulse then failed, her face became livid, 
and her pupils about two-thirds dilated. Inversion 
and artificial respiration were immediately tried, and 
air entered the lungs freely, with a total absence of 
tracheal rales. The pupils were now noticed to be 
about three-fourths dilated, and some half digested 
liquid food oozed out of her mouth. In case any 
might have entered the larynx, although there was no 
reason to suspect such an accident, tracheotomy was 
performed. Artificial respiration was kept up for half 
an hour, and inhalations of nitrite of amyl, injections 
of ether, cold affusion, and an enema of brandy were 
also unsuccessfuly tried, the patient showing no sign 
of returning animation from the first, with the excep- 
tion of closing her jaws firmly about five minutes 
after the commencement of artificial respiration. Post 
mortem examination showed the heart-vessels and 
brain to be healthy, and there was no food in the air 
passages. The abdominal tumor was due to tuber- 
cular peritonitis, and there was general bronchitis, 
and some tubercle was found in the apex of the right 
lung. 

In both cases, the anaesthetic was administered on a 
flannel mask which covered the nose and mouth. — 
British Medical Journal. 

Cannabis Indica ; a Valuable Remedy in Men- 
orrhagia. — Mr. J. Brown, of Bacup, observes: 

" Indian hemp has been vaunted as an anodyne and 
hypnotic, having the good qualities of opium with- 
out its evils. Also in dysmenorrhoea and insomnia it 
has not proved of much benefit. The drug has al- 
most invariably produced some marked physiological 
effect, even in small doses. Text-books give the dose 
as ten minims and upward, bnt five minims is the 
largest dose that should be given at first. If bought 
from a good house, the drug is not inert or unrelia- 
ble. A drug having such marked physiological ac- 
tion ought to have a specific use as a therapeutic 
agent. .Indian hemp has such specific use in menor- 
rhagia — there is no medicine which has given such 
good results; for this reason, it ought to take the first 
place as a remedy in menorrhagia, then bromide of 
potassium and other drugs. The tiiodus operandi I 
cannot explain, unless it be that it diverts a larger 
proportion of blood to the brain, and lessens the 
muscular force of the heart. A few doses are suffi- 
cient ; the following is the prescrtption : Jt tincture 
cannabis indicae re\^ xxx ; pulveris tragac. co. 5 j ', 
spiritus chlorof. 5jj aquam ad gij. One ounce ev'- 
ery three hours. Four years ago I was called to see 
Mrs. W., aged forty, multipara. She had suffered 
from menorrhagia for several months. Her medical 
attendant had tried the ordinary remedies without 
success. Indian hemp was given as above. Its ac- 
tion was speedy and certain. Only one bottle was 
taken. She was afterwards treated for anaemia, due 
to loss of blood. Twelve months after this my pa- 
tient sent for a bottle of the "green medicine," I 
learned afterward that she had sent this medicine to 
a lady friend, who had been unsuccessfully treated by 
another medical man for several months for the same • 
complaint. It proved equally successful. The fail- 



52 



MEDICAL PROGRESS. 



[July, 



iires are so few, that I venture to call it a specific in 
menorrhagia. The drug deserves a trial. It may oc- 
casionally fail ; this, however, is not to be wondered 
at in a complaint due to so many different causes, 
and associated with anaemia and other cases of ple- 
l^thora." 

Robert Batho, m.d., m.r.c.p. , Castletown, Isle of 
Man, writes in reference to the same subject : " Con- 
siderable experience of its employment in menorrha- 
gia, more especially in India, has convinced me that 
it is, in that country at all events, one of the most 
reliable means at our disposal. I feel inclined to go 
further, and state that it is par excellence the remedy 
for that condition, which, unfortunately, is very fre- 
quent in India. 

I have ordered it, not once, but repeatedly, in such 
cases, and always with satisfactory results. The form 
used has been the tincture, and the dose ten to twen- 
ty minims, repeated once or twice in the twenty-four 
hous. It is so certain in its power of controlling 
menorrhagia, that it is a valuable aid to diagnosis in 
cases where it is uncertain whether an early abortion 
may or may not have occurred. Over the haemor- 
• rhage attending the latter condition, it appears to ex- 
ercise but little force. I can recall one case in my 
practice in India, where my patient had lost profuse- 
ly at each period for years, until the tincture was or- 
dered ; subsequently, by commencing its use, as a 
matter of routine, at the commencement of each 
flow, the amount was reduced to the ordinary limits, 
with corresponding benefit to the general health. 
Neither in this, nor in any other instance in which I 
prescribed the drug, were any disagreeable physiolog- 
ical effects observed. 

I could say a few words in its favor, as to its action 
in allaying irritative cough, but I prefer confining 
myself to a point on which experience has left me no 
room for doubt." — British Medical 'yourfial. 

Short Sight in School Children. — Fleet Sur- 
geon Henry Hadlow, R. N., gives a very useful les- 
son in an article in the British Medical Journal of 
May 19, which is the result of his inquiries into the 
management of the Greenwich Hospital School. At 
this school boys were admitted to prepare for the 
Navy. At the age of thirteen they were submitted to 
a special physical examination, which included the 
special test for eye-si^ht by Snellen's types, which 
they were required to read at the full distance ; conse- 
quently every boy in the school above the age of thir- 
teen years must have had perfect vision at this period. 
At fifteen and a half years of age out of 1,074 of 
these same boys, no less than sixty were rejected for 
the Royal Navy on account of defective sight, the 
cause in almost every case being simple myopia ; that 
is to say, that in two and a half years five and a half 
per cent, developed a degree of myopia that unfitted 
them for a service, for which they had undergone a 
long and expensive training. Further, in what is 
termed the select school and special class, out of one 
hundred boys there were seventeen rejections, the 
myopia also being of a higher grade than that found 
in the rest of the school. 

This is adding evidence to an evil to which our 



attention has previously been called — that short-sight- 
edness is developed during school life, and that it is 
found most frequently and of the highest grades 
amongst the most advanced classes; but it is well to 
follow Mr. Hadlow in his further examination into 
the condition of the school itself as regards the pro- 
duction of this affection ; because, as he says, not 
only is asthenopia or myopia a most serious disquali- 
fication for many conditions of life, but we have 
every reason to believe that the predisposition to 
become short-sighted is hereditary, and that the chil- 
dren of short-sighted parents have a much greater 
tendency to develop the same defect, if placed under 
unfavorable conditions, than others. He found the 
desks and stools of the same height for boys of all 
sizes and ages, with no backs, narrow seats placed 
much too far from the edge of the desk, and want of 
proportion between the height of the two. Some of 
the rooms were so dark in corners — and, very large 
corners, too — that it would be impossible on a winter's 
day ibr the boys to see to do their work properly 
without gas ; further, in every case the desks were so 
placed that the boys must sit with their backs to the 
light. 

This must not be considered as the present condi- 
tion of the school referred to, for it has been remedied 
in a most complete manner. The desks and chairs 
are graded to suit the size ; there is a board behind on 
the chair to support the loins just above the hips; 
the edge of the desk is perpendicularly above the the 
front of the seat, and the inclination of the desk can 
be altered from 20° for writing to 40° for reading, 
whilst a foot-board is attached, on which the feet rest 
naturally and easily. Obstructive partitions have 
been removed and windows inserted, to give not only 
a sufficiency of light, but from above and from the 
left. 

But with all these improvements, they fail in many 
cases where the continuous application to daily study 
is too prolonged ; as in a report on the education of 
the young from Alsace-Lorraine, where no fewer than 
eighty per cent, were found physically unfitted for the 
army. With them, boys of thirteen have, on an 
average, about eight hours' study a day; here the 
extreme prevalence of myopia is well known. 

Foreign Body in the Urethra. Dr. George 
Hunter, m.d., Linlithgow, writes: 

" An elderly gentleman, the subject of dysuria from 
prostatic enlargement, thought to aid the efforts of 
his bladder in its evacuation by insinuating the 
rounded head of his wife's veil-pin into the orifice of 
his urethra, and thereby opening up the passage. 
To his dismay, in its descent downwards it slipped 
from his fingers, and the point of the pin disappeared 
from his sight. His attempts at removal only caused 
it to make its way further back, and soon a discharge 
of blood from the meatus, and urgent but ineffectual 
attempts to pass urine, alarmed him, and induced him 
to send for me. On my arrival, I could just make out the 
head of the pin in the membranous urethra in front of 
the prostate, and could feel the point anterior to the 
scrotum. To remove it, I fixed the head by pressing 
on it from behind forwards, and then impaled the 



1883.] 



MEDICAL PROGRESS. 



53 



urethra against the point. By steady pressure and 
traction on the point as soon as it emerged from the 
under surface of the penis, the whole length of the pin 
was pulled through, only the head remaining in the 
urethra. The point was then depressed towards the 
perinaeum, and by compressing the flacid penis, in its 
longitudinal axis, the round head of the pin was easily 
passed through the meatus, and the entire pin with- 
drawn. In its removal, not a drop of blood was lost, 
and the puncture remaining was not more severe than 
that resulting from the use of the ordinary hypoder- 
mic needle. Beyond enjoining rest and quiet for the 
first twelve hours, 'nothing further was prescribed, and 
my patient was next day in his usual health." — Bi-it- 
ish Medical Journal. 

Case of Acute Peritonitis Following Intes- 
tinal Perforation. — Dr.- William Julius Mickle, of 
Bow, describes the following case : 

''M. M., aged 45, formerly a soldier in the 17th 
regiment, was a helper at a laundry for some years, 
and had mad-e no complaint of any malady whatever, 
although some mitral obstruction had been made out. 
Early one morning, complaining of constipation, he 
was given an aperient. After breakfast the bowels 
were freely moved. Then, seeming well, he worked 
all day until about 4:30 p.m., when he felt abdominal 
pains, or "cramps," as he called them, coming on, 
returned to his ward, laid himself down, and looked 
pale. Next, he was doubled up, groaning, breathing 
noisily, and complained of "cramps" over the belly, 
which was tender, and which he would not allow one 
to examine. The pain was obviously intense. The 
pulse was frequent, and variable in this respect ; 
somewhat sharp. Tincture of opium was given in- 
ternally, and a light hot poultice and turpentine : 
were applied to the abdomen. At 9 p.m., there was 
slight vomiting of food and mucus, and later of a 
greenish fluid. 

Next morning, he lay either on his back or on the 
right side, with the knees drawn up. The pain was 
continuous, and he stated it to be worst along the 
middle line; the tenderness, however, was highly 
marked over the caecum ; and in both flanks were 
slight dulness on percussion, and doubtful obscure 
fluctuation. He was eructating and then spitting out ; 
in mouthfuls, a dark-greenish, flaky and flocculent, i 
soup-like material, with brownish, soft, lather-like 
flakes floating on the surface. Temperature 99.7°; 
pulse 117, soft, feeble; respiration t,^, somewhat 
labored, moaning. No urine was passed. The 
bowels were not moved ; the tongue was moist, with 
a greenish and brownish coat. The tips of the ears, 
nose, and fingers were chilly. The eyes were heavy ; ; 
the face was of leaden hue. The pain was heavy | 
and continuous, with exacerbations, during which it \ 
resembled the piercing of knives, There was no \ 
sign of tumour, strangulation, or intussusception of 
bowels. ! 

I ordered him'to have one-third of a grain of morphia ! 
hypodermically ; also to take, each hour, five minims \ 
of tincture of belladonna, one minim of dilute hydro- 
cyanic acid, and one-sixteenth of a grain of morphia. 
He took three doses of this. Half an ou"ce of milk 



was given every half-bour. At 1:30 p.m., his nose 
was cold, his features collapsed; pulse feeble; pros- 
tration was advancing. At 3 p.m., he was somewhat 
drowsy; respiration varied from 18 to 24, and the 
pulse from no to 120, feeble, soft, small, becoming 
\ imperceptible. The pupils were moderately con- 
tracted. The patient, in reply to inquiries, said that 
the pain was relieved. After this, he gradually be- 
came comatose, and the respiration irregular, jerking, 
as if by several contractions of diaphragm ; and later, 
hiccough came on. Brandy was given by the mouth, 
and it and carbonate of ammonia by the rectum, 
while heat was applied to the feet. The pulse re- 
mained at from no to 120, and death occurred at 
5 P.M., or twenty-four hours and a half after the first 
complaint of abdominal pain. 

Necropsy. — Omitting most of the parts examined, 
it need only be said that the abdominal cavity con- 
tained some turbid fluid, partly escaped from the 
bowel, and with sanguineo-purulent material floating 
in it. These were mainly on the left side of the ab- 
domen. The parietal peritoneum was of an almost 
uniform scarlet redness. The great omentum was 
converted into a red fleece, tbe under surface of 
which was smeared in parts with purulent fluid. 
The appendices epiploicae were smeared in a similar 
way, as were also some coils of the small intestine, 
the other coils being slightly lymph-glued to- 
gether. There was general inflammatory redness of 
the outer coat of the exposed coils of intestine. 
In the upper part of the small intestine were much 
yellow mucus and semifaecal matter. In the de- 
scending colon and rectum was patchy redness, and 
in parts slight excoriation. In the lower part of the 
sigmoid flexure was a perforating ulcer, with bevelled 
edges and sloughy surface, which was open through 
an appendix epiploica into the abdominal cavity. 
Another ulcer with greenish edges was just beginning 
to perforate. The heart contained clots and treacly- 
fluid blood ; the endocardium was deeply blood- 
stained ; there was mitral stenosis ; the mitral valve 
was thickened, calcareous, and deformed. There 
was some hypertrophy and dilatation, especially of 
the left auricle. The heart weighed fifteen ounces. 
Some large gall-stones were found in the gall- 
bladder. 

Remarks. — As to the duration of this case — at 
least twenty-four hours and a half — it may be said 
that, writing of peritonitis, Dr. Habershon stated 
that instances of intestinal perforation are generally 
fatal in from five to ten hours ; and Dr. J. R. Wardell 
mentions that, in his cases, death occurred in from 
seven to twenty-three hours, and cites duration- 
periods from other authors varying from four to one 
hundred and five hours. 

Possibly constipation, or passing gall-stones, led 
to the irritation and ulceration of old cicatrices in 
the colon, results of disease contracted when cam- 
paigning long before." 

British Medical Journal. 

Remarkable Monstrosity. — Dr. Mulvaney writes: 
" On November 2, my late partner, Dr. H. C. Lin- 
den, sent for me to a case of a primipara, aet. 28, who. 



:54 



MEDICAL PROGRESS. 



[July, 



had been some hours in labor. It was a breech pre- 
sentation, and favorable progress had been made until 
the pelvic outlet was reached. There the head be- 
came jammed tightly, and during the next two hours, 
did not advance in the smallest degree.' As the pains 
were ceasing, notwithstanding the administration of 
ergot, it became necessary to deliver instrumentally. 
Several attempts at extraction by forceps proved fu- 
tile, and, as exhaustion was threatened, the blunt hook 
was employed, and after an hour's hard work, delivery 
was accomplished. The child was a full-grown anen- 
cephaloid male; life was extinct but very recently. 
The bones of the face were normally developed, but 
there was no calvarium. The cerebral substance was 
wanting, and its place was filled with bloody serum 
and a material which looked like a placenta ; to this 
the placenta proper was attached by its membranes. 
It was very large, measuring 6^ in. by 3^ in., and 
was deeply fissured at its anterior thi^rd. Two abor- 
tive cerebellar lobes were present. At the upper por- 
tion of the spine there was an opening into the spinal 
canal, from which sprang a lobulated body. Four 
cords were present, three focussing at this point; one 
running from the placentoid cerebral substance, the 
other from the placenta, and thethird joining the cord 
proper, a few inches from the umbilicus ; the fourth 
passed from the placenta in the usual way, and pre- 
sented a slight degree of fatty degeneration. It was 
rather large. The other cords had undergone fatty 
degeneration to a great extent. Being rather pressed 
for time, we were obliged to be content with a cur- 
sory examination." — British Medical fournal. 

Transposition of Viscera. — W. P., a sign writer, 
■ died, aged 40, of general paralysis of three years' 
standing. During life the transposition of the areas 
of percussion-dulness of the liver and spleen had been 
noticed. Heart showed aortic ventricle on right side 
thicker, stronger, and forming cardiac apex ; pulmon- 
ary ventricle on left side, auricle receiving systemic 
veins on left side ; auricle receiving pulmonary veins 
on right side — thin septum between, with patent fora- 
men ovale. Aortic arch directed towards the right, 
curved down vertebral column and descended on its 
anterior and' right aspect, through the thorax. Gullet 
passed down left anterior aspect of vertebral column, 
crossed to right below to gain oesophageal opening 
in diaphragm. Left lung had an imperfectly divided 
off middle lobe; right lung had made imperfect middle 
lobe, spleen in right hypochondrium. Liver had 
larger lobe in left hypochondrium and epigastrium, 
smaller lobe extending rightwards to spleen. Stomach 
had cardiac opening and cardiac end to right, and 
pylorus to left, of middle line. Duodenum to left 
end of ileum, the caoecum, and the appendix vermi- 
formis were in the left inguinal region. Ascending 
coloifleft, descending colon right, sigmoid flexure in 
rightjiliac fossa, and rectum slightly to the right side. 
Kidney on the left weighed 5 ozs., on the right 4)^ 
ozs. — William Julius Mickle, m.d, British Medical 
Journal, May 19. 

Foreign Body in Urethra. — J. B. Carter, aet 42 
— admitted into hospital — the day before had been 



drinking heavily, and in the evening was seized with 
severe pain in the perineal region, accompanied with 
some haematuria. On examination, a foreign body 
could be felt lying along the under side of the penis, 
from its lower half towards the perineum, and about 
the middle of the penis a sharp point was discovered. 
A small incision was made through the skin over it, 
and the point of a large black pin was then forced 
through, seized by a pair of forceps, and drawn out; it 
was between three and four inches in length. The head 
of the pin was then found intact in the urethra ; the 
point of the pin was therefore depressed ^, and the head 
pushed up through the urethra and drawn out through 
its orifice. A catheter was passed, and left in the 
bladder for twenty-four hours, and the wound dressed 
with carbolic oil. Blood was passed in the ur^ne 
several times afterwards. No urine escaped by the 
wound, and at the end of the week the man was sent 
out, cured. — Wm. Curtis, British Medical Journal. 

> 

The Oxytocic Action of Quinine. — Mr. Harti- 

gan, M.K.Q.C.P., of Hong Kong, writes: 

'' In three different cases, I have had on several oc- 
casions to discontinue the use of quinine, because it 
bi-ought on ' ' labor-pains, ' ' though the doses were 
small, varying from three to five grains. In one of 
these, during a previous pregnancy, another medical 
man used quinine, and discontinued it for a similar 
reason. All three were in fair general health, suffer- 
ing only from slight malarious fever, and had never 
aborted. One case has come under my notice, in 
which abortion took place, without apparent cause, 
after a ten-grain dose of quinine. The patient was 
the mother of several children, had not previously 
aborted, was in good health, and took the quinine to 
cure facial neuralgia. I know of another ease of 
abortion occurring under similar circumstances after 
quinine. This action of the drug is known to the 
Chinese, who take it (I am told with success) for the 
purpose of producing abortion, following its use by 
copious draughts of hot tea. I have myself heard a 
Chinese 'amah' (/. <?., female servant), recommend 
it. Quinine certainly, in some cases, increases the 
menstrual flow." — British Medical Journal. 

Jequirity (the abrus precatorius) in Granular 
Lids. — Dr. W. A. Brailey, Ophthalmic Surgeon, Eve- 
lina Hospital ; Assistant Ophthalmic Surgeon, Guy's 
Hospital, gives the treatment of three cases {^British 
Med. Jour. May 19), by this drug, introduced from 
the natives of Brazil, by DeWecker of Paris. The 
seeds are used in the form of a strong infusion, and 
applied to, or between the lids, thrice daily, until a 
severe conjunctivitis of a purulent or diphtheritic type 
is set up. He finds it to diminish, very considerably, 
the pain and photophobia, and to have a decided in- 
fluence in cleaning up the cornea, and could not suc- 
ceed in inoculating into the sound eye the ophthalmia 
produced by this agent. 

On the Local Use of Antiseptics After Labor 
AND Abortion. — Dr. W. Gill Wylie, in a paper read 
before the Medical Society of the County of New 



1883.] 



MEDICAL PROGRESS. 



55 



York, and reported in the N. Y. Med. Journal, June 
23, gives it as his practice: ist, to make a vaginal ex- 
amination, in all cases, some weeks before labor, and, 
if there is any leucorrhoea, to give warm vaginal 
douches, i to 50 sol. acid carbol. twice daily, and as 
soon as labor begins, wash the vagina and vulva with 
this solution. 

2nd. To prepare the room by the removal of all 
useless and old stuffy furniture, and to disinfect every- 
thing with the spray of carbolic acid solution. The 
linen so treated is changed twice every day, and two 
sets of blankets are aired and used alternately. All 
instruments and hands used are first washed in sol. 
(i to 20) acid carbol. 

3rd. When labor begins, the spray is set going, 
and after labor, every napkin is carbolized, or carbol- 
ized muslin or oakum is used to catch the lochia, and 
changed, according to the discharge, every hour or 
two, night and day. 

4th. Just after labor, the parts are thoroughly 
washed with a i to 50 sol. acid carbol., and vaginal 
douches are given from two to four times a day, and 
kept up for six or ten days, as required. 

5th. The test required is the total absence of any 
odor pertaining to the lying-in chamber. 

In thirty-six cases so treated by him, none had a 
rise of temperature over 102 F. at any time. He re- 
fers to four cases of abortion, detailing two of them, 
and considers, ist, that septic matter must be excluded 
with great care ; 2nd, that perfect drainage is very 
essential, as versions, and especially flexions, may 
cause retention of the lochia, and that contraction 
and swelling of the os internum very frequently is an 
active cause in preventing a constant and free drain- 
age j 3rd, that when septicaemia has begim within ten 
or twelve hours after the first chill or high tempera- 
ture, almost all cases may be cured by perfecting the 
drainage, and by washing out the cavity of the vagina 
or uterus by frequent douches of sol. (i to 40, to i 
to 20) acid carbol. 

He gives two instances of the dangers of intra- 
uterine injection. In one case, where there were 
symptoms of septicaemia after an operation on the 
cervix, very great shock followed an intra-uterine in- 
jection, but a very small catheter was used, and when 
the bed -pan was removed, not an ounce of the solu- 
tion was in it, nor had it escaped on the bed, for the 
catheter undoubtedly entered the Fallopian tube, and 
the fluid was freed into the abdominal cavity. The 
patient recovered in eighteen months, after suffering 
during that time with an extensive pelvic abscess. In 
another case, a patient with puerperal fever was rap- 
idly sinking, hav ng been brought into the hospital 
eight hours previously with a very high temperature. 
One carbolic intra-uterine injection had been given, 
which was followed by a slight convulsion and a faint- 
ing turn, temp. 105° ; pulse 130, with profuse per- 
spiration, etc. The injections were kept up every 
half-hour. The woman rapidly improved, and made 
a good recovery. If a large tube is used after the 
OS internum is well contracted, the injection may dis- 
tend the uterine cavity, be forced through the Fallo- 
pian tube into the peritoneal cavity, or a clot may be 
forced into a vein or through a sinus, and do harm. 



He recommends a gum elastic catheter, with a ten and 
a half inch mark to limit the length introduced into 
the uterus. 

In the discussion on this paper. Dr. Munde direct- 
ed attention to the fact that in all cases of puerperal 
septicaemia, there was a time when intra-uterine injec- 
tions not only did no good, but were even positively 
injurious : i . In cases where the lochia were not at 
all offensive, and the seat of infection seemed already 
to have spread to the parametric tissues. 2. Where 
the injections had been used faithfully for 48 to 72 
1 hours with little or no benefit — in the latter they 
seemed to provoke a traumatic rise of temperature, 
and sometimes to be followed by more or less haem- 
orrhage. 

Dr. McLean, to avoid the dangers of intra-uterine 
injection, used a continuous stream as from the foun- 
tain syringe, and with a soft catheter. 

Cigarette-Smoking. — This habit is receiving some 
consideration at present from the medical press. The 
New York Medical Journal, of June 23, in an edi- 
torial, considers that there is no just ground for look- 
ing upon cigarettes, used with proper precautions, as 
I in any way more capable of doing harm than either 
I cigars or tobacco. It is asserted, says the editor, that 
' the paper used in making many brands of cigarettes 
contains matter that is poisonous, and arsenic is usu- 
ally mentioned in this connection. If it were really 
\ present serious and unmistakable instances of arsenic- 
al poisoning would long before this have been traced 
: to cigarettes. Another allegation is that cigarettes 
: are sophisticated with some preparation of opium. If 
we compare the market value of tobacco with that of 
opium, we shall find that it will not suit the purposes 
i of the falsifier to adulterate a cheap commodity with 
! one that is expensive. Cigarettes furnish an induce- 
! ment to more frequent smoking it is true, but it takes 
! a number of cigarettes to equal a cigar in narcotic 
: effect, and being cheaper they are more likely to be 
smoked in part only than is the cigar, and the nico- 
tine is more apt to accumulate in the unsmoked end 
of either for absorption in larger quantities. One 
fault, that of inhalation into the lungs, and of ex- 
halation through the nostrils, is more apt to belong 
; to the cigarette smoker than to one who uses the 
^ cigar or pipe, and thus to increase the extent of ab- 
i sorbing mucus membrane. 

The London Lancet, May 26, considers that if 
cigarettes were smoked as in the East, where, accord- 
i ing to Sir Henry Thompson, Turkish ladies consume 
\ fifty or upwards in a day by taking a few whiffs and 
! then throwing the cigarette away, perhaps no harm 
I would ensue ; but to take a cigarette between the lips 
j and keep it there until smoked out, desposits a larger 
' quantity of nicotine from the finely-cut leaf than that 
' thrown by the smoke of a cigar or pipe. The sphyg- 
j mographia tracings are more characteristic in the 
\ cigarette smoker than in others, of the depression 
I produced by tobacco on the vaso-motor center and 
; nerves. Further the dryness of the mouth and 
i throat and the consequent demand for ''brandy and 
' soda," or some other stimulating beverage, is more 
: apt to follow the use of cigarettes than of cigars or 



.56 



EDITORIAL. 



[July, 



pipes. Sir Henry Thompson, it seems, has not found 
it beneath his dignity to invent a form of cigarette- 
holder which opens transversely in the middle and 
admits of being stuffed with cotton-wool, which takes 
up the nicotine from the smoke in passing through it, 
and can be frequently renewed. Used in this way 
he regards the cigarette as the least potent, and there- 
fore the least injurious, form of tobacco smoking. 

A Case of Addison's Disease. — In the report of 
the Western Infirmary, Glasgow Medical Journal 
June, a case of this disease is detailed at considerable 
length in a blacksmith, aet. 38, who attributed the 
cause of his sickness to a strain received while lift- 
ing, and giving him a constant pain in the right 
hypochondriac region. The discoloration of the 
skin came on very gradually soon after this, and his 
friends at first accused him of not having washed his 
face thoroughly. The strain was received in Janu- 
ary, 1882; in July the skin became very dark in 
color. In August had inflammation of and purulent 
discharge from left lower jaw. In September diar- 
rhoea. In December an attack resembling typhoid 
fever. In January, 1883, ^^^ taken with headache 
and shivering, followed by pains in the right side of 
the back, extending down the right groin and into 
the right testicle. This attack lasted three weeks, 
after which he gained flesh and got stronger. At 
present is not emaciated, skin cool and soft ; temper- 
ature generally 98. No alteration of blood seen in 
microscopic inspection ; bowels regular ; appetite 
good ; tongue appears as if slightly stained with ink ; 
mucous membrane inside lips of a mottled, brown 
color, and on the inner side of each cheek opposite 
the teeth the pigmentation is of a blackish tinge. The 
pharyngeal mucous membrane is congested but not 
pigmented ; has always been healthy ; had scarlet 
fever when young ; denies any venereal disease ; cica- 
trices in right groin where he had a suppurating bubo 
twenty years previous ; takes whisky freely ; no 
hereditary taint discovered. 

In the face he has the complexion of an Arab. The 
discoloration is especially distinct on the alge of the 
nose; also below each eye. The conjunctivae appear 
very white. The brown color of the face shades off 
and becomes lighter in those parts that are covered. 
The skin of his neck is very dark behind but 'gradu- 
ally gets of a lighter shade as we pass forwards. At 
the back of the neck are two small cicatrices caused 
by burns ; these are discolored slightly, but around 
them is a distinct zone of skin where the pigment is 
more abundant. A streak of pigmentation runs 
down the lower part of the back in the middle line, 
the color being deeper over each spinous process. In 
the lower part of the lumbar region, on the right 
side, there is an area of the skin where the pigment 
is very abundant ; it corresponds to the place where a 
turpentine stupe was applied. The skin is discolored 
above each clavicle where the braces cross. The skin 
on the chest is very slightly tinged, becoming more 
marked as we approach the shoulders, and very dark 
in the axillary fold. The nipples are of brownish 
black color, and there is a slight secondary areola. 
The color becomes darker on the abdomen ; there is 



a narrow streak of pigment from the xiphoid cartilage 
to the pubes ; the navel is darker than usual ; the 
scrotum is the part most deeply pigmented ; the penis 
being also dark brown ; the legs are pigmented more 
posteriorly than anteriorly, about the malleoli and 
over the dorsi of the feet ; the right arm is more 
marked than the left, the inner side than the outer 
side ; the skin around the olecranon is deeply pig- 
mented. The backs of the hands look as if stained 
by the juice of walnut bulbs ; the palms are almost 
free from pigment. The color of the skin over the 
body is darker when the surface is cold. 



NEW INVENTIONS. 



An Instrument for Collecting Morbific 
Germs Exhaled With the Breath. — Mr. Francis 
Vacher, of Birkenhead, has devised an instrument, 
a wooden cut of which is given, with the description 
in the Sanitary ^^(T^r^ of London, May 15, especial- 
ly intended for measles, but which might be applied 
also to scarlatina and typhus fever. It consists of a- 
hard metal cap to fit over the nose and mouth, the 
border touching the face being lined with an India 
rubber air cushion fitted with a tap. On one side is 
a valve opening inwards, and at the apex of the cap 
is a fine hole through which the exhaled^ breath is 
directed on a glass slip coated with one part of white 
of egg to three parts of distilled water. Before being 
used the instrument is plunged in warm water (about 
100° Fahr.) so that the breath may not condense up- 
on the metal. It is well to add to the water a small 
quantity of some simple disinfectant. As soon as the 
cap is warmed and dried, the glass slip charged with 
albumen is placed in position, and the patient is 
directed to breathe five or six times into the cap. 
Then the glass is withdrawn and dried over a spirit 
lamp, and the instrument is cleansed. A sample of 
healthy breath should be taken at the same time and 
the two' samples may be stained with vesuvian brown 
and mounted in Canada balsam at any convenient 
time. . . 



EDITORIAL. 



The Meeting in Cleveland. — The recent meet- 
ing of the national Medical Association in Cleveland, 
was a successful one in all important respects. The 
large number in attendance, representing the profes- 
sion in all parts of the country, indicated that the in- 
terest in the organization was still on the increase. 
The number of topics of general interest, such as a 
procurement of adequate provision for the Army 
Medical Museum and Library by Congress ; the gain- 
ing of more knowledge concerning the meteorological 
and sanitary condition of important health resorts; 
the communication from a committee of the British 
Medical Association in relation to co-incident obser- 
vations regarding the prevalence of certain diseases; 
the better training of nurses for the sick, etc., equally 
indicated that its influence both in and out of the 
profession was felt and appreciated. The number 
and character of the addresses, reports, and papers in 



1883.] 



EDITORIAL. 



57- 



the several Sections, indicated decided advancement 
in the more scientific part of the Association work- 
And, certainly, the number and high character of the 
social entertainments, afforded ample proof that the 
importance of the organization was well appreciated 
by the citizens of Cleveland. All the business in the 
general sessions was transacted in good order and 
with a commendable degree of harmony and good 
feeling. Dr. Atlee presided with dignity, and all the 
officers, including the committee of arrangements, 
discharged their duties with fidelity and success. 
And, in the selection of that well-known author and 
Nestor of the profession. Dr. Austin Flint, Sr., for 
President, the present year, the Association performed 
an act alike complimentary to itself, to the recipient 
of its highest honor and satisfactory to the whole 
profession. Surely, none of these things betoken 
either premature weakness, or waning influence, on 
the part of our national medical organization. We 
only wish those who keep themselves at a distance, 
and take council of their own suspicions and fears, 
would come inside of the meetings and have both 
dispelled, by lending a helping hand in the important 
work of harmonizing and advancing the interests of 
one of the noblest professions that exist among men. 



Do Moral Principles Change? — Are they subject 
to the Darwinian law of evolution ? Has time ren- 
dered the declarations of the decalogue obsolete ? 

We are constrained to ask the foregoing questions by 
expressions we hear occasionally concerning the 
National Code of Ethics, by a class of physictans 
who are properly represented by Dr. S. Pollak, in the 
preamble and resolutions he offered to the recent 
meeting of the American Medical A.ssociation, and 
which can be found in the record of proceedings con- 
tained in the first number of this Journal. He says: 

" The Code of Ethics has an existence coeval with 
the organization of the American Medical Association. 
It was absolutely necessary then, and it cannot be 
entirely dispensed with now. But in thirty-four 
years this country has presented so many phases in 
its development and progress, that new laws are b^ing 
constantly enacted, and old laws are repealed or 
modified to suit the requirements of the time. The 
Code has accomplished all that it was designed it 
should, but at present many of its features are obso- 
lete, and not adapted to our wants." 

Reduced to syllogistic fomi, the position would- 
stand thus : The Code of Ethics is thirty-four years 
old. During that thirty-four years, there has been 
such progress in the development of the population, 
internal improvements, and various industries of the 
country, that new laws are being enacted, and old 
ones modified. Therefore, many of the features of 
the Code of Ethics relating to the medical profession 
are obsolete. It is about as easy to see a specimen of 
Koch's bacillus tuberculosis through a pair of com- 
mon spectacles, as to see the relation between these 
premises and the conclusion placed as a deduction 
from them. We had supposed that a code of ethics 
was an embodiment and application of those moral 
rules or principles which indicate the duties, and 
.should regulate the conduct, of some class of intelli- 



gent beings. A code of ethics for the medical pro- 
fession should embody the ethical rules or moral 
principles that indicate the duties of the physician 
to his patients, to his brother physicians, and to the 
community in which he lives, with such application of 
those principles as will afford a just guide for the 
regulation of his conduct in each of the three rela- 
tions named. 

Now, our National Code of Ethics is simply this, 
and nothing more. And if it was necessary and 
right thirty-four years ago, what are the changes that 
have taken place in the relations betw^een the physician 
and his patient, or between the physician and his 
brother practitioner, or between the physician and the 
community in which he lives, that have rendered 
"many of its provisions obsolete?" 

Has the mere increase in the number constituting 
the profession, or the extension of the boundaries of 
medical knowledge, or the increase of general popu- 
lation, altered in any degree the practical duties and 
relations of the physician, or the rules that should 
regulate them ? The lapse of time may bring such 
extensions of social, educational, commercial and 
physical interests, as to require the frequent modifica- 
tion of old laws and the enactment of new ones, but 
it cannot change the principles of justice and equity 
between man and man, or the ethical principles that 
should regulate the conduct of any particular class 
in human society. And our friend from Missouri, 
from whom we quoted our text, should know that all 
the essential principles, and much of the language of 
our National Code, are taken from the work of Dr. 
Thomas Percival, an English physician, published in 
in 1803, and which has served as a guide for the En- 
glish profession nearly a century. And the same will 
probably continue to be the guide of the great mass of 
intelligent medical men through the centuries to come. 
As in the past, so in the future, additional clauses or 
sections may be added for the purpose of making ex- 
isting principles cover some new combination of cir- 
cumstances, but neither the lapse of time, nor the pro- 
gress of human society, will change the nature of a 
moral or ethical principle, or render its application in 
the regulation of human conduct obsolete. 



Bacillus Taberculosis. — Each contribution to 
our knowledge of this organism by microscopists 
of eminence is welcome. Some time since Spina of 
Vienna published an account of experiments of his 
own to test the accuracy of those of Koch. He 
found that the tubercle bacilli did not, as had been 
asserted, take stainnig peculiar to themselves and 
different from other forms of bacteria. Koch, in his 
reply to his critics in turn severely criticized Prof. 
Spina's experiments. At a recent meeting of the 
Society of Physicians at Vienna, Professors Strieker 
and Spina reaffirm the previous observations, and 
describe a new series of exjjeriments carried on by 
them to test the same point. They also claimed that 
they had produced tuberculosis in healtKy animals by 
the injection of glass and cinnabar, the possibility of 
which has been denied, provided due care is 
taken to prevent contamination by tuberculous mat- 
ter at the same time. It is not to be presumed 



58 



PHILADELPHIA LETTER. 



[July, 



that gentlemen of such scientific eminence as Profes- 
sors Strieker and Spina would repeat these experi- 
ments without taking every precaution to make them 
trustworthy. Their conclusions, therefore, deserve 
careful consideration by unbiased thinkers. Pro- 
fessor Feltz, of Nancy, France, has also been repeat- 
ing Koch's inoculation experiments with cultivated 
bacilli. He does not consider his experiments de- 
cisive and will repeat them, but, thus far, he has 
failed to produce the disease of which the bacilli 
were the supposed cause. 



of the Chairman of the Section on Practical Medicine 
and Materia Medica, and such other papers belong- 
ing to that Section as the space will permit. 



Endowments. — We are glad and at the same time 
sorry to see that Dr. Eliphalet Clark, of Deering, 
Maine, has bequeathed some valuable land as an en- 
dowment for a new medical college. We are glad 
to see endowments made to medical schools. It is 
only surprising that the many wealthy and generous 
men in our country who have made endowments to 
schools and colleges have almost uniformaly over- 
looked medical institutions. The public should be 
most deeply interested in having medical education 
in this country as good as is possible ; for otherwise 
it will suffer from the ignorance of the profession. 
While it is generally admitted that no literary or 
scientific college can be maintained properly, and its 
grade of scholarship kept at a proper standard with- 
out liberal endowments, still medical colleges have 
been allowed to shift as best they could. Is it sur- 
prising, under these circumstances, that the require- 
ments for admission to, and graduations from, the 
great majority of American medical schools are so 
slight ? We repeat we are glad to see endowments 
made to medical colleges ; but we are sorry that they 
are not made to some of those already established, 
and that have gained reputations for good teaching. 
It is such schools that deserve these pecuniary re- 
wards. 



Notice. — The mailing of the first number was de- 
layed by causes incident to the arranging and 
printing of new mailing lists. We have endeavored to 
supply accurately all the members who have been re- 
ported to us by the Treasurer as having paid their 
annual membership fees, and also all others who had 
sent us pledges of support. If any find themselves 
omitted, or their addresses incorrect, they will confer 
a favor by promptly notifying us. Let it also be re- 
membered that all payments of membership dues 
should be made to the Treasurer, Dr. R. J. Dung- 
lison, P. O. Box 2386, Philadelphia, Pa. And all 
subscriptions from non-members or other matters of 
business, should be sent to the office of publication, 
65 Randolph street, Chicago. 



Editorial Association. — In compliance with the 
unanimous request of the American Association of 
Medical Editors, at its recent meeting in Cleveland, 
we have occupied a large part of the space in the 
present number with the addresses before that body. 
They relate to topics of much importance, and we 
hope their reading will not be devoid of interest and 
profit. The next number will contain the address 



DOMESTIC CORRESPONDENCE. 



PHILADELPHIA LETTER. 



As predicted in our last letter. Dr. Thcophilus 
Parvin was elected to the chair of Obstetrics and Dis- 
eases of Women and Children, at the Jefferson Medi- 
cal College, recently made vacant by the resignation 
of Dr. Ellerslie Wallace. This accomplished physi- 
cian and distinguished teacher, has been for the past 
two years professor of obstetrics and diseases of women 
in the medical department of the University of Louis- 
ville, Ky., where he attained a high reputation as a 
brilliant and instructive lecturer. It is very gratify- 
ing to the students, as well as to the alumni of Jeffer- 
son College, that Dr. Wallace's place has been filled 
in such an acceptable manner ; and the faculty also 
congratulate themselves on such an agreeable acces- 
sion to their ranks. Dr. Wallace has been elected 
emeritus professor. 

Dr. Parvin is also well known as a medical writer, 
having contributed largely to American medical 
literature, both as an editor, and author. Philadel- 
phia maintains her prominence as a medical center, 
not only by the high standing attained by the gradu- 
ates of her schools, but by the wise selection of com- 
petent men to fill vacancies in her ranks of medical 
teachers, for which purpose the very best that the 
country can afford are always chosen. 

On Friday, June 30, the Muller modification of 
the Porro operation, in turn a modification of the 
Caersarian section, was performed at the Philadelphia 
almshouse. Dr. W. H. Parrish, of this city, the sub- 
ject being a dwarf aged forty years. The woman is 
only fifty-one inches in height, though both parents 
are of ordinary stature. She has suffered with a 
curvature of the spine since early childhood, causing 
a malformation of the pelvis of such a character that 
delivery in the natural way was impossible. Ether 
was administered, an incision made through the 
abdominal wall, the uterus elevated from the abdomen, 
into which an incision was then made and a living 
foetus removed. The uterus was then amputated at 
the cervix. This is said to be the fourth Porro opera- 
tion in this country, the first successful one, as far as 
both mother and child is concerned, being performed 
by Dr. Elliot Richardson about three years ago. The 
woman in that case, also, was a dwarf, and survived 
the operation two years, recovering entirely from its 
effects. 

We have just received word that the mother opera- 
ted on at the almshouse Saturday, is dead and the 
child doing well. Such a result was anticipated, 
however, as the patient was suffering with chronic 
Bright's disease of the kidneys at the time of the 
operation. She died of uraemia, the result of an 
acute exacerbation of the kidney difficulty. The 
urine before operation showed numerous hyaloid, 
granular, and epithelial casts, and precipitated one- 



1883.] 



SOCIETY PROCEEDINGS. 



59 



third albumen. An autopsy revealed union along 
the entire peritoneal surface of the abdominal incis- 
ion, no general peritonitis, and a clean peritoneal 
cavity. A full report of the case will be published. 

But little of importance is progressing in medical 
circles in the city, owing to the advent of the heated 
term. The schools are all closed, and the streets 
quite deserted of pedestrians, a general exodus hav- 
ing been made to the various watering places, and 
summer resorts, to escajje the rays of t^ie pitiless sun, 
which beats down upon the stone pavements and 
brick houses with relentless energy. One of the 
features of the fall campaign, however, will be the 
opening of the post-graduate school at the Jefferson 
Medical College. This course has long been needed; 
and, judging from the wise selection of instructors, 
and the valuable clinical material on hand, there is 
reason to prognosticate a successful outlook for this 
new department in educational work. 

We also take pleasure in chronicling the visit to 
our city of Medical Director Gihon of the U. S. 
Navy, who recently spent several days in our midst. 
It is also worthy of special note that two of our emi- 
nent physicians and scientists have recently received 
recognition of their high standing and attainments 
by having conferred upon them the the degree of 
LL.D. We refer to the distinguished chemist. 
Prof. Robert, E. Rogers, of the Jefferson Medical 
College, and Prof. H. C. Wood, of the Medical 
Department of the University of Pennsylvania. Dr. 
Rogers received his degree from Dickerson College, 
and Dr. Wood was honored by Lafayette. 



SOCIETY PROCEEDINGS. 



CHICAGO MEDICAL SOCIETY. 



At the meeting of the Chicago Medical Society held 
June 4, 1883, Dr. R. Tilley presented'' a patient 
under his care, who is being treated for deafness, and 
in whom he recently discovered numerous bacteria, 
in the secretions removed from a decayed tooth. 

The fungi were taken from the tooth in presence of 
the members, and exhibited under the microscope. 
Regarding their origin, the doctor was unable to de- 
cide positively whether their presence was the cause 
or effect of the dental decomposition, but inclined to 
the former opinion. 

Dr. A. Bryan read an interesting paper on the sub- 
ject of -'Stammering," in which several pathological 
points of paramount interest were brought to notice, 
upon which the literature is meager. The following 
extracts upon this topic were taken, which may occur 
in persons of perfect physical integrity, and is the 
result of mal-habit or mal-education of the nerve 
centers, presiding either immediately or remotely over 
the organs of articulation : 

The act of stammering usually consists in the 
attempt of a person to articulate an elementary sound 
while the vocal organs remain in the position proper 
for the utterance of the sound which precedes it in 
the same syllable. 

A traumatic lesion of the mouth may temporarily 



disable a person in certain forms of utterance, if so, 
these cases are confined usually to a single letter, and 
often to only a single word. The worst stammerers 
are capable of stammering upon every letter of the 
alphabet and upon every word in the language, and 
stammer between words. At times momentarv vertigo 
may ensue in the extreme stammerer, and tetanic 
action of a number of the facial muscles may occur. 
Stammering is more persistent in those of small intel- 
lectual caliber, and disappears more readily in per- 
sons of high or good intellectual capacity. Fear will 
enhance the difficulties of the stammerer, so too will 
cold, by decreasing the rapidity of nervous conduc- 
tion. During the hot weather in summer, stammerers 
are often greatly improved. 

Buoyancy of spirits affords relief. Consciousness 
of the presence of superior and arrogant persons 
plunges the common stammerer into difficulty, where- 
as the presence of a benign superior aids him. Vigor- 
ous mental excitement usually aids and relieves the 
stammerer. A sense of healthful joy often does away 
temporarily with all difficulty of utterance. Among 
the causes was antecedent disease. Children recover- 
ing from extreme adynamia in acute disease are liable 
to stammer aftenvard. And a lc.rge proportion of 
stammerers are made by imit-.ting others who (mimic) 
a sufferer from the malady. 

A large number taki on their trouble by uncon- 
scious imitation. A child may imitate its brother, 
sister, or parent — cases that supervene in this manner 
are not so inveterate as those that arise through ridi- 
cule or through a malicious purpose. Children born 
of stammering parents usually stammer with great fa- 
cility, but in these it may be of transient duration. 
Stammering is not analogous to aphasia due to cere- 
bral lesion. The treatment, carried out intelligently, 
should usually be successful, for the tendency is to 
spontaneous recovery. Total non-interference should 
be adopted in treating all young children who have 
acquired the impediment by unconscious imitations. 
The child should be placed in circumstances of abso- 
lute freedom of general growth, physically and men- 
tally. A warm climate enhances recovery by increas- 
ing the velocity of nervous conduction. The self- 
confidence of a child should be cultivated. He 
should be removed from all opportunity to imitate 
another stammerer, and should be taught music, 
dancing, and calisthenic exercise. The intelligent 
adult stammerer should be drilled in elementary ar- 
ticulation. His general culture should be carried to 
on extreme extent and a high form of will should be 
carried on the part of a patient. 

Dr. E. G. R. Trimble, a sufferer from this lingual 
impediment, asked the writer if stammering was apt 
to be accompanied by neurasthenia ; also if, in hered- 
itary cases, the hesitation generally occurred on the 
vowels or consonants. Answered "No," relative to 
neurasthenia, and secondly, that the hesitation most 
■often occurs on the vowel sounds. 



Neurological Association. — At the meeting of 
the American Neurological Association, Dr. J. W. 
Morton, of New York, read a paper on "Neuritis fol- 
lowing Dislocation at the Shoulder. ' ' The peculiar- 



6o 



SOCIETY PROCEEDINGS. 



[July, 



ity of this case was that the inflammatory action 
extended along the affected nerves of the right side 
involving the cord, so that symptoms manifested 
themselves also in the left arm and hand; but instead 
of causing atrophy of the tissues supplied by the 
nerves from the diseased center, as is usual, there was 
an over-excitability of the neuro-muscular tissues. 
The case was treated by electricity, a blister over the 
tract of the brachial plexus, hot and cold douches, 
and the use of cod-liver oil. 

Dr. C. L. Dana, of New York, read a paper on 
"Hydro-Bromic Acid as a Substitute for the Bro- 
mides." He had used it during the last two years in 
cases of epilepsy, alcoholism, various forms of head- 
ache, vertigo, general nervous depression, neuras- 
thenia, chorea insomnia, hysteria, etc. He had 
observed the most benefit in cases of post-hemiplegic 
and lighter nervous troubles. He did not find that it 
would prevent cinchonism. Its chief advantages 
over the haloids are that it is more agreeable to take, 
less irritating, and does not produce bromism. The 
doses should be larger than that usually employed. 
Of the officinal or ten per cent, solution, one to two 
drachms and a half, are the doses which he found 
most serviceable, and of the pure acid from ten to 
twenty drops. 

Dr. J. J. Putnam, of Boston, described eight cases 
of "Lead Poisoning Simulating other Forms of Dis- 
ease," such as chronic and sub-acute myelites, and 
one case of cerebral disease. He pointed out also 
certain sources of error in detecting lead in urine. 

Dr. J. T. Eskridge described a "Case of General 
Neuralgia" and Dr. C. C. Mills a "Case of Loco- 
motor Ataxia terminating as General Paralysis of the 
Insane." The patient had had syphilis, and was 
addicted to venereal and alcoholic excesses. After 
death microscopical examination showed that the 
spinal cord was sclerosed throughout, especially in the 
lumbar region. There was also diffuse inflammation 
of the pia mater. Sclerosis had occurred in the pons, 
the optic thalami and those cerebral convolutions that 
were examined. After reviewing the literature of the 
subject, the author stated his belief that in the case 
described the brain had not been affected by simple 
extension of disease from the cord, but that various 
portions of the cerebro-spinal system had been 
attacked separately. 

Dr. E. C. Spitzka, of New York, made some 
remarks refuting the "Alleged Relations of Speech 
Disturbance and Patellar Tendon Reflex in Paretic 
Dementia. ' ' 

Dr. R. T. Edes, of Boston, described some origi- 
nal experiments upon the "Excretion of the Phos- 
phites and Phosphoric Acid as connected with Mental 
Labor." He was unable to find evidence to corrobo- 
rate the strong popular opinion that the excretion of 
phosphoric acid was increased by mental labor. 

Dr. S. G. Webber, of Boston, reported several 
"Cases of Locomotor Ataxia with unusual symptoms 
and marked remissions in their course. ' ' 

Dr. R. W. Amidon, of New York, described a 
"Case of Tetanoid Paraplegia occurring in a Child," 
the tetanoid symptoms being preceded by indications 
of sub-acute hydrocephalus. Dr. Amidon suggested 



that the central trouble might, by extension to the 
chord, be the cause of the tetanoid manifestations. 
He also described two "Anomalous Cases of Parkin- 
son's Disease." They were peculiar in showing all the 
symptoms of the trouble except the tremor. 

Dr. V. P Gibney, of New York, showed a " Case 
illustrating Progressive Muscular Atrophy" and 
also one manifesting " Fibrillar Twitchings Follow- 
a Gunshot Wound." 

Dr. W. J. Morton, of New York, read a paper in 
which he described an " Apparatus for Treating 
Scrivener's Palsy." This consisted of a light metal- 
lic thimble for the index finger, to the end of which 
was attached the pen. A rubber band was placed 
around the thumb and finger so as to offer some re- 
sistance to extension and abduction. This appara- 
tus kept the muscles on the stretch. 

Dr. G. M. Hammond narrated a " Case of Loco- 
motor Ataxia," in which there was apparently cure, 
and in which even tendon reflex had returned. 

Dr. F. T. Miles, of Baltimore, read a paper on 
" Nutritive Alterations of the Hand from the Press- 
ure of a Dislocated Humerus in the Axilla." 

Dr. Burt G. Wilder, of Ithaca, presented photo- 
graphs and a specimen of the ' ' Brain of a Cat lacking 
the Callosum." During life the animal had shown 
no peculiarities. He also read papers " On the Al- 
leged Homologies of the Carnivoral Fissura Cruciata 
with the Primatial Fissure Centralis," "On the Re- 
moval and Preservation of the Human Brain," and 
"On Some Points in the Anatomy of the Human 
Brain." 

Dr. W J. Morton, of New York, read a paper en- 
titled " Treatment of Migraine." He pointed out 
two types of the disease, the one spastic, the other 
paralytic. In the first form the bromides, especially 
sodium bromide was preferred. When given freely 
it usually aborted the attack. Nitrite of amyl and 
nitro-glycerine were also frequently beneficial. The 
paralytic form was usually most benefited by ergot 
and strychnia. Cauterization a.id electricity judi- 
ciously applied, also did good. 

Dr. W. R. Birdsall, of New York, discussed the 
"Relation of Syphilis to Locomotor Ataxia." From 
the statistics which he had gathered, he was unable 
to agree with Erb, that the disease always followed 
syphilitic disease. 

" Galvanization of the Brain and its Value in the 
Treatment of Chorea," was considered by Dr. C. 
L. Dana, of New York. Anodal electricity when ap- 
plied to the brain, he thought acted as a sedative, re- 
tarding the circulation. In the cases of which he 
kept records, it seemed that under treatment by 
electricity, they recovered much more quickly than 
when using arsenic alone. 

Several other papers were read by title only. 



Triplets. — On June i8, the Chicago Medical So- 
ciety held a regular meeting, and Dr. Henry Ogden^ 
read a valuable paper on Obstetrics. This topic was 
made more interesting ai.d prolific by a carefully 
written report on a " Trio of Cases of Triplets," all 
having occurred in this city recently, within the space 
of seven weeks. The first case cited was the birth of 



1883.] 



REVIEWS. 



6i 



three living girls, born to a German family at 96 Ful- 
lerton Ave., on the morning of February 11, 1883, 
during the half hour intervening between 7:30 and 8 
o'clock. In ten minutes after the last child was born, 
a very large placenta came away. The babies weighed 
6^ tt)s., 5 14 R)s., 4)^ lbs. Mother's recovery was 
protracted, but at this date all are well. 

The second case occurred in an American family, 
at 341 W. Randolph street. The triplets were boys, 
two of whom were born alive, on the morning of 
March 30, 1883, during the half hour from 5:30 to 6 
o'clock. At 7 A. M., the third boy was still-bom, 
and by appearances, had been dead for several hours. 
In about 20 minutes, the placenta came away. The 
following were their weights: 5)^ lbs., 5 lbs,, 4^ 
lbs. The mother was very well all through her ges- 
tation, and is now quite well, and nurses the two sur- 
viving babies. 

Third case, all girls, born to Swedish parents, re- 
siding at 1675 Gehrlce Ave., on March 27, 1883. 
The first child was born at 10 a. m., and was below 
the normal size, the presentation being cephalic. 
The other two were cross-births on presentation, and 
turning was promptly resorted to, the last child being 
born with both arms extending alongside of the head. 
But five minutes intervals occurred between the births 
of the children, which were all born alive, their 
weights being 6 lbs. i oz., 6 lbs. 4 ozs, 6 lbs. 9 ozs. 
The urgency of the case prevented the last child from 
being born in other than the manner in which it was, 
as the arms were above the head at the superior strait, 
and pulsation had ceased in the cord, and a lesson 
from Deventer, who wrote in 1 724, that everything had 
succeeded well in his practice by this method, ' ' not 
much as one head having stuck in the mouth of the 
womb," was called to mind and acted upon. The 
mother's recovery was tedious, on account of an at- 
tack of cellulitis. 

A supplementary' report was stated, wherein Dr. J. 
W. Edwards, of Mendota, Illinois, had kindly fur- 
nished a case of triplets of three girls, born to Irish 
parents, on the morning of June 3, 1881, in that city. 
There were three separate placentae in this case. The 
children are now two years old, and all well, as also 
the mother. Since the above paper was read, another 
case where three children at one birth were born to a 
German family residing on Emma street, all of whom 
are doing well, has come to our knowledge. 



Transactions of the Medical Society of the 
State of Tennessee — Fiftieth Annual Meet- 
ing ; 1883. 

This volume of 104 pages does credit to the 
Society, for it is in good type, on excellent paf)er, and 
is well arranged, and pas.sably well indexed. Dr. A. 
B. Tadlock reports an interesting case of femoral 
hernia; death seventy-four days after the operation. 
Dr. J. S. Sinclair reports two cases of plastic-surgery — 
one for the relief of ectropium, by transplantation 
from the arm; the other for the relief of symblepharon 
by conjunctival flaps. Dr. W. D. Hazzard reports a 
case of ovarian tumor of twenty-two years' duration. 
Dr. J. S. Nowlin discusses vaccination and small-pox, 
and Dr. J. W. Davis reports a case of induced 



delivery in a patient who was treated for abscess of 
the liver, and to whom in the last week of the eighth 
month of pregnancy he gave for this purpose quinine 
gr. 4, morphine gr. ^4 ; dilated the os with very little 
difficulty; ruptured the membranes, and by frequent 
stretching of the os with the fingers, labor was brought 
on in less than two hours, and she was delivered of 
twins. 



REVIEWS. 



A System of Surgery by V.\rious Authors ; edited 

by T. Holmes and J. W. Hulke ; third edition, 

in three volumes. 

A work so large and exhaustive as this, cannot be 
prop)erly reviewed in the small space at our disposal. 

It is twelve years since the second edition of this 
work appeared, and the many additions to all the 
departments of surgery which have occurred since 
then have necessitated a thorough revision of the 
whole work and even the rewriting of many portions. 

The present volumes are well printed, and very fully 
and handsomely illustrated. Each volume contains — 
in addition to many wood-cuts — several full-page 
plates. 

The chapters are grouped under five divisions or 
parts. The first includes General Pathology, and oc- 
cupies about one-third of the first volume ; the second 
part treats of General Local Injuries, and the third 
of Injuries to Special Regions. These three parts fill 
the first volume. Part IV discusses the Diseases of 
the Various Organs, and occupies the whole of the 
second volume and tvfo-thirds of the third. The re- 
mainder of the work treats of Operative Surgery, 
Minor Surgery, Plastic Surgery, Amputations, Excis- 
ion of Bones and joints, and an appendix on Surgical 
Diseases of Childhood. 

The amount of labor expended in revising the 
work and bringing it into its present form cannot be 
shown better, probably, than by giving the names 
and stating the work of the various revisers. W. An- 
derson, Assistant Surgeon to St. Thomas' Hospital, 
wrote the chapter on Animal Poisons, which replaces 
the same chapter in former editions by Mr. Poland. A. 
E. Barker, Assistant Surgeon to University College 
Hospital, replaced the essays of previous editions pre- 
pared by Mr. Athol Johnstone, Mr. Shaw, and Mr. 
Holmes Coote, on Diseases of the Joints, of the 
Spine and of the Tongue; he also edited Dr. Lock- 
hart Clarke's essay on Diseases of the Muscular Sys- 
tem. J. Birkett, Consulting Surgeon to Guy's Hos- 
pital, prepared the articles on Injuries of the Pelvis, 
Hernia, Diseases of the Breast. J. R. Bristowe, Phy- 
sician to St. Thomas' Hospital, edited the articles on 
Diseases of the Skin, which were written by Sir W. 
Jenner, Dr. Hillier and Mr. Nayler. B. E. Broad- 
hurst, Surgeon to the Royal Orthopcedic Hospital, 
wrote the essay treating of Congenital Dislocations 
and Intra-uterine Fractures. C. E. Brown-Sequard, 
Professor of Medicine at the College of France, that 
on Injuries of the Nerves. G. Brusk, Consulting 
Surgeon to Seamen's Hospital, prepared the articles 
on Parasites and the Diseases which they Produce ; 



62 



REVIEWS. 



[July, 



also that on Venomous Insects and Reptiles. H. T. 
Butlin, Assistant Surgeon to St. Bartholomew's Hos- 
pital, prepared the essay on Tumors, and re-edited 
those of Mr. Holmes Coote on Abscess and of Sir J. 
Paget on Ulcers. W. Watson Cheyne, Assistant 
Surgeon to King's College Hospital, wrote that por- 
tion which treats of Artificial Limbs. Mr. Callen- 
der's essay in previous editions on Pyaemia has been 
replaced by one written by H. H. Glutton, Assistant 
Surgeon to St. Thomas' Hospital. The article on 
Gangrene formerly prepared by Mr. Holmes Coote, 
for this edition was written by W. H. Cripps, Assist- 
ant Surgeon to St. Bartholomew's. J. Croft, Sur- 
geon to St. Thomas' Hospital, re-edited Sir J. Paget's 
essay on Wounds, and wrote those on Hectic Fever, 
Treatment of Cases after Operation, and Antiseptic 
Method of Dressing Wounds. W. B. Dalby, Aural 
Surgeon to St. George's Hospital, describes Diseases 
and Injuries of the Ear ; A. E. Durham, Surgeon to 
Guy's Hospital, Injuries of the Neck; and G. Har- 
ley, Apnoea. R. G. Godlee, Assistant Surgeon to 
University College Hospital, reedited the essays" on 
Surgical Affections of the Skin by Mr. T. Smith, and 
Diagnosis and Regional Surgery by Mr. Holmes. Dr. 
Barclay's essays on Delirium Tremens and Diphtheria 
and Croup, Mr. Durham's on Diseases of the Nose, 
and Mr. Holmes Coote's on Diseases of the Thyroid 
Body have been re-edited by J. Warrington Howard, 
Surgeon to St. George's Hospital. T. Holmes, the 
editor, writes the articles on Burns and Scalds, Gen- 
eral Pathology of Dislocations, Diseases of the Bones, 
Aneurism, Excisions, and Surgical Diseases of Child- 
hood. He re-edits Mr. Simon's essay on Inflamma- 
tion; Mr. De Morgan's on Erysipelas; Mr. Savory's 
on Hysteria ; Mr. Moore's on Wounds of Vessels, 
Diseases of the Absorbent System and of Arteries ; 
and Mr. Callender's on Diseases of the Veins. J. 
W. Hulke, Surgeon to the Middlesex Hospital {ed- 
itor) prepared the essay on Injuries of the Upper Ex- 
tremity, and edited those on Tetanus, by Mr. Poland, 
Injuries of the Head, by Mr. Hewett, and Diseases of 
the Eye, by Mr. Dixon. Surgical Diseases of Women 
is written by J. Hutchinson, of London Hospital ; 
Syphilis and Gonorrhoea by H. Lee, of St. George's 
Hospital ; Anaesthetics and Amputations, by J. Lis- 
ter^ of King's College Hospital; Orthopoedic Sur- 
gery, Curvature of Spine, Rickets and Osteotomy, by 
W. J. Little; and General Shot Wounds by T. Long- 
more, Professor of Military Surgery at Neatley. W. 
H. A. Jacobson prepared the articles on Injuries of the 
Back and Face, and Diseases of the Male Genera- 
tive Organs ; also re-edited Mr. Hornidge's article on 
General Pathology of Fractures. Mr. Poland's essay 
on Injuries of the Chest, and Mr. T. Smith's on Mi- 
nor Surgery, are edited by R. Lyell, of Middlesex 
Hospital ; he is also the author of the article on 
Plastic Surgery. The esssay on Injuries of the Lower 
Extremities, by Mr. Holthause, has been replaced by 
one by H. Morris, Surgeon to Middlesex Hospital. 
Injuries of the Abdomen ; Diseases of the Mouth, 
Pharynx and CEsophagus ; and of the Intestines, are 
described by G. D. Pollock, Consulting Surgeon to 
St. George's Hospital. S. J. A. Salter writes on Dis- 
eases of the Teeth ; J. Burdon Sanderson, Professor 



of Physiology at Oxford, Pathology of Inflamma- 
tion; H. Smith, of King's College Hospital, Diseases 
of Rectum; Sir H. Thompson, of University Col- 
lege Hospital, Diseases of Urinary Organs, Lithot- 
omy and Lithotrity, in place of those previously by 
Mr. Poland and Mr. Hawkins. The essay on Scrof- 
ula is by E. Treves, of London Hospital, and takes 
the place of one by Mr. Savory. The articles by Sir 
J. Paget, Surgeon to the Queen, on Pathology of 
Sinus, and Fistula and Contusions, and that of W. 
S. Savory, of Bartholomew's Hospital, on Collapse, 
remain unchanged in the present edition. 



SiTZUNGSBERICHTE DER PhYSIKALISCH-MeDICINIS- 

CHEN Gesellschaft zu Wurzburg, 1882. — This re- 
port of the session for 1882, of the Physico-Medical 
Society of Wurzburg, is filled with valuable material, 
contrilxited by such men as Virchow, Kolliker, Ger- 
hardt, Rindfleisch, V. Rineker, Riezer, Angerer, Gad, 
Flesch, Rosenberger and others. The first article is 
a review by Riezer of hypnotism, followed by a de- 
scription of his illustration of the subject in two girls, 
and several animals ; and also by the ensuing discus- 
sion. He divides the subject into four heads: first, 
that of the old mesmerism; second, the hypnotism of 
Baird, with the present views of Heidenham ; third, 
the clinical neuro-pathological views of Charcot ; and 
fourth, the hypnotism of animals, as demonstrated by 
Czernak, and more fully by Pruger of Jena. His. 
demonstrations excited considerable comment. 

V. Bergmann described a case of extirpation of the 
larynx with the patient before him, using for the pur- 
pose of speaking a phonative apparatus, provided with 
a caoutchouc membrane, which imitated fairly the 
tones of the human voice. The other articles corre- 
spond in merit with the illustrious names with which 
they are associated. 



Nineteenth Annual Report of the Alumni 
Association, etc., of the Philadelphia College 
ofPharmacy, 1883. — This is a very respectable sized 
volume of 180 pages of very fine print ; no table of con- 
tents or index. It evidently, contains much interest- 
ing and instructive matter, but to get at it properly 
one must read closelv. 



BOOKS AND PERIODICALS RECEIVED. 



Sanitarian of June 28, 1883. 

Mississippi Valley Medical Monthly, ^vXy, 1883. 

Treatment of Various Forms of Acne, by G. H. 
Rohe, M.D. (Reprint from Medical Chronicle, 
May, 1883.) 

Sanitaria?! of July 5. 

Tht. Detroit Lancet, July, 1883. 

A System of Surgery by Various authors, edited by 
Holmes. Edition third, in three volumes. Pub- 
lished by Wm. Wood & Co., New York. 

Quarterly Journal of Inebriety, July, 1883. 

Sanitarian of July 12, 1883. 



1883.] 



MISCELLANY. 



63 



Hints on Treatment of Some Parasitic Skin Diseases, 
by Geo. H. Rohe, m.d. (Reprint from Medical 
Record. ) 

Pemphigus and Diseases Liable to be Mistaken for It, 
by G. H. Rohe, m. d. (From Medical Netvs.) 



REPORT OF THE TREASURER OF THE AMERICAN 
MEDICAL SOCIETY. 



Dr. Richard J. Dunglison, Treasurer, in Ac- 
count WITH THE American Medical Associa- 
tion. 
Dr. Cr. 



1882. 

June ; 



1883. 
June 



To cash bal- 
ance 

Delegates and 
members at 
St. Panl 
meeting. 



P e r m a n ent 
members to 
date 



1141.38 



1080.30 



5676.68 



1882. 
June 15 



July 3 
Aug. 10 
Sept. 12 
Dec. 20 



1883 
Jan. 8 

Feb. 16 



March 29 
April 5 

, 13 
May 26 



By cash expenses of 
Treasurer to St. Paul 
meeting, as per order 
of Association. . . 

Dr. W. B. Atkinson, 
Permanent Secre- 
tary, as per order 
of Association . . . 

Dr. Kleinschmidt, Li- 
brarian, for binding, 
etc., as per order of 
Association . : . . . 

Dr. N. S. Davis, 
Chairman, Trustees 
of Journal, on ac- 
count 

Houghton, Mifflin & 

Co.. stereotj'pers. . . 

Postage, expressage, 

etc. , to date 



June 2 



Wm. F. Fell & Co., 
printing 

Dr. N. S. Davis, 
Chairman Trustees 
of Journal, balance 

Dr. N. S. Dapis, 
Chairman Commit- 
tee on meteorology 

Henrj- Barnes, ser- 
vices as clerk 

Thnes Printing House 
Printing vol. 33 

Wm. F. Fell & Co., 
printing 

F. Leypoltt, guaran- 
tee Index Medi- 
cus 

Dr. Kleinschmidt, Li- 
brarian, expenses . . . 

H. C. Levi Love & 
Co., postage, ex- 
pressage, paper, etc. 

T. K. Collins, print- 
ing (1881-2) 

Dr. W. B. Atkinson, 
Permanent secre- 
tary, expressage, 
postage, travel, etc. 

Balance 



105-95 



5676.68 



MISCELLANEOUS ITEMS. 



Dr. T. J. Heard, of Galveston, Texas, reports the 
following case : A boy of ten years of age, of strum- 
ous diathesis ; cervical glands .^ery much enlarged, 
lids granular, conjunctiva and cornea ulcerated. 
Treatment — To take three drops of compound tinct- 
ure of iodine after meals, the part of the eye involved 
to be well sprinkled with finely levigated dry sub- 
nitrate of bismuth three times a day ; eye to be 
thoroughly washed night and morning with luke- 
warm water ; at bed-time the lids to be anointed with 
washed lard. In two weeks' time the eyes were per- 
fjctly clear and well, and the boy's general condition 
improved. The reason I report this case is because I 
have seen no mention made of the use of bismuth in 
such cases. 



Maurice Krishaber, m.d., died of acute pneu- 
monia at Paris, in 1883. Bom at Felacetehazy in 
1836, he took his degree in Paris in 1864. He was 
known both as a surgeon and laryngologist. One of 
Claude Bernard's most intirhate students, he con- 
ducted some extremely interesting physiological re- 
searches. In connection with M. Baillarger, he pre- 
pared the articl.e on Cretinism in the Dictionnaire 
Encyclopedique, which is one of the best works on 
the subject. His most important work, however, is 
his memoir on the cerebro-cardiac neurosis, generally 
described as Krishaber's disease, in which he describes 
one of the most curious forms of functional cerebral 
ischaemia, and which opens a vast field for pathologi- 
cal investigations. Shortly before his death, he re- 
ceived the Monthzon Prize from the Academy of Sci- 
ences for his researches into the inoculability and con- 
tagion of tuberculosis in the monkey. — L' Encephale. 

No award was made of the Fiske fund by its trus- 
tees at the late meeting of the Rhode Island Medical 
Society. They offer §300 for the best essay on 
either of the following subjects: First — "The Origin 
and Progress of the Malarial Fever now prevalent in 
New England;" second, "Original Investigations in 
Household Hygiene." The essays must be forwarded 
to Charles W. Parsons, m.d., Secretary of Trustees, 
on or before May i, 1884. Each one must bear a 
motto in the place of the author's name, and must be 
accompanied by a sealed packet containing the name 
and address and bearing the same motto. 

Dr. H. P. Strong died at Beloit, Wisconsin, June 
20, 1883. He was fifty-one years old. He had been 
Mayor of the city for several years ; Secretary and 
President of the State Medical Society ; during the 
war he was surgeon of the Eleventh Wisconsin Regi- 
ment, and at the time of his death he was a member 
of the State Board of Health. 

The annual meeting of the Delaware State Medical 
Society was held at Wilmington June 12. The Presi- 
dent-elect is Robert M. Hargardine, of Tilton ; Vice 
President, Willard Springer; Secretary, George W. 
Marshall ; Treasurer, J. W. Sharp. 

Dr. John A. Liddell, of New York, died there 
July 8, 1883, aged sixty. He was well known as a 
writer and as Inspector-General of the Medical Staff 
of the Army of the Potomac during the Rebellion. 

Dr. Moritz Michaelis, of New York City, died 
there on the 23d of June. He was well known as an 
obstetrician. He was born at Detmold, Germany, in 
181 1, and came to New York in 1840. 

The New York State Medical Register for 1883 
contains the names of 2,684 physicians living in the 
State, of whom 1,661 reside in New York City and 
510 in Brooklyn. 

Dr. S. Strausser has received a delegate's certif- 
icate from the Secretary of the A. M. A. to represtn 
this body in ail medical societies in Europe where 



64 



NECROLOGICAL. 



[July, 1883- 



the same are in affiliation. The Doctor anticipates 
starting to Germany about the first of August, to be 
absent three or four months. 

Dr. R. N. Isham will leave the city about July 
10 for a trip through Northern Europe. Consider- 
able time will be spent in St. Petersburg, Russia. In 
the fall he will return to resume his lectures in Oper- 
ative Surgery, in the Chicago Medical College. 

Military Tract Medical Association. — The 
next regular meeting of this Society will be held in 
Galesburg, 111., on Tuesday, November 13, 1883. 

Dr. H. C. Hopper, 

Galesburg, 111. Secretary. 

The British Government has determined to send to 
Egypt, to investigate the cholera epidemic there the 
Surgeon General of the Army, who has had much ex- 
perience with the disease in India. 

Louis Pasteur has also offered to organize a commis- 
sion for the same jxirpose, and has applied to Lord 
Granville, the British Foreign Secretary, to furnish 
him with facilities to prosecute the work. 

Dr. Spina, of Vienna who is best known here 
probably for his opposition to Koch, has been nomi- 
nated Professor of General and Experimental Path- 
ology at Prague. 

The Boylston prize of $200 has been awarded to P. 
M.,Braidwood, m.d., of Birkenhead, England. The 
subject was "Measles, German Measles and Allied 
Diseases. ' ' 

Prof. Thomas H. Huxley has been elected Presi- 
dent of the Royal Society of London. 

Dr. DeLaskie Miller leaves the city in a few 
weeks for a trip to Europe. 



NECROLOGICAL. 



Robert Smith, m.d., f.r.c.p., f.r.c.s., died May 
15, at his residence in Strathmore Gardens, Ken- 
sington, England, in the 69th year of his age. 
In 1867 he was obliged by ill health, to give up pub- 
lic professional work, and in 1872 increasing physical 
weakness obliged him to retire from all active work. 
Born in December 1814, he descended from a family, 
members of which, from father to son, had practiced 
medicine in Wimborne, Dorset, for more than a cen- 
tury. He is best known as author of the " Surgeon's 
Vade-Mecum," the first edition of which appeared 
in 1839, ^^^ i^ ^<^^^ ^^ ^ts eleventh edition, nearly 
40,000 copies having been sold ; it has also been 
translated into foreign (languages. This with his 
article on "Inflammation," in Cooper's Dictionary of 
Practical Surgery (1872), are the most important of 
his numerous writings. He was a very active prac- 
titioner and filled many important positions, and in a 
series of published articles, endeavored to combat the 



views on total abstinence, as opposed to temperance. 
The Medical Times and Gazette refers to him as an 
accomplished botanist, a good geologist and an ex- 
cellent chemist, a great student of languages, and a 
theologian of unusual learning and force, with a 
thorough knowledge of the art of music. He died 
affected with intermittent hgematinuria, the symptoms 
of which for its first six years he has himself put into 
print. He leaves a widow, four daughters and three 
sons, the youngest of whom follows his father's pro- 
fession. 

Peter Stewart, m.d., died in Glasgow, Scot- 
land, May 10, 1883, in his 70th year, being born in 
Granock, Scotland, Nov. 16, 1813. Took the degree 
of M.D. at the University of Glasgow 1845. ^^ 
was an active practioner in Glasgow, a Fellow of the 
Faculty of Physicians and Surgeons in 1858, and in 
1854, 1855, 1878 and 1879, president of the Glas- 
gow Southern Medical Society. He was for some 
time one of the managers of the Glasgow Royal In- 
firmy. He was very fond of travel and visited most 
of the countries of Europe, as well as various parts of 
America, Australia and New Zealand. He died of 
malignant disease of the larynx. — Glasgow Medical 
Journal, June. 

JV. E. Scott, m.d., was born in London, Eng- 
land, in 1823. He came to Canada in 1831. Was 
House Surgeon, Montreal General Hospital 1841-43;, 
M.D. McGill College, 1844, at which college he held 
the following positions : Demonstrator of Anatomy, 
1845 J Lecturer on Forensic Medicine, 1851 ; Profes- 
sor of Anatomy, 1856; which last position he held up 
to the time of his death. May 24, 1883. He was the 
senior member of the Faculty of McGill College, one 
of the oldest members of the Board of Governors of 
the Province of Quebec, and the oldest consulting 
physician on the staff of the hospital. He died of 
chronic renal disease and consecutive cardiac de- 
rangements. — Canada Medical and Surgical Journal. 

Hunter, John, m.d. Died in Washington City,. 
July 10, 1883, aged 79. He was a native of Virginia^ 
and a graduate of the University of Pennsylvania in 
the class of 1826. Although a man of fine literary 
and professional acquirements, he passed most of hi ; 
life as a clerk in public office. 

Livingston, Beverly, m.d. Died of diphtheria at 
his residence inthecityof New York, July 2, 1883, aged 
31. He was a graduate of the College of Physicians 
and Surgeons, and was making the diseases of chil- 
dren a specialty. 

Baker, Paui DeLacy, m.d. Died at his residence 
in Eufaula, Ala., July 6, 1883, aged 55. He had 
practiced in the same place for over a quarter of a 
century, and was greatly beloved by the whole country. 

Scott, Thomas A., m.d. Died July 11, 1883, at 
Petersburg, Va., aged 80. He was one of the most 
eminent practitioners in Virginia, and a nephew of 
Gen. Winfield Scott. 



THE 



0urnal#^merican3ieMcal^000ciati0tt. 



EDITED FOR THE ASSOCIATION BY N. S. DAVIS. 

PUBLISHED WEEKLY. 



Vol. I. 



Saturday, July 28, 1883. 



No. 3. 



ORIGINAL ARTICLES. 



ADDRESS OF THE CHAIRMAN OF THE SECTION ON 

PRACTICE OF MEDICINE, MATERIA MEDICA 

AND PHYSIOLOGY. 



BY J. H. HOLLISTER, A.M., M.D., CHICAGO, ILL. 
Delivered to the American Medical Association, June 6, 18R3. 



Gentlemen of the Association — 

In the development of medical science, men have 
been compelled to grapple with some of the most in- 
tricate and difficult problems which can challenge 
investigation. 

In studying those higher relations which lie in part 
beyond the limits of finite conception, reason 
may properly defer to faith, and, seeking the guid- 
ing hand of revelation, walk with a wisdom other 
than its own. But in medicine it is not so. Forces, 
mental and material, interchangeable, inter-depend- 
ent, and inseperable, manifest themselves in ways 
so manifold, and with so many es.sential facts un- 
discovered, that reason is compelled to thread her 
way with steps slow and uncertain, sometimes, in 
truth, oft times in error, ever painfully conscious of 
her weakness, and of the mysteries that confront her 
on every side. Thus only may we account for the 
seemingly meagre fruitage which represents the la- 
bors, for more than two thousand years, of some of the 
ablest minds the world has ever seen. 

Those great problems of health, and of disease, 
of life and of death, which affect the well-being of 
the race, have been matters of patient investigation 
by many of the foremost men in every generation. 
And many of them have wrought out work which 
will endure as long as literature shall survive. 
But the essential causes of diseases have, in the 
main, been so obscure, and their expressions so varied 
and complex, that the best of men have been 
compelled to conclusions largely inferential. Ac- 
cordingly, in tracing the progress of medicine 
through the centuries, we encounter on the one hand, 
flights of imagination and fanciful speculations which 
challenge comparison and provoke our mirth; and 
on the other, ingenious reasonings and logical con- 
clusions which surprise us by their truthfulness. 

In the absence of positive knowledge, no man can 
lay a restraining hand upon the fancies and creduli- 
ties of men, and medicine has ever been the fruitful 
field, above all others, for their exuberant develop- 
ment. Speculations have been piled mountain high by 
one generation of workers, to disappear before 



another as chafT before a driving wind. But des- 
pite the winnowings, there still remained some golden 
grains of truth, and the treasure-house has been 
slowly but surely enriched by these garnerings of the 
ages. The mile-stones that mark the years of spe- 
cial achievement are set with sparing hands, and the 
records of successive years so merge and blend with 
their associates, that each seems but a link in an un- 
folding endless chain. How then shall I presume 
to stand in the presence of these representative men, 
and fulfil the duties of this hour by reciting to you 
the progress of investigations in physiology, in 
materia medica, and in medicine during the brief 
period of a single year ? And yet I may not wholly 
shun the task as though it were an idle one, for I 
am well persuaded of this year that its labors will 
not be barren of good results. 

Let me first present some topics in this brief re- 
view, which pertain to medicine in general, and 
quickly come to others, more legitimate matters for 
this paper. 

First. I think we may congratulate ourselves that 
the year has been so prolific of trustworthy, accurate, 
and able workers. Probably no year in the world's 
history has witnessed an equal amount of legitimate 
original investigation. Fewer men are willing to shine 
with borrowed light. No man can longer as- 
sume a solar altitude, to illuminate a hemisphere. 
The present army of workers seems rather a galaxy 
of stars, differing, of course, in magnitude, but each 
according to his measure, a light unto himself, ready 
and generous to accept what can be verified, and as 
quick to criticise and, if need be, reject where the 
data are insufficient. The labors of such men are 
destined to achieve results which could never be 
accomplished otherwise, and there is born of such 
united work a sympathy and an enthusiasm which is 
becoming world-wide and grand. Neither England, 
Germany, France, nor Switzerland are indifferent 
when Bizzozero speaks from Italy, nor is the old world 
regardless of the new. 

Second. The medical journalism of the year 
claims favorable comparison with any that has gone 
before. An abler literature is given to the press. A 
wiser supervision is clearly manifest. New and able 
contributors are coming to the front. All depart- 
ments of medical investigation are having an abler 
expression of their work. Some curious deformities 
are growing more and more conspicuous — journals 
with representative names, with bodies very small 
and well-nigh meatless, are floated aloft on wings of 
magnificent proportions, upon whose almost count- 
less folds advertising manufacturers display the merits 



66 



ADDRESS OF DR. J. H. HOLLISTER. 



[July, 



of their wares, and, assuming the direction, propose 
to dictate to the profession how medical journals 
shall be run. There will be a movement in that 
matter some day, and, when there is, that hitherto 
unbridled license will be abated. 

Third. The masses of the profession are steadily 
ascending to higher positions of attainment. They 
read more ; they think better ; they practice their 
' profession with more intelligence and with better suc- 
cess. At no time before were there as many talented and 
industrious physicians working in all the domain of 
medicine and surgery as there are to-day. Feats 
are now accomplished by hundreds of operators 
which would have immortalized either of them, 
not a hundred years ago. And pathological investi- 
gations and physical diagnosis have reached a point 
never before attained. 

More than in any year before, the centers of intens- 
est study, have been within the range of microscopic 
vision. 

In the Dictionnaire Annuel for 1882, Garnier's 
opening words are these : ' ' Des Microbes ! tojours et 
J>artout, des Microbes !! Rien que des Microbes !!! ' ' 
And what has been true in France has been equally 
true elsewhere. 

The discoveries in science are not always comfort- 
ing, and I doubt whether it really conduces to our 
happiness to discover what animated bodies we pos- 
sess. 

But — receive it as we will — the microscope com- 
mands the advance to-day, and assertions based upon 
its revelations, be they true or false, can only be 
tested, accepted, or rejected upon authorities equally 
skilled in microscopy. In this new field to which so 
many eyes nOw turn, and in which work so import- 
ant is being done, no man can longer speak as an 
authority who can not, with equal skill, review the 
work of other men. A great educational work is 
going on. Men yet differ vastly in the interpretation 
of what they see — as we shall have occasion yet to 
notice — new fields are opening every day, and new 
facts are added to our knowledge. 

The limit of measurement has now attained to the 
one hundred and forty-six thousandth part of an inch ! 
Beyond this lies the fnolecule, and beyond the atom ! 
It is idle to speculate as to where the limits of 
human vision shall finally fall ; but, from the dili- 
gent study of what lies within the present range there 
surely can come no harm — there is certainly a prom- 
ise of great good. 

In microscopy two subjects more than any others 
command attention at this hour. The one is the 
composition of the blood ! the other, the agency of 
microcytis in the production of diseases. 

There has been of late a bit of sharp practice with 
glasses trained upon the red corpuscle ; some asserting 
most stoutly that a close reticulate network pervades 
every part of the cell, and can be seen most distinctly 
by those who know how to see. To which others 
reply, We can see what you see, when our glasses are 
mal-adjusted ! Correct your optics and your network 
will disappear. 

In this contest between "I do," and "You 
don't," I think the latter has rather the best of it. 



There is another question imder discussion which 
deeply interests medical men. The occasion was this.. 
On the 14th of January, 1882, Prof. Bizzozero, of 
Turin, announced in one of the prominent medical 
journals his discovery of what he was pleased to call 
the ^'' Blut Platte hen,'" and which was brought prom- 
inently to the attention of English and American 
readers by a leader which appeared in the London 
Lancet, under date of Jan. 21, 1882, entitled " The 
New Blood Corpuscle." 

It was claimed as a new discovery, distinct from 
the invisible corpuscle of Norris — not derived from 
other leucocytes, — playing an important part in the 
functional alterations of the blood, — that they rapidly 
increased in certain morbid conditions, notably after 
bleeding, and have an active agency in the produc- 
tion of thrombi. 

The chief point of interest is the role they are as- 
serted to play in the development of fibrine, for if 
this view is accepted, the late theories of fibrine forma- 
tion by the agency of a ferment, or of chemical 
affinities, are set aside^ and that of morphological 
changes induced by the degeneration of these cells, 
must be accepted instead as the essential fact in 
fibrine production. 

This article commanded very general interest, and 
attention was immediately turned to the valuable 
labors in this same field by Prof. Norris, of Birming- 
ham, England. His labors upon blood, its physi- 
ology and pathology, had by no means commanded 
the attention which their worth deserved; but now 
his results, published at various times during the last 
five years, are being reviewed with great interest, and 
it seems to me, as the case now stands, that England 
and not Italy will maintain priority in the discovery 
of the third corpuscle. 

Time will only permit a very brief reference, while 
considering the microscopic changes of the blood, to 
the series of very interesting studies of the blood of 
John Griscom, a man of fine physical development 
and then in perfect health, who voluntarily entered 
upon a prolonged fast, which was commenced on the 
28th of May, 1882, and continued for 45 days, these 
studies being made by Prof Lester Curtis,, of Chi- 
cago. 

The observations are of special interest as showing; 
the effects of the absolute withdrawal of nutrition for 
so long a period upon the number, sizes,, shapes and 
structural changes of the various corpuscles discernible 
in human blood. Some of his descriptions are 
evidently of the same structures which are just 
now described by Dr. Norris,. in his masterly work 
upon the blood, which is just fresh from the press,, 
and one of the most valuable contributions to medi- 
cal science, I think, ever made upon that subject. 
Further investigations will determine what now are 
matters of question, and the morphology of the blood 
is as important as its study is interesting. It is a 
field demanding hard work^ but it promises large re- 
turns. 

If we turn now to the subject of micro-parasitic 
organisms, perhaps the most prominent man that con- 
fronts us is Dr. Robert Koch.. But a few years ago- 
he was an obscure physician in one of the country 



1883.] 



ADDRESS OF DR. J. H. HOLLISTER. 



67 



towns in Prussia. To-day he is at the head of the 
Imjjerial German Health Bureau in Berlin. Prob- 
ably his name has been spoken and written more 
often by his professional brethren than that of any 
other member of the medical profession. This pro- 
minence is based upon his discovery of what is be- 
coming familiar to us as the Bacillus Tuberculosis. 
And whether the discovery shall prove fruitful or 
barren of result, no one can deny but that it was the 
legitimate offspring of long continued, painstaking 
and admirable work. By devising new methods of 
staining, he was at length enabled to find in all tuber- 
cular tissue a characteristic bacillus. It differed 
essentially from all other bacteria except those of 
Lepra, and from these he distinguished it as being 
somewhat narrower and more pointed at the ends, 
and by being differently affected by staining. He 
found these bacilli in all localities where tubercular 
processes were active. In size they were from one- 
fourth to one-half as long as the diameter of the red 
corpuscle. They were sometimes free, sometimes in 
heaps, and sometimes within the cells — especially 
were they found within the giant cells of tubercular 
growths. Not only did he find them in tubercular 
nodules of the lungs, but in tubercular infiltrations of 
the spleen, liver, kidney, and pia-mater as well. 

As this subject will be more fully considered in one 
of the sections during the present session, it is not 
needful that I should give his investigations farther 
attention now. 

One very important question arises in this connec- 
tion, in fact a pivotal one, upon which all others must 
turn. The presence of specific organisms in many 
forms of disease even the most skeptical must con- 
cede ; but the main question is this, are they causa- 
tive, or only concomitants ? 

It certainly will not be conclusive to simply assert 
the presence of characteristic bacilli in the parts dis- 
eased, for in such the soil may be nourishing to the 
one and sterilized for others, affording as many pretty 
examples of the survival of the fittest. 

Accordingly, Koch and many others are now giv- 
ing their attention largely to the matter of germ 
culture and the reproductions of specific diseases by 
successive generations of characteristic bacilli. 

Koch narrates at least one hundred experiments 
upon guinea pigs, rabbits, and cats, using sterilized 
ox-blood-serum most successfully as a culture fluid in 
the germination of bacilli, and he says, that " when 
a small quantity of this infective fluid was injected 
into the anterior ocular chamber of guinea pigs, and 
also into cats and dogs, which do not ordinarily be- 
come tubercular, general tuberculosis made its appear- 
ance in about ten days, and ran a rapid and fatal 
course. ' ' : 

Perhaps anthrax stands at the head of the list of 
diseases that can be propagated by inoculation with I 
specific bacteria. This assertion has been confirmed j 
by so many experimenters, as to leave no reasonable 
doubt, but that this disease is dependent upon the 
presence of specific organisms, and that after succes- 
sive generations, by careful culture, have been isolated 
from other contagium, the introduction of these 
micro-germs will develop this specific disease. 



Erysipelas is coming to be classed in the list of 
parasitic diseases. Fehleisen asserts that he has car- 
ried the culture of the specific bacillus to the 9th gen- 
eration, and by the inoculation of rabbits and of one 
human subject, with the infective fluid, he has devel- 
oped typical forms of erysipelas. 

In leprosy the discovery of a distinctive bacillus is 
asserted by some, and denied by others. 

The same with reference to gonorrhoea and the 
micrococci of the vaccine pustule, and those of 
typhoid fever. 

In most cases the bacillus has not been so absolutely 
separated from other p)ossible causes, as to permit the 
assertion that it is solely responsible for specific results. 
At this point we rest the review of present microsco- 
pic work. 

The subject is of utmost interest, and each year's 
development in this direction, will command the care- 
ful attention of every well educated physician. 

Of course, if we accept the germ-theory of diseases, 
our thoughts turn at once to their germicidal treat- 
ment, and investigators will soon be following in 
the footsteps of Sternberg, with experiments, to deter- 
mine the germicidal value of therajjeutic agents. 

The question that concerns us most, is not as to 
whether we can destroy bacteria, but whether they 
have not a greater vitality than the tissues of the hu- 
man body, and whether, in a germicidal warfare, the 
human organism will not first succumb. 

In this respect our successes may be similar to those 
in the celebrated surgical case, in which the tumor 
was saved but the patient was lost. 

In materia medica the new remedies proffered to 
the profession are almost without number, but none 
seem to me so prominent as to command special atten- 
tion in the year's report. 

I am happy to announce to you, that a law has just 
come into force in Italy, which prohibits the sale of 
patent medicines throughout the kingdom, unless the 
precise composition of the medicines is stated. 
This important decree has been promulgated by the 
Minister of the Interior, the Customs, and the sani- 
tary authorities, with instructions for its rigid enforce- 
ment. 

How long shall enlightened America fall so far 
behind Italy, in the enactment and enforcement of 
similar laws? 

With a view to the advancement of medical science 
in America, to the end that its people may command 
a better service, and that in the advances in the years 
to come the profession in our country may be more 
creditably represented, I shall crave your indulgence 
while I close this paper with the following questions 
and suggestions : 

Is the time not nearly at hand when the medical 
men of the United States, governed by motives 
which rise above and control all selfish considerations, 
shall be prepared to institute something like the fol- 
lowing action : 

Let the medical profession in each State, in such 
manner as seems most satisfactory, designate one of 
its number, to constitute, with a like-appointed mem- 
ber from each of the other States, a Nominating 
Board. 



68 



TREATMENT OF YELLOW FEVER. 



[July, 



Let it be the duty of this board to nominate a list 
of men suitable for appointment by the President 
of the United States as members of a Medical 
Bureau, to be constituted with specific powers 
and duties. In this bureau, composed, say, of ten 
members, let the army, the navy, and the marine 
service have a proper representation. 

Let the members of the bureau be subject to re- 
moval only for causes, one of which shall be the at- 
tainment of a specified age ; and receive a salary, 
each, of not less than ^10,000 annually, to be paid 
by those who are applicants for the degree of Doctor 
of Medicine. 

Let the laws of the various States be so modified 
that the power to confer medical degrees shall vest 
solely in this body. Let sessions for examinations be 
held in all the States at such times and places as wis- 
dom may dictate, to the end that all medical students 
shall have ample facilities for attendance. 

Let the standard of requirement be reasonable, 
but, at the same time, such as shall inspire ambition 
in the student, and respect at home and abroad. 

Let students graduated by the National Medical 
Bureau receive an honorable distinctive title, say that 
of National Fellow of Medicine. 

In due time let all governmental appointments, as 
in the army, the navy, and in the marine service, be 
made from this list. In all contract service and 
marine and railway service, let such graduates have 
preference, and in all civic positions let them receive 
encouragement. Let the State boards of health be 
empowered, after a specified time, to require that those 
only who are thus graduated may legally practice 
medicine in the several States. 

The highest interests of our commonwealth are in- 
separably related with the highest attainment possible 
in the successful treatment of diseases. Let it be 
clearly apparent to the legislatures of the several 
States and to the national government, that the gen- 
eral good could best be served by such procedure, 
and the necessary laws would be speedily enacted. 

To such a movement the colleges could offer none 
other than a selfish objection, and how long would 
the will of a few hundreds of professors stand in the 
way of the expressed convictions of the tens of thou- 
sands of physicians. 

Let the physicians encourage only those to enter 
upon the study of medicine whose ability and pre- 
vious education give reasonable assurance of an hon- 
orable graduation. Let them advise the attendance 
of these students only at such medical colleges as 
have made this provision for final graduation, and all 
reputable colleges would soon fall into line. 

I see no manner in which a common standard of 
requirement can be instituted in this vast republic 
but in some such way. I think I see in such a plan, 
wisely and impartially executed, the possibilities of a 
medical culture of the masses of the profession such 
as the world has not yet seen. 

Is it not time that the profession began emphatic- 
ally to assert its own self respect by calling a halt, 
and requiring that the indiscriminate grinding of the 
diploma mills shall cease. 

With the medical profession of America such an 



advance is possible, and with them is vested the 
power to correct abuses which are only too apparent. 



THE TREATMENT OF YELLOW FEVER. 



BY ROBERT D. MURRAY. 
SURGEON U. S. MARINE HOSPITAL SERVICE. 



[Read to the Section on Practice of Medicine, etc.] 

In presentmg this paper, I do not propose to an- 
nounce any new or certain method for treating a case 
of yellow fever, or to collate an array of cases that 
would prove a definite plan to be invariably success- 
ful, but I will make some practical remarks on the 
management of yellow fever, most of which are the 
gleanings of actual experience in the yellow fever 
epidemics of 1873, 1875, ^'^l^y and 1882. 

I wish to protest in advance against nihility and 
theoretical therapeutics, which find favor with some. 
There is such a process, or art, as treatment of yellow 
fever, and there is also much manoeuvering called 
treatment, the perpetrators of which should be sent 
to Labrador or a colder region on the first news of 
an outbreak; and theorizing in general is of best 
service in a similar climate. It has been my fortune 
to witness much bungling and to see experimentation 
signally fail. 

The common sense, nature-aiding methods of 
years, have been and are successful enough for prac- 
tical purposes. In battle, soldiers are slightly, se- 
verely, or mortally wounded ; the latter class die, 
the former get well, but the ot?iers must trust to luck, 
doctors, and grit — but some of them die from stupid 
bungling, or accident, or loss of pluck at last, the 
results being charged to the enemy. 

So it is with yellow fever patients : Some are fatally 
poisoned at the beginning, a majority will ordinarily 
get well in spite of bad medication, while many die 
from experiments, nihility, fright or accident. It is 
impossible in the onset of an attack to prognosticate 
the result, as some cases, apparently congestive, will 
at once respond to palliative measures, and others 
who apparently promise an ephemeral case, decep- 
tively glide into continued fever or fail in the stom- 
ach or kidneys and go on to a fatal result, too often 
because the preliminary mildness of the attack threw 
doctor and patient off their guard. Thus treatment 
and observation are necessary in all cases. That 
treatment shall be effectual even to the last possible 
chance, and in no case cause serious consequence in 
itself, is important. 

I do not in this brief paper undertake to give any 
pathology of yellow fever which shall furnish a clue 
to rational treatment, but I assume that the condition 
I see when first visiting a case is a result of aforetime 
processes, and that I cannot entirely arrest a process 
already nearly completed, even if I knew what the 
process was. Experiments to arrest it will only be 
loss of time. So I strive to correct the mal-condi- 
tion and forestall the incidents that are presumably 
fatal. It is certain that a routine treatment for the 
most part is preferable to vain seeking after idio- 
syncracies or peculiar circumstances, but the advisa- 



1883-] 



TREATMENT OF YELLOW I-EVER. 



69 



bility of treating the individual patient and not the 
disease is a truism not to be forgotten. 

The importance of early medication cannot be 
over-estimated, and it must be conceded that treat- 
ment to be early in a time of hurry and panic should ! 
be simple, effectual and well known. To wait a 
couple of hours for a physician to come, to send to a ■ 
crowded or short-handed drug store for medicine, to [ 
even deliberate on the necessity for medication, are ; 
often delays of sufficient time to preclude a favorable ' 
result. The first thing to do in the presence of an , 
epidemic is, therefore, to inform the public what to 
give in all cases of suspicious nature, or actual attack - 
of the disease. Mustard, castor oil, compound ca- 
thartic pills, cinchona salts, spirits, and lemons, 
should be provided by every householder or placed 
within easy reach of every possible case. Physicians j 
should carry a sufficient supply of remedies for the 
conditions or complications that may need imme- , 
diate attention. Writing prescriptions consumes a 1 
double portion of valuable time, confuses judgment, 
increases expense, and at times impels a physician to ; 
postpone a modification, or change, when half confi- 
dent it should be made, for fear of alarming the pa- 
tient or his friends by another parade of paper, pen- ; 
cil and directions. l 

WHAT TO DO FOR THE FEVER. 

A person has frontal headache, pain in back and 
thighs, flushed face, malaise, and temperature of 38 \ 
C. or more. Give i to 4 compound cathartic pills or 
8 c.c. to 60 c.c. castor oil according to age, at 
once. Give hot mustard foot bath, by placing a 
foot tub on the bed and under the clothes, bathing ! 
feet and legs till water is cooled, taking care to keep 
the body covered. If the thigh pain is not relieved 
somewhat, add more hot water. When practicable 
it is better to give a full length hot bath, and to lash 
the patient in blankets if there is agonizing headache 
or backache. After two or three hours of profuse 
sweating rub off" with dry towels, change the bed 
clothing, place a wet cloth on the forehead and await 
action of the cathartic. If there is no response from ■ 
it in 4 or 5 hours, give a saline cathartic or an enema. 
It is permissible to allow the patient to sit on a close 
stool or vessel during the first or first two actions. 

Give hot lemonade, orange-leaf, lemon-grass, or 
weak Japan tea for first 24 hours. Cold drinks are 
allowable, but are to be limited as to quantity. Spt. 
eth. nit. and spt. mindereri, or solution of potass, 
chlorat, may be given at regular intervals; not so 
much for the physiological effect of the drugs, as for 
the mental peace of the patient, for, as will be men- 
tioned farther on, every possible means must be 
taken to insure mental tranquility. Insist on quiet 
and recumbency for at least five days. After 24 
hours allow corn starch or hominy gruel, and grad- 
ually add milk and broths as occasion demands. This 
is all that is required in most cases, and additions are 
inadvisable. If all is well on the 4th day give a tonic j 
of cinchona salt to hasten recovery of strength. | 

If malaria is mingled with the fever-cause, always 
give a drachm of cinchona salt within the first 
twenty-four hours, to all cases. This will modify or 
forestall delirium and obviate in a measure the danger 



of a subsequent rise of fever. In such a case cin- 
chona must always be given on the 6th or 7 th day to 
prevent a chill, which may be congestive and more 
than usually dangerous. I beg to say that cinchona 
does not cure yellow fever, but the apt use of it will 
brace up the nervous system in advance of depressing 
conditions, and in this manner it not only wards off" 
complications, but hastens recovery. The shorten- 
ing of convalescence is of prime moment, especially 
if the patient is a physician, commander of a post, or 
member of a relief committee. During convalescence 
the tr. ferri chlor, hydrochloric or nitric acids may 
be administered with the same good effects that char- 
acterize their action in other debilitating diseases. 
But in some cases troubles arise and our hopes of a 
quiet time are shattered, and we are forced to meet in- 
cidents that will tax our patience and skill. 

Restlessness is best controlled by potass, bromide 
and chloral. The medicine should be given by the 
mouth, as long as the stomach will retain it. They 
are effectual when administered by enema, but cannot 
be repeated very often, without injury. Sometimes 
a simple clyster of soap-suds will check it. Bathing 
the face and neck with cologne or perfumed water, or 
the whole body with dilute spirits or dilute vinegar 
are advisable. 

If the temperature persists at 39.° 5 c. or more at 
close of 48 hours, give a clyster, and bathe the body 
with a lotion of cinchona salt, acid hydrochlor. with 
brandy and water every 2 to 4 hours, or perfumed 
vinegar or aqua sedative. If there is no nausea, con- 
tinue the warm drinks and give cinchona guardedly. 
Nausea is an alarming sign and its approach is 
usually detected by tenderness of stomach. Never 
ask a patient if he observes it ? The hint may pro- 
duce the difficulty we fear. Give lime water colored 
with milk or just diluted ; allow small pieces of ice to 
be taken and eaten ; put sinapism or spice-pepper- 
plaster on epigastrium ; give charcoal moistened with 
port or favorite wine, if renewed action of bowels is 
needed, give a clyster. 

Vomiting must be prevented for physical as well as 
moral reasons. On its occurrence give charcoal, ice, 
lime-water, etc. Charcoal is a valuable corrector of 
nausea, and if it fails to prevent vomiting the dread 
of black vomit is allayed more or less by the fancy 
that the color is given by the remedy. A blister is 
advisable in some cases, particularly if the odor of 
the mustard is objected to, or if there is no sign of 
blood in the vomit after 36 to 48 hours. Applying 
a cold towel to the neck or passing a piece of ice 
over face and throat is oft-times effectual. By all pos- 
sible means prevent vomiting ; the loss of blood is of 
less moment than the alarm and exhaustion produced 
by the act. If the stomach is filled with the black 
vomit the best hope is that the ffuid will be carried off" by 
the intestines. Long continued vomiting after danger 
of black vomit is past is best checked by small doses 
of calomel, hypodermic injection of morphia, cold 
to the head, and absolute deprivation of food and 
drink by the mouth. Hiccough is frequently a trouble- 
some complication. Calomel to induce purgation, a 
clyster of warm water followed by a dose of pot. bro- 
mide and charcoal, a tablespoonful of lemon juice. 



70 



TREATMENT OF YELLOW FEVER. 



[July, 



or a few drops of chloroform are to be tried in turn. 

Restlessness, if not relieved by pot. brom. and 
chloral, and by cessation of all irritating surround- 
ings, may be modified by a continued rubbing of 
limbs and back with smooth towels or the bare hands. 
Patients who at the onset have been put under the 
influence of the cinchona salts will not be as restless 
as those who have not been so treated. 

Constipation is out of the question in a fairly be- 
gun case. Diarrhoea and colic sometimes give annoy- 
ance. If no contra-indication exists, ordinary means 
may be used to control them. 

The urine should be examined at the end of 60 or 
72 hours. If it is albuminous, give 2 to 4 c.c. tur- 
pentine in sweet oil, and repeat in three or four 
hpurs. Smaller doses may do, but 4 c.c. will do no 
harm even to children. If the '..reathing is labored 
give spirits guardedly and l..i*ge doses of digitalis. In 
case the turpentine cannot be retained, it may be 
Tubbed in, and a poultice of digitalis and hops applied 
to the hypogastrium. Follow the same plan as to 
sv-ppression of urine, and see to it that the extremities 
are kept warm by flannel wrappings or other artificial 
means. Do not mistake retention for suppression. 
After the stage of albuminuria or suppression, tr. ferri. 
chlor. is always indicated. I believe that the giving 
of it in advance tends to prevent the complications, 
but I doubt the efficiency of all other diuretics. 

Collapse. — Put sinapisms or pepper poultices as 
nearly all over the body as possible. Rub the spine 
with a sponge dipped in alcohol and capsicum. Give 
spirits if borne, or by enema. Warm the extremities 
by hot bottles or bricks. Give rational doses of digi- 
talis. 

Food. — Give practically nothing for three days, 
the only admissible articles plain salted hominy gruel, 
alkaline milk, corn starch gruel, Mexican stole and 
sweet beef essences ; condensed milk should be diluted 
with lime water. Until patient is safe beyond doubt 
give these with no additions beyond milk or wet 
toast, soft eggs and soup. Brandy or whiskey are of 
advantage in some cases, but wines are by all means 
preferable. Champagne is best of all if a fresh bot- 
tle can be opened every time it is given. Port and 
Catawba wines cover the widest range, but if more 
acid ones are liked, they are admissible. Keep up 
observation as to food of a Caucasian patient for at 
least a week. Many a convalscent has been murder- 
ed by undue feeding, while it is hard to conceive of 
one dying from simple exhaustion. 

Observations. — Keep the patient covered with 
one sheet and a blanket to continue skin moisture. 
Do not change clothing unless absolutely necessary. 
Flannel shirts are advisable despite the eczema they 
may cause. Let the chamber be light and ventilated, 
avoiding draughts. Insist on persistent recumbency 
for at least five or six days, and upon the use of bed- 
pans and urinals. The least muscular effort will 
sometimes turn the scale when the patient might have 
recovered. 

Avoid heart depressants in all forms ; there will be 
no inflammatory complications to guard against, and 
the heart will soon get weak enough when deprived 
of all nutrition from healthy blood, and when it is 



pumping a sticky, almost tarry fluid, for days at a 
time. Collapse frequently results from the little ex- 
tra effort of heart, caused by a bit of startling news, 
or slight exertion. Avoid opium as long as there is 
risk of albuminuria. It might be eliminated from 
the yellow fever supplies with benefit to patients. 

The rare neuralgia of the liver as a sequel is most 
effectually relieved by belladonna. Convalescence is 
hastened and always assured by cinchona and the 
mineral acids. 

Hypodermic medication is useless during the feb- 
rile stages, and is always liable to produce abcesses 
which are difficult to heal. 

As the mind of a yellow fever patient is always 
clear during the period of greatest danger, the man- 
ners of the physician have much to do with the re- 
covery and are of great moment, although they 
would seem to have no relation to treatment. It is 
necessary to finesse, and deceive almost every patient 
as to his real condition and prospects, but owing to 
the acuteness of the reasoning faculties it is not well 
to be caught in the deceptions. Do not ask unneces- 
sary questions; make judgment without parade, or 
prolixity, and so as to not arouse suspicions of dan- 
ger. Do not ask about the stomach in a direct man- 
ner, an apparently careless pressure on the epigastrium 
will tell you more than the patient needs to know. 
Use a thermometer not oftener than three times a 
day, and at the same time do not expect to judge of 
degree of fever by pulse, or skin, or tongue. 

In case of physician or experienced person, always 
report the fever as one or two degrees lower than it 
really is, and be sure that no thermometer is at hand 
for the patient's use. A centigrade thermometer is 
sometimes advantageous if the patient does not know 
the rule for conversion. 

Visiting by acquaintances should be interdicted and 
only serviceable friends allowed access. 

Deaf and dumb nurses would be ideally perfect. 
Everything, noises, smells, habits, etc., which can 
disturb the patient, and rumors, gossips, news, or con- 
versation which might excite thought or worry must 
be prohibited, and in all ways the patient must be led 
to consider his condition as favorable. Reports of 
death and sickness and remarks about absent rela- 
tives are cruel. If the patient's will is not made, the 
mention of the fact will insure the need of one. Par- 
adoxical as it may seem, a crowded hospital ward is 
the best place in which to treat a large majority. 
The physicians and nurses go about in a methodical, 
don't care, matter-of-fact way; all emergencies, bad 
signs are observed soon, necessary attention is given, 
no news of panic or death comes in. Sickness is the 
business of all, other patients are worse off", some who 
appeared to be worse off are convalescing, and patients 
get well who under a mother's sympathetic hands 
would die. 

In men particularly, (for priapism and inordinate 
desire are not infrequently accompaniments of con- 
valescence) coition should be prohibited until safety 
is absolutely assured, and the only way to secure ab- 
stinence is to warn the female as well as the patient 
in plain terms. Not a few cases of fatal collapse are 
attributable to the exercise of the marital privilege 



1883.] 



MILK SICKNESS. 



71 



before the tenth day of convalescence ; and I know 
of such even after the man had been instructed as to 
the prostrating effect. Some of these observations 
may appear frivolous, but the saving of most of the 
doubtful cases depends so much on observance of all 
the details of diet and strength-saving, that I have 
run the risk of being prolix in order to state them. 
If only a few lives can be saved, the death-rate is 
made to comport with the possible, and it matters 
little whether they are saved by drugs administered, 
or through the common sense instructions of physi- 
cian and attendants. 

Notes : 

I am almost certain that I saved the life of an es- 
teemed physician by deceiving him as to his temper- 
ature. In disgust that so strong a man could not get 
up a fever higher than 39 C. or 39.5 C, (when it 
was, in fact, at one time 41 C), he concluded that 
he was not so very sick after all. His three weeks' 
convalescence with yellowness of eyes and skin and 
extreme prostration fully evidenced the danger he 
had been in. 

A priest, sick in an upper room, heard some ladies 
speak of the death (which occurred a moment before) 
of the commander of the fort, and of the necessity 
of keeping him ignorant of the fact until his crisis 
had passed. By a strong assertion of his will he de- 
cided not to be alarmed if the news should come to 
him, and not to ask the usual question about his now 
dead friend. He recovered; but if he had been 
startled by the sad news he would have vomited, col- 
lapsed and died. 

_ A young man, with physically favorable prospects, 
conceived that a fellow-boarder was in love with his 
perhaps fatally ill wife. His inability to protect her 
by personal attention caused such distress of mind 
as to continue his fever until the sixth day in spite of 
all care and effort, and death resulted. His wife was 
only saved by concealing the fact of her husband's 
death for twelve days. 

I have little fault to find with other plans of man- 
agement as to medicine, but only give what I have 
reason to be satisfied with. 

Salicylate of soda, carbolate of soda, et al., are 
useless. Pilocarpin has failed to meet my expecta- 
tions. Large doses of calomel as a purge causes loss 
of three to six hours valuable time. The "three 
times three" treatment is useless in early vomiting 
cases — /. e., 3 grs. each of quinine, calomel and 
Dover's powder every three hours. As a febrifuge 
and diaphoretic it is of service. I have seen patients 
die with "liver pads" on them, and have removed 
them to put on a sinapism. 

' ' Liver medicines' ' are of service in preventing the 
antecedent constipation, and thus tend to lighten 
attacks, but they do not prevent. 

The "fever cot" is dangerous, expensive, requires 
two or three attendants on every patient, and is not 
infallible, as I saw the inventor die on one under his 
own directions. 

The Secretary of the Section has furnished the fol- 
lowing brief notes of the discussion which followed 
the reading of the foregoing paper — [Editor] : 

Prof. H. F. Campbell, of Georgia, stated that he 



was impressed by the comprehensiveness of detail ex- 
hibited by Dr. Murray in his treatment of the subject. 
But basing his remarks upon his own experiences of 
the disease, said he recommended phlebotomy and 
the administration of emetics and cathartics, in cer- 
tain cases, and laid particular stress upon the admin- 
istration of quinine and liquid food. 

Prof. Palmer, of Michigan, joined in the discus- 
sion ; and Dr. Elliott, of Pennsylvania, objected 
strenuously to venesection, but advocated diaphoresis, 
and advised moderation in the use of therapeutic 
agents. 

Dr. A. N. Bell, of New York, advocated diaphor- 
esis, the use of sulphur and magnesia to produce 
catharsis, and absolute physical and mental quietude 
during convalesence. 

Dr. Franklin, of Ohio, favored depletion by the 
use of calomel, and a strict diet during convalesence. 

Gen. Elwell, of Ohio, was invited to a seat in the 
Section, and favored the audience with his experi- 
ences of yellow fever, at Port Royal, in 1862. 

Dr. J. B. Hamilton, Surgeon -General of U. S. 
Marine Hospital service, closed the discussion on Dr. 
Murray's paper, stating that he believed in the con- 
tagiousness of yellow fever, in the value and advisa- 
bility of quarantine, and urged quarantining, disin- 
fection and cleansing as means of prophylaxis against 
the fever. 



MILK SICKNESS. 



BV WILLIAM MORROW BEACH, M.D., LONDON, OHIO. 



[A Paper read before the Section on Medicine, of the American Medical 
Association, at Cleveland, Ohio, at the Session of June 5th, 6th, 7th, 
and 8th, 1883.] 

I believe milk sickness to be a disease sui generis. 
In Madison county, Ohio, where I was born and 
raised, I presume nearly one-fourth of the pioneers 
and early settlers died of this disease ; nor is its cause 
entirely eradicated there, or in many other dis- 
tricts of country where it has ever been known to pre- 
vail. Its principal fields have been Western Pennsyl- 
vania, Ohio, Kentucky, Tennesseee, Illinois, Indiana, 
and Michigan ; and it has probably never been known 
in New England, west of the great American Desert, 
nor in any of the countries of the Old World. Its 
existence as a specific diseases has generally been dis- 
credited by the writers of medical literature in the 
eastern cities ; and I think it is nowhere mentioned 
in any text book on theory and practice I have ever 
read. 

The disease in the lower animals is called "trem- 
bles;" and " milk sickness, " when it affects the human 
species. The disease is most common in the late 
summer and early autumn ; but it occasionally occurs 
in the winter season. 

Among domestic animals the trembles usually first 
affects unweaned calves, or lambs or colts. This 
would be expected, as the poison seeks elimination, 
or is eliminated in part, through the emunctory of 
the lacteal secretion; and the unweaned are 
subjected to the double cause — the cause that affects 
the mother, added to the poisoned milk it nurses. 



72 



MILK SICKNESS. 



[July, 



It next affects the other animals of the herd that 
are not giving milk ; and the milk-giving animals 
last of all. This holds true with cattle, goats, sheep 
and horses. 

The poison, whatever it is, is specific. The milk, 
the butter, the flesh of an animal suffering with trem- 
bles or in the prodromic stage of trembles, or bor- 
dering on the prodromic stage, transmit, or are liable to 
transmit, the disease to other animals that partake of 
them. 

Wild animals are no less and no more exempt than do- 
mestic animals. The wolf, the fox, the wild cat, the wild 
hog and the turkey-buzzard that partook of the dead 
body of a deer that had died of the trembles, in the pio- 
neer days of the infected districts, were as liable to con- 
tract the disease as the dog, the cat, the hog, the turkey- 
buzzard, or the fox that eat of the dead body of the 
•calf or other domestic animal of a later day. 

ETIOLOGY. 

ist. Many of the pioneers, as well as many well- 
informed laymen and physicians of the present time, 
attribute the cause to the ingestion of some vegetable 
by herbivorous animals. These advocates are, and 
have been about equally divided between the eupato- 
riuni agei'atoides and the rhus toxicodendron as the 
vegetable that contains the specific poison. 

2d. Others have claimed, and still claim, that it 
is contracted by the herbivora drinking from certain 
sources of water supply contaminated with the specific 
poison. 

3d. Others have claimed that its origin is malarial 
— marsh misamatic. 

4th. That it is of a gaseous or mineral origin, 
and may be breathed, drank with the water, or in- 
gested as it settles on and adheres to vegetation. 

5th. That it is produced by spores, bacteria, or 
some microscopical fungi or disease germ. 

In the consideration of its etiology a few well es- 
tablished facts should be borne in mind. 

ist. The trembles are seldom met with in a wet 
season. 

2d. In exceptionally dry seasons it may be confi- 
dently expected — in localities where the cause is 
known to exist — if domestic animals are not cared 
for by the thoughtful owner. 

3d. In fields where the flora may be supposed to 
be identical, it may be contracted in one field and 
not in the other. 

4th. It is unknown on open prairies or in culti- 
vated fields that have been well opened to the sun and 
have become "tame," although the fields may not 
ever have been plowed. 

5th. It is so safe, that in the experience of my 
life-time I have known of no departure from the rule 
— that domestic animals may roam with impunity 
through the infected districts anywhere, through the 
day time, providing they are brought to the inclosure 
or corral before nightfall, and kept there until the 
fogs and dews have dispersed on the following morn- 
ing. All the pioneers with whom I have ever con- 
versed hold to this theory, and it fully accords with 
my own observations. 

6th. Wild and unimproved lands, densely tim- 
bered, seem to be the favorite haunts of the poison ; 



nor does the quality of the soil or the character of 
the soil seem to influence the danger or prevalence of 
the trembles in herbivorous animals that are exposed 
at night. The rule holds good in the low lands of 
Ohio, Indiana, the groves of Illinois, or the high and 
rugged lands of Kentucky and Tennessee, so far as 
my sources of information have reached. I have 
long held the conclusion that the theory of vegetable 
ingesta alone is not based on satisfactory grounds. 
Within a few miles of where I live I have known in- 
closed lands, both in Madison and Clark counties, 
where trembles will develop during any summer of 
protracted dry weather, when they would not develop 
of an ordinarily wet summer; while the flora would 
be supposed to remain the same from year to year. 
One claim, however, renders this conclusion less con- 
clusive, and that is that in very dry summers the grass 
crop becomes so much exhausted that the herbivora 
are driven to eat of such plants as they might other- 
wise reject. 

But on my own farm, near London, Madison 
county, Ohio, — composed mostly of level, black, 
alluvial soil — within the last fifteen years I have 
cleared up and improved from its natural state about 
seven hundred acres, over much of which the rhus 
toxicodendron and the eupatorium ageratoides were 
abundant, and yet no case of trembles has ever occured 
there to the best of my knowledge and belief. And the 
leaves and the tender twigs of the rhus toxicodendron 
are relished and kept closely trimmed by horses, cat- 
tle and sheep. 

As to the third, or marsh miasmatic theory, I think 
the cause cannot be identical, as the trembles and 
milk sickness have never been known, it is supposable, 
in other countries, or in many sections of our own 
country, where different forms of malarial disease 
have always been known to prevail abundantly. 

As to the fourth, or deleterious water supply theory, 
I think there is something in it. In very dry sea.sons, 
the water supply runs low, and the source of supply, 
in general, probably becomes stagnant and impure. 

Within three miles of where I live, I know of three 
tracts of woodland, of forty or fifty acres each, which 
remain uncultivated, as they are retained in that con- 
dition to keep up the timber aupply for the farms. 
These woodlands are pastured off until about the 
month of June each year, and again utilized in win- 
ter for feed lots for hogs, cattle, etc. , with almost cer- 
tain safety to the stock ; but were the stock left there 
over into the months of July, August or September, 
in a dry season, trembles would almost certainly ap- 
pear, as the experiment has not failed, in a dry sum- 
mer, within the past seventy years. Some seasons, 
the venturesome owners keep thinking that they will 
use them for just a few days longer in the summer ; 
when the appearance of turkey buzzards hovering over 
the woods in large numbers, suggests to them that the 
food these scavengers covet lies below them, dead of 
the trembles. 

These three pieces of woodland are a mixture of 
low alluvial and dry elevations, or ridges, timbered 
mostly with white oak. To rid them of their danger, 
it would only be necessary to cut off the timber, and 
let the sunlight in upon the bare unshaded ground. 



1883.] 



MILK SICKNESS. 



7S' 



In one of these pieces of woodland, the water supply 
is from a spring, which for many years was the water 
supply for a household of poor non-paying squatters, 
and in the twenty-eight years that I have attended 
professionally all families who have lived there, no 
case of milk sickness has ever occurred, nor more 
than the usual amount of remittents or intermittents ; 
but no one ever lived there that owned a cow, or were 
more exposed by reason of milk, butter, cheese or 
diseased meats, than their neighbors who lived on 
cultivated farms. 

I accept the theory as to the cause of trembles, that 
it has its origin in disease germs or spores, bacteria, 
microscopic fungi, etc. ; but whatever its cause, I 
think it is evident that it is 

1 . Specific. 

2. Infectious. 

3. Incubative. 

PREDISPOSING CAUSES. 

Perhaps the most general predisposing cause is 
fatigue. I should think that half of the cases of milk 
sickness I have ever seen in women have followed im- 
mediately upon a washing-day, or a day of hard work 
in cooking or entertaining company, and I recall the 
case of one man who came up out of a well he was 
digging, and went directly to bed, where he died ten 
days later. 

Among the livestock dealers in milk-sick districts — 
it has been the custom, since my recollection, to 
make one of the stipulations in a cattle trade to have 
the privilege of nmning the cattle for five, ten or fif- 
teen minutes, as a test for their safety from trembles. 
If they had trembles, or were bordering on the disease, 
more or less of them would be likely to show it un- 
mistakably, whilst running, or within a very few 
hours thereafter. 

PERIOD OF INCUBATION. 

This, I think, must be somewhat uncertain. I re- 
call the case of a young girl who was a servant in the 
family of one Dr. A. W. Field, at Amity, Madison 
Co., Ohio, about thirty years ago. Her fathers fami- 
ly, five miles distant, in the country, contracted milk- 
sickness, and she went to visit them on Sunday, before 
the true nature of the sickness had been pronounced. 
She stayed to dinner, and ate some butter on her 
bread, but no cheese, milk, or meats of any kind, 
and returned to the village in the afternoon. On 
Tuesday, the second day following, she came down 
with milk-sickness, but had a slow recovery, while all 
the balance of her father's family died. 

In 1867, in the month of August, I was called to 
see the case of the well digger before alluded to. He 
was a farmer, living in Pleasant township, Clark 
county, Ohio, and was digging a well for the use of 
his family, at his own house. I suspected milk-sick- 
ness. He acknowledged that his cows had "stayed 
out" two successive nights, about a week before, in 
the Baily Woods, a heavily timbered, unimproved 
body of land of several hundred acres, adjoining his 
little farm, and belonging to some minor heirs in 
Virginia. They declared their cows and calves were 
healthy ; but I went into the barn lot and commenced 
chasing the calves, and in less than five minutes one 



of them developed into an unmistakable case of 
trembles. 

The products of the dairy were used no more b-jr 
any member of the family; but the wife, who was^ 
e/iciente, was taken two days after ; and within a week 
I had five cases in the family, all of whom had a slow 
recovery excepting the husband, who was somewhat 
intemperate — and that class of cases generally die. 

In August, 1869, I was called to see S. M., on the 
National road, near the line between the counties of 
Clark and Madison, in Ohio, and within about three 
miles of the Baily Woods, before mentioned. Mala- 
rial remittents were then prevalent, and I failed to 
get a clear history of his case, as he was deaf and 
dumb, and his wife a poor interpreter. I concluded 
to prescribe quinine ; which I had administered in 
whisky, to reconcile him to the bitter taste of the 
drug. On the following day I repeated the same ; but 
on the third daily visit I found his wife sick, and I sus- 
pected milk-sickness. I ascertained that their cow 
had "stayed out" one night about a week before, and 
had probably stayed over night in the Baily Woods 
aforesaid. I went to the pasture and chased the calt 
around, but without developing any trembles ; but by 
the next day I found the woman with a well-marked 
case of milk-sickness; and the calf dead of the 
trembles. 

The husband made a good recovery, from a very 
mild case of milk-sickness, in which there was no 
vomiting, no retching, but simply the symptoms of 
the initial stage before vomiting supervenes ; whilst 
the wife died on the twelfth day of her illness, and 
an only child, a boy, twelve years of age, escaped 
entirely. 

In the winter of 1874-75, I was called in consulta- 
tion at night, with Dr. James B. Sprague, to see some 
cases in Brighton, Clark Co., Ohio. 

I found the husband, aged about forty-five, a coop- 
er by trade, in articulo mortis. I found his wife,, 
about forty, in but a little better condition, as she 
died about twelve hours later. 

Now the question in these cases was, where did the 
disease come from ? A beef had been sold by retail 
through the town the previous week, and suspicion 
pointed to that as the cause ; and the development 
of four additional cases in another family, about four 
days later, — all of whom had partaken of the suspected 
beef, seemed to strengthen the suspicion ; although 
other families who bought of the beef escaped. 

And then another question arises, where and when 
had the beef contracted the disease? That cattle 
may have trembles in the winter season, is a matter ot 
occasional observation ; and the old citizens generally 
attribute it to the feeding of cattle upon wild or 
swamp hay. And that suspected animal, it was ascer- 
tained, had been feeding from hay cut in a boggy 
meadow, over which about one hundred acres of the 
drainage of the aforesaid Bailey Woods spread itself 
as it sought the sluggish ditch running across the 
meadow. 

The disease germ in the animal may have been in- 
cubating since the summer season ; but it would seem 
quite as probable that it was attached to the grasses 
and survived until the proper nidus was found in the 



74 



MILK SICKNESS. 



[July, 



ingesta of the animal's stomach, when it started to 
activity and possible multiplication, like a germinat- 
ing speck of yeast plant. 

SYMPTOMATOLOGY. 

In the lower animals the disease is called "trem- 
bles," from the agitated condition of the muscles in 
the animal affected. 

The first symptom of the disease that is generally 
noticed, is that the animal is indisposed to exercise. 
It stands apart from the herd, drooping, languid, 
with a look of extreme fatigue, and persistently ab- 
stains from food. 

The second stage is that of trembling, extreme 
thirst and obstinate constipation. The animal at 
length can no longer stand, and when it lays down 
seldom rises again. The decubitus becomes at full 
length, and the animal becomes a stranger to any 
manifestations of fear, affection or anxiety. The 
respirations are slow, the extremities and surface cool, 
and the eye at length fixed, glazed, and the winking 
ceases altogether. Death generally follows — occur- 
ing, ordinarily, from the eighth to the tenth day. 

In milk sickness the patient is apathetic, complains 
of malaise, weakness, indisposition for exercise, loss of 
appetite or loathing of food, and sometimes of slight 
nausea. This condition may run on for several days, 
gradually becoming more pronounced, when vomiting 
supervenes, and the patient finally takes to his bed. 
There are no chills, no rigors, but usually an unsatis- 
fied thirst. The tongue is large, flabby, tremulous, 
moist, and heavily loaded with a dirty white coating. 
The temperature of the surface sinks below that of 
normal. The skin is dry, and sensible respiration 
suspended. The abdomen is retracted and flabby, 
and comparatively empty. Peristaltic motion seems 
absolutely suspended ; and from that cause, probably, 
and the general suspension of alimentary secretions, 
the bowels become, from the first, obstinately and 
persistently constipated. 

The breath becomes offensive, with an odor that 
some people claim is peculiar to milk-sickness alone. 
I am led to believe that this may be so, but my ob- 
servations do not fully confirm me in the belief. The 
urine becomes diminished, sometimes to eight or ten 
ounces a day, and generally clear and limpid. The 
pulse is variable as to frequency, but is always weak 
and easily compressible, with labored action of the 
heart and pulsating aorta. The temperature rises in 
some cases to 99°, but is usually below normal. 

There is a marked degree of hebitude and indiffer- 
ence, and even in cases where the patient expresses 
no hope of recovery ; the ordinary solicitude for the 
future of the family and friends is rarely alluded to. 

There is an intolerance of covering for the body, 
-especially of the extremities ; and I recall one case 
in which che patient would give no rest to the nurses 
•only as they kept his hands immersed in a basin of 
cold water ; and the ordinary efforts resorted to for 
warming up the extremities usually are attended with 
.an aggravation of the vomiting or retching. 

As the disease advances, the exhaustion becomes so 
■extreme that vomiting is superseded by a feeble retch- 
ing effort, that to be heard once is to be remembered 
always. 



The patient seems to become more and more som- 
nolent ; but there is seldom oblivious sleep ; and if 
there ever is, at all, it is of short and fitful dura- 
tion. 

The vomiting first, and the retching in the later 
stages, continues to the very close of life ; or until 
coma and oblivion shut it off". 

In the later stage the fluid ejections from the stom- 
ach are tinged like the indigo-blueing water used in 
laundries. 

These symptoms increase as the disease advances ; 
the hebitude assumes a semi-comatose condition ; the 
respirations decrease in frequency, and are variable — 
sometimes profound and sometimes scarcely percept- 
ible — like the respirations of a hibernating animal. 
The prostration sometimes becomes profound, the 
process of winking suspended, and the conjunctiva 
and cornea become dry and glazed. The hebitude 
increases to somnolency, and the somnolency to a 
coma. There is stasis of the capillaries, and the 
vital forces, yielding one by one, the patient dies 
without a struggle and almost without a sign. Some 
cases are mild, like the one of the deaf and dumb 
man I have alluded to, and in bad cases, when re- 
coveries take place, the convalescence is by slow and 
almost imperceptible stages. I think I never met 
with but one case in which there seemed to be a 
crisis, characterized by a sudden restoration of the 
functions. This was in the case of a child — a girl 
about twelve years old, in the family of the well-dig- 
ger before alluded to. On about the tenth day of 
her sickness I gave up all hope of her recovery. For 
two days her corma had been continuous ; the process 
of winking suspended for forty-eight hours, and all 
signs of vitality nearly suspended. Altogether unex- 
pectedly to me she had a dejection, deep green in 
color, of about one quart, of the consistency of soft 
soap. Twelve hours later the respirations had in- 
creased by at least five in the minute, and she had 
been noticed to open and shut her eyelids four or five 
times. She gradually recovered. 

PATHOLOGY. 

The consumption of tissue in this disease is limited, 
and not like the consumption of tissue in continued 
fevers. There has been no tenderness over the epi- 
gastrium, or the bowels, and the post-mortem shows 
no characteristic symptoms of inflammation in any 
part of the alimentary canal. The stomach is found 
empty and the contents of the intestines consist prin- 
cipally of lumps of a dark-colored, dry, tenacious 
feculent matter — much the same in appearance as the 
evacuations, whenever they occur in these cases in 
the course of the disease. I think there are no special 
characteristic pathological symptoms by post-mortem 
unless it be the above named appearances of the con- 
tents of the intestines. 

TREATMENT. 

This, to a very great extent, has probably been em- 
pirical. The aborigines in Central Ohio, and possi- 
bly elsewhere, are, said to have placed some reliance 
on the use of pulverized charcoal, suspended in milk. 
I used this not infrequently in the early days of my 
practice, and sometimes have thought that its persist- 
ent use did have an influence in allaying the nausea. 



i883.] 



MECHANICAL RENEDIES IN SKIN DISEASES. 



75 



Effervescent mixtures — carbonic-acid water or soluble 
citrate of magnesia, or lime water, however, have 
seemed to give me more satisfactory results, if I have 
ever had any satisfactory results from anything. Fre- 
quently repeated teaspoonful doses of pure olive oil 
was a favorite remedy in domestic practice; and I 
have used olive oil in four-ounce doses, repeated 
about four times a day, per rectum, but with no ap- 
preciable results. Emetics were sometimes used by 
the botanic physicians ; and drastic cathartics — calo- 
mel, jalap, etc. — by the rrgulars, in an early day ; 
but probably only with the results of hurrying some 
off who might possibly othenvise have recovered. 
Mercury was not infrequently tried, as in mechanical 
obstniction of the bowels ; but I never saw a case so 
treated which recovered, nor ever saw a globule of 
mercury that had been passed per anum. 

I recall the cases of the first family into which I 
was called, professionally, in the capacity of a medi- 
cal adviser, in cases of milk-sickness, in the autumn 
of 1853. The family were residents of Darby town- 
ship, Madison county, Ohio, on the banks of Little 
Darby — a sluggish stream of two or three rods in 
width. One child was already a corpse, and the 
father died on the following day. There was another 
one of the family sick for four or five days ; and I 
recommended the attending physician to give whisky 
and quinine — a remedy recommended probably for 
the first time in that settlement. I cannot say if my 
recommendation was carried out, but the patient re- 
covered. 

The next family was in the autumn of 1855, in 
Monroe township, Madison county, Ohio. One of 
the cases, a young lady of eighteen, was in the fully 
developed stages of the disease, and died on the fifth 
day. Four others of the family — the mother who 
was enciente, in the sixth month, and three children, 
were simply in the prodromic stage, — with lassitude, 
hebitude, and slight nausea. There was consterna- 
tion in the household when the disease was pro- 
nounced ; and in the prodromic cases I advised stim- 
ulating doses of spiritus frumenti, every 4 hours, in 
the shape of punch, egg-nog, stews, with sugar, or 
with sugar or pepj^ermint, or straight, as was most 
desirable to the patient, coupled wfth fresh slippery 
elm bark mucilage, as a drink, and avoidance of all 
unnecessary exercise ; and none of these four cases 
advanced to the stage of persistent vomiting, and all 
recovered within a week or ten days. 

Within the last twenty years I have avoided the 
administration of active cathartics, — as there is sus- 
pended peristalsis during the pronounced stages of 
the disease, — and have confined myself generally to 
mucilage of fresh slippery elm as a drink, occasional 
small effervescing draughts, when agreeable to the 
patient, and alcoholic stimulants either per orem or 
per rectum, in all cases, with better general results 
than when I vacillated too much from this course, in 
the earlier days of. my practice. 

In "trembles" the domestic remedy that was of 
the most general adoption, was feeding the animal 
with green corn, freshly cut from the field. If the 
animal would eat enough to act as a cathartic, it would 
generally get well. 



When I am called upon to prescribe I recommend 
four ounces of whisky to one quart of water, repeated 
every four hours. Deaths from trembles seldom 
occur when this is commeneed early in the case and 
followed up long enough ; or until convalescence be- 
gins. 

MECHANICAL REMEDIES IN THE TREATMENT 
OF SKIN DISEASES. 



BY JOHN V. SHOEMAKER, A.M., M.D., PHYSICIAN TO THE 
PHILADELPHIA HOSPITAL FOR SKIN DISEASES. 



[Read to the Section on Practice of Medicine, Materia Medica, etc , 
June, 1883.] 

Gentlemen : I do not propose to read my pajier " 
in extenso before the Section this afternoon, but while 
giving its salient points, I shall reserve for publication, 
in case of acceptation, its entirety. 

There are a number of remedies which can be used 
in the treatment of skin diseases which cannot be 
classed as drugs, but being mechanical in their appli- 
cation may be appropriately termed mechanical reme- 
dies. 

They are massage, compression, blood-letting, in- 
cision, excision, enucleation, scooping, scraping, set- 
ons, and cauterization, remedial measures which have 
been in vogue almost from time immemorial, but 
which have been more or less lost sight of, and sel- 
dom, if ever, used by therapeutists in the treatment 
of cutaneous diseases. 

These are all valuable agents, as I can attest from 
a long personal experience with them, and I now mil 
proceed to relate what can be accomplished with these 
mechanical appliances in skin diseases. I will begin 
with massage, — the first mechanical agent which I 
shall consider. Although long and favorably known 
as a general remedy it has, however, attracted little if 
any attention as a means of treating skin diseases. 
Its use upon certain morbid conditions of the integu- 
ment, when properly applied, is often followed with 
marked beneficial change and at times with complete 
restoration of the part to its natural state. Massage 
not only acts in this way locally, but by its indirect 
effect when used generally, will add tone and vigor to 
the entire system. This direct as well as indirect ac- 
tion of this powerful mechanical remedy can thus be 
put into execution both for its local and constitution- 
al effect in many skin affections. Massage, if employ- 
ed in its original sense, would simply imply kneading ; 
it has now a wider and more general use, and includes 
as well a group of procedures known as friction, pinch- 
ing, manipulation, rolling, and percussion of the dif- 
ferent external parts of the body. It can be done 
with the hand or with the additional aid of some 
fatty substance, a coarse towel, a hair mitten or a 
brush. It may be performed also by means of ingen- 
ious machines that are now perfected and arranged 
for doing, what the most skillfull manipulator can do 
with his hands. It is better, should the hands be 
used, that the operator should be strong, muscular if 
possible, possessed of activity and energy, cheerful 
and intelligent, with some knowledge of anatomy and 
physiology. If he has not these latter acquirements 



76 



MECHANICAL REMEDIES IN SKIN DISEASES. 



[July, 



he should, at least, possess a thorough preparatory 
training of manipulation. In addition the hands of 
the operator should neither be too small nor too large, 
neither long, bony, doughy, or clammy, but should 
be both firm, soft, and elastic. Now that I have de- 
fined massage and how it is used, I shall next speak 
of its special forms, their mode of application and 
their effects. The first and perhaps the most com- 
mon form of massage used in the treatment of skin 
diseases is friction. Friction can be employed upon 
the integument either by patients themselves or by a 
manipulator with the hands and with the aid of some 
fatty material, liniment, brush, or a coarse towel, or 
mitten, according to the special indication in each 
case. 

It might also be well to make circular at the same 
time with the straight line friction. In thus employ- 
ing friction the whole palmar surface can be used ; 
both hands moving at the same time ; according to 
the method of Graham the one ascending as the 
other descends, at the rate of one hundred and 
twenty-five to two hundred and fifty strokes each 
minute, or two hundred and fifty to five hundred 
with both hands. The strokes will necessarily be less 
rapid on the back and back of the thigh, by reason 
of the skin being thicker and coarser, the muscles 
more prominent, and the part to which it is applied 
longer. 

Friction can and is usually made in all directions 
over a surface without regard to any rule, but it is 
much better and more efficacious to make it either 
vertical or circular. For example, in manipulating 
in this way a limb, the upward or vertical stroke from 
the extremity to the tnmk, followed by the same 
downward movement, will always favor and not re- 
tard the circulation, thus giving a soothing and 
beneficial influence to the part. 

The upward stroke should be strong. and vigorous, 
while the returning one should be light and passive, 
the palm of the hand, however, still remaining in 
contact with the surface. The effect of frictional 
massage is to stimulate the lymphatic vessels and veins 
to augmented action, and thus promote the absorp- 
tion of inflammatory products, should any exist, as 
well as adding tone and vigor to the general system. 
The vessels in course of disease are not only com- 
pressed by inflammatory deposits in the tissue, but 
are also often filled up with plasma and other mater- 
ial, causing stagnation and a loss of their absorbing 
power. The object to be attained by using frictional 
massage in such conditions is to empty by this me- 
chanical procedure the over-distended lymphatics and 
veins, thus increasing their activity, re-establishing 
their absorbing power, which will enable them to 
carry off all deposits and restore the tissues to their 
normal state. Frictional massage can very often have 
combined with it such movements as pinching, knead- 
ing, manipulation, rolling and percussion. This 
group of procedures can be advantageously blended 
.at times with friction, more especially when the ex- 
udation is very great, the innervation of the skin 
marked, and the object is for a more decided action 
upon the superficial and deep parts. 

iMassage. — Itsi Mode of Application and Effects, by Dr. Douglass 
(jraham. (^Popular Science Monthly, October, 1882, p. 725,) 



According, therefore, to the requirements of each 
individual case, one or more of these movements can 
be combined, used alternately or varied. 

Thus friction and manipulation can be employed 
in turn, modified with rapid pinching of the super- 
ficial and deep structures, kneading, handling or 
picking up and rolling the muscles, followed with 
quick but gentle or vigorous percussion with the 
palm or sides of the hand, or the ends of the fingers. 
The action of these combined and varied movements 
are decidedly more effective both as regards their di- 
rect and indirect effects. The lymphatics and veins 
are emptied, as has already been stated, of th^ir ef- 
fete products, whieh cannot return as such, on ac- 
count of the valvular folds within the vessels. The 
vaso-dilators are also influenced through the stimula- 
tion to the muscular nerves by which the calibre of 
the vessels are greatly enlarged, thus increasing both 
the space and speed of the circulation. 

Massage employed in this manner not only has this 
local beneficial influence, but by its alternate con- 
traction and relaxation of the muscles and vessels be- 
comes a powerful aid to the general circulation, 
furthers nutrition, and is the very best substitute for 
active exercise. 

This general effect of massage Nordhoff shows in 
his book on Northern California, Oregon, and the 
Sandwich Islands. In the latter, in particular, he de- 
scribes how it was employed in place of exercise, 
being a most valuable device with the natives for aid- 
ing digestion, relieving weariness from over-exertion, 
and both neuralgia and muscular pains. Its benefi- 
cial effect in its general action upon the system has 
also already been clearly demonstrated by Dr. S. 
Weir Mitchell in his well-known Rest Cure, as well 
as by Prof. Charcot, of Paris. 

Dr. Zabludonski, in a paper read in April (1883), 
at the Twelfth Congress of the . German Surgical 
Society, held in Berlin, also describes in a clear and 
vivid manner the physiology of massage. This em- 
inent author based his conclusions of the action of 
massage upon a number of experiments upon men in 
different physical condition, as well as upon rabbits 
and frogs. His investigations " have led him to believe 
that nearly all the bodily and mental functions could, 
be influenced by the various kinds of massage. The 
weight of the body is reduced in corpulent and thin 
persons, but is increased in those of medium build. 
Capacity for work and bodily strength is increased. 
The mental processes become more active, and sleep 
is rendered more sound and regular. The frequency 
of the pulse is lowered, motility is favored, and 
sensibility is blunted. These effects would serve to ex- 
plain the value of the method in affections of rheumatic 
and neuralgic nature. 

Now that I have thus briefly described massage, 
with its special forms and their modes of application, 
I wish, in conclusion, to refer to its effectiveness in 
certain skin diseases. In the dry form of seborrhoea, 
particularly of the scalp, and in thinning and loss of 
hair, frictional massage, used with moderation, stim- 
ulates and augments the sluggish circulation, furthers 
absorption, and imparts tone and vigor to the scalp 
and hair. In indurated acne and in glandular swell- 



I883.J 



MECHANICAL REMEDIES IN SKIN DISEASES. 



77 



ings it arouses the activity of the sluggish and choked- 
up absorbent vessels, and thus relieves the glandular 
congestion, and the skin again becomes normal in 
being soft, supple, and elastic, and free from these 
lesions. It not only has a local beneficial influence 
upon the class of affections just named, but likewise 
often removes, or assists in removing, when used over 
the trunk, many gastric and intestinal disorders which 
very often keep up the cutaneous irritation. This 
general effect of frictional massage I have witnessed 
again and again in relieving and curing constipation 
and other functional derangements, which are very 
often active factors in keeping up acne, rosacea, hy- 
peridrosis, seborrhcea, uticaria and eczema. 

It is often efiicacious in removing scarf, and in 
cases in which the pigment of the skin is either in 
excess or deficient in quantity, stimulating to renewed 
activity the absorbents, and assisting in again restor- 
ing the parts to their natural state. Massage, whether 
made with one or more of the group of movements 
named, is an invaluable agent in certain neuroses, es- 
pecially in neuralgia, perverted sensibility, and trophic 
disturbances of the skin. It exerts in these affections 
a delightful and pleasing local effect, relieves pain by 
its sedative and counter-irritant effect, increases the 
circulation of the blood in the integument, thus less- 
ening its activity in the internal organs, and likewise 
has as a result a decided tonic action upon the ner\-- 
ous system'. Massage as a general remedy is an im- 
portant and valuable adjuvant in promoting and in- 
creasing oxidization in cases of scrofuloderma and in 
psoriasis. It makes the skin more active, removes 
effete products from within as well as without, and 
increases the red corpuscles of the blood. It is not 
only a good, but even a most useftil remedy both, for 
its general and local effect, in many of the forms of 
subacute and chronic eczema. 

Massage thus applied in some of the subacute 
forms of eczema, in which the surface is dry, slightly 
thickened, and covered with groups of papules, will 
awaken the action of the dormant absorbents, in- 
crease the circulation, arrest the intense itching, and 
very often alone restores the skin to to its natural 
state. It is, perhaps, in the next variety of eczema, 
in some of its chronic forms, that massage has been, 
in my experience, more efficacious and more of a 
■curative agent than in any other of the affections of 
the skin. 

In such cases, where the surface of the skin pre- 
sents marked infiltration, is hard, dry, rough, thick- 
ened, even to a leathery state, and upon which all 
medication has been used in vain, it will often be 
found to yield under this appropriate form of treat- 
ment. 

Massage not only breaks up the exudation, but 
likewise stimulates the absorbents, and so assists in 
removing the inflammatory products from the tissues, 
and restores the skin to its natural soft and elastic 
condition. In chronic eczema, especially where the 
parts become covered with confluent patches of 
papules, and on which there is more or less infiltra- 
tion, dry, and attended with persistent and obstinate 
itching, the judicious use of massage will often not 
only remove the abnormal and p)ent-up effete pro- 



' ducts, but will also produce a sedative action on the 
irritation and give the sufferer a blissful state of re- 
pose, followed with sleep, which formerly had been 
constantly interrupted by the itching. 

Before concluding this important mechanical rem- 
edy, I wish again to call attention to the fact that 
massage is valuable in certain skin diseases both for its 

, local and general effect. When it is employed purely 
as a local agent it is especially advantageous upon 
certain chronic changes of the skin. It should, how- 
ever, never be used directly upon an acute inflamma- 
tory surface, but can be applied in the early stages of 
such conditions with benefit above and below the 
parts in order to afford more area for the returning 
circulation. It is also well in using massage to follow 
certain rules and regulations. These requirements I 
have already partially alluded to in passing, especially 
the qualities which the manipulator should possess, 
such as strength, intelligence, and hands adapted to 
this purpose. Physicians should, therefore, in all 
cases, at least in the beginning of the employment of 
the massage, see that the manipulator has these 
acquirements. The physician should next see that 
the proper rules and regulations that are necessary in 
using massage are carried out, by carefiiUy observing 
its application. He should also note, first, that the 
part to be treated should be properly exposed, and at 
perfect ease for the manipulation ; secondly, that the 
hair, should any cover the surface, be well shaved be- 
fore beginning the operation, othenvise it will inter- 
fere more or less with the movements, and often cause 
considerable irritation ; thirdly, that the manipulator 
should work from the wrists, in which their energy 
should be spent on the muscles, of the hands and fore- 
arms, and not upon those of the upper part of the 
arms and shoulders. Manipulation performed by this 
latter procedure will be awkward, unskillful, Avill 
quickly tire out the manipulator, and give an un- 
pleasant sensation and motion to the patient. 

Fourthly, the movements should be begun moder- 
ately and gently, and carefully graduated and in- 
creased with both force and frequency according to 
the exigency of each case and the ability of the 
patient to bear the manipulation. 

Fifthly, the manipulator should exercise great care 
in stretching the tissues beyond their normal elasti- 
city, which, of course, will vary in each individual, 
and will vary also according to the extent and length 
of disease. He should avoid, in particular, stretch- 
ing the delicate and sensitive integument in opposite 
directions, more especially in the flexors of the joints, 
which often tears the skin by this error. 

Lastly, the dose of massage should, of course, vary 
according to the extent of surface treated, and the 
skill and exj>erience of the manipulator. 

Compression. — Compression is another very use- 
ful mechanical remedy which should receive more at- 
tention from practitioners in the local treatment of 
skin diseases than is given to it at the present time. 
It can be applied by means of any substance which 

\ will afford rest and support to the affected structures. 
The means usually employed are muslin, linen, cotton, 

' silk, and gum, used either alone and bound upon the 

. parts, or arranged in the form of bandages, plasters. 



78 



MECHANICAL REMEDIES IN SKIN DISEASES. 



[July, 



or the several materials combined together and woven 
to the shape of the part to which it is to be applied. 
The use, in the first place, of the ordinary muslin 
lightly bound over the surface of many eruptive affec- 
tions, will not only give rest and support to the parts, 
but will also exclude them from the air, which often 
tends to keep up the active irritation. It will like- 
wise retain the application, should any be made, in 
opposition to the surface, as well as preventing fric- 
tion and irritation from the clothing, assist in arrest- 
ing a discharge, should one exist, assist in limiting 
the disease, and keep at the same time the parts clean. 
The neglect of this procedure, which is at present too 
often the case, will keep up the active stimulation, 
allow the application to run off on the surrounding 
parts, permit the friction and irritation of the cloth- 
ing, causing the discharge, should one be present, 
to increase, the disease to spread, and the parts to 
become often uncleanly and offensive. 

The application of compression with muslin in this 
simple form, wound or bound around the neck, the 
axillary region, or the chest, in many of the eruptive 
affections that involve these regions, is both effective 
and important additional means in assisting the action 
of the local medication. 

Compression can be applied in the same manner to 
the breasts should any of the eruptive diseases develop, 
especially erythema or eczema, and arrest in itself, 
or assist with medication, in rapidly overcoming the 
morbid action that would drag on slowly, or often re- 
sist the curative action of drugs alone. Again, I know 
of no one remedy which is so valuable to apply in 
eczema which involves the folds of the nates and 
genital regions and the abdomen, particularly in those 
having considerable adipose tissue to these parts. 
The use of strips of muslin, or a large abdominal sup- 
port of muslin, silk, or a combination of the fabrics, 
made in the form of an apron, lacing either at the 
sides or posteriorily, will relieve the congestion, arrest 
the effusion, serve to keep the application on the sur- 
face, protect the parts, and prevent friction with the 
adjoining portions of the integument, and thus limit 
the disease. Further, the use of compression in this 
same'form in the treatment of obstinate eczema of the 
scrotum is the best evidence of its value when used, 
and the effect upon the parts when it is not em- 
ployed. 

The value of muslin, arranged in the form of a 
support, with mild compression, to the inflamed, 
thickened and enlarged scrotum, is not only in the 
support that it affords to the pendulous mass as well 
as the enlarged blood-vessels, but also the protection 
and limitation to the spread of the inflammation. 

It is, on the contrary, the neglect of its use that 
often causes the inflamed and oedematous scrotum 
to irritate the adjacent portions, especially the inner 
parts of the limbs, which congestion continues to in- 
crease with the friction of the two surfaces, until the 
individual can only move around wtth the greatest 
difficulty and pain. 

Compression, when employed upon the superior 
and inferior extremities, is usually made with band- 
ages, of muslin, plasters, some woven material, or 
gum. Bandages may be employed in any one of the 



usual forms by which the dressing or application can 
be retained, the parts protected, and equable pres- 
sure made upon the surface. 

Compression may be applied in the local treat- 
ment of erysipelas, and to soothe and protect denud- 
ed surfaces of those recovering from eruptive fevers. 
It is a most important adjuvant in the treatment of 
herpes, Herpes zoster, urticaria, furuncular, and 
glandular affections, erythema, and eczema. 

In acute eczema, it soothes muscular irritation, tones 
up the dilated capillaries, and prevents the escape of 
serosity into the tissues. Again, in subacute eczema 
it will enable the vessels to remove poured-out pro- 
ducts, protect the denuded surface, and exclude the 
air, which is very stimulating to inflamed and irritable 
parts, and so moderate diseased action. In chronic 
eczema of either the superior or inferior extremity, 
the use of water or oil dressings and local medication 
combined with systematic pressure with the bandage, 
will generally afford a mo st ex cellent result. 

The use of the latter means, it will be seen, causes 
the dressing to soften up more rapidly the thickened 
and rough skin, to remove by the constantly gradu- 
ated pressure infiltration, to equalize the circulation 
and increase the absorbative action of the medication 
used upon the surface. This same principle has been 
utilized with the most beneficial result in the treat- 
ment of ulcers of the lower limbs, especially the 
varicose ulcer. I might add in this connection, that 
the ordinary muslin bandage will generally answer for 
all ordinary purposes. I often, however, use i partic- 
ularly when varicose veins are present) the well-known 
silk stocking, composed of gum and silk, or gum and 
cotton together, so as to be quite porous. 

While I must acknowledge the great utility of gum 
by reason of its elasticity and consequent great 
adaptability in making equable pressure over the 
whole surface, nevertheless it combines with it other 
great objectionable features in its use to a diseased in- 
tegument. The principle of its application as first 
brought forward by Dr. Henry Martin, of Boston, 
Mass., was indeed a valuable one, and can be used 
modified to affected parts of the skin. Gum band- 
ages employed alone have the objectionable feature 
of preventing evaporation of the normal secretions 
from the parts, retaining heat and moisture on the 
surface, thus acting as a poultice, and macerating 
away the epidermis, which cannot be overcome by 
applying beneath the gum, muslin and any other sub- 
stance. The only way this objectionable feature to the 
use of this valuable agent can be 
overcome is to have the gum and 
a silk or cotton material woven 
together — preferably the latter, for 
its cheapness. The weaving should 
be moderately loose, such as in 
the specimen which I exhibit, so 
as to have a free porosity over 
the surface in order to allow a 
free evaporation of the secretions 
of the surface to which it is applied. 
Compression can likewise be made 
with plasters, which usually consist of muslin, linen. 




<883.] 



MECHANICAL REMEDIES IN SKIN DISEASES. 



79 



or sheepskin, upon which some simple or compound 

medicinal substance is spread. 

They are not adapted for making compression over 
the general surface, and can be more advantageously } 
used upon certain regions. ' 

Their beneficial influence, cut in strips and applied 
to the surface, is most strikingly evinced in eczema 
of the lips. 

The mucous surface in this disease is torn open 
with every movement of the lips, and all the lotions, 
ointments, and powders will not, at times, soothe the 
muscular irritation and heal the parts until they are i 
protected and placed at rest. In order to accomplish 
this purjxjse, adhesive strips can be made to encircle 
and allowed to meet posteriorily at the nape of the 
neck. In this manner the movement of the lips is 
controlled, the raw surface protected, the irritation 
soothed, and the disease promptly and effectually 
arrested. 

In removing the adhesive strips in cases of this des- 
cription, care should always be taken to detach both 
•ends and draw gradually to the centre, otherwise the 
mucous surface may again be torn open. 

While compression can be made with bandages or : 
plasters to the hands and feet for treatment of these I 
p)ersistent cases of chronic fissured eczema, yet their \ 
lack of adaptability, their inconvenience in applica- i 
tion, the ease with which they fall from the parts, ! 
their unsightly appearance and interference with using 
the members make them very objectionable means to 
employ. They can only be supplemented in the feet 
with tightly fitting porous stockings applied over the | 
dressing, or a stocking woven with some gum mate- ' 
rial in it. i 

The hands in a like manner can have a cotton or j 
-woolen glove, or what I like much better, and which i 
I use, a woolen glove with cotton and gum in the ■• 
fabric. 

The latter form of the glove or any porous mate- 
rial which will fit tightly will retain the application : 
on the surface, allow tree evaporation, sooth and pro- I 
tect the parts from irritating substances with which | 
they come in contact, and arrest all muscular irrita- 
tion that may arise. A woven cotton gum material 
•closely adapted to the parts is equally serviceable in 
eczema of the popliteal region, the knee, and the 
ankle. It is requisite always in using compression to 
apply the substance used so as to support, protect, 
and place the tissues at rest. Great care, however, 
■should always be exercised in order to prevent mak- 
ing too much pressure on the part and thus arrest the 
circulation. j 

Blood-letting. — The abstraction of blood, either j 
as a local or general measure, is one of the most pow- ' 
erful antiphlogistic remedies that can be resorted to 
in the treatment of skin diseases. j 

It is both a sf)eedy and an efficient means of com- i 
bating and arresting morbid changes of the integu- j 
ments. It is especially applicable topically in chronic ' 
conditions after medicinal agents have been exhausted 
in vain attempts to cure many eruptive diseases. \ 
Blood may be abstracted either locally from the ca- j 
pillaries or generally from a vein or an artery. In the 
treatment of cutaneous affections bv means of blood- 



letting, local depletion should be used in the great 
majority of cases, general blood-letting only being 
resorted to in very rare instances. Topical blood-let- 
ting may be performed by puncturing, scarification 
and leeching. 

Puncturing. — Puncturing can be performed either 
by a bistoury, a tenotome, or a sharp-pointed needle- 
knife such as I exhibit, and can be named, used in 
this connection, the dermatome, and is a modification 
of the needle-knife which I used in the treatment of 
skin diseases as early as the spring of 1876. 

This instrument may contain either a long or a 
short blade, which I here show in these two sizes for 
the purpose of convenience and to aid the operator. 
Upon one end of the dermatome is a spoon, while upon 
the other instrument on the same distal part is a cur- 
rett portion which I shall presently refer to. 

The first dermatome is about three-quarters of an 
inch in length, and four lines iu breadth, while the 
second one is some half an inch in length and two 
and a half lines in breadth. 

These instruments which I have just 
exhibited are but modifications of the 
needle knife which I used in the treat- 
ment of skin diseases, as early as the 
spring of 1876. I alluded to this 
needle knife in a lecture delivered in the 
spring of 1878, and published in the 
Medical and Surgical Reporter, August 
10 of the same year. In describing it 
at that time, I stated that this knife 
(the blade part of the dermatome) just 
shown, is like a fine needle, having flat 
sides and presenting the appearance of 
a small spear. This method of deple- 
tion has long been used by the surgeon 
for relieving integumentary inflamma- 
tion. 

Thus, Sir James Paget, ^advised punc- ^ 
turing in gland abscesses, ' and added 
that it will often be found to be an ef- 
fective method of evacuating their con- 
tents. Mr. Lawson Tait,^ also advises 
puncturing of the same kind of glands, 
but uses a hypodermic needle for the 
purpose and draws off their contents by 
the syringe. 

In Philadelphia, for many years. Dr. 
W. H. Pancoast has taught this punctur- 
ing as the antiphlogistic touch of the 
therapeutic knife. While it was in this 
manner used for a long period by the 
surgeon to relieve inflammatory condi- 
tions of the skin, it was not fully ap- 
plied to individual skin affections, until 
the spring of 1876, when I began using 
it, and described its application to va- 
rious skin affections in papers,^ which 
I read before the Pennsylvania State 
Medical Society in 1878, and 1879, and b^ore 



1 Medical Times and Gazette, vol. I., pg. 15, 1858. 
* British Medical Journal , vol. I., pg. 117, 1871. 

See transactions of the Medical Society of the State of Pennsylvania, 
vols. XI, XII. 

American Medical Association, vol. XXX, 1879, 1878-79. 



8o 



MECHANICAL REMEDIES IN SKIN DISEASES. 



,[JULY, 




the Section of Practice of Medicine of the Ameri- 
can Medical Association in 1879. As I have 
already stated in one of the papers referred to, 
I have employed this method of treatment with 
success in inflammation of the hair follicles of the 
beard, in acne, in enlargement of the blood- 
vessels of the face, in chronic eczema, in excess of 
pigment of the skin, in erysipelas, in scrofulous 
eruptions, in boils, carbuncles, and in neuroses. 
Thus, in inflammation of of the hair follicles of the 
beard, depletion in this way relieves the engorged 
glands, and drains off altered and vitiated blood. 
Further puncturing the patches of lupus erythema- 
tosus is a valuable means of relieving the hyperaemia 
present, as well as resulting with good benefit on the 
cellular infiltration going on in the derma. 

A similar effect is produced in acne, by allowing 
the stagnated blood and the broken-down sebum to 
freely ooze from the small incisions. 

Again, the abstraction of blood, by puncturing 
the surface, in enlargement of the blood-vessels of the 
face and in chronic eczema, especially where there 
is a large quantity of hypertrophied tissue, is an in- 
valuable remedy. In these diseases it relieves the 
congestion and stagnation of blood in the vessels, 
equalizes the circulation, and so stimulates the action 
of the absorbent vessels, that all deposits may be car- 
ried off. Puncturing is equally efficacious in arous- 
ing the torpid tissues to activity in excess of pigment 
of the skin, and in allaying the pruritic troubles of 
old age. I have relieved, and with appropriate in- 
ternal treatment, have cured some of the worst cases 
of pruritic difficulty in old persons by the above 
method of puncturing over all the diseased surface. 

This application blunts the irritation of the cuta- 
neous nerves, and relieves the capillary congestion set 
up by the morbid condition of the part. 

After puncturing the surface, it should be allowed 
to bleed freely by the application of warm or hot 
water, either one or the other of which I use in all 
cases of local abstraction of blood. The relief af- 
forded by this method of treating many cutaneous 
affections, will be best manifested by patients wishing 
a repetition of the operation, as has been my experi- 
ence again and again in both dispensary and private 
practice. 

The spoon at the other end of one of the derma- 



tomes will enable the operator to make gentle pres- 
sure upon the sides of cut pustules, abscesses, etc., and 
allow thir contents more readily to escape. The use 
of this instrument or any sharp pointed knife or 
needle for puncturing is not open to the objection 
of the lancet needle, provided with a stop, so as not 
to penetrate too deeply in the derma, as described by 
}iehT3i (IVein, Med. Wochenschrift, Jan. 1878,) or 
to the multiple scarifier invented by Squire. Knives 
thus made, can only penetrate so far by their ar- 
rangement, while the disease may require within a 
small space, both deep and superficial punctures. 

In employing the ordinary, or needle knife for 
puncturing, on the other hand, the operator can allow 
the point to penetrate to various depths, according 
to good judgment and the thickened condition of the 
integument. For instance, upon part of the diseased 
patch, erythema may alone exist, while upon another 
portion either engorged capillaries, papules, tubercles, 
or excessive hypertrophy may be found. 

The former state will necessitate slight puncturing, 
while the latter will need deep incisions, varying of 
course, according to the amount of hypertrophy 
present. In using the dermatome or knife, I usually 
hold it in the right hand, and rapidly thrust it into the 
surface, usually from one to six lines in depth, exer- 
cising, of course, great care to avoid puncturing im- 
portant vessels and nerves. While I thus rapidly 
puncture the surface, and by the quickness of the in- 
cision prevent much pain, I also sponge off the sur- 
face with warm water, so that it may freely bleed. 
This latter procedure, already referred to,will prevent 
the blood from clotting in the incisions, and thus ar- 
rest its flow, will free the surface from the poured out 
blood, which very often obscures the continued oper- 
ation. The object aimed at by the operation, is to 
relieve the congestion and stagnation of the blood in 
the vessels, to enlarge and equalize the circulation 
and thus awaken the action of the absorbents, in or- 
der that all deposits may be carried off. 

When the bleeding is profuse, an impression will be 
made not only upon the part, but also upon the sys- 
tem at large. The operation may be repeated every 
second or third day, or according to the exigencies 
of the case. 

Scarification. — Scarification, the next best means 
of abstracting blood locally, is not as frequently em- 
ployed in the treatment of skin diseases as punctur- 
ing. It is nevertheless very useful in dividing en- 
gorged blood-vessels in an inflamed surface in certain 
cutaneous affections. It can be performed with either 
a lancet, scalpel or bistoury, and the incisions should 
be made in parallel lines and should, if possible, cor- 
respond with the long axis of the parts. Incisions 
passed in this manner, lightly but rapidly over the 
congested and inflamed surface, divide the engorged 
vessels in the superficial part of the derma, and 
promptly permit their contents to escape. 

The length, depth and number of incisions must of 
course vary according to the requirements in each 
case; care also must be necessary that large veins are 
not divided. 

Scarification is employed chiefly to relieve both irri- 
table and indolent ulcers, especially of the extremities. 



1883. 



MECHANICAL REMEDIES IN SKIN DISEASES. 



8* 



It is an exceedingly valuable method, which I have 
long used in ulcerating lupus, in connection with 
scraping and local medication. 

Scarification is also efiicacious in relieving the en- 
gorgement and preventing gangrene in phlegmonous 
er)^ipelas. The operation may be repeated every 
second or third day, but the bleeding should always 
be promoted by the free use of warm water. It may 
also be well to add in this connection, that in some 
cases the depletion that may supervene may be very 
great, giving rise to marked systemic effect, even 
leading to syncope. The operator should therefore 
exercise great care in making the incisions, so as to 
divide only the superficial capillaries, unless he aims 
to have a systemic as well as a local impression, in 
which event deep cuts are advisable. 

Leeching. — Leeching is another mode of topical 
bleeding that may be used in some cutaneous erup- 
tions. It is, however, much inferior and much less 
applicable than puncturing and scarification. It can 
be resorted to when it occasionally happens that some 
individuals have so much fear of being cut with either 
a knife or needle, in which event the European or 
American leech can be substituted for either the 
puncturing or scarification. Again, leeching may be 
used in place of the latter two methods by means of 
an instrument called the artificial leech, which con- 
sists of a small scarificator, a cup and an exhausting 
syringe. Leeching is applicable to the same class of 
skin affections which have been named in puncturing. 
It is an especially effective local method of treating 
erysipelas and all glandular enlargements. 

Venesection. — Venesection (or opening one of 
the larger veins, generally at the bend of the arm, and 
allowing the blood to freely flow until followed 
with a systemic impression) has brought, in some 
instances in my hands, most decided relief in certain 
skin diseases. Generally bleeding should only be re- 
sorted to in those in which the individual is strong, 
robust, and shows every evidence of a plethoric state 
of the system. In such subjects speedy and efficient 
good will often follow general blood-letting. Thus I 
have had the most happy effect result from general 
bleeding in some cases of acute eczema, in which the 
local inflammatory action and the general irritation 
of the system both subsided. Again, in some cases 
of general psoriasis, I believe I have seen most excel- 
lent results follow bleeding. Venesection, used in 
certain skin affections, weakens the action of the 
heart and lessens as a result the circulation, and con- 
sequently lessens the temperature and congestion of 
the integument. It likewise lessens the irritability of 
the nervous system, renders the- blood more healthy, 
and assists both locally and constitutionally in. pro- 
moting the action of other remedies. 

Incisions are employed upon the integument with 
the knife, whether the bistoury or scalpel, for the 
purpose of exposing, dividing, or removing the parts. 
One of the chief values of the incisions is to expose 
tumors in the skin, which can often afterwards be re- 
moved by other means, which I shall presently 
refer to. It is in this way we often deal 
with sebaceous cysts and lymphatic enlarge- 
ments. Incisions may be employed for the purpose 



of dividing the blood vessels, and thus abstracting 
blood from a part, as already alluded to, under scari- 
fication, or cut off an abnormal and often excessive 
supply of blood to a portion of the skin. It is thus 
that the latter procedure is often resorted* to in ar- 
resting the developments of feruncular affections, 
warty growths and the enlargement of the blood 
vessels in rosacea. It is a method that has been ad- 
vantageously used, especially by Nussbaum, to arrest 
and assist in curing obstinate ulcers. This local 
means of treating old ulcers is particularly prompt 
and satisfactory, the patients being narcotized, a cir- 
cumcision, as recommended by Nussbaum, is made 
around the ulcer, and half an inch beyond the cir- 
cumference or outer rim of the sore the incision 
must be of sufficient depth to penetrate to the facia. ' ' 
A large number of blood-vessels are thus severed/ 
often causing considerable haemorrhage, which can be 
arrested by inserting into the incision a piece of lint,- 
and tightly compressing the ulcer with a bandage. 

The strip of lint thus inserted not only arrests the 
bleeding, but also prevents the cut from healing up 
during the night. On the following day the lint and 
bandage can be removed and the ulcer dressed. Ul- 
cers treated by incisions in this way have thus cut off" 
from them the excessive supply of blood that pro- 
duces so much unhealthy pus, which now lessens and 
becomes laudable. The supply of blood having de- 
creased, there is consequent less exudation ; cell-for- 
mation is now permitted to go on, and the ulcer 
gradually decreases in size until it entirely disappears. 
A free incision into abscesses, suppurating glands and 
through sinuses will not only evacuate and drain off 
the pent-up material, but will also give the diseased 
integument an opportunity of healing properly from 
the bottom, and thus avoiding unsightly scars. 

In the event that any unsightly scars should arise 
from either neglecting the above procedure, or from 
other inflammatory affections of the skin, they may 
be removed or improved by a subcutaneous incision, 
as proposed by Mr. Wm. Adams. ^ 

Incisions are likewise made into local inflammatory 
patches, as in sycosis, in erysipelas, and in carbuncles, 
to relieve the tension of the parts, to divide some of 
the sensitive nerves, as well as to afford a free exit to 
the pent-up inflammatory products. Incisions may be 
resorted to for the removal of a portion of the integu- 
ment, they are not necessarily followed, however, 
by severing the normal or abnormal tissue from the 
part, unless the cut, or cuts, are made expressly for 
that purpose. When they are made for cutting off the 
tissue it constitutes more properly, another mechani- 
cal procedure which I shall now refer to. 

Excision. — Excision consists in the removal of a 
part, either by incision of the knife, by ligature, or 
by crushing. Warts, horns, pigmentary and hairy 
moles are often eradicated from various portions of 
the integument by excision with the knife. Excision 
by the knife is also largely used for extirpation of 
many of both the benign and malignant tumors of the 
skin. 

Callosities, as well as curved, twisted, and excessive 
growth of the nails, are often only manageable byex^ 

1 British Medical Journal, vol. i, p, 534. 1876. 



.82 



MECHANICAL REMEDIES IN SKIN DISEASES, 



[July, 



.cision of a certain amount of the offending material 
by means of the knife. Excision may be resorted to 
by the same means for removing chancre, and thus 
lessening the local spot of irritation as well as de- 
.creasing the power of the infecting patch. 

In case that children or adults, more particularly 
the latter, have several superficial dense indolent 
glands, which have resisted and been intractable to 
.all ordinary treatment, excision will not only often 
prevent the neighboring glands from being affected, 
but will also avoid the evil effects of prolonged sup- 
puration and its ill consequences that may follow. 

Disfiguring scars, particularly when there is a 
•change of color in the skin, the surface is rough or 
irregular, often attended with the formation of pro- 
minent bars and ridges of scar tissue may be conven- 
iently and advantageously excised, leaving usually 
.a simple but clean scar, where formerly existed an 
unsightly deformity. 

Excision may likewise be performed through the 
.agency of any substance that can sever the tissues, 
either by a rapid or slow process, as by the galvanic 
,or thermo cautery, by the ligature and by crushing. 

The galvanic cautery, which is the generally pre- 
ferred method of excision by the cautery, is usually 
performed with a loop of platinum wire connected to 
.a suitable galvanic battery, and is both a rapid, blood- 
less and powerful mechanical means of removing 
many of the hypertrophic growths of the skin, espe- 
cially horns and warts. 

It is particularly applicable to eradicate venereal 
warts and pedunculated tumors of the skin. The lig- 
.ature, whether it be constructed of silk, flax, gum, 
wire or animal tissue, can be advantageously em- 
_ployed, only, either by the fingers or by means of a 
needle, in excising by slowly strangulating all the in- 
cluded strictures. It is a bloodless operation, often 
being the very best mode of removing nevoid forma- 
tion and vascular warts from certain regions of the 
body. 

Crushing is another very excellent mechanical 
means of excising parts, as proposed by Chassaignac, 
,of Paris, which, although less rapid than the knife, is 
still greater than with the ligature. This crushing in- 
strument, the ecraseur, consists mainly of an articu- 
lated chain or wire which embraces in its loop, once 
.applied, the tissue, which is gradually but effectually 
crushed by slowly turning the handle of the ecraseur 
to which the chain is attached. It not only pos- 
sesses the combined advantages of the knife and the 
ligature in excising many hypertrophic growths of 
the skin, but it also leaves a small wound, which is 
usually attended with slight inflammation and rapid 
healing. 

Enucleation. — Enucleation is a form of avulsion, 
.and consists in rapidly peeling out diseased structures 
either with the fingers or some hard substance, gen- 
erally the handle of the knife or forceps. It is a 
method often employed advantageously after the skin 
.and capsule has been divided over morbid growths. 
It is in this way that enlarged lymphatic glands, 
x)ften deeply situated in the neck, are removed with 
perfect safety, and the operator running no risk of 
■wounding any of the important blood-vessels in that 



region. It is also, perhaps, the easiest and most 
ready means of extirpating sebaceous cysts. 

Scooping. — Scooping is a species of enucleation, 
now muchin vogue, for removing with a smooth or 
sharp spoon broken-down products and pent-up se- 
cretions. It is an invaluable method of emptying 
cutaneous abscesses, sinuses, and certain kinds of stru- 
mous glands. Dr. Clifford Abbott, in a paper read 
at the last meeting of the International Medical Con- 
gress, states that the result of such operative pro- 
cedure has at least equalled his own and Mr. Teale's 
most sanguine hopes. Dr. Von Lesser, in an article 
on the treatment of strumous glands, in the Central 
f. Chirurg., also uses the same procedure. He first 
punctures into the gland, after which he introduces 
through this wound a small sharp spoon, and scrapes 
the interior of the gland, by which he claims the 
disease is cut short, ulterior dangers are avoided, and 
unsightly scars prevented. Scooping out of strumous 
glands by a Volkmann's spoon is also advised and 
highly recommended during certain stages of their 
development, by Dr. Frederick Treves. In resorting 
to the spoon, it should be upon those cases which have 
usually resisted treatment, and in which the glands 
are closely adherent to the skin. Further, all evi- 
dence of active inflammation should be absent, and 
the glands themselves should either be becoming soft 
or be softened. Glands in such a condition can 
either be attacked through sinuses, should they exist, 
or by puncturing or incising the integument and then 
passing in the spoon and scooping out the soft, 
cheesy portions, which readily yield and come away. 
A material is thus rapidly removed which would re- 
quire by nature's process a long and tedious time to 
eliminate, attended with general derangement of the 
health, in addition to the local disfigurement that 
often follows. If, on the other hand, the spoon 
should be employed on glands that are freely move- 
able under the skin, the products might escape from 
the glands into the loose cellular tissue that may be 
opened up, giving rise to the formation of abscesses, 
sinuses, and their evil consequences.^ 

Scraping. — Scraping, although a very old mechan- 
ical procedure of treating some cutaneous affections, 
unfortunately is not receiving at the present time the 
consideration and attention to which it is intrinsically 
entitled. It is but a modification of scooping, just 
considered, and can be used by means of the spoon, 
providing a little more force is applied. 

Scraping can be performed by means of any hard 
substance employed with a certain amount of force, to 
bring away any material from or within the integu- 
ment. 

It is usually employed with the side, back or 
handle of a knife, but often the forceps, scissors and 
groove director are brought into requisition for the 
operation. The modern instruments, however, 
which are especially designed for scraping, are the 
spoon, smooth, or a little roughened, and a round or 
oval instrument something like a spoon, having a 
hole through its centre to permit all substances to 



I. A full account of this form of treatment will be found in Scrofula and 
Its Gland Diseases. By Frederick Treves, f.r.c.s., London, Eng., 1882; 
p. 191. 



1883.] 



MECHANICAL REMEDIES IN SKIN DISEASES. 



83^ 



escape through, with the edges moderately sharp, 
called the curette. 

The object of this instrument is to tear and break 
down the parts to which it is applied, generally dis- 
eased tissue, or abnormal products. The purpose of 
this method is to rid the surface, or parts within the 
integuments, as much as possible by means of this 
mechanical procedure, of morbid products, thus fa- 
cilitating, as well as assisting, local remedies to act 
more rapidly and bring about a cure. 

Scraping, as has already been stated, can be ac- 
complished by any hard substance, and probably not | 
any one is better than a sharp sea-shell, which has ] 
been used and handed down from the early times in | 
certain parts of Egypt. Thus Dr. Josiah Williams, 1 
in an article published in the British Medical Journal ; 
on medical notes of travel in Egypt, speaks in this 
manner of the native treatment of syphilis in young 
girls: 

"Close to the town (Souakin) in the Red Sea, is a 
little island, called originally Sana Gin, and from 
which the town takes its name. 

"The girl is taken across to this island by six women; 
she is then laid naked on her back — on each arm and 
each leg sits a woman, another on her chest. The op- 
erator, another woman, provided with a sharp sea- 
shell, scrapes away in the vagina until she is satisfied 
that all diseased parts are removed, and then, utterly 
regardless of the shrieks of the girl, gets a handful 
of sand from the sea, and rubs that in. 

"The disease is then supposed to be cured by this 
rather rough operation." 

This primitive method of scraping away diseased 
tissue has been used from the most remote times, 
more particularly along the sea-board portions of va- 
rious countries by the natives. It makes very little 
difference, however, whether the morbid tissue be 
scraped away either by one or the other ways — ^just 
so the offending portion, or as much as can be, is 
removed as well as possible from and among the 
healthy tissue. 

The application of scraping is, perhaps, no better 
illustrated upon any class of cutaneous affections than 
upon strumous, broken-down lymphatic glands. In 
very many of these cases it will require more than the 
ordinary scooping out, the parts within as well as 
without being covered with exuberant granulations, 
disfiguring sinuses filled with filthy discharges, all of 
which must be eradicated by thoroughly scraping off 
and out of the tissue these abnormal products, to save 
the system from being poisoned, and to bring about 
some local beneficial effect. 

Scraping is equally efficacious in assisting old, in- 
dolent abscesses, and bubos complicated with the de- 
velopment of unhealthy granulation. It removes from 
the parts an offending material, which nature is often 
unable to overcome, and places them in a most suit- 
able state for other applications. 

In epithelioma, in old ulcers, and in ulcerating lu- 
pus, scraping is often an essential, as well as a requi- 
site, part of the treatment. 

In warts, horns, and callosities, it is usually neces- 
sary to scrape the hypertrophies well before applying 



local medication, providing it is the aim to arrest 
these affections by this method of treatment. 

In some old and exceedingly chronic cases of cir- 
cumscribed psoriasis or eczema, where the surface 
is covered with thickened scales or hard and unyield- 
ing crusts, no means will act half as advantageously 
as scraping off these products and afterwards medi- 
cating the surface beneath by a seton. A seton in the 
form of a thread of silk is occasionally used for the 
treatment of gland tumors. The measures already 
enumerated, or that to be described will be found 
however, in the majority of cases, far more preferable. 
The employment of the seton in cutaneous affec- 
tions, therefore, is very limited, being applicable only 
in particular to indurated glands in which the object 
is to effect their elimination by suppuration. In the 
event that it is decided to use a seton, a silk thread 
should be selected for that purpose, and passed entirely 
through the long axis of the gland. This mode of 
treatment will within a few days cause the gland to 
take on active inflammation, which will terminate in 
suppuration in from three to four weeks. 

Cauterization. — Cauterization can be performed, 
in addition to the use of caustic medicinal remedies, 
by heating a metallic substance to a high degree of 
temperature, or by means of the solar rays and a lens, 
and thus accomplish the same result through the burn- 
ing-glass. The mechanical cautery, as usually em- 
ployed, consists simply of variously shaped pieces of 
iron fixed in wooden handles, although needles, pins, 
and other metallic substances can be heated in the 
ordinary fire, spirit lamp, or brazier to either a white 
or dull red heat and rapidly applied to the affected 
integument. While the measures just enumerated are 
the most commonly employed, yet it is often very 
difficult to maintain and control them according to- 
the degree of temperature required by the operator. 
For instance, in one case a white heat may be de- 
sired, while in another a dull red or black heat may 
be required ; consequently the effects of the applica- 
tion of these different degrees of temperature will 
greatly vary. Another and more efficient method 
of applying heat has been made in the form of the 
galvano and thermo-cautery, means which will enable 
the operator to have the temperature perfectly under 
his control at all times. The application of the 
actual cautery in some of the more common cutane- 
ous affections has proved of inestimable value, and in 
many diseases has superseded the use of local medi- 
cinal substances. Thus its use in feruncular affections 
has been productive of the most happy results. Es- 
pecially has it been efficacious used, preferably in 
the form of Pagnelin's thermo-cautery, in the treat- 
ment of carbuncle. In this affection, particularly 
where there is a tendency to great exhaustion from 
excessive and protracted suppuration, the thorough 
application of the actual cautery will lessen the lia- 
bility to such a condition, will quickly promote a 
separation of the dead tissue, and will prevent, as has 
been shown by Vermeuil, Post, Connor, and particu- 
larly by Langenbeck, the development of pyaemia. 

Decidedly good results of the actual cautery are also- 
well seen in its application to old ulcers, exuberant 
granulations of the skin, in epithelioma andinulcera- 



S4 



THE ALIMENTARY CANAL IN BRONCHITIS AND PHTHISIS. 



[July, 



ting lupus, which may either limit these affections 
and lessen suppuration, or be followed by the forma- 
tion of a healthy granulating surface, which soon 
cicatrizes, with less deformity in the shape of scarring 
than by almost any other method of treatment. 

It can be used advantageously in angioma, naevus 
chancroids, elephantiasis arabum, in destroying the 
vessels and hypertrophied tissue in the second and 
third stages of rosacea, and for the removal of horns 
and warts. Dr. Cellier in a recent issue of the Journal 
de Med. etde Chir. Pratiques, recommends the follow- 
ing novel means of cauterization for the removal of 
warts. An ordinary pin is passed through the base 
of the wart, the skin protected, after which the head 
of the pin is heated in the flame of a candle, causing 
the hypertrophic growth to become white, fissured, 
and to come away in a few minutes on the point of 
ihe pin. 

Dr. Cellier further adds, that it is only necessary to 
remove one wart, though there may be a dozen pres- 
ent on the part, all the others will disappear without 
treatment. Pins or a shoemaker's awl thrust into 
naevus at a black heat, as was suggested in a clinical 
lecture by Dr. Jas. L. Little {^Medical News, May, 
1883), will often effect a cure and leave but a slight 
cicatrix. It is probable that one of the very best 
.curative measures that can be used for scrofulous 
glands is in the form of cautery puncture. The 
thermo-cautery points employed by puncturing the 
glands with it in this manner has been long used with 
^reat success in France. It has been equally effica- 
cious in England, and especially practiced and de- 
:Scribed by Dr. Frederick Treves. It is a method 
that is applicable to any enlarged gland, preferably 
those which are adherent. It is necessary in making 
this application to fix any of the moveable glands by 
seizing them between the fingers, after which a 
medium cautery point, having the thickness of either 
a No. 7 or 9 American bougie (the size of the point, 
of course, varying according to the dimensions of the 
gland enlargement) is passed rapidly through 
the skin into the gland and twisted around 
within its substance, after which it is with- 
drawn. The ordinary dressing follows, unless 
pus or a soft cheesy material escapes, in which 
event a poultice applied will be very advantageous. 
If the gland contains no pus or soft cheesy material, 
a slight acute inflammatory action sets up, attended 
with a little enlargement and discharge. These effects 
.quickly subside, owing to a healthier action which 
has been established by the operation. The gland 
glowly shrinks and a permanent cure soon follows. 

If pus and broken-down products are present, the 
opening thus made will give them a free exit, the 
;Suppuration gradually lessens, and the part heals up 
within a favorable period of time. 

In circumscribed, thickened and infiltrated spots of 
eczema, which do not yield to the ordinary treat- 
ment, the application of the actual cautery has 
been followed, in some typical cases under my care, 
by complete recovery. 

In conclusion, let me add that these mechanical 
remedies, just enumerated, may be used separately or 
combined, or they may be employed in conjunction 



with constitutional treatment, and with the assistance 
of certain appropriate local medication. In some 
cases they can be used alone, at the very beginning 
of certain cutaneous affections, with decided curative 
results. In others they will often be found to be in- 
valuable adjuncts in arresting some very obstinate 
cutaneous affections. In still other instances they are 
the only means that can be resorted to after medici- 
nal remedies have utterly failed. 

It is this latter class of intractable chronic skin 
diseases to which, in closing, I wish especially to com- 
mend the mechanical remedies as being very often 
curative. It is necessary, however, to state that if 
one or the other of the remedies that have been 
named be selected and employed, it should be 
done with good judgment, skill, and a thorough 
knowledge of the subject under consideration. For 
example, in employing massage the operator should 
have a certain knowledge of physiology, anatomy, 
and be thoroughly versed upon medical rubbing, 
otherwise more harm may be done than good accom- 
plished. 

Again, in resorting to blood-letting, compression, 
cauterization, etc., sound judgment, combined with 
great care both before, during, and after such pro- 
cedure, is always essential and requisite to accomplish 
in a satisfactory manner the desired result. If, there- 
fore, these mechanical means be suitably handled by 
physicians, they will be found to be at all times power- 
ful remedies for many of the so-called incurable skin 
diseases. 



THE ALIMENTARY CANAL IN BRONCHITIS AND 
PHTHISIS. 



BY THOMAS N. REYNOLDS, M.D., DETROIT, MICH. 



[Read to the Section on Practice of Medicine, Materia Medica. 
etc., June, 1883.] 

An abnormal condition of the alimentary canal 
and necessarily of the portal and lacteal systems pro- 
ceeding from it, is often the predisposing cause 
of both acute and chronic affections throughout all 
parts of the entire respiratory apparatus. 

But speaking here only of bronchitis and phthisis, 
and first of bronchitis, we may say that acute tracheo- 
bronchitis is frequently produced by excess in the 
dietary, with proportionately incomplete waste elimi- 
nation. Of course there is generally an exciting 
factor, most commonly chilhng of the surface, but 
that relating to ingestion and elimination is in the 
mass of cases to which we refer — the great underlying 
principal cause, which only needed some slight prov- 
ocation to produce an attack. An unusual general 
fullness of the blood-vessels renders the body more 
susceptible to local congestions; and when, added to 
the fullness there is the sepsis of retained and reab- 
sorbed tissue waste, congestions become true inflam- 
mations, which are purulent in character, largely in 
proportion to the amount of retained excrementitious 
matter. 

In young and otherwise healthy subjects of acute 
tracheo-bronchitis, this condition of body is usually 
the principal obstacle to a speedy recovery. 



iSSs.} 



THE ALIMENTARY CANAL IN BRONCHITIS AND PHTHISIS. 



85 



With this fact in mind, the treatment should be 
prompt evacuation of the bowels, and restriction of 
the diet to a light liquid form, and quiet and an 
equably warm surface should be maintained. If 
severe, the patient should be ordered either to bed or 
3. comfortably warm room, and in any case he should 
be clothed a little extra and warned against becoming 
chilled. It is quite as important to protect the lower 
extremities from cold as it is to protect the chest, and 
not less important during an attack to protect the 
wrists and arms. 

The cathartic removes obstruction and promotes 
■elimination from the intestinal mucous surface, and 
abundant warm drinks do the same from the great 
secreting structures of the kidneys and skin. The 
withdrawal of solid food soon brings about sufficient 
depletion of blood, and the withdrawal of fats and 
nitrogenous substances at the same time, lessens the 
excess of animal heat, produced probably more 
largely by the assimilation and disassimilation of 
these two elements of vital force and tissue construc- 
tion, than by that of any other elements of food 
supply. 

Besides the depurating effect of the cathartic and 
the hot drink diet, a revulsion of nervous energy to 
the bowels, kidneys and skin takes place from the 
excited vessels of the inflamed tracheo-bronchial 
mucous membrane, which cannot usually be excelled, 
and probably not equalled, by aconite or veratrum 
viride or any other medical material. 

This revulsion of nervous energy and vascular ex- 
citement will also be permanent, if warmth of the 
surface be likewise observed. 

This should be maintained by means of extra ! 
clothing or sitting near the fire, rather than by heat- : 
ing too much the atmosphere of the room. 

If these features in the management are really en- ; 
forced, no other treatment is necessary in uncompli- 
cated, acute tracheo-bronchitis. ; 

Astringent, stimulant, and saccharine cough mix- • 
tures commonly used, have neither theoretically nor | 
practically any beneficial influence over the affection. ; 
On the contrary, they tend to prolong it by a delete- 
rious action on the stomach, bowels and liver, and in I 
some degree also on the kidneys and skin. l 

If medicines be resorted to at all in the first stage, ! 
the best, both in theory and practice, are full doses ; 
of morphine and quinine, either separately or com- 
bined, or small frequent doses of aconite or vera- 
trum viride. But these do not usually equal, either in 
immediate or ultimate results, the treatment without 
special drugs, which we have previously outlined. i 

Whatever be the treatment, it is a great desidera- ' 
tum to cut the inflammation short, for besides the 
tendency to extend to the capillary tubes, which ren- 
ders it immediately dangerous to life as well as more ; 
damaging to lung tissue proper, an ordinary bron- '. 
chitis, when prolonged and purulent, often necroses i 
and thickens irreparably parts of the mucous mem- { 
brane, and produces fibroid thickening of the con- 
tiguous peribronchial connective tissue, and always, ' 
■especially when severe, renders the patient much more , 
susceptible to a succeeding and probably worse attack. ! 
Every succeeding attack adds an increment of dam- ■ 



' age and functional impairment to the bronchial and 
pulmonary tissue, and the patient then has more or 
less wheezing, asthma, emphysema, perceptibly im- 
paired elasticity in breathing, with a catarrhal and 
fibroid phthisis pulmonalis always impending, and 
this is chronic bronchitis, which we try so especially 
to avoid when treating the acute. 

If derangement of the primae and secundar viar is 
causative of acute in the healthy, it is more so in those 
previously affected, especially if there be loss in the 
bronchial mucous membrane. There is in the chronic 
form the same necessity for harmony between the food 
supply and assimilation, and disassimilation and elim- 
ination. 

But an older person bears excess in the dietary 
much worse than a younger, for his capacity is not so 
good for extraordinary efforts in constructive and de- 
structive tissue metamorphosis, or for performing the 
I more purely chemical changes. 

I So any unusual high living, without sufficient ac- 
companying exercise, will invariably increase the 
chronic bronchitic man's cough, and if his diet be 
not properly regulated and the emunctories slightly 
stimulated, he will be likely soon to have increased 
expectoration, or a pronounced attack of the acute. 
The different so-called expectorants rarely do any 
special service, and many do very serious harm in 
chronic bronchitis by interfering with both gastro-in- 
; testinal and hepatic digestion. But if the secretion 
i be abundant and purulent, gr. ii or iii of quinine 
; four or five times a day, proves generally very benefi- 
cial ; lessening the secretion of pus, without impair- 
; ing digestion, and improving the tone of the vascu- 
• lar system. 

As to diet, it is not wise to press stimulants and 
strong nourishment, when not readily and perfectly 
; digested. 

■ As to clothing, while it should be sufficient in the 
; elderly bronchitic patient, it should not be excessive. 
A common mistake is that of wearing too much on 
the chest. I have seen a few cases of striking im- 
provement in patients going about, from removing 
two or three extra undershirts and a chamois leather 
lung protector. 

Physical exercise involving free use of the lungs 
restores w^onderfully their normal elasticity, after an 
attack which has left thickening of the peri-bronchial 
connective tissue. It dissipates the thickening and 
adhesions, just as continued free motion dissipates 
the thickening and adhesions from around a recently 
inflamed joint. This is important in the lung for 
other than immediate comfort in breathing; for if 
there remain no hyp>erplasia of connective tissue there 
can follow from it no subsequent sclerosis and degen- 
eration — in other words, no fibroid phthisis. 

To prevent catarrhal phthisis proper is, nearly al- 
ways, to prevent too frequent and prolonged attacks 
of suppurative bronchitis. 

To treat prof>erly catarrhal or advanced fibroid 
phthisis, either separately or combined, is to treat it 
as one would an inaccessible suppurating part any- 
where else, not by cod-liver oil or any other supposed 
specific alone, or by specifics at all, if they nauseate, 
or in any way interrupt or interfere with normal di- 



86 



MEDICAL PROGRESS. 



[July, 



gestion. But a frequent and sometimes liberal use of 
quinine is immensely useful in these suppurating les- 
ions, reducing body heat and the secretion of pus, 
and-acting otherwise as mentioned in speaking of sup- 
purative bronchitis. 

If early in its course, the patient should cultivate 
an out-door life, with plenty of physical exertion, 
and wholesome mental occupation. Under this re- 
gime, digestion will soon become perfect, tissue build- 
ing will go on properly, the lung cavities will become 
more firmly circumscribed, and will often cease to 
suppurate, rendering recovery complete. 

One is often asked what is the best region to go to, 
but probably any region free from malaria or other 
unwholesome emanations, with a temperature permit- 
ting an almost constant out-door life, with exercise, 
will answer the purpose. \ 

I shall not refer to tubercular phthisis, further than 
to say that it has sometimes also seemed to me to be 
excited or produced, in those of tubercular family 
history, by a profuse and prolonged bronchitis, which, 
in turn, followed upon a prolonged constipated habit 
and general defective elimination, caused again, in 
its turn, by inactive in-door life. 

In dyspepsia with constipation and septic ferment- 
ation of the ingesta, it would seem not impossible 
that the septic products which result, may, be carried 
by the portal and lacteal vessels direct to the pulmo- 
nary arterioles and capillaries, and be there sometimes 
auxiliary in causing bronchitis and phthisis, in any or 
all of their forms. 



MEDICAL PROGRESS. 



New Reasons for the Use of Woman's Milk in 
Nursing. — M. Bechamp has discovered for us a new 
element in woman's milk, by which it differs essen- 
tially from the milk of other animals, not only by its 
density, quantity of sugar, of fats, of salts, and of 
water, but by the presence of a special ferment which 
modifies considerably its digestive qualities. This 
ferment is called zymase by M. Bechamp, and its his- 
tory classes it among the microzymas, which he con- 
siders as integral parts of the normal tissues of the 
organism. It is these microzymas which, becoming 
diseased, are converted into bacteria. This zymase 
has the property of converting starch into sugar. In 
cow's milk, besides the caseine, there are two distinct 
albuminoids, one of which is soluble in water after 
being precipitated by alcohol — this is galactozmase 
which is capable of dissolving the starch of farinaceous 
substances, without converting it into sugar. The 
zymase of woman's milk has the saccharifying prop- 
erty. To obtain it, the woman's milk is slightly 
acidulated by acetic acid ; then is added at least three 
times its volume of alcohol, 90 centesi. The albu- 
minous precipitate, which is very abundant, is re- 
ceived on a filter, washed by weaker alcohol to re- 
move the sugar of milk, the fat removed by ether, 
then treated with distilled water. After the lapse of 
several hours it is again filtered, and the solution ob- 
tained possesses in a high degree the property of dis- 



solving and converting into sugar the starch of 
farinaceous substances. To study this new zymase 
properly, Bechamp used 500 cubic centimetres, but 
to verify the fact 20 to 30 cubic centimetres will be 
sufficient, and in using 10 cubic centimetres of water 
to dissolve the precipitate, the solution should render 
fluid and convert into sugar 20 to 30 cubic centi- 
metres of starch to the twenty-fifth part of the fari- 
naceous substance used. To avoid all error, it is well 
to wash the breast with water slightly mixed with 
creosote, and to receive the milk in vessels washed by 
the same. The milk tested has been taken from the 
breast just before, just after and during the nursing 
by the child, and the results are always the same. 

The important conclusions so reached are, that no 
milk from other animals can replace the woman' s- 
milk ; they are very different in character, and fur- 
nish a strong reason to the practitioner for encourag- 
ing nursing by the mother or by some other woman. 
Again, this explains the benefit of still nursing from 
the breast after the infant has begun, at 4 or 5 
months, to use farinaceous substances, which has 
seemed to some to be superfluous, or even dangerous. 
According to experiments, a nursing of 50 grammes 
gives enough zymase to make 40 centigrammes of 
glucose, which, added to the ferments of the saliva 
and of the pancreatic juice, gives the child at the 
breast at least three products of secretion capable of 
transforming starch into sugar, and assisting in its 
absorption. We are warranted, then, in concluding 
as follows : 

1. The woman's milk contains ferment capable 
of saccharifying crude or cooked starch. 

2. The special nature of woman's milk, due to the 
presence of zymase, renders it preferable to all others. 

3. An equivalent for woman's milk cannot be 
found in the milk of the cow, the bitch, or the ass. 

4. The milk of domestic animals, pure or mixed,, 
may be taken when woman's milk cannot be had^ 
but it is not of the same value. 

5. We should, as far as possible, nourish infants at 
the breast in preference to all other modes of nursing 
or artificial feeding. 

6. When children are old enough to partake of 
farinaceous food, woman's milk is still useful in con- 
verting the starch into sugar. — Bonchut, Paris 
Medical, June 2, 1882. 

The Salivary Digestion of Starch by Infants. — 
This writer used for his purpose corn -starch pre- 
viously boiled, cooled into a paste, put into little 
linen bags, and given to infants to suck for two min- 
utes at a time. Pary's test was then used ; the corn- 
starch paste exhibited before the experiment bore no 
evidence of sugar change. The linen was thorough- 
ly boiled without discoloration of the solution. The 
bags with their contents were in each case thrown 
into a test tube. These observations are given in 
tabular form, in twenty-one cases of children varying 
in age from six days to seventeen months. The 
sugar change was noted in all but three ; one of these 
was a babe six days old (fed on breast milk), whilst 
in another babe seven days old a marked reaction 
was observed (also fed on breast milk). Five of 



1883.] 



MEDICAL PROGRESS. 



87 



these cases, relatively 4 months, 5 months, 8 months, 
13 months and 17 months, fed on corn starch and 
crackers, were recorded as follo>\-s : First, well 
marked ; second, slight ; third, breast and crackers 
marked ; fourth, well marked; fifth, condensed milk, 
none. The writer makes the following conclusions : 
The saliva of some infants possesses the property 
of converting starch into glucose, regardless of age. 
AVhen such a condition is found to exist, a small 
<juantity of well-prepared farinaceous food is valuable 
as an element in the diet, incorporated with mixed 
cow's milk. We would add, in view of the recent 
experiments by Bechamp, that the food be better 
mixed with the breast milk of the nurse. — Keating, 
Boston Medical and Surgical Journal, July 12, I883. 

The FiECES of Starch-Fed Infants. — This is a 
record of the examination of the faeces in 24 cases of 
■children varying in age from 45 days to eighteen 
months, and fed on condensed milk and crackers. 
The presence of starch was exceptional, and appar- 
ently in no degree dependent upon the age of the 
child. The stools of eighteen out of the twenty-four 
•contained either no starch or but a trace, that is, no 
more than is frequent in the evacuations of a healthy 
adult upon a mixed diet. Six of these specimens 
were from children of three months or less, the 
youngest being but forty-five days old. In many 
cases the broken and empty cellulose envelopes of the 
-starch granules were clearly discernible. 

The six infants in whose evacuations a noteworthy 
amount of starch was present, were aged respectively 
three, four, ten, thirteen, fourteen and seventeen 
months. The eldest two were in very bad health. 
The facts presented, appear to justify the following 
conclusions : 

First, that many infants of under three months can 
■digest starchy foods. 

Second, that the individual variations in this re- 
gard are so numerous that no broad and general 
statement can be made as to the period at which in- 
fants begin to digest starches ; and 

Third, that the physician can be absolutely certain 
that a farinaceous ingredient in the diet of a young 
infant is beneficial only by an examination of the di- 
jecta under such diet. 

This paper was read June 6, 1883, before the Col- 
lege of Physicians of Philadelphia, and in the discus- 
sion which followed, both Drs. Keating and Randolph 
mentioned, as of interest in this connection, cases 
where fat was found in the faeces, after inunctions of 
cod-liver oil had been used. — Dr. N. A.Randolph, 
— Boston Medical and Surgical Journal, July 19. 

Spina Bifida Successfully Treated After 
THE RoBSON Method. — Dr. R. I. Hayes, of Roch- 
■ester, N. Y. , reports a case in the Medical Record, 
•where he followed the new method laid down by Mr. 
Robson, of Leeds, England, in the British Medical 
Journal. The patient was a female of 9}4 weeks, the 
tumor in the lower dorsal region was more than twice 
the size of a hen's egg; fluctuation was felt readily 
with one hand on the tumor and the other over the 
anterior fontanelle. Aspiration was used first, five to 



six fluid drachms being all that could be obtained ; 
the tumor was then dissected, and a double sac found, 
the outer sac not communicating with the spinal 
canal, but being the source of the fluid aspirated. 
The true sac was then aspirated. On the 
introduction of the needle, the patient collapsed, 
was restored, and ten fluid drachms removed and the 
sac opened; the superfluous portion of the membranes 
were then removed, and union formed by six interrup- 
ted catgut sutures. Some twenty small grafts of fresh 
periosteum from a rabbit were introduced on the 
surface of the membranes, and the external flaps, 
fatty tissue and all, trimmed and closed. Union oc- 
curred throughout the wound by first intention, at all 
but one joint. Here a sinus existed, through which 
clear serous fluid drained very freely — several fluid 
ounces daily for four or five days, then more and 
more sparingly, until the tenth day, when the sinus 
at once closed. Eleven weeks after the operation, 
the child is remarkably bright, the tumor is reduced 
one-half in size, of the feel of fatty tissue, not 
especially sensitive, and reasonable pressure fails to 
produce any effect. Dr. Hayes makes two points : 
ist, care in running a portion of the fluid before free 
incision as a guide to the degree of tolerance, and 
2d, careful maintenance of such a position in the pa- 
tient during and for some time after the operation, as 
will best favor the retention by gravitation of the 
largest amount possible of the cerebro-spinal fluid. 

Angular Anchylosis of Femur at the Hip 
Joint, treated by Subcutaneous Division of the 
Shaft at the Trochanter. — Dr. Stephen Smith 
gives a full and very interesting report with illustra- 
tions, in the Medical Record, of successful treatment 
of this affection. He used the fenestrated canula 
saw of Dr. Geo. F. Shrady, which consists of a 
trocar, fenestrated canula, and a staff" with handle and 
blunt extremity. A portion of this staff" at a short 
distance from the extremity is flattened, one edge 
being made into a knife-blade, and the other edge 
being provided with saw-teeth. The staff" replaces 
the trocar, and then the saw or knife can be worked 
to and fro within the canula, or fixed as one piece by 
a thread-screw. The soft parts are protected from 
injury no matter in which way the instrument may be 
worked — the saw and knife being guarded on all sides 
except on the limited cutting edge. In this case a 
division was made at the small trochanter, and as 
non-union was liable to occur from displacement, a 
half tenon and mortise was cut, causing the fragments 
to lock. The operation was successful, but while ad- 
justing the plaster-of- Paris dressing, the lower frag- 
ment of the femur slipped twice out of its inter- 
locked position, but was replaced and remained satis- 
factorily. About a week after the operation, an ab- 
scess formed, which was superficial, and extended 
nearly to the knee, but soon closed. The patient now 
walks without any support, erect as she would with 
a healthy limb, and with but a slight halt. 

Modern Circumcision. — The official circular of 
instructions, Jan. 10, 1883, says the Med. Press and 
Circular, issued to the Israelitish communities of 



88 



MEDICAL PROGRESS. 



[July, 



Baden, sets forth that the only persons who are to be 
permitted for the future to perform the rite of circum- 
cision, shall be such as shall be authorized by the 
Jewish Supreme Council. i. The knife must he 
freshly polished and the forceps properly purified. 
8. The quadrangular pillow employed, as well as the 
sausage-shaped ring, must be frequently renewed, 
and before every circumcision, covered with new 
gutta-percha tissue or new sarsanet. 7. The opera- 
tor, immediately before the operation, must carefully 
wash his hands with soap, and cleanse the nails with 
a good hair brush, taking peculiar care that no dirt 
be allowed to remain under the nails, more especially 
under those of the thumbs. The hands must in addition 
be washed in a 5 percent, solution of carbolic acid. 
The operator is no longer to suck the wound, nor irri- 
gate it with wine ejected out of the mouth. Instead 
of this the blood is to be removed by gently wiping 
the wound with pledgets of purified boracic lint 
dipped in wine. The wound is to be closed by being 
enveloped in a strip of 10 per cent, boracic lint. 
The further removal of fluids and blood clots is only 
to be effected by means of a new sponge previously 
soaked in a 5 per cent, carbolized solution or by sal- 
icylized lint. A medical man must be immediately 
called in if haemorrhage be considerable, and cannot 
be at once stopped, or if it be from an artery. Such 
authorized persons are forbidden to perform the rite, 
if suffering from any infectious disease, and until 
complete recovery has taken place. 



A Doctor's Model House. — Really, our English 
cousins are becoming too much of a puzzle to us. 
Here we have just established the fashion, which has 
become wide-spread, of houses with open fire-places 
and windows that are easy of access and have facili- 
ties for the free entrance of fresh air, in accordance 
with English prejudices. And now we find the Lan- 
cet, under the above heading, congratulating Dr. 
Hogg, of Bedford Park, Chiswick, on his successful 
attempt to solve the vexed question of house-heating 
and ventilating, by building a house in the Queen 
Anne style, where no window can open, and where 
there is no fire-place except in the kitchen. 

He has placed a large passage under his hall for an 
air-chamber that can be cooled in summer and heated 
by steam-pipes in winter. This air then penetrates 
throughout the house by apertures in the skirtings 
and cornices. In the roof of the house is a foul air 
chamber with which each room connects by exhaust 
shafts. The kitchen fire is utilized to produce ex- 
haust suction in a large shaft running from the foul 
air chamber to the back of the fire, and travels again 
up and out by the chimney. It is calculated that the 
atmosphere is entirely changed throughout the dwell- 
ing in twenty minutes without the slightest draught. 
The even temperature throughout is an argument in 
favor of health, the absence of dust from fires and the 
small cost of heating is an argument in favor of 
economy and housekeeping. 

IcTHzoL is obtained from a bituminous min- 
eral at Seefeld, in Tyrol, which is subjected to 
dry distillation in iron retorts, resulting in the 



production of a tarry-like substance of a peculiarly 
disagreeable odor ; from this, after long standing, a 
thin fluid oil is separated. After thorough purifica- 
tion, it is treated with concentrated sulphuric acid. 
The superfluous sulphuric and sulphurous acids have 
then to be separated from the sulphate which is formed. 
It has the consistency of vaseline — partly soluble in 
ether and partly in- alcohol — totally in a mixture of 
the two. Forms an emulsion with water, and may be 
mixed in any proportion with vaseline and fat. The 
mineral from which it is derived contains in its mat- 
rix a great number of fossil imprints of fishes, and 
the bitumen is regarded as the animal remains of these 
— hence the name. 

It has been employed with good results in eczema, 
and Prof. Unna, of Hamburg, speaking of its use in 
acute and chronic rheumatic arthritis, says: " I be- 
lieve from my few cases I may say that, up to the pres- 
ent time, there is no external application of equal ef- 
ficiency." It has not been found useful in simple 
neuralgias. If added to a large quantity of water and 
heated, the icthzol is decomposed, giving off H.,S03. 
S &c. Employed by way of inhalation in this 
manner, Herr Unna has observed remarkable results 
in affections of the respiratory tract. — Med. Press and 
Circular. 

Subcutaneous Injections of Ether. — Dr. Moiz- 
ard in the Jour, de Med. et de Chi. , calls attention to 
the care that must be taken in selecting a proper site 
for these injections. When used upon the forearm 
paralysis has ensued, especially of the extensor com- 
munis digitorum, in one case lasting about a month. 
These injections have become useful in adynamia 
from various causes to sustain the enfeebled forces, 
and the local inflammation produced can be generally 
prevented by inserting the needle deeply into the 
subcutaneous cellular tissue, and a selection by 
preference should always be made where this tissue 
is the thickest, as over the superior and external 
parts of the thigh. 

The amount usually employed is from 0.28 to 0.30 
centigr. , and can be repeated frequently, as it is very 
rapidly eliminated, which is well shown by the char- 
acteristic odor of the patient's breath, a few moments 
after its use. It is quite as useful in children as in 
adults, and is a remarkable adjuvant to the use of 
alcohol. 

The Ligature Tightener.— Mr. John Clay, Lan- 
cet, June 9, 1883. — This instrument is devised for ap- 
plication to a stricture so situated that the fingers can- 
not be efficiently used to tighten the ligature; or of be- 
ing applied to a morbid growth, the size of which re- 
quires greater constrictive power than can be produced 
with the fingers alone. The ends of the ligature are 
fastened to the stem of the instrument, which is then 
worked as an ordinary wire-rope ecraseur. 

Election of Prof. Richet to the French 
Academy of Sciences. — The French medical press 
is congratulating the profession on the election of 
Prof. Richet to the Academy of Sciences in the 
place of Ledillot in the Section of Medicine and 



i883j 



EDITORIAL. 



89 



Surgery. It seems that Brown-Sequard was his prin- 
cipal competitor, and the election of Richet silences 
two objections which were urged, viz : that neither 
medicine or surgery can be classed among the scien- 
ces, and that the physician exercises a lucrative pro- 
fession, and is not a disinterested high priest of sci- 
ence. In the light of development and evolution 
our catalogue of the fixed sciences has become very 
small, and happily other professions, such as that of 
the engineer, the chemist, etc., have been lucrative in 
themselves. 

NEW JOURNALS. 



The American Pscychological Journal is issued 
quarterly by the National Association for the Pro- 
tection of the Insane and the Prevention of Insanity. 
Joseph Parish, m.d,. of Burlington, New Jersey, is 
the editor. 

The Electric Light for Microscopic Work. — 
Dr. Henri Van Heurck, in the Journal de Mtcro- 
graphie for May, 1883, gives a very interesting ac- 
count of the utilization of the electric light for illu- 
minating the microscope and for use in microphoto- 
graphing. In illuminating the field, the delicate striae 
of the amphipleura and the nineteenth group of No- 
bert's test were defined with perfect distinctness. Pro- 
fessor Abbe explains this as due, ist, to the great' 
whiteness of the light ; by the mensurations made by 
Prof. Abbe in different monochromatic illuminators, 
it has been demonstrated that the separating power of 
an objective of a given aperture increases in the same 
proportion that the wave length of the light em- 
ployed dimishes ; it results, therefore, that the electric 
light will show delicate details more readily than the 
yellow light of gas or of lamps. 2d. The specific in- 
tensity of the electric light being much greater than 
that of other artificial lights, a sufficient illumination 
is obtained by a pencil of light that is much smaller 
than can be obtained by any other means. 

These minute electric lamps can be attached to the 
microscope in three ways: i, attached above the ob- 
jective by a collar which permits rotation upon an ar- 
ticulated arm for illuminating opaque objects ; 2, 
placed on the substage so as to be pushed laterally, when 
required, and give oblique illuminations ; 3, with 
greater illuminating power and attached to an articu- 
lating arm in place of the mirror, to be used in polari- 
zation and photomicrography. The microscope is 
placed upon a metal plate, and is provided with a lob- 
inet which diminishes or increases the force of the 
electric current, and a commutator in three directions 
allows the current to pass at will to any one of the 
three lamps. 

NEW DRUGS. 



an oil that unites with hydrochloric acid. One 
striking effect is shown in coloring the urine of the 
person taking it brown or olive green, and more 
rarely grass-green. The urine usually contained bac- 
teria in considerable quantity. Prof. Ludwig gave 
this account at a recent meeting of the Royal Medi- 
cal Society of Vienna, and Prof. Drasche gave his 
experience with it. In doses of )4 grain every two 
hours up to three grains in the twenty-four, a consid- 
erable fall of temp>erature took place, accompanied 
by shivering and grave symptoms of collapse. He 
afterwards gave it in 0.2 grain doses until 2 grains 
had been given in twenty-four hours. The dose of 
0.3 grains caused a fall of 5.° 8^ F. in a case of 
pneumonia, and in another a dose of o. 2 grains re- 
duced the temperature 7.° 8 F. Doses of 0.3 grain 
in a severe case of tj^phoid fever gave rise to rigors, 
collapse, and feebleness of cardiac action. He con- 
siders that kairine is superior to all other drugs as a 
promptly-acting anti-pyretic, and that it has a great 
future before it. — Medical Press and Circular. 



NEW INVENTIONS. 



Ax Automatic Tongue-Depressor.. — Dr. Alex- 
ander Ferguson gives a wood-cut and description of 
this instrument in the British Medical Journal, which, 
without the cut, may be described as a blade which 
applies to the tongue, and is so constructed on a slid- 
ing principle, as to suit it to any size of tongue — that 
is, it can be lengthened or shortened at will. The 
tongue-plate is provided by an arm at right angles to 
it, when open, which has a ratchet fitting into a tube 
attached to a chin plate and caught there by a tooth. 
The chin plate is horseshoe in shape and lined with 
morocco leather, being so constructed as to comfort- 
ably adapt itself to the long ridges of the lower jaw. 
The inventor condemns the chin-pad of ordinarj' 
tongue-depressors, as, by being applied to the soft 
parts, they ser\-e to press the tongue upwards. Both 
blades are jointed, and closing, make the instrument 
so compact as to be carried in the vest pocket. 



EDITORIAL. 



Kairine. — This comes to us from Vienna, where 
last year attempts were made to find a substitute for 
quinine, resulting in the s}Tithetic manufactiu-e of 
chinoline out of aniline, nitro-benzol, glycerine and 
sulphuric acid, which had anti-febrile properties. 
Other experiments gave us from chinoline a prepara- 
tion technically called methoxychinolinetetrahydride, 
to which the name of kairine has been given. It is 



Advertisements. — Under the headof corresf)ond- 
ence \s\SS. be found a brief letter from Dr. G.R. Henry, 
of Burlington, Iowa, making vigorous protest against 
the insertion of advertisements in the advertising 
columns of the Journal concerning "ready made 
prescriptions," etc. If our correspondent had ex- 
amined more carefully the advertisement of Parke, 
Davis & Co., on our last page, he would have seen 
that it contained no reference to prescriptions of any 
kind. While the well-known firm to which 
our correspondent refers, has yielded to the pernicious 
practice,at present almost universal among drug man- 
ufacturers, of putting up and selling "ready-made 
prescriptions " or formulae, they are entitled to the 
credit of abstaining from the still more objectionable 
practice of resorting to trade-mark, copyright, or 
other means of holding exclusive proprietorship in 



90 



CHICAGO LETTER. 



pULY/ 



medicines of any kind. The rule adopted by the 
Board of Trustees, and sanctioned by the National 
Association, concerning advertisements in this Journal 
is as follows: ''Advertisements may be admitted 
from medical educational institutions and hospitals 
open for clinical instruction, from book publishers, 
pharmaceutists, instrument makers, and all other 
legitimate business interests. But all advertisements 
oi proprietory, trade-tnark, copyrighted, or patented 
medicines, should be excluded. Neither should any 
advertisement be admitted with one or more names 
of members of the profession as endorsers, having 
their official titles ox positions attached." 

If we violate this rule,it will be by mistake or inad- 
vertence. 



Epidemic Cholera. — For two or three years the 
prevalence of this disease has been steadily increas- 
ing in India, and during the present season is pre- 
vailing, in a severe form, in Egypt. 

This event has created no little alarm in the coun- 
tries of Western Europe, and their governments are 
taking active quarantine and other sanitary pre- 
cautions for preventing its introduction into their re- 
spective countries. It is probable that the value or 
efficacy of such measures in preventing the spread of 
this pestilence from one country to another will re- 
ceive a fairer test than ever before. 

The popular doctrine, both in and out of the pro- 
fession, is that the disease is caused by some species 
of organic germ, capable of being transported in 
various ways from one place to another, more 
especially along the lines of travel and commerce. 
There are many facts, however, connected with the 
history of past epidemics of the disease, that are not 
readily explainable upon such a theory. And it is 
not quite certain that special meteorological condi- 
tions, existing coincidentally with bad local sanitary 
states, have not more influence over the question 
of its prevalence, either in Western Europe or in 
our own country, than that of the importation of its 
supposed cause. If its increase in India and present 
prevalence in Egypt is really the beginning of one 
of those wide-spreading epidemics, such as occurred 
from 1848 to 1854, it will not be likely to reach 
Western Europe until late the present season, or early 
the next summer, and this country the summer fol- 
lowing. But in neither this nor any other civilized 
country can the governmental authorities give too 
great an amount of attention to the removal of every 
source of local contamination of air, water, and soil. 



New Subscribers. — To save answering the same 
question many times, it is proper to state that a suf- 
ficient number of extra copies of this journal have 
been printed to supply all new subscribers, or addi- 
tional members who may desire it, with the numbers 
from the beginning, and we shall be careful to keep 
enough of each issue on hand to furnish complete 
files for, at least, six months to come. 



Discussions before the Sections. — In answer to 
several inquiries, it is proper to state, that no reports 



of the remarks made by members in discussing the 
papers read in the several Sections of the Associa- 
tion, have been made in the majority of instances. 

In such, of course, none can be published in con- 
nection with the publication of the papers. In other 
instances, however, reports of the remarks made 
have been preserved and revised by the speakers. In 
all such cases we shall endeavor to have the reported 
comments appear with the papers to which they 
relate. 



CORRESPONDENCE. 



CHICAGO LETTER. 



[For The Journal of the American Medical Association.] 

Chicago, it seems, is about to be blest with several 
new hospitals. The one most recently mentioned 
has been started by several Presbyterian gentlemen. 
At present there is but one Protestant general hospital 
in the city. St. Luke's, which is under the care of 
the Episcopalians. A charter has been obtained for 
the Presbyterian Hospital by Tuthill King, Daniel 
K. Pearsons, William Blair, Robert C. Hamill, John 
H. Barrows, C. M. Henderson, John B. Drake,. 
Nathan Corwith, Samuel M. Moore, Henry M. Ly- 
man, James M. Horton, Willis G. Craig, Cyrus H. 
McCormick, Jacob Beidler and J. P. Ross. The 
hospital is promised at no distant day, as many of our 
wealthy citizens insure its financial success. It will 
not be denominational further than being under 
Presbyterian management. 

Rush Medical College is about to build a hospital 
of its own on ground in close proximity to the college 
buildings. The hospital will be built so that it can 
be enlarged in the future. The college is undoubt- 
edly led to make this move because of the many 
hinderances thrown in the way of clinical teaching in 
the County Hospital, by the County Commissioners. 
During the last two years or more, the students have 
not been allowed to enter the wards, and go to the 
bedside for instruction, but have been required ta 
receive all clinical instruction in the amphitheater. 
More recently the Board of Medical Attendants were 
all discharged, and on the new Board only one mem- 
ber of the faculty of each of the colleges was ap- 
pointed. 

The New St. Luke's Hospital is fast nearing com- 
pletion, and will be ready for occupancy in the course 
of a few months. This hospital has long needed en- 
largement. Its wards are always full to overflowing. 
The new building is expected to be one of the best 
planned hospitals in the country. They still have 
as much more ground as is now used, on which they 
can build in the future. This hospital will furnish 
much additional clinical material for the students of 
the Chicago Medical College. The hospital is only 
a few blocks from the college, and three of its staff" 
are professors in that institution. They have been 
giving several clinics each week during the last year, 
in the old hospital. The Chicago Medical College 
is now peculiarly well supplied with clinical material, 
for in addition to St. Luke's Hospital, it still has the 



1883.] 



BOSTON LETTER. 



91 



use of the material in Mercy Hospital, which is situ- 
ated on the same grounds with the college. Mercy 
Hospital accomodates between two and three hundred 
patients. Some four or five blocks off there is also 
the Michael Reese Hospital, in which occasional pri- 
-vate clinics are held. 

Our summer hospital, the floating hospital for 
iDabies, has entered on its annual era of usefulness. 
No charity is more worthy of commendation ; by 
means of it the poor suffering children and their 
mothers, from our closely packed, poorly ventilated 
and drained tenement houses, are given a breath of 
pure fresh lake air. For a number of years this in- 
stitution has done much for the poor children of our 
<:ity. We are glad to say that an additional institu- 
tion of the same character has just been opened upon 
the lake front, in the South division of the city. A 
breakwater running along the shore at the foot of 
25th street has been covered by an awning, and a 
house has been built at one end for the storage of 
such articles as are necessary for the hospital, cots 
and swings are furnished for the comfort and accom- 
modation of the little ones. Nurses and physicians 
are on hand each day from 6 a.m to 8 p.m. 

The recently issued announcement of the Chicago 
Medical College contains the outline of a four year 
course which this faculty recommends. For many 
years they have offered only a graded three year's 
•course. The need of an additional year is felt by all 
conscientious students, and this last provision will be 
welcomed by them. An honor has been conferred 
upon one of the best known and most respected 
members of the faculty of this college of which all 
his friends rejoice to learn. The North-Western 
University at its commencement in June, conferred 
upon Dr. Hosmer A. Johnson, the degree of Doctor 
of Laws. 

Through the munificence of some of its friends, the 
Northwestern University has been cleared of all in- 
debtedness, leaving the institution to enjoy the full 
benefit of the income from its magnificent property, 
which now amounts to over a million dollars. In 
1 88 1, Dr. John Evans, formerly a citizen of Chicago, 
but during recent years a resident of Denver, Colo- 
rado, offered the university, in addition to magnificent 
endowments that he had given it in its early history, 
j$25,ooo if they would raise $75,000 more before the 
university commencement of 1882, and also $25,000 
towards a second $100,000 to be raised before the 
same time in 1883. The $200,000 thus to be raised 
would clear the institution of debt. Many friends of 
the institution united to raise the required amount. 
Mr. William Deering, however, by his great gener- 
osity contributed a considerable portion of it, giving 
^25,000 towards the first hundred and $50,000 
towards the second hundred thousand. 

The recent lard investigation in Chicago has at- 
tracted considerable interest on the part of the medi- 
cal profession of the city, as several of its members 
were called upon for expert testimony. Just before 
Mr. Peter McGeoch's recent failure he refused to ac- 
cept of Messrs. Fowler Brothers 500,000 tierces of 
lard, alleging that they were not pure as they should 
be, but were adulterated with cotton-seed oil and 



tallow. The Chicago Board of Trade undertook an 
investigation of the matter. Professor Walter S. 
Haines, Dr. I. N. Danforth, Dr. W. T. Belfield, Dr. 
R. Tilley and Dr. P. S. Hays were variously em- 
ployed as experts. In the course of his investiga- 
tions Dr. Belfield found that by allowing the fats to 
crystallize out of an etherial solution, lard and tallow 
could be readily distinguished from one another. 
The former produce plate-like crystals, rhomboidal in 
shape and bevelled at the ends; the latter are plume- 
like and curved as the italic/. Among the many ex- 
perts called in the case by both sides were Professors 
Remsen, Doremus, Witthaus, Sharpless and Habers- 
ham. For the present the investigation is closed, 
but will be reopened in August, when it is under- 
stood further expert testimony will be procured. 

The State Microscopical Society is making prep- 
arations to receive the members of the American 
Society of Microscopists who meet here in August. A 
large meeting is expected, as many, undoubtedly, who 
intend to attend the meeting of the American Asso- 
ciation for the Advancement of Sciences, which con- 
venes a little later in St. Paul, will start early enough 
to attend the Society of Microscopists here. A re- 
ception will be tendered the society at the Calumet 
Club on August 9. A fine display of microscopi- 
cal objects, it is hoped, will add to the interest and 
entertainment of the evening. 

In this letter I shall not have an opportunity to 
speak of the work being done by our medical and 
other scientific societies, although meetings of interest 
are still being regularly held by them. 



BOSTON LETTER. 



[For The Journal of the American Medical Association.] 

With the annual meeting of the Massachusetts 
Medical Society, which usually occurs early in the 
month of June, each year, all the active society work 
in medical matters in Boston may be said to 
end. That event is the grand culmination of the 
season, and at its close the profession draws a long 
breath and prepares to enjoy a few weeks of relaxa- 
tion from the really arduous duties of the previous 
nine months. With each summer a constantly in- . 
creasing number of physicians adopt the vacation 
system, now so generally indulged by the rest of suf- 
fering, sweltering humanity, and the doctor is al- 
ready beginning to look forward to the time when he 
may close his town residence entirely and spend an 
uninterrupted holiday of two or three months in 
some accessible suburban resort, instead of being re- 
stricted to occasional outings of two or three days, or 
at most a fornight, as is now generally the case. Our 
city is most fortunate in possessing a great number of 
picturesque and interesting localities in its immediate 
vicinity, and the many railways and other means of 
communication render it quite easy to reach almost 
any desirable point within a radius of fifty miles, at 
very moderate expense of time and money. A very con- 
siderable proportion of our winter population is to be 
found permanently domiciled in these country re- 
treats during the heated term, and in many places 
the "summer residences" of our city people out- 



92 



BOSTON LETTER. 



[July, 



number by far the houses of the original inhabitants 
of the town. With each year there is a steady in- 
crease in the number of these rural abodes, until in 
some places they seem like small cities by themselves. 
It has already come to pass that much of the winter soci- 
ety in Boston is so conveniently disposed at the various 
"shores" and "hills" that the feeling of strangeness 
is never known, as old friends and neighbors are al- 
ways within an easy drive, or possibly reside within 
sight from the window. Several physicians are so 
fortunately situated as to be able to fly away with 
their friends, and spend the entire season in these de- 
lightful surroundings, thus ■ obtaining much needed 
recreation, and giving to their winter patrons the 
feeling of security which their presence affords, in 
localities where good physicians are not always easily 
accessible, and where the need of their services may 
at any time become speedily urgent. 

During the present week the chemical department 
of Harvard Medieal College is being transferred to 
its quarters in the newly-erected building, to which it 
was hoped and expected that the entire collegiate 
functions would ere this time have been transposed. 
A most unfortunate conflagration, which occurred 
early in June, in the main wing of the structure just 
as it was being finished, wrought such extensive dam- 
age both to the inside and out of the edifice, that it 
now seems highly probable that many of the labora- 
tories and special departments will unavoidably be re- 
tained in the inconvenient and unsightly old build- 
ing where they have for some years struggled and 
languished. It has for some time been an ardent 
hope among the friends of the college that a new 
building, and modern conveniences for work, would 
supply the necessary stimulus to enable the college to 
make necessary and radical changes in many ways, 
and to raise itself in its medical department to the po- 
sition which its importence as a great university, its 
position as the leading New England educational in- 
stitution, imperatively demands. ' Whether these 
changes will follow the magnificent gift of a noble 
building we cannot know for one year longer, but if 
the prolonged delay is at length followed by results 
so desirable no one will murmur. 

Apropos, it is interesting to observe how a finished 
"fire-proof" building may be so completely ruined by 
a conflagration originating in one portion that months 
of labor are required to render any portion of the 
structure habitable. The question of fire-proof con- 
struction would really seem still as far from a positive 
solution as that of ventilation, or acoustic qualities in 
architecture, or of antisepsis in surgery. To this last, 
however, it still offers much similarity, in that its acci- 
dents are best treated by the "spray." 

From our safe hermitage in Boston, where we sit 
down and rise up in safety, surrounded a,nd defended 
by filth and off-scourings of every State around us, 
by quacks belonging to our own members, and by 
every sort of medical pretenders, with diplomas or 
without, who have been driven from the peaceful pur- 
suit of their nefarious occupation in other places, and 
have come to Massachusetts, where they find a chari- 
table reception and a secure asylum for the further 
prosecution of their peculiar practices, we cast our 



eyes complacently acrosss the border to our sister 
city of New York, and behold with equanimity the 
struggle there being enacted in regard to the Code 
question. Fortunately, no such cloud looms in our 
own professional horizon, no such agitation disturbs 
the apathetic sluggishness of our medical repose ; in 
the words of the Queen's speech " our relations with 
all surrounding powers continue to be amicable." 

When we reflect that these include all the men, 
women and things in any way connected with the so- 
called " practice of medicine," and that eclectics, 
clairovyants, mediums, seers, bone setters, abor- 
tionists and the rest are gathered into one happy 
family and nurtured under one and the same provis- 
ion of law, in the providence of the Commonwealth 
of Massachusetts, it becomes at once evident that 
this State and this city are the nearest approximation 
to elysium yet demonstrated to a waiting and expect- 
ant race. 

The recent closing of the case celebre, the "Tewks- 
bury Investigation," has afforded a sensation of re- 
lief to a weary people who had begun to think the end 
was' as far away as a verdict in chancery. Of all the 
State business ever transacted within the common- 
wealth, it is doubtful if any one action ever interested 
and concerned every calling, profession, trade, or 
occupation, and all ages, sexes, relations and previous 
conditions of servitude to the extent which this no- 
torious expose has done. The result has not been yet 
publicly announced, but two reports have been pre- 
sented, a minority and a majority report. The latter 
is an able and vigorous document, and treats the en- 
tire subject in the- most clear and candid manner. It 
directly accuses the Governor, Gen. B. F. Butler, of 
making charges against the institution which have no 
foundation in fact, and spares no words in denuncia- 
tion of the manner in which the chief executive ma- 
gistrate of the State has conducted the case as prose- 
cuting officer. It is doubtful if any incumbent of the 
gubernatorial chair has ever received such a casti- 
gation at the hands of a legislative committee, and 
it is sincerely to be hoped that no one has ever been 
proved so worthy of censure. The report is very 
long, and recites every grievance mentioned by the pro- 
secution, most of which do not directly interest the me- 
dical profession, but its closing paragraphs are so con- 
cise, so clear, and so comprehensive in relation to the 
general sanitary and hygienic condition of the State 
Almshouse, that every physician must feel an interest 
in its perusal. 

The treatment accorded by his Excellency to the 
professors and teachers of Harvard University has 
also been deemed worthy of rebuke. What, if any 
result follows this scandalous investigation is still a 
matter of conjecture, but the moral atmosphere and 
the daily press have already become somewhat purer 
since the testimony in the case was concluded. Ap- 
pended is a verbatim copy of the final clauses of this 
admirable report, as it was presented to the legisla- 
ture by the joint committee from the two houses : 

"We have visited Tewksbury — many of us several 
times — and examined the institution in all its parts. 
We have seen and tasted the food of its inmates, and 
had bbfore us the men who cooked it and served it 



1883.3 



BOSTON LETTER. 



93? 



for many years. We have had before us one of the 
late trustees, the superintendent, the clerk, the physi- 
cian, matrons, the nurses and attendants. We have 
examined the official reports of the State Board of 
health, lunacy and charity. , which by agreement are 
made part of the case. Further, we have had before 
us Fr. Gigault, of Lowell, the Catholic priest, whose 
presence is such a benediction at the almshouse ; 
also the official report of Mrs. Clara T. Leonard, one 
of the efficient members of the State Board ; also Dr. 
George A. Tucker, the eminent expert from Austra- 
lia, and Dr. Charles F. Folsom. And, after hearing 
all the evidence in the protracted hearing, we declare 
the present condition of the State Almshouse at Tewks- 
bury to be good, and with one single exception, 

ENTIRELY WORTHY THE STATE. 

That one exception is that the appropriations have 
been too small. The evidence is cumulative that 
there should be more and better attendants and bet- 
ter food for the sick and infirm, more amusements 
and recreation for the hopeless insane, and other 
things as recommended by Mrs. Leonard in her offi- 
cial report: 

We pronounce the main charges of His Excellency 
the Governor groundless and cruel. The question of 
infant mortality was an old one, well settled, as every- 
body knew. The delivery of dead bodies under the 
law was under the control of the trustees and super- 
intendent, and any irregularity should have been 
remedied by them without publicity, if proof there- 
of had been furnished, and the people of this proud 
commonwealth would have been saved from the 
shame and humiliation so recklessly and needlessly 
brought upon them. Surely the truth should have 
been ascertained before making such awful charges. 

Our order was to investigate the other institutions, 
but we have heard no cause of complaint, and have 
had no time to devote to them. We made the ordi- 
nary tour of inspection, and found them in good 
condition. 

We commend to the Legislature and to the people 
all our public charitable institutions as still worthy 
this ancient commonwealth, although, in the lan- 
guage of one of his Excellency's distinguished pre- 
decessors, they are constantly requiring changes to 
meet the recurring exigencies and the demands of a 
progressive philanthropy. 

Your committee desires to place upon the record 
their strong disapprobation of some things said and 
done by the Governor during the course of this hear- 
ing. \ye pass by the insults to the committee and to 
the chairman who presided at this hearing by invita- ' 
tion of the regular chairman, with consent of the 
committee ; also the reference in the argument to 
" clearing out this State House " by his veteran com- 
rades ; and consider graver things. His excellency 
announced, on the first evening of the hearing, that 
he had not come into the case ; 

WITH A BLACKINCJ BRUSH. { 

But when, ■ in cross-examination of a young lady 
witness [p. 1839], in order to ascertain whether, in 
a certain campaign, a distinguished citizen of this 
State tarried over night at the State almshouse, he 
said : "I don't know what you knew by sleeping 



with him"; when he spoke of a matron who had been 
a witness as " that little chit, who could do no good 
among old men except to excite their passions"; 
when he insinuated that the father of Charlotte 
Anderson's child was the aged superintendent of the 
almshouse ; when he tried in vain to make Thomas 
Kelliher, one of his witnesses, admit that he took 
money and suffered imprisonment for being the 
father of a bastard child on solicitation of the assist- 
ant superintendent ; when he suggested that another 
respectable lady witness employed at Tewksbury be- 
longed to " the harem"; when he spoke of the State 
almshouse as a " hell upon earth," and the home for 
discharged females at Dedham as a '' den"; when he 
spoke of the eminent physicians who controverted 
Dixwell's testimony as the " refuse" and again as the 
" empytings" of Harvard medical school, and again 
as " rascals" and "runts," your committee thought 
the blacking brush had been brought into requisition. 
When he, in his argument, related his own disgust- 
ing description of the operation of craniotomy; when 
he brandished what he called a woman's skin and 
pointed to the audience the nipple of the woman;, 
when to defend the New York witness, Eva Bowen,- 
he averred that, under God, her seduction and fall- 
are due to the school system of Massachusetts; when* 
we see him flourish a piece of human skin which had 
not been put into the case, with an alleged crucifix 
tattooed upon it; when he alluded to old and young 
men whose jaded passions are to be excited by wear- 
ing slippers made from a woman's breast, your com- 
mittee blushed for the commonwealth, and turned 
away in amazement. But worse than these was his 
portentous reference to the French revolution. Can 
it be possible that the people of this commonwealth 
are slumbering upon such a volcano as burst upon 
the people of France in 1789, whose fires are to be 
kindled because four reckless medical students have 
caused to be tanned for their own purposes a few 
pieces of human skin ? Is this what his Excellency 
means when he says we must see that the wheel don't 
go round once again ? 

We have examined the 3,000 proofs of the testi- 
mony in this case with solicitude to be just, just to the 
management of the Tewsbury almshouse, just to His 
Excellency the Governor, who made the charges and 
conducted the prosecution, andj above all, just to the 
commonwealth whose servants we are. 

Onslow Gilmore, 
Edward P. Loring, 

Senate. 
George E. Learnard, 
Roger Wolcott, 
George D. Chamberlain, 
William E. Chester, 
Lyman K. Putney, 

House. 

Burlington, Iowa, July 23, 1883. 
Dear Doctor. — I have received your first number, 
and am delighted with it as a journal ; but I am not 
so pleased with your advertisements. Parke, Davis 
& Co. have bored the physicians of the Northwest 
sufficiently with their ready-made prescriptions. In 



"94 



REVIEWS. 



[July, 



fact, they have taken the place of Ayer'^ Pectoral and 
Humbold's Buchu, and are patronized by all the 
.quacks and all the patent medicine men in this 
country. Soon I presume you will advertise Warner's 
.safe cure for kidney trouble. Now, I protest right 
here against the organ of the American Medical As- 
sociation being the means of disseminating any such 
.advertisements. I ask a place for this in your corre- 
spondent's column, and see if I am not indorsed by 
jiine-tenths of the physicians in the land. 

Yours truly, G. R. Henry, m.d. 



CHOLERA. 



BY H. RAYMOND ROGERS, M.D., DUNKIRK, N. Y. 



Words ot warning come from the East, of the ap- 
proach of cholera in its worst form. To the medical 
profession, therefore, to be forewarned should be to 
ibe forearmed. The duty of the hour is to look well 
to our conceptions of the disease — its cause, its path- 
ology and its treatment. We have to-day only the 
.experience of the past to guide us. This, confessedly, 
is not assuring; since all theories and all forms of 
treatment have been fruitful only of disastrous results. 
In fact, no treatment at all has given nearly as good 
results as the most scientific treatment. The average 
mortality has ever been 50 per cent, of the persons 
.attacked. 

Under these circumstances only one course is open 
to us, i. e., to boldly discard all old theories, and 
every system of practice, and improve the opportunity 
to study each case with earnestness, to the end that 
we may find a philosophy that will take into account 
.all its phenomena, and constitute an exact science of 
the disease. Briefly, the demand is for a new founda- 
tion. 

In response to this imperative demand I submit a 
theory of the disease which, in practice, has afforded 
^ood results, viz: i. That cholera is a true neurosis; 
2. that it consists essentially in a disturbance of the [ 
general innervation; 3. that its leading symptom is a j 
true haemorrhage; 4. that its source is to be sought [ 
for in meteorological conditions. 

That it is a true neurosis is abundantly demonstra- 
ted. The fact that a person in full health and strength 
may be attacked and die in the space of twenty or 
thirty minutes, effectually disposes of every theory of 
poison, and shows conclusively that in these rapidly 
fatal cases the force of the disease is expended upon 
;the brain and nervous system.. No evidence of the 
action, or existence of poison, has yet been discov- 
.ered, even after many thousands of autopsies conducted 
with the most rigorous exactness.. 

The initial sense of malaise, the regurgitative vom- 
iting, the cramps, and the unlocking of the walls of 
the blood-vessels, permitting the escape of the serum 
into the stomach and bowels, — these all indicate a 
disturbed innervation. 

That the leading symptom — the rice-water dis- 
charges — is a true haemorrhage is., demonstrated by the 
fact that these are constituted of the serous element 
of the blood. The rapid escape of a single element 
joi the bipod is disastrous .in the same manner as the 



I escape of the full blood itself in abortion and other 
forms of active haemorrhage. 

To discuss its source and mode of dissemination 
i now, would not be wise or profitable, as this can be 
done more intelligently after an epidemic. We know 
that this disease laughs at a cordon sanitaire, or quar- 
antine. 

The characteristic symptoms, and the pathological 
conditions, unerringly determine the mode of treat- 
ment. If we would look upon cholera-haemorrhage 
as subject to the same general principles of treatment 
as other haemorrhages are, the question of treatment 
would become a simple one. 

The horizontal position, or with the body more or 
less inclined, with the head downward — according to 
the gravity of the case — and persistently continued 
until convalescence is a.ssured, is the sheet-anchor in 
the treatment of this diseuse. 

When we consider that the physiological action of 
the mucous membrane is reversed in this disease, — 
that exosmosis takes the place of endosmosis, the 
futility of relying upon remedies internally adminis- 
tered becomes apparent. The medication par excel- 
lence, is morphia hypodermically applied, or sprink- 
led upon a blistered surface. This remedy changes 
the perturbed condition of the nervous system, and 
effectually, and quickly, closes up the diminutive ave- 
nues through which the life current ebbs away. For 
the mouth, but little is required save pounded ice, or 
cool water, frequently repeated. 

Much can be done in staying the progress of this 
scourge, when epidemic, by informing the public 
through the columns of the press as to what should be 
done immediately, when diarrhoea sets in, viz : that 
a mild opiate should be taken, and more or less fre- 
quently repeated, and the horizontal position main- 
tained for a number of hours. This course would 
prevent a fatal termination in a majority of the at- 
tacks. 

The larger proportion of the cases which occur 
during an epidemic are due alone to the effects of 
fear, and a knowledge of the fact that these simple pre- 
cautions will rob the disease of half its dangers, will 
go far to remove such fear, and thus secure a degree 
of exemption from its ravages.' 

1 This subject is more fully treated by the writer in the Transactions ot 
the American Medical Association for 1876. 



REVIEWS. 



The Relation of Micro-Organisms to Disease. 
By Wm. T. Belfield, m.d., Chicago. W. T. 
Keener, 1883. 

Such wide publicitv has already been given to this 
admirable work of Dr. Belfield throughout both the 
professional and non-professional press, that it is al- 
most needless to remark it is a reprint of the Cart- 
wright lectures, recently delivered by him in New 
York, before the Alumni Association of the College 
of Physicians and Surgeons. That he fully appre- 
ciated the compliment bestowed upon him by the 
invitation to deliver these lectures, is plainly evinced 
by the amount of care which he has taken in their 



i 



1883.] 



MISCELLANY. 



95^ 



preparation, for they bear the imprint of most dili- 
gent research. The value of his publication is great- 
ly enhanced by the addition of numerous excellent 
cuts of the various forms of bacteria, copied for the 
most part from photograms by Koch. 

The scope of the work may be estimated by refer- 
ence to the classification which the author has made 
of the evidence upon which the germ theory rests. 
He discusses first the evidence with regard to an- 
thrax, whose bacterial origin has been affirmed by in- 
oculation experiments in the hands of several com- 
petent observers. Second, the testimony regarding 
tuberculosis, which has been adduced by one com- 
petent observer. Third, those diseases which are 
characterized by the presence of bacteria in the tis- 
sues, but which have not been induced by inocula- 
tion with isolated bacteria. Fourth, those diseases, 
after death from which bacteria have been discov- 
ered in the tissues, and fifth, those diseases in which 
the presence of bacteria has been asserted. 

The entire subject is treated from the standpoint 
of one who has closely followed the development of 
an intricate problem, and has endeavored to deduce 
therefrom the logical results, and thus accurately de- 
fine the present status of an important question. 



Several visitors from other States are expected to be 
in attendance who have promised papers. Dr. Wm. 
D. Cooper, of Morrisville, Va., is President ; Dr. 
Hugh M. Taylor, of Richmond, Va., Correspond- 
ing Secretary and Dr. I^ndon B. Edwards, of Rich- 
mond, Va., Recording Secretary, to either of whom 
letters of inquiry or communications intended for the" 
society may be sent. 



BOOKS AND EXCHANGES RECEIVED. 



The Cituinnati Lancet and Clinic, June 30 and 
July 21, 1883. 

The Sanitarian, New York, July 19, 1883. 

Transactions of the Medical Society of the State of 
West Virginia, Sixteenth Annual Session, 1883. 

How to Conduct Inquests and Post-Mortems, and how 
to Give Official and Expert Testimony before Courts 
of Law in Cases of Homicide. By C. H. Von Klein, 
M.D., Hamilton, Ohio. 



MEDICAL SOCIETY ITEMS. 



MEETINGS OF SOCIETIES, ETC. 

The British Medical Association holds its fifty-first 
annual meeting at Liverpool, England, on July 31 to 
August 4, and the three main physical requirements 
which the editor of the British Medical Journal sets 
forth as necessary for a place of meeting, commend 
themselves with full force to the American Medical 
Association. They are (i) facilities of success, (2) 
ample hotel and other accommodation, and (3) local 
attractions. The work in the sections has been 
arranged for the most part at least seven weeks be- 
fore the meeting, and is full and comprehensive, and 
among the entertainments for relaxation is the annual 
banquet, which is conducted through subscriptions by 
the members. The Association has thirty branches, 
with a membership of 7,416. 

The Medical Society of Virginia will hold its 
Fourteenth Annual Session at Rockbridge, Alum 
Springs, Va., September 4, 5 and 6. It is ex- 
pected to be a session of more than ordinary interest. 



SOCIETY NOTICES. 



The sixteenth annual session of the American 
Ophthalmological and Otological Association was held 
at Hotel Katerskill, Catskill Mountains, July 18. 

Ax Iowa State Veterinary Society was organized at 
Burlington, July 17. 

The thirteenth annual meeting of the Wisconsin 
Dental Society began July 17, at Milwaukee. 



MISCELLANEOUS. 



RECENT LAW TO REGULATE MEDICAL MATTERS 
IN MICHIGAN. 



ACT NO. 167, LAWS OF 1 883. 

An Act to Promote Public Health. 



Section- i. The People of the State of Michigan: 
enact. That from and after this act shall take effect, 
it shall not be lawful for any person to practice med- 
icine or surgery, or any branch thereof (except den- 
tistry) in this State, without having the qualifications 
required in the provisions of this act, and without 
having first registered in the office of the county clerk 
as provided in this act. 

Sec. 2. The necessary qualifications to practice 
medicine in this State shall be : 

First, That every person who shall have actually 
practiced medicine continuously for at least five 
years in this State, and who is so practicing when 
this act shall take effect, shall be deemed qualified to 
practice medicine in this State, after having registered 
in the office of the county clerk as provided by this- 
act. 

Second, Every graduate of any legally authorized' 
medical college in this State, or in any one of the 
United States, or any other country, shall be deemed 
qualified to practice medicine and surgery in all its- 
departments, after having registered as provided in 
this act. Provided, That the provisions of this act 
shall not be construed so as to prohibit any student 
or under graduate from practicing with and under the 
instruction of any person legally qualified to practice 
medicine and surgery under and by the provisions of 
this act. Provided, That every person qualified to 
practice medicine and surgery under the provisions of 
this act, shall, within three months after this act shall 
take effect, file with the county clerk of the county 
wherein he has been engaged in practice or in which 
he intends to practice, a statement sworn to before 
any officer authorized to administer oaths in said 



^6 



NECROLOGY. 



[July, 1883. 



county, setting forth, first, (if he is actually engaged 
in practice in said county), the length of time he has 
been engaged in such continuous practice, and if a 
graduate of any medical college, the name of the same 
and where located, when he graduated, and the length 
of time he attended the same, also the school of med- 
icine to which he belongs. And if he is a student or 
under graduate, the length of time he has been en- 
gaged in the study of medicine, and where, and if he 
has attended a medical college, the name of the same, 
and where located, and the length of time so attended 
and when, also the name and residence of the physi- 
cian under whose instruction he is practicing or in- 
tends to practice. It shall be the duty of the county 
clerk of each county in this State to record in a book 
provided by the county, the affidavit (or sworn state- 
ment) of every physician practicing in said county, 
for recording each statement the county clerk shall 
receive fifty cents, to be paid by the person filing the 
same. 

Sec. 3. It shall be the duty of the supervisor, at 
the time of making the annual assessment in each 
year, to make out a list of all the physicians and each 
student practicing under the instructions of a precep- 
tor residing within his township, village, ward or city, 
with the name, age, sex, and color of each, and the 
length of time each has been engaged in practice, and 
if a graduate of a regularly established and reputable 
college, the name of the college and the date of grad- 
uation. Such list shall be returned by the supervisor 
to the township, village or city clerk, and by the clerk 
recorded in the book in which are kept the records 
of the local board of health. 

Sec. 4. No person who practices medicine, surgery, 
or midwifery in any of their branches (except dentis- 
try), shall be able in any of the courts of this State to 
collect pay for professional services rendered subse- 
quent to the time that this act shall take effect, unless 
he was, at the time such professional services were 
rendered, duly qualified and registered as a medical 
practitioner according to the several provisions of this 
,-9-ct. 

Sec. 5. The supervisor, township, village or city 
clerk is hereby authorized to administer the oaths re- 
quired by this act. 

Sec. 6. Whoever advertises or holds himself out 
to the public as authorized to practice medicine or 
surgery in this State, when in fact he is not so author- 
ized under the provisions of this act, shall be deemed 
guilty of a misdemeanor, and on conviction thereof 
shall be liable to a fine of not less than five dollars nor 
more than fifty dollars for each offense. 

Sec. 7. It shall be the duty of the supervisor and 
health officer of the local board of health in each 
jtownship, village, ward or city to enforce this act, 

Approved June 6, 1883. 



with those of Louisiana. The difficulty arose from 
the recommendations of the Sanitary Council in 
regard to quarantine against yellow fever. 

A rather odd suit has been brought in New York 
by a negro hotel waiter, who allowed eight ounces of 
his blood to be drawn and transfused into the arm of 
a white gentleman. The gentleman claims to have 
paid him and also paid for his services in his hotel 
bill, but still suit is brought against him for $250. 

An International Board of Health, with headquar- 
ters at Geneva or Lugano, is being discussed by sev- 
eral of the European powers. 

Cholera has appeared among the British soldiers in 
Egypt at Cairo, Suez, and other points. 



COLLEGE ITEMS. 



To the chair of Physiology in the Westminster 
Hospital College, Dr. Heneage Gibbes has been 
appointed. At Cambridge, England, a chair of 
Physiology has been created, and Dr. Michael Foster 
has received the first appointment to it. To the chair 
of Anatomy in the same school. Dr. Alexander Macal- 
ister, of Dublin, and to the chair of Surgery Prof. 
Humphrey. 

Prof. John C. Dalton, the well-known teacher 
and author who has held the Professorship of Physi- 
ology in the College of Physicians and Surgeons, 
New York, for many years, has resigned the chair. 
Dr. John G. Curtis, who for several years has been 
the adjunct professor, will be his successor. 

To the chair of Obstetrics and Diseases of Women 
and Children, in the University of Louisville, re- 
cently made vacant by the resignation of Profesrso 
Theophilus Parvin, Dr. John A. Octerlony has been 
elected. 

The chair of Diseases of the Mind and Nervous 
System, in the New York Post-Graduate College, has 
been given to Dr. Chas. L. Dana, and Dr. J. L. 
Corning has been made lecturer on the same subject. 



NECROLOGY. 



Warder, John A., of North Bend, Ohio, died 
July 14, 1883, aged 72. 

Leforgee, Walker L., died at Decatur, 111., July 
II, 1883; born in Marion Co., I'll. Aged 23 years. 



A DISPUTE has arisen between the Louisiana State i 
Board of Health and Dr. John H- Rauch^ of the 
Illinois State Board of Health, and the Sanitary 
Council of the Mississippi Valley. The first-named 
jBoard asked the Governor of Louisiana to request the 
jGovernor of Illinois to request Dr. Ranch to attend 
fo the affairs of his o>yn State, and not to meddle 



The Editor of this Journal would be glad to 
receive any items of general interest in regard to local 
events, or matters that it is desirable to call the atten- 
tion of the profession to. Letters written for publi- 
cation or containing items of information, should be 
accompanied by the writer's full name and address, 
although not necessarily to be published. All com- 
munications in regard to editorial work should be 
addressed to The Journal of the American Medi- 
cal Association, 65 Randolph St., Chicago, 111. 



— 'i& T 13: E •e«'^ 



Journal of the American Medical Association. 

PUBLISHED WEEKLY. 



Vol. I. 



Saturday, August 4, 1883. 



No. 4. 



ORIGINAL ARTICLES. 



ADDRESS OF THE CHAIRMAN OF THE SECTION OF 
OBSTETRICS AND DISEASES OF WOMEN, 
OF THE AMERICAN MEDICAL ASSO- 
CIATION, READ JUNE, 1883/ 



BY J. K. BARTLETT, M.D. OF MILWAUKEE. 



Part I. 

Mr. President arid Gentlemen of the American Medi- 
cal Association : 

The position with which you have honored me re- 
quires, by ordinance, that a resume of the so-called 
advances in our special department should be made 
the subject of this address. This rule has not been 
obser\ed for the past two years, and would now, per- ! 
haps, "be better honored in the breach than in the ' 
observance ; but being a law-abiding subject, the ' 
writer has chosen mainly to comply with it, and will ! 
serve you an "olla podrida," containing some recent j 
items oC interest, seasoned with personal views upon ; 
other subjects, concerning which there is much differ- j 
ence of opinion among the profession. Seen by the 
light of present teachings, some of these opinions may j 
be deemed heretical ; they are certainly conservative, | 
and perhaps it is well, amid the rush and excitement : 
of our modern mode of life and thought, that there ' 
should be an occasional protest against the speed with ' 
which all earlier views are left far in the background, ! 
lest something of real value should be lost and for- ! 
gotten. i 

Dr. John B. Hunter, at the close of an article pub- I 
lished more than a year ago, said, "The triumphs of 
gynaecology have been gained almost entirely in the ' 
field of surgery." Accepting this dictum, we shall j 
first direct attention to some topics in Gynaecological | 
Surgery. i 

Two years ago my predecessor. Dr. J. R. Chad- i 
wick, when more ably discharging the duty which ■ 
now devolves upon me, referring to Emmet's opera- ' 
tion (a name which seems preferable to the long i 
Greek derivative), stated that "it could hardly be said 
to have passed from the stage of novelty to that of \ 
criticism ; that it was destined to be a fertile topic for ' 
several years to come, when it would be assigned to ' 
its proper sphere, and cease to excite discussion." j 
This was truthftil utterance. Our journals, native and i 
foreign, have teemed with cases, papers and criticisms. ' 
Prolonged observation has shown that undue influence 
was attributed to the lesion, and experience has 
proved, that the relief claimed to follow the operation 



has not been uniformly attained. A more definite un- 
derstanding of the conditions really requiring it, and 
the limits to which it should be restricted, as well as a 
more just appreciation of its real merits, has thus been 
attained. As a consequence, medical opinion now 
indicates with tolerable clearness its permanent status 
and scope, even if all the conditions are yet fully de- 
termined. Dr. Emmet's early statement, "In every 
instance where laceration is evident, and where en- 
largement of the uterus still remains, or where the 
woman suffers from neuralgia, I consider the opera- 
tion necessary, notwithstanding the parts may have 
completely healed ;" led to its performance in many 
cases where it was unnecessary, and in which it failed 
to relieve. A reaction followed the first enthusiastic 
reception and adoption of the measure, in this country, 
and sharp, and sometimes unjust criticisms came from 
abroad. 

As an illustration of the truth of the statement that 
reflex nervous disturbances do not depend upon this 
lesion, when accompanying it, and may' be cured 
while it still exists, a brief abstract of a case reported 
by a noted New York gynaecologist, a few months 
since, will be presented. It occured in a woman 39 
years old, who had given birth to a child eighteen 
years before, and had suffered since that time from 
pain in the sacrum, right groin, and down the right 
thigh, with migraine, nausea, and vomiting at the 
time of menstruation, which function was unduly pro- 
longed. She had been many years under the care ot 
a gyucecologist without benefit. A large bilateral 
laceration of the cervix existed, with surfaces and 
angles dense and cicatricial ; the movement of the 
uterus was slightly impeded, and, in the vaginal vault, 
on the right, closely connected with the upper angle 
of the rent, was felt a flat, hard, immovable disk, pres- 
sure upon which caused pain in the groin, and down 
the right sciatic nerve. Preparatory to the operation, 
she was treated locally by hot water irrigations, appli- 
cations of iodine, etc., and afterward, by the use of 
tampons, which produced so much disturbance that 
they were discontinued. Her physician then began 
the use of galvanism, experimentally, placing the 
negative pole against the induration in the vagina, 
and the positive over the right ovarian, and the 
trochanteric regions alternately. A light current was 
at first employed, gradually increased in strength for 
fifteen to twenty minutes, the poles being occasion- 
ally reversed. The pain was much relieved by the 
first application, and the patient expressed herself as 
feeling easier than for weeks before. The sittings 
were continued every second day, and the time ot 

I American Journal of Obstetrics, Oct. 1882, pg. 909. 



98 



ADDRESS OF DR. J. K. BARTLETT. 



[August, 



use extended to one-half or three-quarters of an hour, 
the strength being gradually increased to sixteen cells ; 
and during the week preceding menstruation a 
sound connected with the negative pole was intro- 
duced into the uterus for half the time. The suc- 
ceeding menstruation was attended with scarcely any 
pain in groin or side, and with migraine only for the 
first day. The galvanization was continued every 
•day during the next interval, and was followed by 
menstruation entirely free from pain, or migraine. 
The application was then made less often, and two 
more painless periods passed. The patient attended 
a ball and remained until 3 o'clock a. m., without 
any unpleasant results. ''To all intents and purpos- 
es," says the narrator, "she was cured," The plastic 
exudation had disappeared, hastened, he thought, by 
the hot vaginal irrigations which had been continued. 
Of the influence of the galvanic current in producing 
this result he says nothing. For a month longer the 
■doctor debated, "whether he should not leave well 
■enough alone," but finally concluded to operate. 
He states that while he has often used the galvanic 
■current to reduce a hyperplastic uterus, he had never 
before employed it as a uterine application in reflex 
hemicrania. To the writer such a result is not new 
or surprising, as for many years he has found it effi- 
cient in the same conditions associated with uterine 
trouble, and a year ago treated and relieved similar 
symptoms supposed to depend upon cervical lacera- 
tion. 

While there appears to be satisfactory evidence that 
the great majority of cervical lacerations are attended 
by no symptoms which can properly be attributed to 
them ; that some even of a severe character have been 
found by competent observers, which had existed 
through several pregnancies without producing any 
disturbance of health ; that the operation will not, 
with certainty, remove uterine hyperplasia, or hyper- 
trophy, and experience has proved it unreliable for 
the relief of presumably dependent reflex nervous 
disturbances, and while it is still a mooted point 
whether it is warranted by the existence even of he- 
reditary tendencies which make it possible that epith- 
elioma may spring from the cicatricial tissue; 
there yet remain exceptional cases (not perhaps 
as frequent as Dr. Munde s estimate makes them, 
twenty-five per cent, of al') of stellate lacerations, 
where decided local symlptoms are present ; and 
deep bilateral rents with co-existing ectropion, hy- 
pertrophy of cervix, and consequent local symptoms, 
which are speedily and effectively cured by reunion 
of the lacerated cervix. In such, it is so marked an 
improvement upon cervix amputation, or the use of 
the actual, or potential cautery, that for the relief of 
these alone, the gratitude of the profession is due to 
the deviser of the operation, to which in honor his 
name is justly given. 

Another operation which has been tested for some 
years is that of Dr. Battey. Most of the indications, 
which have been claimed to warrant it, are now gen- 
erally admitted. Some doubt still exists respecting 
its ultimate results when performed to check uterine 
haemorrhage produced by myomata. It has appeared 
to be successful in interstitial and subperitoneal fib- 



roids, unless the latter are so large as to prevent the 
operation ; but its results appear more doubtful in 
the submucous variety, as the haemorrhage has some- 
times returned, after a check of a few months. Even 
with this doubt, it is indicated in much reduced pa- 
tients, where enucleation could not be borne. Cau- 
tion must also be observed where the tumors have 
been treated by ergot, as there is, at times, a central 
disorganization and sloughing, which may lead to 
blood poisoning after the operation. There is also 
some diversity of opinion concerning its efficacy for 
the relief of epilepsy, or hystero-epilepsy, and mania, 
seemingly dependent upon, or associated with, ova- 
rian troubles. Dr. Goodell advocates the operation 
in such cases of insanity, and quotes Esquirol, to the 
eff"ect that derangements of menstruation are causal 
in one-sixth of all cases due to physical causes. 

Mr, Lawson Tait, of Birmingham, England, was 
one of the trio, who each, independently of the oth- 
ers, originated and performed this operation in the 
months of July and August, 1872. It was published, 
at that time, only by Dr. Battey, whose name it just- 
ly bears. Mr. Tait has since had a much wider field 
for ej^perience than our modest, but inventive and 
skillful American surgeon, and quite recently has 
astonished the profession, abroad and at home, as 
much by the boldness and originality of his views, as 
by the remarkable success which he has attained. 
His deductions controvert some long-established 
opinions, and whether these are accepted or not, his 
researches aff"ord clues, which followed, promise to 
lead to a more accurate understanding of some 
hitherto obscure pelvic affections. His earlier oper- 
ations were performed for the relief of haemorrhage 
from myomata, and he then removed only " the ova- 
ries, but afterward included the fallopian tubes also, 
an addition which he deems of great importance. 
He published in July, of last year^ , remarks upon the 
diagnosis and treatment of chronic diseases of the 
ovaries, in which he advanced the opinion that ab- 
dominal operations in the hands of an expert, are so 
little dangerous as to be justifiable for relief from 
long-continued suffering ; and that the earlier usage 
of deferring operative interference until life was im- 
mediately threatened, was an error. He also states, 
that all the evidence before him showed the phenom- 
ena of menstruation to depend upon the fallopian 
tubes, and not in the least upon the ovaries ; that 
the tubes are involved in all cases of ovarian disease, 
and, in the large majority, are the principal seat of 
the difficulty ; that many cases of abnormal men- 
struation can be relieved in no other manner than by 
the removal of the tubes and ovaries, and that the 
proceeding is justifiable ; that, in his last series, of 
thirty-five cases of chronic ovaritis and tubular dis- 
ease alone, he had lost but one, and, the operation 
being yet in its infancy, he believes this percentage 
of mortality can be materially lessened. He claims, 
also, that these recent operations for oophoritis have 
done more to enlighten us upon the physiology and 
pathology of ovarian disease than all other previous 
sources of information ; that they have also shown 
that many of the sufferings from pelvic symptoms, 

1 American Journal of Obstetrics, July, 1882. 



I883.J 



ADDRESS OF DR. J. K. BARTLETT. 



99 



which have been referred to the ovary, are really 
dropsy, inflammation, and suppuration of the tubes, 
producing sterility, and a host of painful ailments 
which make life a burden. The diagnosis, he allows, 
is not always clear. Examination will often reveal 
to the practiced finger, in the vaginal cul-de-sac, a 
fixed tender mass composed of the enlarged and 
probably adherent ovary, and of the occluded and 
distended tube ; and the peculiar sickening pain felt 
when this is touched, will afford conclusive proof as 
to its nature. When this evidence cannot be at- 
tained, the presumptive diagnosis must rest upon the 
history of the case and the symptoms manifested. 

Dr. T. A. Emmet, at a meeting of the New York 
Academy of Medicine, last December*, stated that 
he had learned orally from Mr. Tait, that in cases of 
obscure pelvic inflammation, characterized by severe 
symptoms, and which did not yield to treatment 
within a reasonable length of time, he opens the ab- 
domen and invariably finds this dropsical condition 
of the tubes, which are distended with either serum 
or pus. The removal affords immediate relief, and 
it is the only means which can. Dr. Emmet also 
added that the improvement which he had personally 
observed to follow Mr. Tait's operations, had been 
something almost beyond conception. 

In a paper read before the New York Academy of 
Medicine, last December, Dr. T. G. Thomas said, 
in reference to the views of Mr. Tait, that while he I 
did not feel warranted from his own observation and 
experience in accepting them fully, he thought there 
was sufficient of truth in the statements to make the 
essay the most valuable to the gynaecologist which 
the present decade had produced. He also men- 
tioned another proposition of Mr. Tait, which was 
not included in the paper, but orally communicated 
to Dr. Emmet : That tubal dropsy and ovarian dis- 
ease are often the real cause of recurrent peritonitis 
or cellulitis, which is produced by an occasional dis- 
charge of the purulent contents of the tubes. Dr. 
Thomas reported four cases in which he had operat- 
ed, where great menstrual derangement existed, to- 
gether with recurrent peritonitis and cellulitis, con- 
ditions which the operation showed to have been 
produced by the state of the tubes described by Mr. 
Tait. In three of these, the result was very satisfac- 
tory ; the fourth patient was in an exceedingly re- 
duced physical condition from recent attacks of per- 
itonitis, when the operation was performed, and 
died on the sixth day, from an insidious attack of 
the same disease which came on twenty-four hours 
after. More recently he has operated upon a fifth 
case, the patient completely bed-ridden, and re- 
quired no less than ten grains of morphine, subcu- 
taneously, per day, to relieve the intolerable suffer- 
ing. The ovaries and tubes were again found in the 
typical condition described by Mr. Tait. He also | 
remarked that no one of the five patients upon whom ' 
he had operated would not have considered death a 
welcome relief from their sufferings. 

It appears singular that this condition has not been 
before noted or suspected ; but it is stated that since 
the publication of these facts, a well known micro- 

'^ Nev) Vork Journal of Medicine, Tsmuary, i88-j. I 



scopist of New York has said, in his examinations he 
had frequently noted distension of the fallopian tubes. 
Mr. Savage, of Birmingham,* also takes the ground 
that hydro and pyosalpinx are met with quite fre- 
quently, and states that the first effect of the inflam- 
mation is to close the uterine or fimbriated extremi- 
ties of the tubes, allowing collection of the abnormal 
secretion ; thinks that the relatively large amounts o 
areolar tissue in the walls of the tubes, as compared 
with the uterine wall, accounts for the frequent pres- 
ence of pus in the former: He says the diagnosis 
must often be presumptive, and based upon the phy- 
sical signs and clinical history. The operation of 
removal is often difficult and tedious, from the firm- 
ness of adhesions, and the risk of the escape of the 
fluid contents in the pyosalpinx. The results of such 
conditions when left to themselves, may be : First, 
resolution or absorption, which is very improbable 
when pus is present, and which would not affect the 
results of former adhesions. Second, bursting into 
the uterus, or vagina, which may be curative, or into 
the peritoneum, which would be almost certainly 
fatal. The same physician, later,- calls attention to 
the comparative frequency of recurrent attacks of 
pelvic inflammation caused by pyosalpinx, and thinks 
that many cases of supposed pelvic cellulitis hitherto 
regarded as incurable, can be relieved by the removal 
of the tubes. 

Dr. T. G. Thomas recently introduced a patient 
at the clinic of the College of Physicians and Sur- 
geons, who was suffering from recurring pelvic peri- 
tonitis, and in whom he deemed these attacks due to 
the cause pointed out by Mr. Tait, as both ovaries 
and tubes were enlarged. The first attack of peri- 
tonitis had been light, the second more severe. He 
remarked that " although the tubal enlargements 
could be apparently made out with unusual clearness, 
still the diagnosis was not a positive one, and he did 
not think operation advisable, because the woman 
was not suffering to an extent warranting so radical 
a procedure." He added, " I cannot impress upon 
you too strongly, that the dangers of this operation 
are very great, and the great fault I have to find with 
Mr. Tait is, that he makes too light of them alto- 
gether. I cannot believe that the high standard of 
success which he has so far maintained, will be kept 
up in the future." This opinion corresponds with 
that expressed in an able paper read by Dr. G. I. En- 
gleman before this Association in 1878, in which he 
faithfully depicts the difficulties and dangers of Bat- 
tey's operation ; but Mr. Tait idoes not always " make 
light" of these difficulties, for in a paper published 
in February of this year, he says, speaking of the 
hydro and pyosalpinx cysts : " Generally they are 
much smaller, holding only a few ounces, and then 
their removal, by reason of dense adhesions, consti- 
tutes by far the most difficult class of cases I ever 
have to deal with. Why the simplest of all, the re- 
moval of a parovarian cyst, should be classed as an 
' ovariotomy' and held up for admiration, and these 
most difficult cases dubbed 'Oophorectomies,' and 
held up to scorn, I cannot imagine." 



1 London Lancet, January 6, 1883. 

■- Birmingham Medical Review, January, 



ADDRESS OF DR. J. K. BARTLETT. 



[August, 



Dr. P. Harris' paper upon the revival of symphy- 
siotomy in Italy/ is worthy of notice from the remark- 
able-success which attended the operation. Between 
1866, and December, 1880, fifty cases are reported, 
with eighty per cent, of maternal recovery and eighty- 
two per cent, of living children. Nine of the ten 
-women who died were delivered of living children, 
and eight of the nine mothers who bore dead chil- 
dren, recovered. Of the children lost, five were 
shoulder and breech, and four vertex presentations. 
In only one instance did mother and child both die, 
and this was a case of back presentation, operated 
Tipon on the fourth day of labor. There have been 
three additional cases since, in which all the mothers 
recovered, but two children were lost. All the oper- 
ations were performed upon rachitic subjects, the de- 
formity being generally antero-posterior contraction. 
The separation at the pubis amounted to about two 
inches, which was obtained without any effort, and 
without lesion of the sacro-iliac synchondroses. An 
immovable dressing secured firm reunion of the parts 
in all who recovered ? No after pelvic disease oc- 
curred, and the women were in good health. In one 
■case only, vesico-vaginal fistula followed, which was 
•easily cured. The operations were performed prin- 
cipally by Professors Morisani and Novi, of the Uni- 
versity of Naples. The section is made subcutane- 
ously, with a probe-pointed sickle-shaped bistoury ; 
an incision being made above the pubis, the knife is 
slowly passed behind the symphysis until it reaches 
the pubic arch, when its cutting edge is brought to bear 
upon the ligaments, and they are divided from below 
upward; the pelvis is not forced open, the foetus not 
dragged upon, but when the head presents, the con- 
clusion is generally left to nature. The incised part 
is treated antiseptically, and by irrigation in warm 
weather, and as soon as convenient the bones are kept 
in opposition by the immovable dressing. The usual 
time for complete pelvic restoration was from forty to 
fifty days. Dr. Harris remarks that " this more ex- 
tensive test upon the living has proved that greater 
pelvic mobility exists than John Hunter demonstrated 
upon the cadaver;" each inch of pubic separation, 
though increasing but little the sacro-iliac, adds to the 
transverse and oblique diameters, and makes it possi- 
ble, if time is allowed, for the head to mould itself 
sufficiently to pass ; this result is shown by the state- 
ment that forty-two out of the forty-six vertex pres- 
entations were thus delivered alive, with a recovery 
of eighty per cent, of the mothers. Dr. Harris states 
that the Porro operation in Italy saved 45.5 of the 
women and 77.5 of the children ; and I find elsewhere 
that he has stated,'"* that out of the last twenty-eight 
cases, from May, 1879, ^^7 P^^ cent, of the women 
were saved. But the two can hardly be compared, 
as the sphere of symphysiotomy is confined to those 
cases having a conjugate of 2^ inches (sixty-seven 
millemeters), and upwards; cases not very uncommon, 
where the pelvis is somewhat too small to permit the 
birth of the child, and in which premature labor 
would save it, did opportunity offer. With a diameter 
less than 2^ inches, other means must be adopted. 



1 American Journal of Medical Sciences , January, 1883. 

2 British Medical Journal , April 21, 1883. 



Dr. Montgomery, of Philadelphia, not long since 
published conclusions which he had drawn from an 
analytical study of this subject, which are here briefly 
stated. That craniotomy is never justifiable, since it 
is our duty to try and save both mother and child. 
That in pelvis of a conjugate of 3.25, or over, forceps 
can be employed, when 2.75 or upwards, version; 
2^ or over, symphysiotomy, and in less than 2^, the 
Caesarian section, performed reasonably, offers better 
results for the mother. This should not, however, be 
the old operation, but the modification recently in- 
troduced, I think by Sanger,^ which has been found 
more successful than the old method ; and a case is 
recently recorded which was operated upon by Dr. 
Leopold, in Germany,^ in which both mother and 
child were saved. 

In a limited number of cases, when the os is dila- 
ted, laparelytrotomy may be preferable to uterine 
section. In all lesser degrees of distortion, when op- 
portunity is afforded, or in subsequent pregnancies, 
premature delivery should be induced. 

EXTRA-UTERINE PREGNANCY. 

Some important advances have recently been made 
in the treatment of extra-uterine pregnancy up to a 
certain stage of its existence, which appear to offer a 
safer and surer path out of this difficulty than previ- 
ously discovered. The first instance of this treat- 
ment which the writer has found recorded, was re- 
ported by Dr. J. C. Reeve, in 1879.' I^ this case 
the diagnosis was positive, and the time about the end 
of the third month. Faradization was used as strong 
as it could be borne, for nine days successively, for 
about ten minutes each session ; one electrode upon 
the tumor in the vagina, the other, sponge covered, 
carried over the external abdomen. Ten days after 
the last application the patient was decidedly better, 
and in a month the breasts had become flaccid and 
the tumor gradually decreased in size. This was suc- 
cessful, although accomplished with inferior appara- 
tus, and more than necessary disturbance. Cases 
have been reported within two or three years, by Drs. 
Lusk, Bache, Emmet, and others, where the diagnosis 
was regarded as satisfactory, and similar treatment was 
successful. Dr. T. G. Thomas last year,* in a paper 
upon this subject, fully discussed the means of diag- 
nosis, and related the results of his own experience 
in twenty-one cases. Six of these were treated by 
galvanism, and all recovered. His conclusion is, 
that if such a tumor be discovered, and its nature 
tolerably settled before the fourth month, the de- 
struction of the foetus by galvanism should be pre- 
ferred to any other method of treatment. If there 
should be error in diagnosis, it could do no harm, if 
diagnosis were correct, experience proved it effective. 
Dr. Garrigues remarked that it had been successful 
up to the middle of the fourth month in every case 
in which it had been employed, and he thought it 
could be used with advantage at any period of foetal 
life. The last communication upon this subject was 
from Dr. A. D. Rockwell, the operator in many of 

1 See paper by Dr. GsiTTigacs, Atn. Journal Obstetrics, May and June, 
1883. 

2 Archives fur Tynaskel, xix p. 400. 

3 Trans. Am. Gynaecological Society, 1879. 

4 " " 1882. 



i883.] 



ADDRESS OF DR. J. K. BARTLETT. 



Dr. Thomas' cases,* in which he reports seven cases, 
with the method of use of the agent. His first case 
was one of tubal interstitial pregnancy at almost 
three months, and was perfectly successful. More 
recently he had treated three which had been pub- 
lished, and three more which had not. The results 
in all, more thoroughly establish the value of the 
treatment. Two of these will be briefly epitomized 
to show the method. His fifth case was declared by 
Drs. Thomas and Emmet to be a combination of 
both intra and extra-uterine pregnancy, and was 
about two and a half months advanced. There was 
a tumor of the size of a pullet's egg distinctly per- 
ceptible two inches to the left of the median line, 
and nearly on a level with the pelvic basin. It could 
be moved from Douglas' cul-de-sac towards the mar- 
gin of the ribs, and it gradually increased to the size 
of a billiard ball. The negative pole of a galvanic 
battery was brought into contact with this growth 
through the vagina, the positive, a large flat electrode 
placed upon the abdomen, the object being so to 
diffuse the current as to produce the least possible ac- 
tion upon the abdominal muscles. The maximum 
strength employed was eighteen cells, or power of 
twenty-four volts, used with rapid interruptions. This 
was repeated four times in six days. 

The tumor not only diminished perceptibly in size, 
but changed its position an inch or two. Since that 
time it has gradually grown smaller, until now, three 
months after, it can hardly be detected ; at the same 
time there is now developing, in the uterus, a six 
months' foetus. 

The sixth case was about four months advanced, a 
current of twelve cells (about i6 volts) was used, in- 
ternipted for ten minutes, then quickly increased for 
one minute without interruption. Great care was 
exercised, in this case, on account of the increased 
distention of the fallopian tube from the more ad- 
vanced stage, and the consequent danger of rup- 
ture. A second application, the following day, con- 
cluded the treatment. Two weeks after the tumor 
had decreased one-half, and, after several months, 
cannot be perceived by external examination. 

In the last case, the pregnancy had advanced to 
the third month, and the tumor, about the size of a 
child's fist, was movable, and could be distinctly 
felt, both from without and within. An anaesthetic 
was given, at the advice of Dr. Emmet, for fear of 
cyst rupture from involuntary movements ; a current 
of 1 6 volts only was used, and repeated three times 
afterward, at intervals, during six days. The con- 
tour and seat of the tumor were changed after the 
first application, and it rapidly decreased in size. 
The treatment was repeated afterwards to accelerate 
the process of absorption. 

This method of treatment is safe and simple, only 
requiring caution, in advanced cases, to avoid rup- 
ture of the sac by too much strength of current. 
Galvanism is decidedly preferable to Faradism, as 
being more certain. Catalytic effects pertain only 
to the former, and the changes produced by this ac- 
tion, in organic bodies, continue long after the cur- 
rent has been used. 



POST PARTEM H.«MORRHAGE. 

A reference to some recent suggestions for the re- 
lief of severe cases of post partem haemorrhage and of 
the collapse which follows : The hypodermic injec- 
tion of ether has been lauded in extreme acute 
anaemia. It appears, however, only to act as a tem- 
porary stimulant, of the same character as the intro- 
duction of a small quantity of ammonia into a vein. 
Professor Hayem's experiments on artificially ex- 
sanguinated animals, recently detailed at a session 
of the Paris Academy of Medicine^ prove that no ef- 
fect is produced except a temporary excitation of the 
heart beat, while the use of defibrinated blood, in 
many cases, prevented a fatal result. 

Professor Chahbazian, of Paris'*, extols an alkaloid 
of ergot, called ergotinine, which is prepared by M. 
Tanret, of Paris. Only three grains of this can be 
obtained from a pound of the ergot. One-fiftieth of 
a grain is dissolved in twenty minims of alcohol or 
chloroform, and five to ten minims of the solution 
injected hypodermically, to be repeated, if necessary, 
but never to exceed twenty minims in all. He 
states that it acts very speedily and energetically, 
uterine contraction following its use in from two to 
five minutes. 

Dr. Langay, of Paris, says that he has found farad- 
ization the speediest and most effective means of pro- 
ducing instant and energetic uterine contraction in 
cases of this difficulty. 

Dr. J. F. LePage, in a recent article*, refers to an 
old but now neglected method, auto-transfusion, in 
acute anaemia from post partem haemorrhage, and be- 
lieves that where patients are not in articulo mortis, 
it will prove successful. 

It is also again recently referred to by Mr. Percy 
Boulton*, who, after enumerating the ordinary means, 
including hot water iio° to 120° injected into the 
fundus uteri by a syphon syringe, says, should symp- 
toms of collapse appear, raise the foot of the bed to 
an angle of 45°, apply a sinapism over the heart, 
and bandage firmly legs and arms, beginning at the 
extremities, etc. 

Confidence in the practical efficacy of direct 
blood transfusion, in cases where death appears im- 
minent, has very much lessened in France, Germany, 
and England, and Dr. Lusk, one of our late author- 
ities, says, that although theoretically it is the most 
rational method of treatment — practically it is un- 
satisfactory. Dr. Matthews Duncan, at a meeting of 
the London Obstetrical Society, last January,* spoke 
of transfusion as merely a hopeful proceedmg, re- 
marking that patients who survived it were often 
spoken of as being saved by it, which was a mani- 
fest mistake. In many cases it has caused death, and 
most of the difficulties and dangers were produced 
by the attempt to transfuse blood. 

These estimates are due partly to the uncertainty 
of obtaining a blood supply, and to the unpleasant 
symptoms which often, and the fatal results which, 
at times, follow direct transfusion, and partly to the 



' New York Medical Record, February 17, 1882. 



1 British Medical Journal, Ychm&ry 17, 1883. 

2 London Lancet, January ,1 1883. 

* British Medical Journal , April-22, 1883. 

■♦ London Medical Times-Gazette, Alay 5, 1883. 

^ British Med. Journal, January 27, 1883. 



I02 



ADDRESS OF DR. J. K. BARTLETT. 



[August, 



delicate instruments and manipulations required. To 
mediate transfusion may be objected the same want 
of blood supply, and the loss of time occupied in 
defibrinization and re-heating, the chance of embol- 
ism from imperfect separation of all fibrinous par- 
ticles, and the possible danger of contamination from 
bacteria during the process of whipping. Other 
fluids have been suggested, such as fresh milk, by Dr. 
Thomas ; but this is found open to grave objections, 
and has iDcen but little used. Many years ago weak 
saline solutions were suggested where blood could 
not be obtained, but physiological objections were 
strongly urged against the measure. Dr. Barnes 
states that they were employed, some years since, by 
Drs. Little, Woodman, and Hickford, in England, 
and that one of the cases of Dr., Woodman recov- 
ered. 

Mr. Schwartz published, about two years ago, the 
result of experiments made upon artificially exsan- 
guinated animals, with the conclusion that a saline 
solution thrown into a vein would relieve the phe- 
nomena which accompany an extreme degree of 
anaemia. The first application of this to the human 
subject, in Germany, as far as records are accessible 
to the writer, was made by Dr. J. J. Bischofif, in 
i88i,^ in a case where death seemed imminent from 
haemorrhage ; who injected into the left radial artery, 
on account of the difficulty of finding superficial 
veins, about forty ounces of a solution of common 
salt, six parts to one thousand, with the addition of 
a few drops of lye, as no soda was at hand. This 
was allowed to flow slowly in, from a receptacle ele- 
vated a little above the arm, and an hour was occu- 
pied in the process. During this time the pulse fell 
from 156 to 122, and rapid improvement of the 
patient was observed, followed by recovery. None 
of the unpleasant symptoms of oppression, which 
attend blood transfusion, were manifested. Schwartz 
has recently published his conclusions more fully,^ in 
which he states that death from cessation of the cir- 
culation is due not so much to the great diminution 
of the blood globules, as to the disproportion be- 
tween the size of the vessels and their fluid contents, 
and that the latter is safely and surely remedied by 
injections of weak alkaline solutions. The minimum 
quantity to be administered to an adult should be 
about five hundred cubic centimeters (about seven- 
teen ounces). He also reports a violent haemorrhage 
following the removal of uterine cancer, where the 
pupils were insensible, consciousness lost, etc., where 
he injected one thousand cubic centimeters into the 
median vein, with the most satisfactory result. He 
mentioned five other cases which were reported by 
Bischoff, Kiistner, Kocher, and Kiimmel. 

Recently it has been again brought into notice in 
England.^ Mr. Jennins, resident accoucheur at the 
London Hospital, reports a case which occurred, last 
August, in a woman who, after a fall at full period, 
was attacked with profuse antepartum haemorrhage, 
and was collapsed, to a marked extent, when seen. 
The OS was fairly dilated, and right shoulder present- 
ing. The flooding was temporarily checked by hypo- 

1 New York Med. Journal, February, 1882. 

2 Berlin Klin. Woch., No. 40, 1882. 

3 London Lancet, Sept. 16, 1882. 



dermic injections of sclerotic acid and brandy, and, 
thinking that any attempt at delivery would prove fatal, 
the median basilic vein was found with much difficul- 
ty, and sixteen ounces of a saline solution thrown into 
it, by means of a common metallic syringe. Signs of 
animation are stated to have speedily followed, vision, 
hearing, and speech returned, and the subsequent 
progress was favorable. The solution here used was 
composed of common salt fifty grains, chlorate of 
potash three grains, sulphate and carbonate of soda 
two grains each, to twenty ounces of water, to which 
two drachms of absolute alcohol were afterward 
added. 

Mr. Coates related two cases before the Obstetrical 
Society of London, December 6, last year,^ both of 
severe secondary haemorrhage after labor. In the first 
it had recurred violently several times, and continued, 
on the last occasion, for eight hours after the patient 
was seen by the medical attendant. She was found 
almost moribund, unconscious, and pulse barely per- 
ceptible. The saline alcoholic solution was allowed 
to flow into the radial vein, the only one perceptible 
of any size. The result is described as marvellous — 
sight and consciousness returned, and she was soon 
able to retain stimulants. 

In the second case, the haemorrhage occurred the 
ninth day after labor, following labor at stool. Half 
an hour after, her appearance showed a great loss of 
blood, which was still flowing in gushes. The uterus 
was relaxed, filled with clots, and could be felt exter- 
nally, extending almost to the ensiform cartilage. 
The OS barely admitted a finger. Sclerotic acid hy- 
podermic injections, ice, kneading, etc., failing to 
arrest the haemorrhage, she was brought to the hospi- 
tal. She was much worse after her arrival, and one 
of Barnes' dilators was introduced, with a view of 
further examination. Before this could be accom- 
plished her condition became most critical — pulse 
hardly perceptible, respiration irregular, extremities 
cold, jactitations, etc. The median cephalic vein 
was found after some delay, and twenty-two ounces 
of simple water, at a temperature of ioo° F. injected. 
The pulse ceased to intermit, respiration improved, 
sight returned, and the uterus slowly but distinctly 
contracted. The os being now fully dilated, the uter- 
ine interior was examined, but nothing found to ex- 
plain the flooding. As there was still considerable 
bleeding, the uterus was swabbed out with a mixture 
of equal parts of a saturated solution of persulphate 
of iron and water, and an enema of beef tea and 
three ounces of brandy administered. In a short 
time she could swallow, and stimulants were freely 
given. The patient progressed uninterruptedly after 
this, having no bad symptom except a rise of temper- 
ature to 102° F. for the first few days. The narrator 
thinks that the omission of the salines in no way les- 
sened the success of the injection, and though a fluid 
of a different specific gravity, and one previously sup- 
posed to produce swelling of the red globules, and 
loss of pigment, the result was wholly beneficial. He 
also states that he examined the globules microscop- 
ically, twenty-four hours after the injection, and there 
was no obvious alteration in their appearance. 

1 London Lancet, Dec. 30, 1882. 



1883-] 



ADDRESS OF DR. J. K. BARTLETT. 



103 



Dr. Robert Barnes, referring to this case,' said : 
" That the dynamic condition of the circulation, un- 
der such conditions^ can be restored, even to a par- 
tial extent, by the injection of twenty-two ounces of 
simple water, is one of the most interesting physio- 
logical and clinical demonstrations I have recently 
obser\ed. ' ' 

Dr. H. J. Garrigues, of New York, after advocating 
the injection of defibrinated blood, in place of direct 
transfusion, closes a short recent article, thus : "When 
blood cannot be obtained, I should prefer a saline so- 
lution as containing no foreign substances, no solid 
corpuscles — being always attainable, and not liable to 
decomposition. Table salt is found in every house, 
and all that is needed is to inject a half per cent, so- 
lution of this substance. ' ' 

It is not improbable that all the cases which have 
been cited might have recovered without intravenous 
injection ; but as a prelude and adjunct to other mea- 
sures, where the prostration is so great that stimu- 
lants or nutriment cannot be taken or absorbed, this 
offers a safe and ready auxiliary. The knowledge 
that such a remedy is always at hand, and that it can 
be used with safety and decided advantage, appears 
a great accession to our therapeutic resources in these 
alarming cases. 

FORCEPS. 

A few words upon a subject not novel — the fre- 
quency of forceps' use now taught, and the existing 
tendency to the abuse of this valuable aid to the ob- 
stetrician. For many years past much thought and 
labor have been expended upon this instrument. A 
majority of tfeachers, and some who are not, have in- 
troduced new forms and variations, each claiming 
some superior quality. Much of this has been un- 
doubtedly due to the increased knowledge of the 
rationale of labor, but the pendulum appears to the 
writer to have swung too far in this direction. One 
of the latest additions is the invention to which Dr. 
Alex. Duke called the attention of the Obstetrical 
Society of Dublin last year. It consists of tractors, 
which are applied with the forceps blades, and before 
they are locked ; these can be attached to a belt 
about the waist of the operator, and with toe-caps 
upon his shoes, to prevent slipping, the inventor 
claims an immense gain of power for shortening 
labor. He considers that there is more chance for 
the child and less risk to the soft parts of the mother, 
by pulling the head forcibly through the pelvis than 
if allowed to remain and mould itself to the outlet. 
We shall probably next hear of a small electro-motor 
of one-horse power, so arranged as to do the pulling, 
and save the operator as well as the mother any 
exertion. 

The contest between the advocates of a judicious 
use of forceps and those who employ them with un- 
.warranted frequency, has been going on in Great 
Britain for some years. Arguments for the latter ; 
course have been based upon statistics, claimed to 
show a considerable gain to maternal and a large one 
to foetal life from this practice. Statistics possess 
valuable elastic qualities. Four years ago this evi- 
dence was examined and reported upon by the writer 

' London Lancet, Jany. 27, 1883. 



with widely different conclusions. Ochers have 
drawn the same. Dr. Galabin, from statistics of 
over 40,000 cases, proved that the maternal mortality 
when the forceps was used once in ten or twelve 
cases, was nearly double that which occurred when 
they were seldom used, while the gain to infant life 
was only o. 4 per cent. 

While this is being written, an address of Dr. Den- 
ham, presiding officer of the Obstetric Section of the 
Academy of Medicine in Ireland, has appeared. In 
this he cites statistics of the Rotunda Hospital at 
Dublin, taken from the reports of Drs. Collins, 
Shackleton, and the more recent ones of Dr. George 
Johnston, amounting in all to over 39,000 cases. 
Commenting upon the figures, he says: "It is 
patent that by the more frequent use of forceps in 
modern obstetrics much has been done for the relief/ 
without adding to the danger of labor. ' ' This is a 
most singular deduction, as the figures clearly show 
that Dr. Collins, who used forceps in 1.6 per 1,000 
women, lost 9.99 p>er 1,000; Dr. Shackleton, who 
used them in 14.5 per 1,000, lost 11.8 per 1,000; 
while Dr. Johnston, using forceps in 82.4 per 1,000, 
lost 18.98 per 1,000, the maternal mortality being 
almost double that of Dr. Collins in about eighty 
times the number of forceps cases, nothing is said of 
the foetal life. No one can have a higher estimate of 
the value of this instrument, when really needed and 
skillfully employed than the writer, but have we not 
gone far beyond this, and all rational limits, in in- 
strumental obstetrics? The tendency of present 
teaching and practice is to send forth young men 
who are not, and cannot be, skilled in forceps use, 
with the conviction strongly fixed, that if there be 
some delay in the second stage of labor, forceps is 
the immediate remedy. 

Dr. Hamilton, of Falkirk, formulated a general 
rule that the second stage of labor should not be 
allowed to last usually much more, and sometimes 
even much less, than two hours ; and similar opinions 
obtain with us. Five years ago the writer heard ex- 
pressions from members of a society which should be, 
and is, regarded as of the highest authority, which 
were so extremely radical as to excite great surprise. 
It was claimed by one, that if there was a cessation of 
advance by the head for fifteen minutes during the 
second stage, forceps should at once be used. Another 
stated that after waiting a time for nature, even if he 
knew that in two or three hours more the labor could 
be successfully completed by her efforts, rather than 
subject the woman to this additional pain it was the 
duty of the accoucheur to apply the instrument and 
deliver at once. There were, however, present those 
older and of wiser counsel who differed much from 
these opinions, and suggested that the tone of the 
discussion needed modification. 

Rules specifying any time beyond which the appli- 
cation of forceps should not be delayed, appear to be 
made rather for the benefit of the doctor, than that 
of the patient. Time is a very unsafe guide when the 
interest of mother and child only are concerned. 
Natural labors are often eight, ten or more hours in 
the second stage, and terminate in all respects suc- 
cessfully for mother and child. Nature requires time. 



I04 



ADDRESS OE DR. J. K. BARTLETT. 



[August, 



especially in primiparae, to mould the head to the 
pelvic outlet, and at intervals, progress is hardly per- 
ceptible. The cause of retardation, and the maternal 
conditions are the considerations which should influ- 
ence interference. If impaction is positively shown, 
forceps ; if retardation is due to loss of nervous power 
in the mother, quinine; if to insufficient uterine effort, 
ergot, discreetly and properly used. But the fashion- 
able usage of the day calls for forceps, whatever the 
cause of delay. The young physician thus taught 
will never dare to wait sufficiently long to know what 
nature can accomplish, because of the vivid picture 
of impaction, sloughing, death of child, etc., which 
will rise before his excited fancy. It will be long, if 
ever, before he learns that such dangers are very much 
overstated, as my own experience and that of thou- 
sands who commenced their work before this forceps 
craze became rife, can testify. A knowledge of 
healthy action is necessary to, and must precede 
an understanding of pathological conditions. He 
who has never ascertained what nature's forces can 
accomplish in labor, cannot compare the results of 
this physiological process with those produced by his 
own interference, and consequently never will realize 
that what has been done artificially by his so-called, 
and often miscalled aid, might have been better and 
more safely accomplished without it. 

An able editorial appeared in the London Lancet a 
few months since, deploring the want of means of 
instruction in practical midwifery, and urging the 
necessity of providing increased facilities for this pur- 
pose. The writer remarks : "A knowledge of /^^'w to 
use instruments is no more, or even less important 
than the knowledge of when to use them, and the 
latter is more difficult of acquisition than the former;" 
and again: "Otherwise students go forth with in- 
structions to use forceps when labor is delayed, or at 
least when it ceases to progress, and great injury, 
both to patients and doctor, is the result of their ig- 
norance of both the above items. ' ' 

These words are hopeful indications, since they 
evince a partial comprehension of the mischievous 
results which attend the use of forceps in unskilled 
hands. 

What motive can even the expert in their use have, 
to apply the instrument when he thinks labor will be 
safely ended in two or three hours without interfer- 
ence. Anaesthesia offers relief from pain, without 
danger, and there certainly is more tendency to after 
haemorrhage from hastening labor by the instrument. 

What is the reason for thus interfering? Can it be 
economy of time for other engagements ? This mo- 
tive would not be generally avowed by those who 
thus act, but it is, at times, openly acknowledged. 

Six years ago Dr. West, in his presidential address 
to the Obstetrical Society of London, used the fol- 
lowing language: "There is one point on which I 
think it impossible to insist too strongly — instruments 
are to be used and operations resorted to for the sake 
of the patient and the child, never for the sake of the 
doctor; and yet I have in years gone by heard men 
say a could not wait any longer ; I had this or that 
to do, so I put on the forceps and got the case over. ' ' ' 

To-day, in a recent journal, the writer chanced up- 



on the following statement, from one well-known in 
the profession. Speaking of a case of labor, he says r 
"As the head rapidly neared its exit, and a few more 
pains would have expelled it" — suffice it to say he 
applied the forceps in order to shorten labor by one- 
half hour, to be in time for another engagement. 
This gentleman knew that in his hands the instrument 
would do no harm, but he also knew that it was un- 
necessary, and the motive for its use an improper one. 

It must be remembered that those who are experts 
in forceps use are very few when compared with the 
numbers who practice obstetrics. If this is the rule 
for the expert, it will certainly be the practice of the 
non-expert, and at a cost to female humanity such as 
elicited the strong language of Dr. Goodell, when he 
said: "To tell you the truth, such grave lesions to 
the mother, and for that matter to the child also, are 
so constantly brought to my attention that I am dis- 
posed to accept Baudelocque's dictum, that, take it 
for all, the forceps has been more injurious than use- 
ful to society." 

Even if used, as probably it mostly is, really and 
only for the sake of relieving the mother from some 
hours more suffering, such relief is often dearly bought, 
and the attendant, if competent for his duty, has or 
should have, a power in anaesthesia not only to relieve 
the pain, quiet complaint, and sustain the patient, 
but one which will subdue any spasmodic or irregu- 
lar action, assist in perineal dilatation, and contribute 
to make delivery safer if not more speedy. 

Within a few years the writer has found it neces- 
sary at different times to leave two primiparse just 
before labor, in charge of different brother practition- 
ers. They had both been trained in the recent prac- 
tice, and considered themselves fully competent to 
use forceps. The women were healthy and well pro- 
portioned, and the writer feels assured could have 
been safely delivered naturally, after a somewhat te- 
dious first labor. Forceps were used in both cases. 
One had a severe double cervical laceration extend- 
ing to the vaginal junction, the other a perineal rent 
extending into the rectum, neither of which accidents, 
of sufficient importance to attract attention, ever oc- 
curred in the writer's obstetric practice of over forty 
years. 

In view of such facts, and with the knowledge that 
they are of daily occurrence, how can one who has 
delivered many hundreds of women with but sparing 
use of forceps, and results for mother and child which 
will compare well with those which any frequent for- 
ceps advocate can show, how can such an one avoid 
a protest against this fashion of the time, in the name 
and for the sake of the mothers, as well as for the ul- 
timate repute of a useful, but now much misused in- 
strument. 

ERGOT AND ANESTHESIA IN LABOR. 

The object in noticing this subject is to suggest a 
reason for the wide difference in opinion which exists 
with regard to its usefulness in obstetrics. The state- 
ment has been not infrequently made that ergot 
should never be used during actual labor, because it 
produces tetanus and permanent contractions, which 
are dangerous to both mother and child. The effects 
of any medicine vary exceedingly, in accordance 



i883.] 



ADDRESS OF DR. J. K. BARTLETT. 



105 



with the genuineness of the article, the dose given, 
and its mode and frequency of administration. 

In this country, fluid and semi-solid extracts have 
been thought reliable. The object to be attained by 
its use in the second stage of labor is merely a suffi- 
cient additional impetus to render feeble and ineffi- 
cient uterine contraction more regular and effective. 
The object when used, as it constantly is, to check 
post partum haemorrhage, or as a preventive to its oc- 
currence, is to secure full and permanent contraction. 
If the same doses are used for the former purpose as 
for the latter, is there any cause for wonder that ef- 
fects result such as have led Dr. Barnes to say: 
^' When you have given ergot, you are likely to be in 
the position of Frankenstein — you have evoked a 
power which you cannot control. Ergotism, like 
strychnism, will run its course." Would Dr. Barnes 
hesitate to use strychnine as a nerve tonic, from the 
fear that strychnism, as he terms it, would follow? 

The dose of ergot necessary for securing contrac- 
tion after delivery is not so important, provided 
enough is given. In providing it for the widely dif- 
ferent purpose of strengthening insufficient uterine 
contraction during the second stage of labor, there 
is evidence of a general ignorance or carelessness as 
to dose and repetition. Very little has come under 
the notice of the writer in which reference was made 
to properly small and repeated doses. Leishman ad- 
vises an infusion of sixty grains to six ounces of 
water, one-fourth to be given every ten or fifteen 
minutes until distinct increase of action is mani- 
fested. This is about twice the needed dose, and 
repeated much too often. 

Playfair says fifteen to twenty grains of the pow- 
dered ergot mixed with water, or the fluid extract in 
doses of twenty to thirty minims will make uterine 
contraction more efficient in fifteen minutes, and says 
nothing of repetition. He does, however, remark : 
'' Perhaps, as has been suggested, the administration 
of the fluid extract — five to ten minims every ten 
minutes until energetic action sets in — would remedy 
some of its risks." 

Dr. Lusk advises entire abstinence from its use, 
unless as a prophylactic against post partum haemor- 
rhage. One paper only has come to the notice of the 
writer in which smaller doses are advised from prac- 
tical experience. This is from Dr. W. H. DeCamp,^ 
who declares his conviction that ergot can be safely 
and beneficially given for the purpose named, pro- 
vided the dose is properly regulated. He states that 
ten to fifteen drops of the fluid extract will always 
€xcite uterine contraction, and that it must not be 
pushed too far, or tonic contractions may result. 

The writer administered this drug for many years, 
in cases not very frequently seen, where the second 
stage of labor was retarded by insufficient contrac- 
tion and no pelvic obstacle existed. He regards it 
as a valuable resource in such cases, and has never 
witnessed, in his own practice, the tetanic contrac- 
tions attributed to it since he learned how to employ 
it. For this purpose an infusion of the freshly and 
coarsely powdered kernels, two grammes (about thirty 
grains,) to eighty-five grammes of water, or about 

1 Western Medical Reporter, Ocloher, 1881. 



three ounces, has been the preparation used. Of 
this a tablespoonful given every thirty minutes until 
some effect was apparent. In some cases this was 
obvious after one dose, in some two or three were re- 
quired. In cases of nervous exhaustion on the part 
of the patient, a full dose of quinine was also given. 

It should be added that the writer, as a rule, makes 
use of anaesthetics in labor, save in some exceptional 
cases of feeble uterine action, and that where ergot 
was administered and the pains become efficient, the 
anaesthetic was also used. How much modification 
of the effects of the former were produced by the 
latter agent he cannot positively determine, but is 
sure that they act well together. 

Dr. Fordyce Barker, at the last American Gynaeco- 
logical Society session, after enumerating the condi- 
tions in which ergot was inapplicable, stated that 
there were cases where it could be used with great 
advantage. He usually gave an anaesthetic and then 
full doses of ergot, and the result had generally been 
that labor was speedily and successfully terminated. 

In this connection it might be mentioned that Mr. 
Fancourt Barnes claims that nitrate of amyl possesses 
properties antagonistic to ergot, and states that three 
minims of this drug, added to one drachm of ether, 
and taken by inhalation, will act as a sedative and 
anaesthetic without producing loss of consciousness, 
and will also subdue the trismic contractions pro- 
duced by full doses of ergot. 

There is no doubt that this drug has been abused, 
and what valuable agent in the materia medica has 
not ? That it has been given when entirely inappropri- 
ate, with only deleterious effects. There is no less 
doubt in the mind of the writer that the crusade 
against it has been due, not entirely to its improper 
use, but to the fact that the fashion of ergot use 
has given place to the fashion of forceps use, in 
hastening labor. Forceps, however useful, do not 
take the place of ergot. The child may be speed- 
ily removed by the former, but the ergot must be 
given after, to prevent the haemorrhage which in- 
sufficient uterine action is apt to induce. 

The contrariety of views in regard to the usefulness 
of anaesthesia for the relief of pain in labor, also ap- 
pears to the writer only explainable upon the supposi- 
tion that it has been improperly and injudiciously 
used by those who oppose it. This has been before 
the profession between thirty and forty years, and 
during this whole time, and to-day, many obstetri- 
cians of eminence constantly employ it as safe, ser- 
viceable and entirely beneficial, while others denounce 
it as inducing post partum haemorrhage, and various 
other evil effects, both upon mother and child. 

The writer has previously recorded the favorable 
results of his own experience in its use since 1847, ^^^ 
i can here only attempt briefly to show how such di- 
verse opinions may be, and probably are, the result 
I of faulty administration. 

Mr. Coates, in a recent article^ upon the true 

method of inducing surgical anaesthesia safely, by the 

'' use of small quantities, repeated as often as needed to 

i produce the desired effect, uses an illustration which 

\ is even more applicable to its obstetric use. He says, 

' 1 London Lancet, January 27, 1883. 



io6 



ADDRESS OF DR. J. K. BARTLETT, 



[August, 



"the educated practitioner, who has made up his 
mind to give one grain of opium every hour, or twenty 
grains of chloral every four hours, for twenty-four 
hours, would hardly think it the same thing to give 
the twelve or sixty grains at once. There are three 
stages of anaesthetic effects which may be produced : 
First — the lessening or annulling of sensibility to 
pain ; second — by increased dose, the abolition of in- 
telligence ; third — the abolition of mobility. The 
method and object of anaesthesia in surgery and labor 
differs very widely. In the former it is generally car- 
ried to the second if not to the third stage of effect 
before the pain is inflicted. For the latter it is rarely 
necessary to produce much more than its first effect, and 
this is produced -'pari passu" with the pain. A lit- 
tle experience will soon teach the physician how to 
arrest its effect at this stage, or at least before the sec- 
ond is fully attained, and to vary the amount as may 
be required by different degrees of pain. 

Care in administration as to the quantity employed 
and the length of time, and regularity, of inhalation, 
is the whole secret of successful use. As a rule it 
should not be regularly given until the beginning of 
the second stage of labor, although where progress at 
an earlier period seems delayed by the rigidity of the 
OS, the inhalation of ether in small quantity will 
quiet irregular contractions, and effect a more rapid 
cervical expansion. After the second stage of labor 
is reached, inhalation should be allowed only with 
each pain, commencing when uterine contraction is 
first felt to be returning, by a finger in the vagina, 
or'by the sensations of the patient, with full inspira- 
tions for a minute or two, until uterine contraction 
has reached its climax. The inhaler is then at once 
to be removed, and not again used until the pain 
again recurs. When little experienced in its use, the 
writer sometimes allowed inhalation to relieve feelings 
of discomfort or alleged pain during the intervals of 
uterine contraction. This resulted in irregularity of 
recurrence, and disturbance. He can clearly see 
that where the rule of administration just given is 
not mainly adhered to, disappointment as to general 
results might ensue. Not only should the time of 
administration exactly correspond with that of the 
commencing and augmenting pain, but as the labor 
progresses, and pain increases in severity, the dose 
should correspond. 

There is no proof which the writer has ever seen, 
that used in such a manner, anaesthesia produces, or 
tends to produce, post partum haemorrhages. 

Dr. Barker spoke very positively upon this subject^ 
when he said, last fall, that he had used chloroform 
in several thousand cases, and had not had post par- 
tum haemorrhage but in one instance. He always, 
however, gives ergot after placental expulsion, to pro- 
mote uterine involution. 

It has been said to narcotize the child and lessen 
the favorable convalescence of the mother. The 
writer has seen no evidence that this" is true. Where 
it has been used most fully and freely, the children 
have cried vigorously immediately after birth, and as 
to the mothers, the conviction was strongly forced 
upon him that convalescence was more rapid and per- 

1 Trans. Am. Gy. Soc'y, 1882. 



feet under its use, when compared with the previous 
results of six years without it. We all know how 
pain exhausts nervous power ; this is avoided. 

In conclusion, if anaesthesia ever produces post 
partum haemorrhage, injury to child, or other than 
beneficial results, experience tells us that it must be 
due to the impurity of the anaesthetic employed, or 
to the want of that experience and discretion in its 
use, which is necessary not only here, but in all 
therapeutic measures which we employ for the relief 
of human suffering. 

ANTISEPTICS IN PRIVATE OBSTETRIC PRACTICE. 

A few words of inquiry as to the extent and neces- 
sity of aseptic precaution in ordinary labor in pri- 
vate practice. A little more than a year since Dr. 
Robert Barnes published^ a paper upon the subject 
containing many valuable suggestions. He divides 
toxaemia into endosepsis, autosepsis, and exosepsis, 
and counsels measures for the avoidance of each. 
With auto-infection, at present, we shall mostly deal . 
For the avoidance of this he gives directions for rou- 
tine aseptic minutiae, iiicluding washing out the uterus 
once or twice daily, with plain or carbolized water — 
the attendant bathing the hand in carbolic acid solu- 
tions, all chamber utensils being rinsed with the same,, 
and a little left in them. 

None of those prophylactic measures seem to the 
writer necessary in cases of uncomplicated labor, 
and some of them absolutely dangerous. Intra-uter- 
ine injections are especially so regarded, and even 
those of carbolic acid solutions into the vagina have 
not always been harmless. Dr. Minot, of Boston, a 
few months ago, wrote% that '* he had been in the 
habit of using carbolized vaginal injections after 
labor, but since alarming symptoms had followed in 
two cases, he now only makes use of them when the 
lochial discharge becomes offensive." At a meeting 
of the New York Academy of Medicine, last March, 
a case was related, in which, after a week's use of 
uterine injections, a chill, followed by a decided rise 
in temperature, occurred, and Dr. Barker stated that, 
although he had occasion frequently to resort to this 
measure, it must be used with care and not too long, 
even in conditions which required it. He remarked 
that the uterine sinuses closed ordinarily within three 
or four days after labor, and he had seen cases where 
he felt convinced that the use of this means, by the 
Chamberlain tube, had reopened some of the blocked 
up sinues, and absorption of septic material had fol- 
lowed. In normal cases, outside of hospital ser- 
vice, the writer must think it bad and meddlesome prac- 
tice to use not only carbolic solutions for vaginal and 
uterine injections, but any vaginal douche, on account 
of its tendency to remove from the bruised and ex- 
coriated surfaces an exudation which nature provides 
for their protection ; besides, such measures as used 
by ordinary nurses may, through carelessness or ig- 
norance, be made to supply increased facilities for 
septic contact and absorption. But whatever maybe 
the necessity for such measures, or others, in hospi- 
tals, when the atmosphere is loaded with poisonous- 
emanations, and however necessary strict cleanliness. 

1 A^nerican Journal Obstetrics, January 1882. 

- Boston Medical and Surgical Journal , November 23, 1882. 



1883.] 



ADDRESS OF DR. J. K. BARTLETT. 



107 



on the part of the attendant at all times and in all 
places, an experience of upwards of forty years con- 
vinces the writer that either these minute aseptic us- 
ages are unneccessary, or, that a great and sudden 
change has taken place in our external conditions, or 
in the female organization ; for, during the attend- 
ance of many hundreds of obstetric cases, not unfre- 
quently severe and protracted, in which there was 
very little interference with nature's powers, and no 
aseptic precautions observed, except cleanliness as far 
as possible, very few cases of child-bed fever devel- 
oped, none of any gravity, and among his own pa- 
tients he never saw one fatal. There is no question 
as to the utility of vaginal irrigation, carefully per- 
formed, in cases of foetid lochia, when associated with 
rise of pulse and temperature. We have, in this case, 
absorption of the products of decomposition. It has 
been stated that the poisonous principle of septic 
fluids has been isolated in the form of two alkaloids. 
Dr. Simpson, of Aberdeen, considers this proved. 
This is, however, not material to our purpose; the 
poison is there, and in the present state of our knowl- 
edge, we have no proof that we can chemically de- 
stroy it in the human organism, by any agent which 
can be safely used. We can remove it, not by a 
syringe, but by thorough irrigation from a reservoir 
which affords a constant stream of water at 96°, until 
the fluid shows itself clear as it flows out. The material 
used is of little importance, provided it be harmless. 
Its value does not depend upon the addition of a 
germicide of sufficient strength to destroy bacteria, 
for its purpose is simply to wash away the decompos- 
ing detritus of blood and tissue. Lesions of the 
vaginal tract or uterine neck are more liable to ab- 
sorb poisonous material than the uterine cavity itself, 
and hence vaginal irrigation, only, will often prove 
sufficient. As an illustration of this, the writer will 
append a condensed statement of a case furnished by 
Dr. N. Senn, of Milwaukee. Patient a primipara of 
twenty-eight years ; labor tedious, and completed by 
forceps in the hands of a skillfull accoucheur ; child 
born healthy ; considerable haemorrhage after placen- 
tal delivery; Dr. S. saw the patient four days after, 
in consultation ; she had had a chill two days before, 
and slight chills afterward, with high temperature 
and profuse sweating ; when he saw her the pulse was 
120, temperature 102^° F. ; the labia, vaginal wall, 
and cervix, on the right side, were found deeply lac- 
erated, and the wound filled with coagulated blood, 
the vaginal discharge very offensive, and the right 
para metrium exceedingly tender ; anti-pyretic doses 
of quinine had failed to control the temperature ; 
constant irrigation was advised, and performed by 
means of a rubber tube attached to a fountain syringe, 
and inserted into the vagina, so that the upper ex- 
tremity reached the highest point of th." wounded 
surface ; the reservoir was suspended above the pa- 
tient's bed, and the rubber tubing secured in place 
by strips of adhesive plasters ; a solution of 5 parts 
of salicylic acid, 100 of rectified spirits of wine, and 
895 of pure water, kept at the temperature of the 
body, was allowed to slowly flow through, making its 
exit into a bedpan, which was changed when neces- 
sary. About two gallons were used daily. The 



' temperature fell the first day to 100° F.; the irriga- 
tion was continued four days ; the wound assumed a 
healthy appearance, and the patient rapidly recov- 
ered without an untoward symptom. 

At the meeting of the New York Academy of Med- 
icine, April 26, D. R. Tauszky read a paper^ upon 
treatment after parturition, in which he advised, for 
the relief of offensive lochia, accompanied by fever, 
syringing the vagina several times a day with a disin- 
fectant solution, and thought uterine injections un- 
necessary, save in^ cases of internal violence, such as 
attend manual separation of the placenta or use of the 
forceps. When they are deemed necessary, prefers 
thjTnolized or simple water to carbolized water. 

In a discussion in the New York Academy of Med- 
icine, April 26, the opinion seemed quite general that 
septicaemia in the majority of cases originated in 
wounds of the vagina and cervix. Dr. Chamberlain 
remarked that a breach of surface anywhere in the 
genital canal might be causative; but "he did not 
deem the existence of septicaemia an indication for 
washing out the uterus, unless the cause could be lo- 
cated within that organ, though it might be an indi- 
cation for washing out the vagina. ' ' Doubtless the 
retention of decomposing material within the uterus 
is, at times, the cause of septicaemia, and if the vagi- 
nal irrigations do not speedily reduce the tempera- 
ture, intra-uterine irrigation may be needed. For 
this purpose, however, the writer believes that a very 
weak antiseptic solution, or even water alone, is all 
that is needed. The results recorded by Dr. E. Her- 
vieux,- of Paris, thirteen years ago, in cases of hos- 
pital puerperal fever, seem to confirm this view. 

While writing, an article by Dr. T. G. Thomas,^ 
lately published, has attracted attention from its bear- 
ing upon this subject. Two severe cases of puerperal 
septicaemia are detailed, in which uterine injections 
of carbolic acid were employed ; but this part of the 
treatment not commenced until there had been time 
for a full development of the autogenetic poisoning. 
Two days were lost after the first manifestation of 
the disease in the first case, and five or six in the 
second, before Dr Thomas saw them and commenced 
this treatment. The second case died twenty-four 
hours after. The first, a primipara, had a short and 
uncomplicated labor. The nurse was directed to 
syringe out the vagina carefully, the next day, with 
carbolized water, which was done. About thirty-six 
hours after labor the temperature was 101°, twelve 
hours after this 102. °5, the succeeding morning 103°, 
no chill having occurred, but some pain in the right 
iliac fossa ; the same evening the temperature was 
io6.°5, the pulse 145. This was the condition when 
Dr Thomas saw her. He found a bilateral cervical 
laceration reaching to the vaginal juncture, and 
directed washing out the uterus, with carbolized 
water. This was carried out by two physicians, who 
remained with her during the night, every four 
hours, by means of a Davidson's syringe and Cham- 
; berlain tube. The next morning the pulse had fallen 
[ to 120, and the temperature to 101°. She felt much 



1 Medical Record, May 26, 1883. 

* Traite Clinique et Pratique des Maladies Puerpirales , Paris, iS/o. 

3 Neiv York Medical Journal , March 31, 1883. 



io8 



ADDRESS OF DR. J. K. BARTLETT. 



[August, 



better, but had taken opium freely all night. The uterus 
was now washed out at longer intervals, but the tem- 
perature again rose, and again the injections were 
resumed every three hours. Opium was also freely 
administered, ten grains of quinine given every eight 
hours, and rubber tubing, through which a current 
of ice water ran, was also placed over the abdomen. 
The injections were continued two days, and then 
stopped ; the temperature again rose, and they were 
resumed. On the thirteenth day after this treatment 
was commenced the intervals between the injections 
were made longer, and they were gradually discon- 
tinued. Is there any evidence here to show what 
influence the carbolic acid had in the result ? We 
see that very active medication of another character 
was resorted to, and we are not informed of the 
strength of the injections, or whether the quantity 
of fluid was sufficient to thoroughly cleanse the uterine 
cavity, so that the fluid ran out clear at the close of 
the procedure. A syringe was used, not steady irri- 
gation, and it appears doubtful whether this result was 
fully attained. The temperature and pulse improved 
after each injection, and we might suppose that the 
carbolic acid aided to produce this effect, had it not 
been observed again and again, as a result of simple 
cleansing, when no acid was used. It appears to the 
writer that the poison which had already been 
absorbed before the injections were begun, continued 
to produce its effects in the organism, more or less 
influenced by the powerful medication employed ; 
possibly increased, or renewed by the frequency of 
the injections; certainly only modified, as far as 
their influence was concerned, by the imperfect 
washing away of the uterine contents. It is very 
probable that in this case the seat of absorption was 
the lacerated cervix, and that constant irrigation of 
this region, earlier begun, would have produced 
speedier and more decided results. 

Dr. Thomas' conclusion from this case is, that 
puerperal fever should be treated upon as simple a plan 
as septicaemia of any other kind, viz.: by washing 
out with some antiseptic fluid the surface where the 
disease originated. In his language: "With some 
fluid which will remove the poisonous material which 
is being absorbed, and also, as far as possible neu- 
tralize its poisonous qualities. ' ' The last part of this 
sentence intimates a doubt as to the possibility. Is 
there any evidence that an antiseptic agent can be 
safely used of such strength as to destroy, or neu- 
tralize, a formed poison in the tissues or cavities in 
the body? We know that they can be so used as to 
prevent the formation of such poisons, but it is nec- 
essary that this influence should be constantly pres- 
ent and in action, and not pass away with the mor- 
bid products which are removed by injections or irri- 
gations. In the latter case the writer can see no 
cause for the relief except in the removal of the 
poisonous material. 

The case is quite different with the treatment advo- 
cated by Dr. AUoway, of Canada,^ who reports, re- 
cently, three cases of puerperal septicaemia which he 
treated by first washing out the uterine cavity with 

J Canada Medical Review, March 17, 1883. 



plain or carbolized water, and then, by means of a 
Sims' speculum and a tent insertor, passing a sup- 
pository of iodoform of ten, fifteen or twenty grains 
to the fundus uteri and leaving it there. He usually 
employed this procedure night and morning, and 
had observed no poisonous or unpleasant results. 

By the use of this agent in this manner, a constant 
antiseptic influence is generated which should prevent 
the development of poisons, if it can be used safely 
in sufficient quantity. 

Similar in operation, and less liable to objection, is 
the effect of the oil of eucalyptus globulus, so much 
lauded by Dr. Sloan^ as a preventative of septicaemia, 
when it is to be feared, on account of lesions in the 
parturient canal from forceps or any other source. 
He employs it in the form of suppositories, consisting 
of oil of eucalyptus two parts, white wax one part, 
ol. theobroma two parts. Each suppository contains 
about twenty minims of the oil. He states that it is 
neither poisonous or irritating in this quantity, does 
not coagulate the lochia, its odor is agreeable, and it 
appears to aid in uterine contraction. Mr. Lister 
has also stated that this germicide was entirely devoid 
of any deleterious effects. 

The conclusions which the writer thinks can be 
legitimately drawn from what has been presented, 
are, that the danger of auto-genetic poisoning after 
ordinary labor in private practice is not such as to de- 
mand the routine precautionary minutiae which Dr. 
Barnes has suggested ; that very many cases in which 
the lochia are offensive, are attended with, and fol- 
lowed by, no disturbance; and that cleanliness as 
thorough as can be attained, and care as to the gen- 
eral condition of the patient, are only usually nec- 
essary. That even in cases where rise of pulse and 
temperature occur, vaginal irrigation is frequently 
sufficient. That in cases where relief has tollowed 
the use of carbolized injections, vaginal or intra- 
uterine, the advantageous results do not so much de- 
pend upon antiseptic virtues as upon the cleansing 
effects by even a simple fluid, used in such manner 
and quantity as to secure entire removal of any de- 
composing matters retained in the uterine or vaginal 
cavity. 

That when there is reason to apprehend absorption 
of morbid material by existing vaginal or cervical 
lesions, the suppositories of ol. eucalyptus are much 
preferable to carbolic acid syringing, though they 
may be advantageously preceded by vaginal irriga- 
tion. That if these means should not avert a rise 
of pulse and temperature, continued irrigation of ,^ 
the parts affected, by a weak solution of Condy's 
fluid, salicylic acid, or some similar agent, should be 
employed. If these do not soon lower the tempera- 
ture, or if the seat of absorption appears to be 
located in the uterus, intra-uterine irrigation of the 
same character may be adopted, to the extent of 
washing away all decomposing material. When anti- 
septic intra-uterine action is clearly indicated, the in- 
troduction of iodoform suppositories will accomplish 
everything additional that can be done locally, in 
the present state of our knowledge of the subject. 



1 Med, and Surreal Reporter, March 17, 1883. 



1883.] 



ADDRESS OF DR. J. K. BARTLETT. 



109 



is a maternal mortality of 2.7 j)er cent., 
is much less than any previously published 
for 



PLACENTIA PREVIA. 

The rep)ort of M. HofTmeier, of Berlin,^ upon this 
subject, deserves notice from its unusually favorable 
maternal results. He cites forty-six cases, thirty-five 
of which occurred in one year. Three of these were 
so near death from haemorrhage when first seen that 
there was no opportunity for treatment. Of the re- 
maining forty-three, six were treated by the waiting 
method and the tampon ; in the other thirty-seven 
no tampon was used. Of the six treated at an earlier 
date by tampon, one died, two had a long and severe 
illness, and four of the children were dead. Of the 
thirty-seven others treated differently, one mother 
only died, and she had been treated by the tampon 
for twenty-four hours, and the placenta was offensive 
when delivered. 

This 
which 

rate. The results for the children, even with no 
hurried delivery, were : Seventeen already dead, 
three died from perforation of the placenta, and 
three were premature — giving 37 per cent, of the 
whole living, which reaches the usual standard. The 
placenta was located centrally in nineteen, laterally 
in sixteen, marginally in eight. 

In central insertions he favors perforation of the 
placenta and bringing the feet through. This was 
done in five cases, in three of which it was necess?.ry 
on account of the urgency of the symptoms, and two 
in which the child was already dead. His practice 
is to wait until some symptoms of labor are present, 
in the shape of uterine contraction or a funnel-shaped 
dilatation of the cervix, then as early and actively as 
possible proceed to deliver. The earlier this is done 
the more easily version, by the combined external 
and vaginal method, (one or two fingers in the os,) 
can be effected. This version was practiced when- 
ever possible, and the hand introduced into the 
uterus only when absolutely necessary ; the feet hav- 
ing been guided to the os and there seized, firm trac- 
tion made, and the haemorrhage effectually stopped 
by the buttocks. This was done in thirty cases. In 
six — three of which were breech presentations — in- 
ternal version was used, and in one, a head presenta- 
tion, forceps applied. After bringing the breech 
into the uterine opening, the rest of the delivery 
should be slowly accomplished. The condition of 
the child may modify this rule, but must not increase 
the mother's risk. He says: '•One must have the 
courage to let a doubtful child's life be lost in his 
hands, rather than subject the mother to an increase 
of danger." 

He states that haemorrhage occurred after delivery 
in some cases, although ergotine was given, subcutan- 
eously, during extraction. This was easily controlled 
by ergotin and iced or hot water injections. 

Such maternal results are certainly worthy of atten- 
tion, for Mueller estimates the total mortality in such 
cases at not less than thirty-five to forty per cent. , and 
Lusk states that as many as one in four die during or 
shortly after delivery. 

Dr. E. L. Partridge, of New York, has recently 



1 American Journal 0/ Obitetrics , Supplement, November, i£ 



reported^ four cases of this affection, in three of which 
labor was induced, at full time, by the use of Barnes' 
dilators, in the other labor occurred spontaneously. 
Internal version was practised in three of the cases, 
the fourth, a head presentation, was delivered by the 
forceps, the child being probably premature, was still 
born. All the mothers recovered, and two of the 
children were saved. The relator objects to tampons, 
and deems the rubber bags safer and more efficient. 
He states that the cervix is usually soft and easily 
dilatable, but uterine action does not follow to the 
same extent as after the dilatation of a healthy cer- 
vix ; the contractions are generally insufficient to 
drive the head firmly down, if it presents, and the 
use of the forceps is difficult, from the necessity of 
avoiding the placenta, and often from the length and 
thickness of the cervix ; hence, almost without ex- 
ception, turning is preferable As associated with the 
treatment of this condition, a new method of plug- 
ging the vagina may be here mentioned, which Dr. 
Chassagny, of Lyons, recently described to the Paris 
Academy of Medicine.^ He states, that he had made 
use of it in two cases of abnormal insertion of the 
placenta, with the effect of inducing premature labor 
without haeniof rhage. The apparatus consists of a blad- 
der to which a rubber tube is firmly attached. The emp- 
ty bladder is introduced into the vagina, and a syphon 
is then connected with the tube, which allows a flow 
of water into the bladder from a vessel placed about 
two and a half feet higher than the pelvis of the pa- 
tient. To prevent the expulsion of the bladder a 
cylindrical speculum is introduced after it is in place, 
which is forced out as the water enters. The act of 
distension separates valves attached to the sides of the 
speculum, which by resting upon the internal surface 
of the vaginal opening, occlude the outlet and pre- 
vent expulsion. The pressure of the full bladder 
causes abundant secretion, and soon induces rapid 
dilatation of the os and energetic uterine action. It 
is also stated that, in cases of post partum haemor- 
rhage, when this apparatus is introduced into the 
uterus and distended, it closes the uterine sinuses 
and determines uterine contraction, which occurring, 
the water is allowed to flow out slowly, until the or- 
gan is fully contracted. 

Part II. 

DVSMEXORRHOEA. 

A few remarks concerning a painful female afTec- 
tion, which we are all, and often, called upon to re- 
lieve. Our object is not to enter upon a full discus- 
cussion of the etiology of dysmenorrhoea, but to ques- 
tion the causative influences of some conditions sup- 
posed to produce it, to suggest the close alliance of 
many of its ultimate determining causes, and allude 
to some methods of local treatment. 

Anteversions and flexions have not only been 
shown by Fritsch, of Breslau ; Vedeler, of Christiana ; 
Herman, of London, and others, to be generally nor- 
mal conditions; but both these and stenoses, once 
deemed principal factors in the production of this af- 
fection, are proved to rarely exist to such a degree as 

' Ne-w York Medical Journal , December 1882. 
- British Medical Journal , March 3, 18S3. 



no 



ADDRESS OF DR. J. K. BARTLETT. 



[August, 



to prevent free egress of the menstrual fluid. They 
are not present in many instances of painful menstru- 
ation, and where either, or both, do exist, they are 
not necessarily attended by it. We may fairly as- 
sume that, although at times factors in the production 
of dysmenorrhoea, they are so only quite exceptionally, 
and, as Dr. Macan remarks, "we must look elsewhere 
for the cause. ' ' Perhaps we may gain a clearer idea 
of the usual nature of this affection, not only by review- 
ing some of the morbid conditions and states which 
have been assigned as causes, but by also noting the 
treatment which has proved effective, and deducing 
thence the character of the abnormal conditions which 
such measures would be reasonably supposed to re- 
lieve. 

Mr. Clement Godson,^ of London, in some re- 
marks, about two years since, upon what is called 
spasmodic, or obstructive dysmenorrhoea (though 
he doubted the obstruction, and prefers the for- 
mer term), says: "It seems tolerably certain that 
the most sensitive part is the so-called internal 
OS, that portion of the uterine cavitywhich merges 
into the cervical canal. I cannot explainthe path- 
ological cause why this part is so hyperaesthetic. 
I know, however, that the morbid sensibility can be 
overcome by the passage of metallic bougies." This 
treatment, in his hands, used about midway between 
the menstrual periods, was quite successful ; though 
in some cases the difficulty returned, and he was 
obliged to resort to the introduction of intra-uterine 
silver stems, which proved curative. 

This same method, the introduction of metallic 
bougies, was also employed quite successfully by Dr. 
Mackintosh, of Edinburgh, as early as 1836. His 
theory was that ot obstruction, although he remarks, 
" I believe it may sometimes depend upon inflamma- 
tion of the lining membrane of the uterus, as well as 
inflammation in the substance of the cervix, and on 
the encroachment of tumors diminishing the calibre 
of the outlet." 

Dr. Godson, after advancing valid reasons for not 
believing obstruction the cause of the difficulty, and 
yet regarding it as curable by dilatation, asks the 
pertinent question, " How does the dilatation re- 
lieve the dysmenorrhoea?" In reply, he remarks, 
I have already suggested that the pain seems due to 
spasm, which, at the approach of the menstrual flux, 
seizes upon the uterus, the endometrium of which 
is in a state of hypergesthesia. The contact of a for- 
eign body like a bougie or dilator seems to increase 
the morbid sensibility at first, but as the structures be- 
come accustomed to its presence, the spasm subsides. 
The impression left upon the endometrium, after the 
withdrawal of the bougies, is such as to render it less 
sensitive and liable to spasm. How is this ex- 
plained ? This he does not attempt, and it would 
be difficult upon the assumption that hypergesthesia 
alone was the condition of the cervical mucosa. The 
beneficial action of the bougies would, in this case, 
.always be transitory. But assuming hypergemia to 
exist, and to cause, or at least aggravate the hyperges- 
thesia, an attempt at explanation can be offered. The 
pressure produced by bougies, tents, intra-uterine 

1 Transactions of London Obstetrical Society, 1881. 



Stems, dilators, etc. , would not only lessen the hyper- 
gesthesia, but effect, by frequent or prolonged press- 
ure, a change in the hypergemic condition, by produc- 
ing absorption, or other nutritive modification of the 
tissues, and thus restore the lining membrane to a 
normal condition. This idea is in harmony with the 
results secured by such remedial agents. Dr. Munde 
says that for temporary relief he employs EUinger's 
dilator; but for permanent cure, tupelo tents. The 
latter, by their prolonged pressure and contact, na- 
turally produce more effective modification in the 
tissues. 

What is the nature of the pain in dysmenorrhoea? 
The spasm induced by the disordered condition of 
the lining membrane, which was accepted by Dr. 
Godson, might have led him to the conclusion arrived 
at by Dr. C. D. Palmer, of Cincinnati^, who regards 
dysmenorrhoea as essentially a neurosis. The writer fully 
accords with this opinion, and, if he understands Dr. 
P.'s remarks correctly, also with the view that in some 
cases this neurosis is a result of general health disturb- 
ance, of neurasthenia, angemia, want of developement, 
etc. These often find relief from change of climate 
and surroundings, or other agencies which improve 
the general condition; but in other, and perhaps the 
majority of cases, the neurosis is the consequence of 
the abnormal condition of the endometrium, the 
mucous membrane of which is turgid, or hypergemic, 
and " its sentient nerves in a state of hypergesthesia," 
as a result. Even in cases where shreds are dis- 
charged the pain is still neurotic, though the false 
membrane acts obstructively in producing it. The 
most plausible explanation of the origin of this latter 
form, is that of Dr. Reamy — that the membrane is 
not a product of inflammation, but a normal one, 
that is usually removed by undergoing gradual change 
through fatty degeneration, and then forms the debris 
of the menstrual discharge. This solution and disin- 
tegration of the membrane is prevented by lessened 
vital activity, and consequent failure of the normal 
nutritive ehanges. This is also the view of Williams 
and Aveling. 

Professor Heinrich Fritsch, of Breslau, in a recen 
article'^ upon dilatation of the os uteri, etc., ascribes 
dysmenorrhoea, in the large majority of young 
women, to a dilatation and hyper-secretion of the 
muciparous glands. To facilitate the passage of this 
over-secretion he dilates the external os, or makes 
small crucial incisions, snipping off" the little lobes 
thus formed, and then employs free irrigation of the 
uterine cavity with weak disinfecting solutions for 
one or two weeks, for the purpose of reducing the 
over-action ; he also dilates the internal os if not al- 
ready patent. He speaks of other cases occurring in 
parous women as well as in virgins, and, although he 
considers most cases of this affection as of compli- 
cated origin, states that he has both temporarily and 
permanently effected cures by a single, and by re- 
peated, use of his dilators. 

The local agents which have been mentioned, 
whether mechanical or medicinal, appear to have 
produced their beneficial effect by acting upon the 

1 Cincinnati Lancet and Clinic, April 8, 1882 

"^ American Journal of Obstetrics, February, 1883. 



1883-] 



ADDRESS OF DR. J. K. BARTLETT. 



Ill 



cervical and uterine mucosa. When the bougies or 
stems fill the cervical canal they cause a determina- 
tion of blood to the part ; so much is this, at times, 
the case, that in the use of the stem pessary it has 
been asserted that some bleeding, or even a free dis- 
charge, is an indication that the application will be 
effective. To this same alterative effect must be as- 
cribed the relief obtained from local excitant or 
mildly caustic applications to the uterine mucosa. 
Dr. Fordyce Barker stated, a few years ago, that he 
had cured cases of membranous dysmenorrhoea by 
dilating the os and modifying the condition of the 
uterine lining membrane by the introduction of pen- 
cils of iodoform. 

There is another agent, which, from the experi- 
ence recently published of its results, as well as from 
its success in the hands of the writer, appears better 
adapted to produce the nutritive changes in the en- 
dometrium necessary for the cure of this affection 
than any generally employed. 

Dr. I. D. Mann says, upon this subject,^ " The 
old-fashioned term, neuralgic dysmenorrhoea, still 
expresses all that is known of the causation of many 
cases. There is also often an irritable condition of 
the mucous membrane of the uterine cavity, which, 
under certain .circumstances, evokes painful uterine 
contractions. In such cases electricity affords great 
relief, probably by modifying nutrition, and from 
the direct action of the current upon the terminal 
nerves. The anode is carried' into the os, and the 
cathode applied over the ovarian regions. If ovarian 
neuralgia exist it can be relieved by placing the 
anode over the ovary and the cathode over the lum- 
bar spine. It is inadmissable in ovaritis proper, but 
tenderness, with slight enlargement and absence of 
systematic disturbance, is probably due to passive 
hyperemia, and is often quickly relieved by the 
same means. The relief in simple ovarian irritation 
is speedy and very decided." 

Dr. J. S. Rockwell'- speaks very decidedly of the 
beneficial effect of galvanism in what he terms spas- 
modic dysmenorrhoea, and, in cases where great ten- 
derness of the OS uteri and the neighboring vaginal 
walls existed, he ascribes the satisfactory results to 
the influence of this agent in relieving spasmodic 
muscular contractions of the os. The results are 
undoubted, but the writer thinks the action of this 
agent far more comprehensive. It brings relief, not 
only by removing the spasmodic action, but, which 
is of much more importance, by also modifying the 
disordered conditions which underlie the neurotic 
disturbance. This is probably effected by what 
Remak calls the catalytic action of the current. 

Over thirty years ago the writer treated dysmen- 
orrhoea upon the stenosis principle, with fair success 
by dilatation ; farther experience convinced him that 
it was not the narrowness of the passage which lay at 
the foundation of the difficulty, and experimenting 
first with faradism and later with galvanism, he ascer- 
tained that even better results could be attained with- 
out any pressure upon the mucosa of the uterine neck. 
No record has been preserved of the cases thus treat- 

1 London Lancet , \\3\y 23, 1881. 

- Lectures upon Medical Electricity, 1881 . 



ed, they weremany, extending over a period of at least 
thirty years. Faradism, with a moderate current 
was found efficient, but preference in most cases was 
given to galvanism ; the covered anode is placed 
usually over the region of the lumbar vertebrae, at 
times over the pubis or ovaries, while the cathode, 
connected with an insulated sound is applied to, or 
carried into the uterine os ; the current should not be 
strong, from 8 to lo cells of a Bartlett or Fleming 
battery, never sufficient to produce pain or anoyance, 
and occasionally reversed. The sittings, from twenty 
to thirty minutes, should be repeated at intervals of 
three to five days between the menstrual periods, until a 
week before the expected return, then daily for four or 
five days. After a few applications, the next mens- 
tniation will sometimes be attended with less pain, 
and if continued regularly, the second nearly or quite 
painless ; usually, however, a longer use is required, 
and in cases of long standing the treatment must be 
quite protracted. Positive proof is wanting that 
membranous dysmenorrhoea has been cured by this 
method, in the hands of the writer, but he feels quite 
assured, from the description of the discharge, that 
this was effected in some instances. 

The deductions which the writer thinks may be 
made, are, that dysmenorrhoea is a neurosis, some- 
times resulting from derangement, of the general 
health, and especially that of the nervous system, but 
more often due to morbid conditions of the lining 
tissues of the cervix and uterine cavity, which differ 
rather in degree and extent, than in character or lo- 
cation (always excepting those caused by virulent in- 
fection) and which vary from simple hypersecretion 
of the muciparous glands, to hyperasmia and hyper- 
nutrition of the endometrium and escu of the uterine 
tissues. 

In the former cases medical and hygienic measures 
are most essential ; in the latter, the morbid condit- 
ions are relieved in the earlier stages by mechanical 
agents, the pressure from which produces a change 
in the nutrition of the affected parts, and in this stage 
as well as in some more advanced, by local applica- 
tions which act upon the same principle and produce 
a like result. That faradism and galvanism not only 
relieve spasmodic action, but the latter especially is 
curative by the power it .possesses, when properly and 
perseveringly employed, to effect such favorable 
changes not only in the uterine mucosa, but in the 
submucous tissues, and even in the parenchyma of 
the uterus itself, as render it a most efficient means 
of cure in this affection. 

THE APPLICATION OF ELECTRICITY TO GVX.ECOLOGY. 

Although the effects of electricity in some of its 
forms have been already mentioned, as a method of 
treatment in pelvic affections, and its manner of use 
partially described, the recent indications of a better 
recognition of its value, and of an increased disposi- 
tion to investigation of its various powers, will per- 
haps warrant a few more remarks. 

We fully agree with Professor Erb,^ when he urges 

" the more extensive utilization of a curafive agent 

which has gained for itself a permanent position, and 

j the effect of which, for manysidedness, energy, and 

' 1 Handbuch der Elektrotherapic , Leipzig, 1882. 



ADDRESS OF DR. J. K. BARTLETT. 



[August, 



reliability, are not surpassed by any remedies with 
which we are acquainted." 

In regard to the explanation of its action, we have, 
at present, little more than hypothesis. After discuss- 
ing different theories. Prof. Erb concludes that our 
main task should now be to discover the therapeuti- 
cal resources of this agent in a somewhat empirical 
manner, as our knowledge of the precise method in 
which the unquestionable therapeutic results are at- 
tained is still .defective ; and it is premature to limit 
its use, or always endeavor to make it accord with 
physiological premises, while we know next to noth- 
ing of the molecular disturbances of nutrition. 

Professor Dujardin Beaumitz, of Paris, ^ in a lecture 
recently given, after speaking of the action of gal- 
vanism upon the nervous and circulating systems, 
touches upon the important physiological effects which 
we may expect to obtain from it in pelvic affections, 
when he writes : " Under the influence of continued 
currents, nutrition is seen to improve, and the vitality 
of tissues is restored with new energy. Although we 
have no absolutely scientific explanation of this effect 
upon nutrition, it results probably from a double ac- 
tion. First — that directly exerted upon the trophic 
nerves ; second the action upon the tissue molecules 
of the organisms whose vital energy is increased. ' ' 
Remak has called this a catalytic action, to distin- 
guish it from the electrolytic, which is destructive, by 
producing solution of the tissues, while the former 
promotes circulation and absorption by dilating the 
walls of the blood-vessels. 

The rules for selection of the different forms of 
this agent for producing the best effects in varied con- 
ditions, are not fully settled. The directions of 
Prof. Beaumitz are brief and practical, and are based 
upon experience: " When we desire to modify cu- 
taneous sensibility and nutrition in general, we make 
use of static electricity ; when we seek to limit the 
action to a group of muscles, or to restore contractil- 
ity to certain muscles, we use Far&dism ; when we 
wish to modify the molecular action of certain nerves, 
or give new activity to certain tissues, we employ the 
galvanic current." 

A fact is recently stated to have been determined 
by careful experiments made by Professor Ziemssen,^ 
viz : that the induced current has no influence what- 
ever upon the frequency of force of the cardiac con- 
tractions, while the continued current most distinctly 
affects them. This is of practical importance, es- 
pecially in case of threatening death from chloroform. 

The rules just quoted are, of course, general, and 
only experience can teach, in our present state of 
knowledge, which particular form is best applicable 
to each case. The writer's deduction, from his own 
use, would be, that galvanism is more generally indi- 
cated for gynaecological use, although Faradism is 
efficient in some conditions. Static electricity, made 
recently more available by improvements in thfe in- 
strument, does not promise to be as directly useful to 
the gynaecologist, except as an adjunct to general 
tonic treatment. It has been used, however, efficient- 
ly in amenorrhoea by Golding Bird and others many 

1 Boston Med. and Surg . Journal , April 12, 1883. 

2 Nen< York Medical^ Record, January 6, 1883, page 16. 



years since. Dr. Blackwood, of Philadelphia, has" 
made use of it as a galactagogue, and states that it is 
the only form from which he has obtained beneficial 
results in agalactia. 

In regard to the strength of the current used, as 
well as the frequency and duration of the application, 
there is considerable difference in the practice of op- 
erators. They of course must vary in accordance 
with the affection treated and the result desired. As 
a general rule, unless for the check of post paftem 
haemorrhage, a medium current is sufficient to pro- 
duce pain or disturbance, and employed daily, or 
once in two or three days, for twenty or thirty min- 
utes, is preferable, for gynaecological use, to a more 
powerful application for a shorter time. Dr. W. O. 
Stillman, in a recent article,^ commending the gene- 
ral tonic effects of galvanism, remarks that its best 
effects are often not realized from using a too power- 
ful current, and that in nearly all classes of cases he has 
observed the best results from decidedly weak ones. 
This is also the conclusion of Drs. Beard and Rock- 
well, and the writer's experience is similar. 

The successful employment of these agents in extra- 
uterine pregnancy and dysmenorrhcea has been already 
noticed. Galvanism is also efficient in uterine sub- 
involution and its results. This condition has recently 
attracted attention as the cause of subsequent and 
serious uterine derangements. 

We can only recognize the physiological change 
occurring in involution, by the gradual and nearly 
regular diminution in the size of the organ. When 
normal, according to most authorities, the uterus can- 
not be felt above the pubis after the tenth day, and 
the time necessary for the entire removal of the old 
tissues and their replacement by new material is esti- 
mated by A. Serdukoff, of Moscow, as eight to ten 
weeks. The frequency of subinvolution may be in- 
ferred from statistics similar to those presented to the 
British Medical Association by Dr. J. Williams. "■' He 
stated that of 1 1 3 deliveries in one year at the Lon- 
don lying-in hospital under his charge, only ninety 
might be considered as normal in involution at the 
twelfth day ; that is, the uterus had then retired into 
the pelvis ; but this does not necessarily ensure sub- 
sequent normal progress. He thinks haemorrhage, 
dysmenorrhcea and prolapsus are often results of im- 
perfect involution. 

The causes retarding or checking involution are 
both general and local. The former can often be 
beneficially treated before as well as after labor. Some 
of the latter, as retained portions of placenta, or mem- 
branes, rents in the perineum or cervix should re- 
ceive early attention, and will not be here considered. 
Dr. Williams says: " The prevention of subinvolu- 
tion means three things : an empty uterus, a well con- 
tracted uterus, and the absence of fever. ' ' An empty 
uterus being secured, the indication is to produce and 
perpetuate normal uterine contraction. For this pur- 
pose the claims only of electricity will be now noticed, 
as it promises the best results, not only in the early 
stages, but even in the later and more confirmed con- 
ditions of uterine-hyperaemia and hyperplasia. 



1 Medical and Surgical Reporter, April 21, 18 

2 British Medical Journal , September 2, 1882 



1883.] 



ADDRESS OF DR. J. K. BARTLETT. 



"3 



Its action is both local and general ; and in this, as 
well as in many other affections where galvanism has 
been beneficial, the result may be ascribed not only 
to the favorable nutritive changes effected in the 
litems, but also to its tonic power in improving gen- 
■eral nutrition. 

At a meeting of the Paris Academy of Medicine, 
a little more than a year since. Dr. George Apostoli 
read a paper in which he proposed the use of the 
Faradic current in all cases of labor, immediately 
after delivery, for the purpose of producing more 
thorough uterine involution and averting engorge- 
ment or metritis. In cases of normal and full-term 
labor, he employed it eight or ten times within 
about six days. In difficult or premature labor, it 
was continued longer. In thirty-two cases he had 
found it always harmless, its effect being invariably 
calming and sedative. It hastens convalescence by 
securing more rapid and perfect involution, reduces 
the amount of the lochial discharge, and prevents 
uterine deviations ; but Faradisra is not the best agent. 
Dr. Paul Helot, in November, 1881,* states, among 
his conclusions from trials of different forms of elec- 
tricity, that uterine contractions can be produced by 
a Faradic current when the interruptions are very 
rapid, but that the process is painfiil, and should be 
restricted to the treatment of post partum haemor- 
rhage ; that galvanism with the constant current, in- 
terrupted, is the best method, the pain being 
very slight, and the catalytic action adding to its 
value. 

The testimony of a competent observer. Dr. J. D. 
Mann,* shows that galvanism will not only secure fiill 
involution in an empty uterus after labor, but also 
that in cases of subinvolution of some duration, it 
will effect more than any other agent in reducing and 
removing hj'pertrophy. He sa^, in reference to this 
condition: " It should be treated in the early stage, 
for when prolonged hyp)ergemia has produced hyper- 
plasia of the areolar tissue, and the stage is reached 
when an excess of fibrous tissue preponderates over 
the muscular elements, absorption becomes a matter 
of grave difficulty." Again, "In dealing with an 
hypertrophied uterus, composed of muscular fibers 
infiltrated with fluid, but sparingly so with cellular 
growth, any method of treatment which will stimu- 
late the nutrition of the organ, and accelerate the 
absorption of the morbid products, tends to promote 
a cure, and such is galvanism. ' ' He introduces into 
the uterus an insulated sound, connected with the 
cathode, placing the anode over the lumbar spine ; 
a moderate current, 90 dix millevebers, is passed 
from ten to twelve minutes every alternate day, the 
current being stabile for the first half of the time, 
and during the last, interrupted at intervals, the 
strength being then reduced. The patient should re- 
main in the horizontal position some hours after each 
application. If the uterine wall is so soft as to make 
the passage of a sound dangerous, a cervical electrode 
is substituted. He states that in a case recently 
treated, each application was followed by a temporary 
discharge, and slight pains of the after-pain type. 

1 American Journal 0/ Medical Sciences , 'is.iwaxy , i88j. 
3-Londo» ZMHcetj July 23, j88i . 



The Uterus was reduced to its normal condition in 
seven weeks. 

Dr. Paul F. Munde, of New York*, stat^ that he 
has frequently used the galvanic current to reduce the 
hyperplastic uterus and bring on the menstrual flow ; 
also, that in a case of large cellulitic exudation in the 
right pelvic fossa, which produced severe sciatica 
by its pressure upon the sacral plexus, galvanism, 
vaginal and post-trochanteric, cured it permanently 
in less than a week. The same author, in another 
paper*, after mentioning the varied and usually unsat- 
isfactory treatment of uterine displacements, saj'S : 
" Electricity rationally and scientifically employed for 
a sufficiently long time, offers chances of cure in cases 
comparatively' recent, which call for a more thorough 
and persistent trial." Still later, before the State 
Medical Society of New York, last Januar)-*, speak- 
ing of cervical erosions and their treatment, he saj'S : 
" In a few intractable cases I have found the negative 
pole of a galvanic battery applied by a round button 
to the erosion, the positive sponge being placed over 
the abdomen, produce a marked tendency to cicatri- 
zation. In one such case, grafting of healthy 
uiauibrane upon the denuded surface occurred 
to me, but the galvanic current finally effected a 
cure. ' ' 

Dr. Frank P. Foster, of New York*, has used it 
with relief in oophoralgia, and concludes an article 
thus : ' ' The three great remedies for chronic extra- 
uterine inflammation, are hot water, iodoform, and 
galvanism." In a private communication he states 
that galvanism has appeared to hasten the absorption 
of pelvic exudates, and that in some cases, where 
great tenderness existed, it has been the only local 
measure he has found that did not add to the pa- 
tient's discomfort for the time being ; that in pure 
ovarian pain, apart from inflammatory conditions, he 
has generally found Faradization more useful. 

The writer would add that he has found Faradiza- 
tion and galvanism very useful in amenorrhcea, where 
general anaemia was not present, and even when the 
latter existed, and constitutional treatment was ob- 
viously required, has found them valuable adjuvants. 
He has also used galvanism with advantage in cases 
of cervical and uterine catarrh, and recalls one of 
long standing, where the beneficial effect was very 
marked. 

We have yet much to learn of the influence of this 
agent, even in the conditions which have been re- 
lieved by its employment, and still more concerning 
its, until recently, almost unrecognized power of pro- 
ducing favorable modifications in diseased organs and 
tissues, independently of any electrolytic or destruc- 
tive action. It certainly deser\-es attention, investi- 
gation, and more careful and thorough trial than has 
hitherto been accorded. 

In the beginning of this paper a reference was 
made to the recent brilliant advances in gynaecologi- 
cal surgery. Prof Heinrich Fritsch, of Breslau, be- 
gins an article upon uterine therapeutics thus: " The 
general surgical teaching of recent years forces gynae- 

1 Am . Journal of Obstetrics, October, 1882. 
-Am. Journal of Obstetrics, October, i83i. 
^ Medical Record, February, 1883. 
^ New York Medical Journal, March, 1882. 



114 



ADDRESS OF DR. J. K. BARTLETT. 



[August, 



cologists, also, to employ uterine surgery more and 
more, in place of medua/ gynsecology." 

Dr. Angus McDonald says:^ "We live in times 
when thoughtful gynaecologists cannot avoid feeling 
that a tendency to a too frequent resort to surgical 
and instrumental methods in dealing with woman's 
diseases is widely, and not infrequently disastrously, 
present." These are utterances seasonable and 
pregnant with meaning. 

What is to be most earnestly sought by us in the 
future? The notable success which has attended 
operative gynaecology, since Lister taught the use of 
carbolic acid, and, by implication, of perfect clean- 
liness, has had a tendency to call attention away 
from the less demonstrative, but even more impor- 
tant, investigation of constitutional as well as of local 
medical methods. Is there not great danger that the 
patient search for therapeiitic resources, general, 
local, hygienic and all others, which it should be our 
aim to undertake, will be comparatively neglected ? 

A successful and brilliant surgical procedure is very 
attractive ; but is not a resort to mutilative surgery, 
though a great boon to humanity in our present state 
of knowledge, an avowal of ignorance, or of our inabil- 
ity to cure ? While we hail gladly any advance in 
our surgical art and in the devices for lessening its 
mortality, we should not forget that, were our attain- 
ments in knowledge more thorough and perfect re- 
specting the causation of diseases with which we have 
to deal, — were our skill in early diagnosis and treat- 
ment more sure and extensive, such disordered con- 
dition might be arrested and cured before reaching 
that stage which can only be relieved by the knife of 
the surgeon. 

Our grandest aspirations should lead us to the study 
of the underlying morbid processes which precede 
graver deviations from the normal state in the pelvic 
organs. Our endeavor should be to forestall and 
prevent the latter, not only by rational therapeutics, 
but by teaching conformity in daily life with nature's 
laws. "Obsta principiis" should be a motto in med- 
icine as well as in morals. 

Woman has in action, for a period of about thirty 
years, a set of organs upon which depend the perpet- 
uation of the race. At the time these organs begin 
their functional activity, the greatest care is requisite 
both physically, mentally and morally to secure to 
them freedom from injurious influences, and that 
proper balance of development, which shall fit the 
woman for her after duties. Here is work in pre- 
ventive medicine for the gynaecologist, if he be, as he 
should be, also physician, of the most important 
character. At the very threshold of female life a 
thousand dangers beset the neophyte. To those re- 
sulting from climate and constitutional proclivities, 
are added, in our artificial life, the exactions of the 
tyrant fashion, in dress, habits and manners, with all 
their attendant dangers. It is here the physician 
alone, who, by instruction, warning and admonition, 
may exercise some influence in restraining and cor- 
recting habits and influences, which may render after 
life but a scene of illness and suff'ering. 

The necessity of careful constitutional treatment in 

1 Edinburgh Medical Journal , July, 1882. 



pelvic disease has often been urged, but does not re- 
ceive the attention its importance demands. Spe- 
cialism, when exclusively practiced, is apt to produce 
narrowness of view, its efforts for cure to be only a 
variation in local treatment rather than a careful 
study of the relations existing with functional disturb- 
ances elsewhere, which influences, if they do not pro- 
duce, will intensify the local troubles. Especially is 
this the case with those educated as specialists "ab 
ovo." No one who has not received thorough train- 
ing in general medicine, and has not tested, con- 
firmed and enlarged the knowlege thus attained, by 
many years of general practice, is fitted for a spe- 
cialist. 

The human body is an entity, not a mere collec- 
tion of organs. We must consider not only the local 
expression of trouble in the pelvis, but aim to fully 
understand and appreciate the relations of the var- 
ious parts of the organism ; to investigate the influ- 
ences which general disturbances, neurotic, functional 
or organic have upon the generative system ; which 
influences are sometimes primarily'causative, but more 
often come into action when disordered parturition, or 
some other deviations from normal function occur. 
We hail everything which aids to enforce the usefulness 
of such studies as a harbinger of onward progress. 

Such has been the tendency, for some years, of 
the utterances of Dr. Fordyce Barker, whose able 
paper, of last autumn, upon the constitutional origin 
of leucorrhoea, and the cure of its resulting local le- 
sions by rational therapeutic and hygiene measures, 
should be thoughtfully read and re-read by every 
gynaecologist 

A paper has been recently published, by Dr. L. C. 
Boisliniere, of St. Louis, which, in no uncertain tones, 
calls attention to general conditions as causative in 
pelvic disease, closing by the statement that our ex- 
treme tendency to specialize has led us to attach too 
much importance to pelvic lesions, and too little to 
the general condition. In the same direction was also 
an address of Dr. William Goodell, of Philadelphia, 
which shows that many affections of the " reproduc- 
tive apparatus" are merely local expressions of their 
cause, general neuroses. 

Time will forbid dwelling upon this all-important 
subject. It is only by realizing that the physician is 
larger than, and must include, the specialist, — that 
we can progress toward the goal we ultimately hope 
to reach. All that is new is not progress. We some- 
times follow the will-of-the-wisp light of error into de- 
vious paths, from which we return, not always enough 
wiser for the lesson, to prevent again going astray in 
another direction. True progress in medicine, as in 
most human affairs, is not usually by a directly onward 
course, but rather by following a rising spiral curve, 
which in time brings us again quite near to the point 
of departure, but upon a somewhat higher plane. 

" Experience teaches slowly, and at the cost of 
mistakes," and through long tentative efforts only, 
can we arrive at truth. Patient, protracted, arduous^ 
labor is necessary. We must 

" Still achieving, still pursuing, 
Learn to labor and to wait." 

Like the first Napoleon, we must veto the word im- 



i883.] 



DIFFUSION OF ARSENIC. 



"5 



possible, When medical gynaecology is thus stud- 
ied and practiced, the writer has confidence to be- 
lieve, with the larger general and local therapeutic 
and hygienic resources which such research will in 
time develop, with closer attention to any deviation 
from normal functional conditions, and with the 
clearer and surer diagnosis which the future will bring, 
that the time will come when the present " brilliant 
triumphs" of the surgical gynaecologist will pale be- 
fore the achievements of his medical co-workers : 

" Kiihn ist das Muhri, 

Herrlich der Lohn." 



DIFFUSION OF ARSENIC THROUGH THE BODY 

WHEN THROWN INTO THE MOUTH AND 

RECTUM AFTER DEATH. 



BY VICTOR C. VAUGHAN, M.D., AND 
JAMES H. DAWSON, PH.C. 



Within the past six months there has been tried, 
in this State (Michigan), a murder case, in which an 
interesting and important question was presented to 
the medical experts. The facts of the case, so far as 
expert testimony was concerned, are briefly as fol- 
lows: — Mathew Millard was accused of poisoning his 
wife with arsenic. The lady was taken sick about 
April 1 8, 1882. She was seen nearly every day, 
and sometimes twice a day, by a physician, 
and twice the attending physician had coun- 
sel. The lady had long been subject to uterine 
trouble (the nature of this trouble does not seem to 
have been understood by the attending physician). 
During her illness she vomited frequently, and, in- 
deed, seldom retained either food or medicine. The 
testimony as to the symptoms manifested was so con- 
fused and conflicting that nothing could be made out 
of it. The attending physician thought she had 
fever, but he never took her temperature. The lady 
died May 7. After her death the husband requested 
the undertaker to embalm the body, so as to preserve 
it until a casket could be brought from Detroit. The 
undertaker replied that he did not know how to 
embalm the body. The husband then asked the 
undertaker to procure some poison, and he (the hus- 
band) would inject it into the body. The under- 
taker procured a poison (he states strychnine), and 
the accused claims that, aided by his brother, he in- 
jected arsenic suspended in water into the mouth and 
Tectum. He claims to have put about a teaspoonful 
■of arsenic into a teacupful of water, and to have in- 
jected one syringeful into the mouth and two into the 
rectum. The syringe which he claims to have used 
was an ordinary bulb syringe, with rectal tube 
attached. 

One hundred and five days after her death the 
^body was taken up, and the stomach and rectum 
placed in one jar, and a piece of the liver and one 
iidney in another ; and the jars were sent to Prof 
A. B. Prescott for analysis of their contents. (When 
the officers came to remove the body the husband 
stated that he had embalmed it.) Dr. Prescott found 
in the stomach and rectum together about twenty 
grains of arsenious oxide, and from his analysis he 



calculated the amount in the whole liver to be from 
six to fifteen grains, according to the size of that 
organ. Later the body was again taken up, and the 
brain and a part of the muscles of the calf of the leg 
sent to Prof Prescott for analysis. In these he failed 
to find any poison. 

The question asked the experts, and the one which 
this paper considers, was : " Granting that the 
arsenic was injected into the mouth and rectum in 
the manner claimed, could it reach the liver and 
other organs outside the alimentary canal?" This 
was the main question, and on it the experts were 
divided. Drs. Kedzie, Thomas, and Vaughan held 
that arsenic so injected after death might reach any 
or all of the organs of the thoracic, abdominal and 
pelvic cavities. On the other hand, Drs, Prescott, 
Dufiield, and Gundrum held that arsenic would not 
diffuse through the body after death. 

This seems to be a new question in medico-legal 
science, and authors have not mentioned it directly. 
However, whatever testimony can be found in the 
books certainly supports the negative of the question. 

Having determined to investigate this matter, we 
made the following experiments : — 

A large musk-rat, which had been caught by one 
of the students, was killed, and about 50 grains (3.24 
grams) of arsenious oxide suspended in cold water 
was injected with an ordinary bulb syringe with rectal 
tube attached into the mouth and rectum. The rat 
was placed in a pine box and buried. After twenty- 
five days it was disinterred and the various organs 
removed and subjected to analysis, with the results 
shown in the following table. In this experiment we 
did not, think to weigh the different organs. 

XT _ r r> .. 17 -J Amount of Arsenic calculated as 

Name of Part Examnied . ^^ ^^^ f„„„j 

Kidneys, 00095 gram. 

Liver, oic^2 ,, 

Lungs 19252 „ 

Stomach and contents, 00686 ,, 

Large Intestine, 40339 .. 

Small Intestine, lo'S? .. 

Heart 02507 ,, 

Brain, 03960 ,, 

Total As.) O3 recovered, . 78078 gram . 

It will be noticed that the lungs contained a much 
larger amount of arsenic than the stomach. Evi- 
dently the larger portion of that injected into the 
mouth passed down the trachea instead of going 
down the oesophagus — indeed, the amount found in 
the liver is larger than that found in the stomach. 
It is likely that the poison passed from the lungs into 
the liver. The amount found in the brain is large, 
but in the musk-rat tlie bones of the skull are thin in 
texture, and are not firmly united. 

In the second experiment a cadaver was used. The 
person had been dead between two and three days 
when the injection was made. An unweighed quan- 
tity of arsenious oxide was suspended in cold water, 
and this was injected by means of a common bulb 
syringe, with rectal tube, into the mouth and rectum. 
The body was lain away in a dry cellar for twenty- 
five days. The various parts, as given in the table 
below, were then removed, weighed, and subjected 
to analysis. In dissecting the body it was observed 
that, although the cuticle had decomposed to a cer- 
tain extent, the internal organs were firm to the 



ii6 



MEDICINE AND SURGERY OF WINNEBAGO AND DAKOTA INDIANS. [August, 



touch, and remained in a fair state of preservation. 
This was true of all the parts removed, except the 
brain, which was broken down to a semi-fluid con- 
dition.. 

The following table shows the part analyzed, its 
weight, the amount of arsenic, estimated as arsenious 
oxide, found, and the per cent, of arsenic found in 
the various tissues : 



Name of part taken. 



Right kidney 

Left kidney 

Liver 

Lower lobe of right lung. . . 

Heart 

Transverse section of colon 

Rectum 

Spleen 

Stomach 

Brain 



•^ '5 


■so 


Grams . 


104 


A distinct 
mirror. 


90 
86s 


.00703 
.08316 


99 


•04333 


370 

85 
22 


.02199 

.02659 

1.65000 


48 


.00455 


300 
1028 


2. I 1200 
.00363 



.0 



.00782 
.00961 

•04376 

.00594 
.03128 
7.5000 
.00947 
• 70405 

.00030 



It will be seen that, while the right kidney con- 
tained only an unweighable quantity, the left kidney 
furnished nearly as large a per cent, of arsenic as 
was furnished by the liver. We account for this by 
supposing that on the right side the liver caught up 
the greater portion of the arsenic passing down from 
the right lung, while on the left side the arsenic 
passed on more freely into the kidney. Contrary 
to what was observed in the experiments on the 
musk-rat, the stomach of the cadaver contained a 
large amount of arsenic, and it seems probable that 
some of the fluid thrown into the mouth passed di- 
rectly into the stomach. We were surprised at find- 
ing the arsenic in the brain, and the query arises, by 
what avenue did the poison reach this organ ? We 
noticed that, while throwing the fluid into the mouth 
at one time, when the bulb of the syringe was very 
forcibly compressed, a portion of the fluid returned 
through the nose. It is probable that some of the 
arsenic adhered to the roof of the pharynx and along 
the nasal passages, and from thence penetrated the 
brain. 

Independently of our work Prof. Kedzie, of the 
Michigan Agricultural College, has made an experi- 
ment on this question, and we herewith quote his re- 
sults as communicated by him to one of us in a letter. 

He says : " One of our students obtained a cat 
which had been killed a few hours before by a gun- 
shot wound in the head. Under my directions a 
quantity of arsenious oxide suspended in water was 
injected into the stomach and rectum, and the cat 
was then buried for thirty-one days. At the expira- 
tion of this time the animal was taken up, the liver, 
spleen, heart, and kidneys removed without contact 
with the contents of the alimentary canal, washed 
with water, and then oxidized by potassium chlorate 
and pure hydrochloric acid. The residue was re- 
duced with pure zinc and sulphuric acid and the 
metallic arsenic collected in a glass tube. From two- 
thirds of the liver twenty-two milligramms of me- 
tallic arsenic was obtained, equivalent to .53 of a 
grain of arsenious oxide for the entire liver. The 
heart, spleen, and kidneys were treated together, 



and from them I obtained 13 milligrammes of me- 
tallic arsenic. 

" There were thus obtained from these viscera 35 
milligrammes of metallic arsenic, and if the whole of 
the liver had been used "there would have been 46 
milligrammes of metallic arsenic, equivalent to .89 
of a grain of white arsenic, obtained from viscera 
which could have received this arsenic only by post- 
mortem diff"usions from the contents of the alimen- 
tary canal. This result is directly opposed to the 
dictum of the older writers on medical jurisprudence, 
that imbibed arsenic in the viscera is proof of its ad- 
ministration before death." 

It will be seen from these experiments that the ar- 
senic was quite as widely diffused through the body 
as it would have been had it been administered dur- 
ing life, and had it been the cause of death. These 
experiments also show that in a case of suspected 
arsenical poisoning, if arsenic has been introduced 
into the mouth and rectum in the manner above 
given after death, the finding of the poison in the 
various organs mentioned in the table will be nO' 
proof that the poison was administered during life 
and caused death. Now, embalming fluids contain- 
ing arsenic are quite generally and indiscriminately 
used. They are used by the physician, by the un- 
dertaker, and by others who prepare the body for 
burial. Some throw the fluid into the mouth or 
rectum, or both ; some puncture the abdominal walls 
with a trocar and then fill the cavity with the fluid ;: 
others simply bathe the body with some soluble form 
of arsenic, or cover the body with cloths saturated 
with such a solution ; others still inject a solution of 
arsenic into an artery. The most weighty argument 
yet urged against cremation is that it may be used as 
a means of covering up crime ; but in a case of ar- 
senical poisoning the use of an arsenical embalming 
fluid may be employed as a more certain method of 
covering up the crime than the incineration of the 
body would be. On the other hand, so long as the- 
present frequent use of these embalming fluids con- 
tinues some innocent person may be accused of com- 
mitting murder by arsenical poisoning, and arsenic 
being found in the "body, may suffer an unjust sen- 
tence. 

In all of these experiments, not only were "chem- 
ically pure" reagents used, but these were thoroughly 
tested for arsenic. The tissues were oxidized with, 
hydro-chloric acid and potassium chlorate, and the 
metallic mirror was obtained by the modified Marsh 
apparatus of Chittenden and Donaldson (American- 
Chemical journal, Vol. 2, pages 235 et seq. 1 In 
every case the gas was allowed to run from one-half 
hour to two hours (to prove the absence of arsenic 
in the zinc and sulphuric acid) before the substance 
under examination was added. 

University of Michigan, June, 1883. 

THE MEDICINE AND SURGERY OF THE WINNEBAGO 
AND DAKOTA INDIANS. 



BY F. ANDROS, M.D., MITCHELL, DAK. 



The following interesting account of aboriginal 
medical art is just received from Dr. F. Andros, 



1883.] 



MEDICINE AND SURGERY OF WINNEBAGO AND DAKOTA INDIANS. 



iif 



now of Mitchell, Dakota Territory, but formerly j 
well-known and eminent at McGregor, Iowa. Dr. ! 
.Andros is said to be the grandson of Sir Edmund 
Andros, the British governor of New York in colonial 
times. He is now over eighty years of age, but writes 
a firm hand, and is still actively engaged in practice. 
He has lived nearly all his adult life in contact with 
the Indians. Among the Winnebagoes he was a "great 
medicine man," and was admitted to the lodge of 
their secret society, which has its signs and passwords, 
and is in many respects like some of the secret orders 
among the whites. Being thus closely intimate with 
the Indians at a very early day, before they were much 
modified by contact with civilization, his testimony 
as to their original medical and surgical methods has 
peculiar historical value. ; 

Edmund Andrews, m.d. ; 

The Indians' knowledge of anatomy is very limit- 
ed, and is mostly comparative. They have a name 
for all the different organs of the body. They have 
no idea of the functions of the lungs in the oxygeniz- 
ation of the blood, or of the kidneys in conveying 
off the nitrogenous elements from the system, and 
yet they know from observation that the suspension 
of the functions of either will be fatal to life. They 
are acute observers, as illustration, when a new , 
beaver lodge is discovered, if successful in capturing 
the mother beaver first, they determine the number 
of young beavers to be looked for in the lodge. And i 
this they determine by the number of eschars on the I 
ovaria. They have no definite idea of the circulation of i 
the blood, and yet know that the heart is the organ 
which propels the blood through the body. 

As regards surgery, they never amputate. 

In large incised wounds, the parts are carefully 
brought together and secured with sutures of animal 
sinew. These they remove in six or eight days. The sin- 
ew, smoke dried, is not absorbed. Union by first inten- 
tion is prevented by putting a thin piece of bark be- 
tween the edges of the wound, believing that the 
wound should first heal from the bottom. In 1853 
I saw an Indian stabbed, the knife entering the lung. 
I dressed the wound;and had union by first intention. 
A few days after I saw the case again, and found the 
wound had been opened and air was again bubbling 
from it. Another case : The abdomen wounded 
with a knife, bowels protruding ; replaced the bow- 
els ; union complete the next day. Three or four 
days later the wound was opened. Both patients 
died, victims to their ignorance. 

In gunshot wounds they never 3xplore for the ball, 
and never attempt the removal unless very close to 
the surface. They carefully clean the wound and 
apply a poultice of slippery elm bark or the young 
sprouts of the basswood, powdered and soaked in 
water until quite soft. The wound is kept moist 
with a mucilage from the bark, and is frequently 
cleansed by suction with the mouth. 

They dress a fracture very neatly. First procure a 
cylinder of bark from a tree about the size of the 
broken limb. This is soaked in water till quite soft, 
then carefully adapted to the limb and suffered to 
dry, first securing it in position with strings of bark. 
They never use extension or counter-extension, and 



yet you seldom see shortening or deformity. I once 

saw a case of compound fracture of the leg, four or 
five inches above the ankle. Both tibia and fibula 
were broken, and the soft parts much lacerated. A 
semi-cylindrical piece of bark was procured, consid- 
erably larger than the limb. This was cut deeply on 
both sides at the knee, so as to bend to a slight in- 
clined plane. This cylinder was filled with soft clay 
and the limb embedded in it, from the heel to the 
groin, except the wounded portion, which was left 
open. The wound was kept clean and dressed with 
the thick mucilage of elm bark. The patient made 
a rapid recovery, with but little shortening. 

This case was treated by the Indians themselves, X 
being a simple " looker-on in Venice." 

As regards the bite of snakes and the stings of in- 
sects, they seem to have no general remedy, each 
band usually employing a different remedy. The 
most common treatment for the bite of the rattle- 
snake is first to suck the wound with the mouth and 
apply the bruised leaves of the common plantain, or 
blacic snake root. They use no internal remedy. 
For the sting of bees or wasps they use the wild 
onion bruised, which, from experience, I know al- 
most instantly relieves the pain. 

Hydrophobia is not uncommon ; for this they 
have no remedy, put the patient in a separate lodge 
and carefully guard him till relieved by death. 

Mitchell, D. T., July 20. 

The Indian possesses a constitution of wonderful 
recuperative power. They are subject only to those 
diseases that depend on atmospheric vicissitudes and 
malarial exhalations, excepting eruptive diseases — as 
small-pox and measles, and I am inclined to the belief 
that those diseases are from contact with the whites. 
Scarlatina, diphtheria or typhus, or typhoid fever, I 
never saw among them, their mode of life being un- 
friendly to their development. 

The fevers common among them are intermittent 
and remittent. For the treatment of these they 
have a routine treatment — an emetic or cathartic, fol- 
lowed by a vapor bath, from which the patient is 
immediately plunged into a cold one, or, if a pond 
or pool of water is not convenient, a sponge bath^ 
using cold water, applied with a wisp of grass, after 
which they are covered with blankets or skins, and 
diaphoresis kept up for some time by the use of 
warm drinks — as the calamus, or some of the 
varieties of the mints. As a tonic they use the bark 
from the root of the different varieties of the willow 
(salix) in decoction, also the bark of the aspen, pop- 
las tremuloides. It is rarely that they die from remit- 
tent fever. They also often use the lancet, bleeding with- 
out regard to sex, age or physical condition. This prac- 
tice I think they have borrowed from the whites. For 
this operation they use a thin scale of flint, fastened 
by screw in a stick and driven into the vein, as the 
horse farriers used the fleam years ago. In pneu- 
monia, bleeding is the most common remedy. In 
rheumatism they rely almost wholly on the vapor 
bath, yet I have seen the cimicifuga (black cohosh) 
used by them in decoction. The vapor bath is a 
small tent, made by bending two small poles across- 
each other and fixing the ends on the ground, then- 



*i8 



MEDICAL PROGRESS. 



[August, 



■covering this frame with skins, several large stones 
being heated and placed inside. The patient is 
placed within, and water sprinkled on the stones, 
soon ' ' raising steam. ' ' 

They have no idea of the sympathy which may 
.exist between the different organs, but locate the dis- 
.ease wherever the pain may be. I have frequently 
had them call on me for headache medicine, side-ache 
medicine, belly-ache medicine, etc., making no 
greater mistake than I have seen made by men with 
M.D. attached to their names, prescribing for symp- 
toms in place of the disease. They use quite a num- 
ber of the indigenous medicinal plants, having learned 
from experience that certain plants will produce cer- 
tain effects ; that chimaphila will increase the flow of 
urine, and that a decoction of the bark of the butter- 
nut (juglans) will produce a cathartic effect. 

They have one remedy for mucus enteritis which 
is deserving of a trial. It is the bark of the button- 
wood, or american sycamore (platanus occidentalis). 
It is used in decoction, and is used ad libitum. Its 
taste slightly resembles chocolate, is very slightly 
.astringent, and powerfully diaphoretic. 

During the autmn of 1853 dysentery prevailed 
among the soldiers, and also among the Indians, as 
.an epidemic. I watched their treatment, and found 
they were more successful in the treatment than I 
•was, whether owing to their great recuperative 
powers, or to some other cause, I will not say. 
Since that time I have used the same remedy in my 
private practice, in conjunction with the usual reme- 
dies, and was pleased with the result. On this bark 
they relied solely. 

Cupping seems to be one of their old remedies. 
You will scarcely see an Indian of any age who has 
not the scars of scarification about the temples or 
neck. The operation is performed by scarification 
-with a scale of flint, and the blood extracted by suc- 
tion with a horn by the mouth of the attendant, used 
particularly in inflammation of the lungs and head- 
.ache. They pay no attention to diet, the sick using 
the same food as the other occupants of the lodge. 

For poisons, snake-bites, and the stmgs of insects, 
they have no reliable remedy. The most important 
is suction of the wound with the mouth. I observed 
that the different bands each had its particular 
remedy. The most common are the senega snake- 
root and the common plantain (alisma plantago). 
.and the yellow dock (rumex crispus). The bite rarely 
proves fatal, either among the whites or Indians. 
When death ensues it is from haemorrhage, bleeding 
from the nose and gums. The poison seems to defi- 
brinate the blood. I have probably treated over fifty 
.cases of rattlesnake-bites, and never saw but one fatal 
result. Many of the recoveries were long and 
tedious. 

The general treatment is like the treatment of 
typhus fever, an expectant and supporting treatment. 
Ammonia is one of the most valuable remedies in 
the early treatment, both internally and externally 
to the wound. Whisky, the vaunted remedy, is of 
very little account after the first few hours, except 
given with milk as a supportant. — (This is wander- 
ing from my subject, but, as I told you before, my 
reniarks would be disconnected.) 



The following is a list of the rernedies in most 
common use : 

The cambium of the different varieties of the 
pines, as expectorant, and also in gonorrhoea; 
symplocarpus foetidus (skunk cabbage), expectorant 
and used in asthma ; Sambucus canadensis, used as a 
poultice; Alisma plantago (plantain), in snake bite 
and poison from the ivy or poison sumach ; 
Sassafras, expectorant ; Chimaphila Maculata, di- 
uretic ; Ulmus (fulva), emollient, demulcent ; 
Asclepias Tuberosa, emetic; cortex Salicis, dififer- 
ferent species, febrifuge and tonic; Leptandra viginica, 
snake bite ; Polygala senega, snake bite ; Rumex 
crispus, snake bite ; Acorus calamus internal 
fever ; Lycoperdon bovuta (puff-ball), styptic, and 
in wounds to arrest haemorrhage : Artemesia cana- 
densis, tonic; Cortex Querci, tonic and astringent ; 
Geranium maculatum, astringent, used extensively 
in diarrhoea. The bark of the button wood (Pla- 
tanus occidentalis), used in dysentery. As a stimu- 
lant they use a plant, in common parlance called 
horse mint, and named by botanists Monarda puncta- 
ta, which is of the same genus as the well-known 
Oswego tea. This I saw them use in cases of Asiatic 
cholera, which prevailed among them, using it both 
internally and externally — very hot. I think they 
were as successful as I was in the treatment. 

Eruptive diseases are almost always fatal among 
them, the eruption being repelled by cold applica- 
tions, to which they invariably resort in all cases of 
increased heat of the surface. 

Measles is fully as fatal as small-pox among them. 

If you wish to ask any particular questions, shall 
be happy to answer, if able to do so. 

Hoping to have the pleasure of a personal inter- 
view sometime during the summer. 



MEDICAL PROGRESS. 



A Ramrod in the Brain — Recovery. — This is a 
most graphic and interesting account of a case, the 
details of which would take up far more space than 
we can afford to give. By the discharge of a carbine 
an iron ramrod passed into the right side of the back, 
near the fourth dorsal vertebra, upwards along the 
thorax, through the deeper tissues of the right side of 
the neck, penetrating through the skull and brain, 
and projecting 30 cm. outside of the skull on the left 
side of the head. By cutting down upon the wound 
in the neck, the ramrod was extracted after striking 
the projecting end (through the back) with a hammer 
several times, and the patient recovered with loss of 
sight in the right eye. 

The patient, Mutz, was a 1 7 year old man servant, 
who was shot at a Schutzenfest by a young peasant 
who stood directly behind him, the ramrod in the 
barrel of the carbine, and by dropping the butt sud- 
denly upon the ground the gun was discharged. The 
first movement made by Mutz after he was shot, was 
a tottering without falling, and seizing the ram- 
rod with both hands. A comrade sprang to him, 
put out the fire of his clothing at the back, and laid 
him on the grass, where he remained ten minutes 



1883. 



MEDICAL PROGRESS. 



iiy 



motionless, without speaking and with his eyes shut. 
There were two different ineffectual attempts made by 
the bystanders to draw the ramrod out ot the wound, 
raising his head and shoulders from the ground, and 
dragging him a short distance ; following this came 
nausea, vomiting, a deep sigh and intelligible answers 
to questionings. 

He was first seen by Dr. Fischer at the hospital 
several hours after the accident, when 30 cm. of the 
screw end of an iron ramrod projected from the left 
side of the skull, 8 cm. distant from a line perpendicu- 
lar to the left supra-orbital foramen, and so tightly 
wedged that not a drop of blood escaped. The tis- 
sues about the angle of the lower jaw on the right side 
were swollen and very painful on pressure, the finger 
passed deep into the pharynx, found nothing abnor- 
mal. Between the right shoulder-blade and spine, on 
a level with the fourth dorsal vertebra, was a gimshot 
wound of the size of a ten-penny piece, with black- 
ened edges, from which oozed a thick bloody fluid. 
He lay exhausted and apathetic with closed eyes, put- 
ting his hand now and again to the right side of the 
neck ; but when spoken to gave proper answers, com- 
plaining of headache, pain in the right side of the 
neck, and of not seeing so well as usual ; the pupils 
were dilated. From the right nostril a bloody colored 
fluid was discharging. He vomited a tablespooufnl 
of dark red blood, and his sputa was bloody. Pulse 
60; respiration normal. 

The question now was how to extract the ramrod, 
— in the direction of entrance or from the wound of 
exit in -the skull. As these ramrods have a thick knob 
at the end, it was decided to cut down on the course of 
the missile in the neck and so withdraw it. The opera- 
tion was performed without narcosis, by an incision 
6 cm. long, made from the angle of the lower jaw, on 
the right side to the anterior border of the sterno- 
mastoid muscles, the knob of the ramrod being found 
lying deep beneath the upper part of the muscle near 
its posterior border. The greater vessels were not 
exposed — not much haemorrhage, only one small artery : 
to ligate. An incision was then made down to the 
point of exit, and the ramrod was found to be im- 
movable, with no fissures in the bone about it. A 
hammer was used for striking careful blows on the 
exposed end, when after a few blows the rod moved, 
but in the direction of the original wound, and threat- 
ened to pass into the soft parts. By changing the 
position of the body, and passing elevators under the 
projecting part, he was enabled finally to remove it. 
The patient was conscious during the operation, and 
at its close his pulse was 72; he complained only of 
headache. The ramrod was 50 cm. long, varying in 
thickness from 6 to 7 mm. On the 68th day Mutz 
was discharged as cured. 

Symptoms — Braiti. — At the moment of being shot, 
a tottering ; in the first ten minutes he lay motion- 
less, speechless, eyes closed, with a deep rattling in 
the throat. After an hour he answered questions cor- 
rectly. Three and a half hours later, on his entrance 
into the hospital, the period of depression was over. , 
During the operation he was perfectly conscious. 
After the removal of the ramrod there must have 
been some bleeding along the track from -the wound 



of the dura mater at the points of entrance and exit, 
which was unimportant, as no symptoms of compres- 
sion of the brain followed. The headache which en- 
sued may be traced to this cause and not to meningi- 
tis", as there was no fever. This, on the third day, 
was severe, and on the eighth and ninth days was ac- 
. companied with constipation ; then became les& 
marked, and disappeared on the nineteenth day. 
Vomiting occurred only the first night and the day 
after the operation. Sleep became natural after the 
fifth day. There was no paralysis. The pulse fell 
to 52 on the fourth day. On the twenty-eighth day 
and after he could sit up for an hour at a time. His 
memory tailed him as time passed ; he could remem- 
ber everything up to the time of receipt of the injury, 
but his being laid on the grass, brought to the hos- 
pital, and being operated on he had forgotten. 

Discharge of the Cerebro-Spinal Fluid from the 
Right Nostril.. — This continued for twelve days, at 
first continuously and bloody, then intermittent and 
of a yellow color ; at times passing into the pharynx 
and coughed up. It never came from the left nostril. 

Amaurosis of the Right Eye. — On his entrance 
into the hospital he complained of not seeing well;- 
both pupils were dilated and nothing abnormal was 
noticed. The following day amaurosis of the right 
eye, with perfect vision of the left, was diagnosti- 
cated. At the sixth week a commencing atrophy of 
the right optic nerve was determined by the ophthal- 
moscope. 

Suppuration of the Right Ear. — On the twelfth 
day Mutz complained of a pricking in the right ear,- 
from which a slight discharge came. He heard the 
watch only 12 cm. removed, but very well when 
pressed against the bone. On the seventeenth day 
a suppuration was established, which soon stopped 
under treatment by pulverized boracic acid. In the 
fifth week he heard the watch one-half meter distant. 
In the seventh week both ears were alike. 

The sense of smell was normal. 

Temperature and Pulse. — On the morning of the 
operation the thermometer was 37.9, in the evening 
38.3. In the first two weeks the morning tempera- 
ture was usually 37.6, and in the evenings 38.3. In 
the next five weeks, morning 36.8, evening 37. Only 
once, on the ninth day, did the thermometer indicate 
anything serious. On that day the record stood,- 
morning 38.8, midday 39.9, evening 39.9. An 
operation from the bowels relieved a constipation of 
three days standing, and the temperature was re- 
duced. The pulse gave no special indications. The 
character of the patient seemed to undergo na 
change. His employer described him as a very good- 
peasant, who took his punishment quietly. In the 
hospital he seemed phlegmatic, and careful of his 
health. 

Direction of the Wcmnd. — After considering care- 
fully the various symptoms, and experimenting upon 
the cadaver. Dr. Fischer comes to the following con- 
clusion as to the course of the wound : The ramrod 
entered the right side, opposite the fourth dorsal ver- 
tebra, between the splenius cervicis and levator 
anguli scapulae, without penetrating the cavity of the 
thorax, and passed up the neck in front of the inter- 



f 20 



MEDICAL PROGRESS. 



[August, 



nal jugular vein and common carotid artery, and be- 
hind the sterno-cleido-mastoid, posterior belly of 
^the digastric, stylohyoid, and stylo-glossus muscles. 
It entered the base of the skull behind the posterior 
■border of the middle root of the pterygoid process, 
went through the right sphenoidal sinus and the 
jlower portion of the alae orbitalis, through the right 
optic canal, lacerating the optic nerve, and passed 
from the border of the sphenoid into the cranial cav- 
ity. Here the ramrod struck the right gyrusrectus, 
.and then passed freely for some distance between the 
two hemispheres, on the left side of the falx cerebri ; 
then passed between the two gyrifornicati, just in 
front of the anterior border of the genu of the 
■ corpus callosum, and passed through an extent of 3 
iCm. in the left gyrus frontalis superior, out through 
;the frontal bone. The track of the wound is 35 
cm. long. — Dr. G'E.o^GY.Yx'^cvi'E^, Deutsche Zeitschrift 
fur Chirurgie, XVII., B., 5 and 6. 

Case of Separation of the Symphysis Pubis. 
' — This occurred in a sixteen-year-old girl, who was 
thrown from her horse whilst riding astride on a 
man's saddle, and dragged some distance. When 
seen, a little over six weeks after the accident, she 
was found to be suffering from bed-sores on the back 
and buttocks, with a sinus in the left groin passing 
close to the labium. There was a copious, thick 
.and very fetid discharge from the vagina — gritty 
when rubbed between the fingers. There existed a 
separation of the pubic symphysis of i )^ inches. On 
introducing the finger into the vagina the roughened 
edges of the pubic articulation, denuded of cartilage, 
could be easily made out. The finger in the vagina 
could be plainly felt by the finger of the other hand, 
- placed on the mons veneris, nothing but skin inter- 
-vening between the two. The orifice of the urethra 
was dilated and in an altered position. Six months 
after the accident the finger, introduced into the 
•vagina, encountered firm bands of tendenous sub- 
stance, and uniting the pelvic articulation, part of 
the edges of the pubic articulation could still be felt, 
but smooth and covered by membrane. When first 
allowed to walk the girl felt " loose," and a feeling 
,as though she was falling asunder. This only exists 
in a very slight degree later, and is quite counteracted 
by a firm band round the hips. Incontinence of 
urine from the first and cessation of the menses. — 
J. S. Hayes, m.d., Australasian Medical Gazette, 
April 15, 1883. 

A Case of Chylous Ascites. — Mr. Kien commun- 
icates to the Societe de Medicine de Strasbourg, as 
reported in the Gazette Medicale de Strasbourg, the 
•case of an old maid of 50 years of age, who, suffering 
from abdominal dropsy, had been tapped by him 
•eight times in four months, drawing off each time 
some four gallons of a fluid absolutely like milk in 
color and density. He was unable to detect any ab- 
normal condition in the cavity itself, which was easily 
palpated after the removal of the fluid, or in the abdom- 
inal viscera. Prof. Recklinghausen made a micro- 
scopical examination of the fluid, and declared the 
.case to be one of chylous acites. He found lym- 



phatic cells — leucocytes — in different morphological 
conditions, some fibrinous flakes and some large cells 
adherent to each other in groups of two or three, with 
a conformation which might indicate cancer. He 
considered the fluid might come from a rupture of 
the chyliferous vessels of the intestine or mesentery. 

Physiology in England. — Judging from the re- 
port for 1882 of Mr. George Burk, the Home Sec- 
retary, who grants licenses for vivisections, physiolo- 
gy must be seriously on the decline in England. The 
British Medical Journal X.€\\% us (June 16, 1883) that 
but twenty-six persons performed experiments, and 
that but between twenty and thirty animals, mostly 
frogs, were used. How far would twenty or thirty 
frogs go in a well appointed physiological laboratory? 

The same journal tells us, however, of the appoint- 
ment of Dr. Michael Foster as Professor of Physiol- 
ogy at Cambridge, with Dr. Alexander McAlister as 
Professor of Anatomy in place of Dr. Humphrey ; 
and that physiology is more and more vindicating its 
place as the scientific basis of that part of medical 
science which is not purely empirical. Cambridge 
University now proposes to extend elementary biology 
over two terms, and to make it form a more complete 
introduction to general morphology. Botany, com- 
parative anatomy, and much of the old materia med- 
ica are being laid in the background as no longer com- 
pulsory studies. 

Rapid Formation of Blood Tumor in Left 
Labium Majus during Labor — Spontaneous Rup- 
ture — Excessive Hemorrhage. — Dr. Morris A. 
Rodger, (^Canada Medical and Surgical Journal, 
j July, 1883), describes the formation of this tumor as 
! coming on some time after the commencement of 
labor-pains, — when first noticed it was the size of a 
pigeon's t^^ — then increased rapidly with each pain 
to the size of a foetal head and burst before the 
child's head had passed the brim of the pelvis. 
The rent to?k place on the inner side of the labium, 
and was about three inches in extent, running close 
down to the rectum, but not injuring the perinseum 
proper — bleeding was very profuse and not controlled 
until after a forceps delivery of the child, when fine 
silver wire sutures were used, passing them deeply into 
the neighboring tissues. There was no history of 
swelling in the legs, or elsewhere, and no varicosities 
of the perineal veins. The patient did well. 

Reduction of Backward Luxation of the 
Thumb. — Dr. J. F. Hubner {Philadelphia Medical 
Times, July 14, 1883) treats this condition by sepa- 
rating the two heads of the flexor brevis muscle with 
two uterine tenaculi, bending their ends to a very 
acute angle. He inserts them by holding them as 
nearly parallel as possible to the metacarpal bone, 
and by a circular motion inserts the curved end of 
the tenaculum, keeping the point subcutaneous. Next 
introduce the tenaculum under the head of the muscle 
in the same manner as you would a tenotome ; then, 
turning the point upward, you have the head of the 
muscle in the elbow of the tenaculum. Insert the 
second one in the same manner. Now push the 



i883.] 



MEDICAL PROGRESS. 



I2t 



heads of the muscle asunder, and allow an assistant 
to push the phalanx in place. In order that the 
tenaculi may be withdrawn easily, care must be taken 
not to insert them too far from the normal position 
of each head of the muscle, and in withdrawing to 
make a circular sweep of the handle. 

In the report of the Committee on New Remedies 
to the State Medical Society of West Virginia, Dr. 
J. M. Lazzell called attention to the somewhat pe- 
culiar action of an old remedy : Tinctum digitalis, 
long continued, produces a peculiar and remarkable 
kind of sweat over the whole body. This is con- 
tinuous and will remain several days after discon- 
tinuing the remedy. The skin is bathed in perspira- 
tion, and is shriveled and corrugated like a washer- 
woman's hands. 

CvsTicERCUs IN THE Eye. — This parasite has been 
found imbedded in the fundus of the eye, to the 
outer side of the left optic disc and projecting into 
the vitreous, overlapping and obscuring the inner 
third of the area of the optic papilla. Dr. W. J. 
Collins reports it in the Lancet as being present in a 
girl of six. It has produced intense hyperaemia with 
effusion, and severe headache. There is no move- 
ment as yet, and there are no indications requiring 
immediate operative interference. Probably sooner 
or later the eye will be lost. 

Dangerous Soda Water. — Dr. George Hay 
{Philadelphia Medical Times, July 14, 1883) has 
been examining the soda water of a particular drug- 
gist, who himself called his attention to it, and found 
the water to be dangerously impregnated with copper, 
existing as carbonate of copper, held in solution by 
excess of carbonic acid, and derived from the satura- 
tors, which are in all cases made of that metal and 
generally coated inside with tin, which gets dissolved 
in time and exposes the copper. 



pyema treated by free incision; for, when the pad is 
inflated, it becomes fixed in position between the ribs, 
forms an elastic wedge which prevents the escape of 
fluid around the tube, and exerts a comfortable and 
even pressure in sustaining the open and dilated con- 
dition of the incision. 



Professional Rewards. — The Gazette Hebdoma- 
daire des Sciences Medicates de Montpellier, for June 
30, 1883, tells us that Dr. Monnet last January, while 
passing through a certain street, went to the assist- 
ance of a drunken man whom he saw fall and injure 
his head. He had him taken to an apothecary's shop, 
gave him a medicinal mixture, and dressed his head, 
for which he received a severe blow with the fist. Ten 
minutes later the drunken fellow was walked out of 
the shop by a policeman. As the doctor was about 
to follow, the apothecary demanded 36 cents of him 
as the price of the mixture, which the doctor refused 
to pay. A. few days later Dr. Monnet received two 
letters ; one from the apothecary summoning him be- 
fore a justice of the peace ; the other from the police 
authorities, requesting him to appear and give inform- 
ation regarding the dnmken man. The doctor, be- 
ing a very busy man, neglected to pay proper atten- 
tion to these letters. Consequently, in March last 
an officer presented himself with the intention of at- 
taching the property of Dr. Monnet, and he found 
that by this time he had to pay for the sake of the law 
the sum of $9.96. 



NEW INVENTIONS. 



Block's Maximum Thermometer. — This instru- 
ment is provided with a system of magnifying lenses, 
which are so attached to the tube, as to glide over its 
surface and allow a ready reading of minute subdi- 
visions of the degrees. 

Burq's Circular Thermometer, with Maximum 
and Minimum Indices. — This thermometer is intend- 
ed to measure surface temperatures, and has con- 
nected with it a series of all the malleable metals 
which Dr. Burq calls the metallos.^opic " gamut," to 
determine the thermic variations corresponding to 
metallic sensibilities. 

A New Drainage Tube. — By J. Ward Cousins, 
M.D., London, British Medical Journal. — This is an 
elastic tube which is enclosed at one end in an elastic 
air-pad, to which a fine tube is attached, and by this 
the pad can be inflated to the required extent. The 
inflating tnbe is then securely closed with a knot or 
ligature. It is especially serviceable in cases or em- 



The Confiscation of the Entire Issue of one 
Number of a Medical Journal. — The Medicinisch 
Chirurgisches Central-Blatt of Vienna, has on its No. 
6, for February 9, 1883, the words "Second edition," 
which it explains by the following notice: 

"To our readers: The whole edition of No. 6 of 
our publication was confiscated on account of an 
editorial on the ministerial decree concerning the 
titles of surgeons. We have prepared this second 
edition by leaving out the incriminating article, which 
we now send to our subscribers, unfortunately some- 
what delayed." 

A similar action has been taken by the authorities 
with regard to a recent number (June 2) of the Wiener 
Medizinische Wochenschrift, which offended by re- 
marks concerning the botanical garden in connection 
with the Josefs-Akadamie. The editors promise a 
second edition without a repetition of the offense. 



The Mortality of the Principal Cities of 
Europe for the first quarter of the current year: 
London, (nearly 4,000,000) 22.1 per 1,000. Measles, 
scarlatina and whooping-cough have influenced this 
rate greatly. St. Petersburg, 40.6 per 1,000. 
Typhoid fever and diphtheria have prevailed with 
great intensity. 

Berlin, 24.3. Croup caused the death of 663 in 
1,200.000; Brussels, 25.7 ; Paris, 27.3; Stockholm, 
27.8 ; Vienna, 31. 1 ; Madrid, 36.4. Measles alone 
gave 402 deaths in a population of 400,000. — Paris 
Medical. 



«22 



EDITORIAL. 



[August, 



TH K 



Journal i American Medical Association. 



PUBLISHED WEEKLY. 



The Editor of this Journal would be glad to receive any items of 
general interest in regard to local events, or matters that it is desirable to 
call to the attention of the profession. Letters written for publication or 
containing items of information, should be accompanied by the writer's full 
name and address, although not necessarily to ,be published. All com- 
munications in regard to editorial work should be addressed to the Editor. 
Subscription Price, including Postage. 

Per Annum, in Advance. $S,oo. 

Single Copies lo cents. 

Subscriptions may begin at any date. The safest mode of remittance 
iis by bank check or postal money order, drawn to the order of the under- 
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of the publishers, by forwarding in registered letters. 
Address 

Journal of The American Medical As.sociation, 

No. 65 Randolph Street, 

Chicago, Illinois. 

SATURDAY, AUGUST 4, 1883. 

Yellow Fever. — We gather from the secular 
papers the following facts regarding measures for pre- 
venting the introduction of ships and other things in- 
fected with yellow fever, into the seaports on the coast 
of Maryland and Virginia. The United States Hos- 
pital Marine service, under the direction of Surgeon 
General J. B. Hamilton, established a quarantine [ 
.and sent the hospital barge Selden to Hampton Roads ; 
for the reception of yellow fever sufferers. Infected ! 
vessels were ordered to anchor about six miles out I 
from Ocean Beach and Fortress Monroe, until re- ' 
Sieved by the health inspector. The boats were thus 
brought in plain sight of the many visitors at the re- 
. sorts, and caused so much uneasiness among them that I 
;an appeal was made to Secretary Folger. On con- 
sultation with the Surgeon General it was decided to 
call a meeting of the health authorities of Baltimore, i 
Washington, Richmond, Portsmouth, Norfolk, 
Ocean View, Newport News, and Fortress Monroe, to 
discuss the general situation and decide upon some 
plan which would insure concert of action on the 
part of all places concerned in the emergency thought 
to confront them, and to obtain the benefit of all 
available knowledge as to the best locality for the es- 
tablishment of quarantine grounds. The conference 
was held July 28, at Fortress Monroe. There were 
present Surgeon General Hamilton., Dr. Smith 
Townshend, President of the Washington Board of 
Health; Dr. George H. Benson, health commis- 
sioner of Baltimore; Dr. J. G. Cabell, President of 
the Board of Health of Richmond j Hon, H, Lib- 
;bey, member of Congress from the second district ; 



Col. Loder, commandant at Fort Monroe ; Capt. 
Evans, U. S. N., lighthouse inspector ; Gen. .V. D. 
Gronor, member of the Norfolk common council ; 
the mayors of Newport News, Portmouth, and Nor- 
folk. 

Remarks were made by those who objected to the 
anchorage of infected vessels off" Fortress Monroe. 
It was thought at the conference that Fisherman's 
Inlet would be the best location for the quarantine 
station. It was resolved that " the Secretary of the 
Treasury be requested to establish a rigid quarantine 
between the capes immediately, and to continue as 
long as he thinks necessary," and "that the Gov- 
ernors of Virginia and Maryland be requested to in- 
struct pilots of these waters to pilot all vessels com- 
ing into or through the.se capes from fo.eign ports to 
a point opposite the quarantine station, wherever it 
may be located." 

Pilots present inquired whether they would be al- 
lowed to go home after piloting in a vessel with yel- 
low fever on board. The Surgeon General said that 
he did not think the pilot on an infected vessel should 
be allowed to come ashore for several days after hav- 
ing taken a ship into quarantine. The United States 
health officer in charge mustdetermine when it would 
be safe for them to leave. This was not agreeable 
news to the pilots, although one afterwards admitted 
having previously caught the fever while piloting an 
infected vessel into quarantine, and that he had car- 
ried the disease on shore. 

The action of the conference met with the appro- 
bation of Secretary Folger. Surgeon Henry Smith 
and Assistant Surgeon Glennon, of the marine ho.spi- 
tal .service at Norfolk, were sent to Fortress Monroe 
in order to carry out the orders of the Surgeon Gene- 
ral in reference to quarantine. The hospital barge 
Selden was taken to Fisherman's inlet, above Cape 
Charles, where the quarantine station is established. 
A steamer arrived at quarantine, off Baltimore, on 
July 27, with four cases of yellow fever on board. 
She was direct from Vera Cruz, and had lost three by 
death during the passage. A seaman belonging to a 
brig from Havana died from the fever on July 25, 
at the Lazaretto station, near Philadelphia. It is evi- 
dent that under the superintendence of the Surgeon 
General of the Marine Hospital service. Dr. J. B. 
Hamilton, the efficacy of quarantine regulations in 
preventing the introduction of yellow fever will be 
tested as fully as the existing laws of the general Gov- 
ernment will permit. 



Progress or Cholera. — During the past week, 
intelligence from Egypt to July 31 shows that the 



1883.] 



SOCIETY PROCEEDINGS. 



125 



epidemic had probably passed its crisis, as the num- 
ber of deaths daily in Cairo and several other cities 
had diminished more than thirty-three per cent. In 
\ht British Medical Journalior ]\.\\y 21, 1883, is a 
report by Dr. J. Mackie, the British consular physi- 
cian at Alexandria, in reference to the origin of the 
disease at Damietta, the place where it first made its 
appearance in Egypt the present season. From the 
facts stated in the report, it is evident that all the 
local causes known to favor the development of an 
epidemic of cholera were present in a high degree of 
perfection, not only in Damietta, but throughout the 
whole delta of the Nile. In addition to the ordinary 
and well known uncleanly and unsanitary condition 
common to all Egyptian cities, the river from which 
the inhabitants take their supply of water had been 
thoroughly contaminated with decomposing animal 
matter, from having been made the receptacle of the 
bodies of numerous animals dead from cattle disease 
or bovine typhus, which had been prevailing among 
them severely for several months. The atmospheric 
temperature was also unusually high at the time of the 
cholera outbreak. Dr. Mackie, up to the time of 
making his report, had not found any reliable evi- 
dence that the disease had been introduced into 
Damietta from the East or any foreign source. Not- 
withstanding some rumors to the contrary, there is no 
evidence that any cases of epidemic cholera have yet 
occurred in England or any of the European coun- 
tries. But while all eyes have been turned towards 
Egypt as the focus from which the cholera plague 
might speedily find its way to other countries, the 
news comes to our National Board of Health that it 
is already on this side of the Atlantic, twenty-four 
deaths from cholera having been reported as occur- 
ring at Rio de Janeiro during the week ending July 
26, 1883. 



SOCIETY PROCEEDINGS. 



Dr. Roswell Park, who has been in Chicago since 
1876, and until recently was Demonstrator of Anat- 
omy in the Chicago Medical College, has received the 
appointment to the chair of surgery in the medical 
department of the University of Buffalo, and will in 
a few weeks move to that city, where his new duties 
await him. We congratulate the Buffalo school in 
securing a man of ability, a good scholar, and apt 
teacher. 



REPORT OF THE SECRETARY OF THE SECTION ON 

PRACTICE OF MEDICINE, MATERIA MEDICA, 

AND PHYSIOLOGY, FOR THE REGULAR 

MEETINGS, JUNE 5, 6, 7, 1883. 



Tn^ Journal of Psychological Medicine and Mental 
Pathology, has ceased its publication. It is one of 
the old journals connected with the last generation, 
and was first issued under the editorship of the late 
Dr. Forbes Winslow, Sr. 



On June 5, 1883, at 2.30 p. m., the Section met in 
the chapel of the Young Men's Christian Association, 
349 Euclid Avenue — Dr. J. H. Hollister, of Chicago, 
Illinois, in the chair, and J. G. Lee, m.d., of Phila- 
delphia, Pennsylvania, Secretary. 

After some preliminary words of welcome by the 
Chairman, Dr. T. W. Miller read a paper on the 
"Treatment of Yellow Fever," by Robert S. Murray, 
M.D., of the U.S. Marine Hospital Service. 

The paper elicited an interesting discussion, in 
which several members of the Section participated. 
(See a very brief abstract appended to the paper in 
the number of this journal for July 28, 1883.) On 
motion, the paper read by Dr. Murray was referred 
for publication. 

Dr. William Morrow Beach, of London, Ohio, then 
read an interesting paper on " Milk Sickness." Dr. 
A. B. Palmer, of Michigan, made some interesting 
remarks on the subject, after which the paper was 
referred for publication, and the Section adjourned. 

On June 5, 1883, at 2.30 p.m., the Section con- 
vened at the Opera House, 355 Euclid Avenue — Dr. 
J. H. Hollister in the chair, and Dr. J. G. Lee, 
Secretary. Dr. Thomas N. Reynolds, of Detroit, 
Michigan, read a paper on " The Alimentary Canal 
in Bronchitis and Phthisis. ' ' After a short discussion, 
the paper was referred for publication. 

Dr. W. F. Belfield, of Illinois, then delivered a 
lecture on the '' Germ Theory of Disease," accom- 
panied by microphotographic illustrations. 

At the conclusion of the lecture, on the motion of 
Dr. Austin Flint, Sr., of New York, a vote of thanks 
was awarded by the section to Dr. Belfield for his in- 
teresting and valuable address. The germ theory of 
disease was further discussed briefly by Drs. Austin 
Flint, Jr., of New York, and A. B. Palmer, of 
Michigan. 

Dr. John V. Shoemaker, of Philadelphia, Pa., 
then read a most interesting paper on " Mechanical 
Remedies ip the Treatment of Skin Diseases." 

On motion, this paper was referred to the Commit- 
tee on Publication ; after which Dr. L. B. Tucker- 
man, of Ohio, read an essay " On a New Method of 
Procuring Pure Pancreatic Juice, with Exhibition of 
Animal." 

On motion of Dr. Hollister, the thanks of the 
Section were voted to Dr. Tuckerman, and his paper 
was referred to the Committee on Publication. 
On motion, the Section adjourned. 

On June 7, 1883, ^t 2:30 p. m., the Section met 
in the Opera House, on Euclid avenue. Dr. J. H. 
Hollister in the chair, J. G. Lee, m.d.. Secretary. 

Dr. Wm. M. Beach, of Ohio, begged leave to state 
that his friend. Dr. H. G. Sharp, of Ohio, not being 
able to be present, his paper on "Is Croupous Pneu- 
monia an Essential Fever, and is Blood-letting De- 



:I2 4 



SOCIETY PROCEEDINGS. 



[August, 



manded in its Treatment?" which had been en- 
trusted to him, would have to be referred to the Com- 
mittee on Publication, without being read. 

In accordance with the rules of the American Med- 
ical Association, the Chairman announced that he 
would appoint Dr. H. A. Johnson, of Illinois, Dr. 
A. B. Palmer, of Michigan, and Dr. Walter Hay, of 
Chicago, members of the committee to which the 
papers not read before the Section should be referred, 
Dr. Johnson to act as chairman. 

Dr. Henry A. Martin, of Massachusetts, being 
momentarily absent, his paper on "Vaccination, and 
Propagation of Vaccine Virus," was deferred; and 
Dr. -J. Solis Cohen, of Pennsylvania, read a paper on 
the " Elements of Prognosis and Therapeutics of 
Laryngeal Tuberculosis," upon terminating which, 
Dr. Cohen exhibited some handsome colored plates, 
illustrative of the facts set forth in his paper. 

On motion of Dr. Fairbanks, of Michigan, a vote 
of thanks was extended Dr. Cohen for his valuable 
and instructive paper, which was then briefly dis- 
cussed by Dr. HoUister, and referred to the Publica- 
tion Committee. 

Dr. Henry A. Martin, of Massachusetts, then read 
a paper on " Vaccination and Propagation of Vac- 
cine Virus." Dr. Mitchell, of Rhode Island, cor- 
roborated Dr. Martin's statements, and gave the Sec- 
tion the benefit of his experience in using the proper 
sort of vaccine virus. 

On motion. Dr. Martin's paper was referred to the 
Publication Committee. 

Dr. James C. Wilson, of Pennsylvania, being 
absent, his paper on " The Specific Treatment of 
.Enteric Fever ' ' was omitted from the proceedings. 

Dr. A. T. Keyt, of Ohio, then read a paper on 
'' Diminution of Retardation of the Pulse in Aortic 
Insufficiency." During the discussion which followed. 
Professor Palmer, of Michigan, said that Dr. Keyt's 
paper was worthy of the highest praise, sentiments in 
which he was joined by Drs. Hollister and Scott. 
Upon motion of Professor Palmer, the thanks of the 
Section were voted to Dr. Keyt, and his paper was 
referred to the Committee on Publication. 

Upon motion of Professor Palmer, of Michigan, a 
vote of thanks of the Section was extended to the 
Chairman and the Secretary for the admirable 
manner in which they conducted the meetings of the 
Section. 

On motion, the section then adjourned sine die. 



MEDICAL SOCIETY ITEMS. 



We have received the following preliminary an- 
nouncement relating to the American Public Health 
Association, and commend it to the attention of our 
readers : 

This Association will hold its eleventh annual ses- 
sion at Detroit, Mich., commencing Tuesday, Nov. 
13, 1883, ^"d ending Friday, Nov. j6. 

The following subjects are chosen for special con- 
sideration at that time.: 

I. Malaria. — Its etiology, its American history, 
its specific particles, its origin., methods of preyen- 
|:ion, etc. 



II. Foods. — Their adulterations; healthy or dele- 
terious modes of preservation, and the function of 
legislation in regard to them. Ascertained facts as to 
adulterations in this country ; facts as to canned 
goods, condensed milk, artificial butter and cheese, 
prepared meats, etc. 

HI. Vital Statistics. — Methods and results ; 
defects apparent ; how foreign modes of tabulation 
are to be followed ; systems of collection and classifi- 
cation ; race vitality and the care of population as 
indicated by statistics. 

IV, The control and removal of all decomposable 
material from households; the mechanical laws, con- 
structions and appliances relative thereto ; the con- 
struction of all inside pipes and their connections, 
their traps and syphonage ; flushing ; ventilation ; 
how they shall be connected with out-door recepta- 
cles, and yet be free from ill effect. 

The executive committee desires to secure facts 
and opinions as to practical methods of dealing with 
the interest of the public health. Reasons for the 
views entertained, the results of experience, and the 
best judgment as to preventive and restrictive mea- 
sures are especially sought. 

Methods and systems of physical education, drill, 
etc., feasible in the school-room, will be discussed. 
While papers of merit on other topics are by no means 
excluded, it is believed wise to concentrate the prepa- 
ration of papers and discussion upon these topics. 

The special committees on compulsory vaccination, 
the management of epidemics, and on diseases of ani- 
mals, will, before the completion of their reports, be 
glad to receive communications from any who have 
facts or opinions bearing on these subjects. 

The executive committee feels warranted in saying 
that the meeting promises to be one eminently invit- 
ing and profitable, and urges the attendance and co- 
operation of physicians, engineers, architects, teach- 
ers, and all those interested in the advancement of 
public health and physical well-being. 

Inquiries of a local character may be addressed to 
Wm. Brodie, m.d.. Chairman Local Committee, 
Detroit, Mich. 

A later notice giving such detailed information as 
to local points, programmes, transportation, etc., as 
may be available, will be issued in due season before 
the meeting. 

The fifty-first annual meeting of the British Medi- 
cal Association was held at Liverpool July 31, 
August, I, 2 and 3. Its presiding officers for 
the year 1883, were, President, Thomas Law^es Rogers, 
of Rainhill ; Vice Presidents, George H. Savage, of 
London, and David Yellowlees, of Glasgow. 

The sixth annual meeting of the American Society 
of Microscopists will be held in Chicago next week. 
The opening session will be at the Weber Music hall 
and the regular meetings at the College of Pharmacy, 
corner of Van Buren street and Michigan avenue. 
The following is a list of the papers which are to be 
presented so far as yet received: W. H. Birchmore, 
Carbondale, Kan., "Some Notes on Embolism in 
Pigs;" Thad. S. Updegraff, Elmira, N. Y., "A List 



1883-] 



REVIEWS. 



125 



of Hitherto Undescribed Infusoria;" A. H. Chester, 
Clinton, N. Y., "A New Method of Dry Mounting;" 
George E. Blackham, Dunkirk, X. Y., "On the Re- 
lation of Aperture to Amplifying Power in the Selec- 
tion of a Series of Objectives ;" W. A. Rogers, Cam- 
bridge, Mass., "A Critical Study of the Action of 
Diamond in Ruling Upon Glass;" W. A. Rogers, 
Cambridge, Mass., "Report on the Standard Centi- 
metre Prejjared by the United States Bureau of Weights 
.and Measures;" W. C. Brittan, "On the Laminate 
Structure of Dentine;" W. H. Birchmore, "Details 
of a Neoplasm ;" M. L. Holbrook, "The Termina- 
tion of the Nerves in the Kidneys;" J. T. Brownell, 
Mansfield, Pa., "A Basis of Natural Classification of 
Plants Founded on Their Seeds;" J. T. Brownell, 
Mansfield, Pa., "The Eureka Turn-table;" George E. 
Fell, Buffalo, N. Y., "Effects of Ozoon on Bacteria;" 
D. S. Kellicott, m.d., Buffalo, N. Y., "Some Para- 
sites of the Crayfish ;" D. S. Kellicott, m.d.., Buffalo, 
JM. Y., "An Improved Aeroscope;" F. M. Hamlin, 
Auburn, N. Y., "Microscopical Examinations of 
Seminal Stains on Cloth;" C. M. Vorce, Cleveland, 
O.," "On Organisms Found in the Waters of Lake ^ 
Erie;" A. M. Bleile, Columbus, O., "Further Notes 
on the effects of the Division of the Vagi;" H. L. 
Smith, Geneva, N. Y. (title of paper not yet given) ; 
Allan Y. Moore, Cleveland, O., (title of paper not yet i 
given); L. M. Eastman, Baltimore, Md., "On Some i 
Egglike Bodies in the Liver of Rabbits." [ 

At the recent meeting of the American Otological 
Society, Dr. C. H. Burnett, of Philadelphia, was 
made President for the ensuing year; Dr. J. S. Prout, \ 
of Brooklyn, Vice-President ; Dr. J. J. B. Vermyne, ; 
of New Bedford, Secretary and Treasurer. j 

The American Dental Association meets August 7 I 
at Niagara Falls. Its officers are — President, W. A. j 
Goddard, of Louisiana ; Corresponding Secretary, A. | 
W. Harlan, of Chicago ; Recording Secretary, Geo. | 
A. Cushing, of Chicago. , 

The officers elect of the American Ophthalmolog- 
ical Society are. President, Dr. H. D. Noyes,of New ] 
Y^ork ; Vice-President, Dr. W. F. Morris, of Phila- 
delphia; Secretary and Treasurer, Dr. R. H. Derby, 
of New York. 

The National Dental Association will meet August 
3, in Washington, D. C. President, J. B. Rich, of 
New York ; Secretary, R. F. Hunt, of Washington. 

From the 25th to the 28th of September a society 
of alienists will meet at the asylum, Nueva-Belen, 
■near Barcelona. 

The Sanitary Institution of Great Britain will hold 
its meetings from the 25th to the 29th at Glasgow, 
Scotland. 



REVIEWS. 



Guv's Hospital Reports, Vol. XLI. — The an- 
nual report of Guy's Hospital for 1882 begins its 
pages with a memorial biography of Joseph Towne 
(by Thomas Bryart), modeller to Guy's Hospital for 



fifty-three years. It seems that his first work of im- 
portance was done at the age of seventeen years, in 
secret and by night, with the dim light of a candle. 
It was the model of a human skeleton, and was built 
up from drawings taken from books, and from such 
sp>ecimens of human bones as could be obtained in a 
then remote country village, was exhibited at the So- 
ciety of Arts in the year 1826, and won the first gold 
medal of the Society. It brought Mr. Towne directly 
under the notice of Sir Astley Cooper, who accepted 
him as his protege, and led to his employment by 
Guy's Hospital, where his works, to the number of a 
thousand, testify to his industry and faithfijlness to true 
scientific representation and the principles of art. Cal- 
cutta, Madras, Bombay, New York, Alabama, New 
South Wales and Russia also possess many fine speci- 
mens of his work. He executed several successful models 
as a sculptor, as a bust of Sir Astley Cooper, of Dr.Thos. 
Addison, an equestrian statue of the Duke of Kent, 
and others, but found it necessary to give up the work 
of the sculptor, as it interfered too much with his 
modelling. He also delivered a course of lectures at 
Guy's Hospital, on the Brain and the Organs of 
the Senses and of the Intellect, contributing valuable 
and suggestive papers on the Stereoscopic Theor}- of 
Vision, etc. He died June 25, 1879. 

Dr. C. Hilton Fagge reports a case of phosphorus 
poisoning, with recovery, under the administration 
of turpentine. The patient swallowed half a sixpenny 
bottle of Cooper's phospho-paste mixed with whisky. 
He came under treatment first by emetics, two and a 
half hours after taking the poison. The emetics evi- 
dently assisted in the removal of much of the phos- 
phorus, when he was put upon the turpentine treat- 
ment, leaving the hospital in ten days time. 

Dr. W. Hale White reports a case of symmetrical 
softening of the corpora striata, followed by bilateral 
descending degeneration, with secondary anterior 
poliomyelitis, and Dr. George H. Savage discusses 
several cases of exophthalmic goitre with mental dis- 
order. 

Dr. W. Arbuthnot Lane, in giving cases of empy- 
ema in children treated by removal of a portion of 
rib, considers that a portion of rib or ribs be removed 
at first, in this disease, and the cavity thoroughly 
drained from the beginning, in none of his cases, ex- 
cept one, did he have any trouble with the growth of 
bone interfering with the opening except in the first 
one. He divides the periosteum longitudinally, turns 
it off the rib, and then removes a piece about three- 
quarters of an inch long with the cutting forceps. 

An account of abnormalities observed in the dis- 
secting-room of Guy's Hospital, by Drs. Carrington, 
Horrocks and White, makes us wonder why more of 
this sort of work is not done by our own men. No 
one can pass a season in the dissecting rooms of any 
of our colleges without observing something that is 
worthy of permanent record as anomalies. Our 
demonstrators of anatomy should all of them be com- 
pelled by their respective Faculties to keep such a 
record as a report of work done, which they could 
publish afterwards to their own credit, and add valua- 
ble material to the cnrrent literature. 

Drs. Golding-Bird and Mahomed give two cases of 



126 



REVIEWS. 



[August^ 



pulsating tumor at the root of the neck. One was 
aneurism, but was accompanied with peculiar symp- 
toms. The other was a post-sternal abscess, which 
simulated aneurism. The sphygmographic tracings 
taken in connection with these cases are interesting 
features of their reports. 

The surgical affections of the tongue, by Thomas 
Bryant, forms an admirable grouping, with illustra- 
tions, of a variety of cases, and among other things 
illustrates the connection of syphilis with cancerous 
disease of the tongue. 

Mr. Samuel Wilks, in a paper on Hemianesthesia, 
gives cases with metallotherapie. He admits certain 
facts observed in connection with the cure of anaes- 
thesia by metals, but has as grave doubts as to their 
modus operandi as he has to the correctness of the 
theory as to the supposed seat of the disease. He 
finds a difficulty in distinguishing between men and 
women in respect to considering this disease a func- 
tional disorder, as the hysterical phenomena show 
themselves also in the male, with the same kind of 
mental and moral perversity as exists in women. In 
one case he makes the following comment: "The 
case exemplifies what every medical man must have 
seen, not only that in hysteria and some nerve dis- 
orders medicine is useless, but that it often does pos- 
itive harm. Whilst this girl was under treatment she 
made no improvement, and when the case became in- 
teresting, on the introduction of the new system of 
' metallotherapie, ' all chance for her was gone. 
Neglect was the treatment she needed. It was more 
than she could withstand. Her reflections, on finding 
herself in bed for a fortnight with no one caring for 
her, roused her dormant will, and was, therefore, ex- 
actly the stimulus she wanted." 

Dr. Goodhart reports four cases of what he calls 
saturnine lunacy ; and Dr. Davies Colley gives cases 
of acute gonorrhoeal rheumatism, considering that 
this disease occurs as often in females as in males, if 
not more often, and that its favorite seat is the fibrous 
tissue of the elbow joint. 

Mr. Jacobson discusses enchondromata of the sal- 
ivary glands ; and Dr. Pye-Smith, in a long and val- 
uable article, gives a case of idiopathic anaemia of 
addison, with a commentary and tables of selected 
cases, which is a valuable monograph in itself, as it 
thoroughly covers the ground and gives a full biblio- 
graphy of the subject. 

Dr. Thomas Stevenson, under the head of poison- 
ing by aconitine, gives the details of the case of pois- 
oning by Dr. George Henry Samson of his brother- 
in-law, Percy Malcolm John, which excited much in- 
terest in 1 88 1. A full description of the analysis of 
the viscera follows,with an account of aconitine and 
cases of poisoning by the use of the drug. 

Golding-Bird, in giving laboratory notes on the 
working of the histological class, sets down what he 
considers the best and shortest way of preparing tis- 
sues, cutting and staining sections, etc. He gives an 
excellent cut of the ether microtome. 

Cases of paralysis of the abductors of the vocal cords 
are recorded by Dr. Frederick Taylor, in which he 
illustrates both organic and functional affections. In 
the first he recognizes the unexplained fact that in in- 



jury or disease of the roots or trunks of the pneumo- 
gastric, spinal accessory or recurrent nerves, the ab- 
ductor filaments are liable to become affected sooner 
than the others, and may be affected alone. Two of 
his functionally affected cases illustrate the fact that 
dyspnoea and inspiratory stridor from approximation 
of the vocal cords, may occur as a temporary affec- 
tion, which is not spasmodic, and has not for its re- 
mote cause an organic lesion, but probably some con- 
ditions of nerve failure, as hysteria or exhaustion. 

Dr. Carrington, under the head of Multiple Small 
Abscesses of theLiver, records thirteen cases at consid- 
erable length, and Dr. Golding-Bird discusses Pes 
Valgus Acquisitus, Pes Pronatus Acquisitus and Pes 
Carus. Dr. Thomas Stevenson discusses lead-poison- 
ing, and Dr. Branley closes the volume with an 
article on the vitreous body in its relation to various 
diseases of the eye. 



Transactions of the Medical Society of the. 

State of West Virginia. Held at Grafton, May 

i6 and 17, 1883. 
Proceedings of the Eighth Annual Session of 

the Southern Illinois Medical Association. 

Held at Sparta, 111., May 9 and 10, 1883. 

These are two pamphlet volumes containing a 
record of the proceedings of each society. In the 
latter no papers are printed. The proceedings as 
recorded consisted of questions and answers from 
various members of the society upon very common 
subjects. The utility of a printed record of this 
kind is limited entirely to the members of the society. 

In the former the first twenty-four pages contain 
a record of business transacted, an enumeration of 
the papers read, and, very briefly, the comments made 
upon them. The remaining sixty pages give : The 
Address of the President, Dr. B. W. Allen, of Mor- 
gantown ; the Report of the Committee on Epi- 
demic Diseases, by Dr. R. W. Hall, of Mannington; 
the Report of the Committee on New Medicines, by 
Dr. J. M. Lazzell, of Fairmont. A short but most 
excellent article follows these by Dr. E. C. Myers, of 
Wheeling, on the "Germ Theory of Disease." He 
j briefly, but impartially, and very thoroughly reviews 
the subject, pointing out facts, and distinguishing 
carefully between what is supposed and what is true 
or demonstrated conclusively. The next paper is by 
Dr. D. P. Morgan, of Clarksburg, on the "Abuse 
of Ergot in Obstetric Practice." Dr. G. H. Car- 
penter, of Moorefield, discusses " Insanity as a Dis- 
ease," and urges the general practitioner to study 
this subject with greater care, and not to leave it so 
much in the hands of specialists. If this were done 
asylums might not be so well filled, and, at the 
same time, there would be fewer insane persons in 
the community. " Puerperal Fever and Its Treat- 
'' ment by Intra-Uterine Antiseptic Irrigation," is ably 
considered by Dr. S. L. Jepson, of Wheeling. He 
has carefully culled the opinions of the best authorities 
on the subject, and presents the matter clearly and 
logically for consideration by the reader. The two 
last papers are " Report of a Case of Intra-Peritoneal 
Haematocele," by Dr. R. W. Hall, of Mannington, 



1883.] 



REVIEWS. 



127 



and a " Record of Some Anomalous Obstetrical 
cases," by Dr. C. F. Ulrich, of Wheeling. 



Bacteria and the 6erm Theory of Disease ; by 

Dr. H. Cradle. Chicago: W. T. Keener; 1883. 

This volume comprises eight lectures delivered at 
the Chicago Medical College by Dr. Cradle, Profes- 
sor of Physiology in that institution. 

In this work it was evidently the writer's aim to 
present a clear and concise statement of the facts 
which have been established concerning the genn 
theory of disease ; and not only this, but also to de- 
scribe the methods which have been employed by the 
principal investigators in the elucidation of the mani- 
fold mysteries in which this interesting and impor- 
tant subject is involved. By succeeding in these re- 
gards, as he certainly ha^ done, he has given his 
readers a volume replete with interest, and has en- 
abled them to judge for themselves of the reliability 
■of the testimony which has been advanced for the 
substantiation of the theory. 

The subject is systematically and thoroughly dealt 
with from beginning to end, but, while criticism is 
freely employed, it is, nevertheless, so fairly done and 
is so free from all personality, that the writer cannot 
be accused of undue prejudice, although it is clearly 
■evident that he is inclined to adopt the most advanced 
views with regard to the etiology of the diseases 
which are discussed. 

The reader's attention is first directed to the uni- 
versality of microscopic parasites and their relation to 
putrefaction and fermentation, the accomplishment of 
which is regarded as the life work of living beings. 
In the second lecture the microscopic examination of 
bacteria is fully considered, and their structure, 
habits, and modes of reproduction are described. 
The third lecture is occupied with further considera- 
tions of bacterial life, and a discussion of the 
agencies which are at work in nature for the accomp- 
lishment of their destruction. Lecture four consid- 
ers bacteria with reference to their relations to the 
animal body, both in health and disease, and dis- 
cusses the results of protective vaccination against 
chicken-cholera and charbon. The fifth, sixth and 
seventh lectures treat of the relations of bacteria to 
each of the several constitutional diseases with which 
they have been regarded as causatively associated. 

With regard to tuberculosis, the author takes the 
ground that the presence of characteristic tubercle 
bacilli in the sputum is one of the most constant signs 
of the disease, for the bacilli can be found, as he as- 
serts, in the sputum of at least 90 per cent, of phthis- 
ical patients. The author himself, who is an enthus- 
iastic investigator, and has given much careful atten- 
tion to the examination of bacteria, found the bacilli 
in 35 consecutive cases of tubercular patients. He 
admits that the tubercle bacilli are not always to be 
found, but asserts that no one has as yet been able to 
show that the disease can ever exist without the pres- 
ence of the bacillus tuberculosis 

In this connection mention is made of Spina's ex- I 
periments, which have recently been published as a [ 
complete refutation of Koch's work. To meet these 
objections to Koch's theories, the latter is quoted to the 1 



effect that Spina's experiments show a lack of skill and 
familiarity with the projjer methods of investigation, 
while his results are substantiated merely by the effects 
produced by the inoculation of two rabbits, Koch's 
assertions, on the other hand, being based on the results 
of researches involving over two hundred animals of 
various kinds. 

The final lecture is devoted to a consideration of 
the local diseases which may be regarded as of bac- 
terial origin. 

Taken as a whole, this is a work which redounds 
greatly to the writer's credit. No extreme grounds 
are taken, but the evidence is carefully epitomized 
and candidly placed before the reader. To those who 
are unfamiliar with the amount of painstaking labor 
required by the men who make it their work to in- 
vestigate this most difficult subject ; it will come as a 
pleasing revelation, while by that more numerous 
class which has long been more or less acquainted 
with the results of microscopic investigation, it will be 
welcomed as a highly interesting summary of all that 
has been accomplished in this direction up to the 
present day. 

Alcohol as A Food, A Medicine, A Poison, and 
as a Luxury, by Ceorge D. Pitzer, m.d., of St. 
Louis. This is a pamphlet of sixty-one pages, written 
in any easy and readable style, well adapted for pop- 
ular use. The more important views of the author 
regarding the effects of alcohol and its uses may be 
gathered from the following quotations from the clos- 
ing paragraph of the essay: "It (alcohol) is not, nor 
can it be, a substitute for food. But is a poison 
greatly to be dreaded, and can be used as a medicine 
only in skillful hands, and then, in many cases where 
it is still used, other drugs recently introduced are 
far more effective, besides a great deal safer. It has 
no power to avert disease when taken as a beverage 
in health, but on the contrary, it renders people more 
liable to be attacked, and its continued use greatly 
reduces their power of endurance, and they are not 
nearly so able to resist disease when it comes. ' ' 



Electricity in Medicine and Surgery, by Ceo. 
C. Pitzer, m.d. The author of this little book is a 
professor in an eclectic medical college of St. Louis ; 
but that need be no reason why his book, if a good 
one, should not be read. The first part is occu- 
pied with simple descriptions of electrical machines. 
The rest is a brief consideration of electro-therapeu- 
tics. Many extended quotations are made from good 
authors, and a few cases are detailed by the author in 
illustration of the good and negative results of treat- 
ment by electricity. From the work one could not 
get a thorough nor a very satisfactory knowledge of 
the subject, although, by its guidance, he might use 
electricity in his practice with success. 



BOOKS AND PAMPHLETS RECEIVED. 



The Hydatiform Mole, by J. P. Miller, m.d., (Re- 
print). 

The Electric Light in Surgical Diagnosis, by Ros- 
well Park, m.d., (Reprint). 



128 



NECROLOGY. 



[August, 1883. 



Report of the Health' Officer of the District of Col- 
umbia for 1882. 

Berichte des Naturwissenschaftlich-Medicinischen- 
Vereins in Innsbruck, XI Jahrgang i88o-'8i. 

Perinaphric Abscesses, Roberts {irom American Jour, 
nal of Medical Sciences), April, 1883). 

Double Synchronous Amputation of Lower Extremi- 
ties in Five Cases of Railroad Crush. By E. H. 
Woolsey. (From Transactions of State Medical So- 
ciety of California, 1883.) 

Therapeutic Value of Cephalic and Spinal Electriza- 
tion. By C. H. Hughes. 

A Physical Analysis of a Legally Sane Character. By 
C. H. Hughes. 

The Simulation of Insanity by the Insane. By C. H. 
Hughes. (From Alienist and Neurologist, 1883.) 

Proceedings of the Eighth Annual Session of the South- 
ern Illinois Medical Association, 1883. 



MISCELLANEOUS. 



The first annual supper of the Chicago Dental In- 
firmary occurred at the infirmary, Nos. 22 and 24 
East Adams street, July 3 1 . The infirmary has been 
open a year and is doing excellent work. The offi- 
cers are : James A. Swasey, President ; A. W. Har- 
lan, D.D.S., Vice President; Eugene S. Talbot, m.d., 
D.D.S., Recording Secretary; Truman W. Brophy, 
M.D.,D.D.s., Corresponding Secretary; Edgar D. 
Swain, d.d.s.. Treasurer. 

The institution is incoporated under a general law 
of the State of Illinois, and is authorized to give in- 
struction in the specialty of dental surgery. It is 
empowered also, to confer the degree of Doctor of 
Dental Surgery. This degree will be conferred only 
upon persons holding a degree in medicine from col- 
leges recognized by the Illinois State Board of Health. 
Matriculates intending to take the degree of doctor 
of dental surgery must hold a degree in medicine or be 
pursuing studies to that end in some reputable medi- 
cal college. 

It is the hope of the founders of this institution, 
that in time all dentists will be graduates in medicine 
as well as skilled in their specialty. The Infirmary 
affords clinical advantages for the study of dentistry, 
while it is expected that at the same time its students 
will attend some one of the regular medical colleges 
of this city. 

Dr. Brown-Sequard, on account of his labors in 
physiology, has been awarded by the Royal College 
of Physicians, the gold medal which was founded in 
memory of Dr. Baly. 



NECROLOGICAL. 



McDowell,George Montgomery, M,D., of Barnes- 
ville, Georgia, was born in Pike county, Georgia, 
July 26, 1834, died at his residence, July 22, 1883. 
He was the son of Charles and" Elizabeth Heard 
(Grain) McDowell. His education was derived from 
private tutors and at the Pike Academy. His medi- 
cal degree was conferred after due attendance on lec- 



tures at the Jefferson Medical College in Philadel- 
phia, in 1855. The same year he began practice in 
Barnesville, but in 1857 removed to his plantation. 
In i860 he resumed general practice. The war be- 
tween the States breaking out, he raised a company 
in the 4th Georgia Battalion, which he commanded 
as Captain, and in which position he was both popu- 
lar and brave. But the demands were so general for 
his medical services by all who knew him, that he was 
induced by General Bates to give up his command and 
accept the commission of Chief Surgeon of his di- 
vision, which position he held until near the close of 
the war, when he was promoted to Medical Director 
of the Western Army. Dr. McDowell was a mem- 
ber of the Middle Georgia Medical Association, of 
which he was Vice-President in 1874, and President 
in 1875. Also, he was a member of the Georgia 
Medical Association, and of which he was President 
in 1 87 1 and 1872, and a member of the American 
Medical Association in 1879. He was active and 
influential in the organization of the State Board of 
Health, which was organized in 1874. In 1855, 
Dr. McDowell was united in marriage to Sophrona 
L. Mays, of Barnesville. His wife and five children 
survive him. He was a member of the Knights of 
Honor, Royal Arcanum and A. O. U. W., which 
secures :o his family about ^7,000. The busi- 
ness houses- in Barnesville were closed until 12 
o'clock on the morning of his funeral, and almost the 
whole population joined in the service and cortege 
to the Methodist cemetery. j. m. t. 

Newman, S. T., born in Mississippi, November 
30, 18 1 6, died suddenly of apoplexy at his resi- 
dence in St. Louis, Mo.. July 15, 1883. While a 
child his parents removed to Kentucky, and he re- 
ceived his education at Augusta College. His medi- 
cal degree was received from the Transylvania Univer- 
sity at Louisville in 1839. He began practice at 
Amsterdam, Miss., where he resided five years, when, 
on account of his health, he removed to Richmond, 
Ky., where he remained till 1856, when he was 
induced to take up his residence in St. Louis. Here 
in his new field he acquired a large and responsible 
practice, and was popular both Avith the public and 
the profession. He was a member of the St. Louis 
Medical Society, and its President in i860. A 
member of the American Medical Association 
in 1873. J- ^- '^• 

Warder. John A., m.d., born in Philadelphia., 
1 813, died of paralysis at his residence in North 
Bend, Ohio, July 14, 1883. He was a graduate in 
medicine in the Jefferson Medical College, Philadel- 
phia, in 1836. Before graduating in medicine he 
had removed to Ohio. For years he held the Chair 
of Chemistry in the Ohio Medical College. He was 
a prominent member of the American Forestry Con- 
gress, and was a writer of note — author of " Hedge 
Manual," 1858; "American Pomology," 1867; 
edited Botanical Magazine and Horticultural 
Review, and hass contributed largely to periodical 
literature. A member of the Ohio State Medical 
Society, and, by invitation, a member of the Ameri- 
can Medical Association in 1867. j. m. t. 



— 'i& T 131 E ''Si' — 



Journal of the American Medical Association. 

PUBLISHED WEEKLY. 



Vol. I. 



Saturday, August ii, 1883. 



No. 5. 



ORIGINAL ARTICLES. 



ADDRESS OF THE CHAIRMAN OF THE SECTIO N 
ON SURGERY AND ANATOMY-READ TO THE 
MEETING OF THE AMERICAN MEDI- 
CAL ASSOCIATION, JUNE, 
1883. 



BY W. F. PECK, M.D., OF UNIVERSITY OF IOWA. 



In performing the duties of Chairman of the Surgi- 
cal Section, it is not deemed practicable to encom- 
pass all that the organic law of the Association may 
contemplate. For, in reporting upon the progress 
made in surgical science, it is recognized that many 
theories are, at present, announced as facts, which, 
when experience and demonstration shall have 
thoroughly tested them, may be eliminated, to per- 
haps reappear when the cycle of professional experi- 
ence again completes its revolution. 

The greatest progress has been made in operative 
surgery, although other departments have been con- 
stantly receiving new light and attaining results 
that add to our already extensive accumulations. It is 
not claimed that large numbers of new operations 
have been originated and j)erformed, but it is evi- 
dent, that the better understanding of pathological 
conditions, has stimulated surgeons to establish a 
standard for operations hitherto ventured upon in 
rare and extreme instances only. 

In pathology the microscopist has been active in 
trying to define and locate the germ cause of dis- 
ease. 

Since Cohnheim gave to the profession, in a com- 
plete and formulated manner, the character and im- 
portance of the colorless corpuscle in pathological 
changes, strenuous efforts have been put forth by 
Pasteur, Koch and others to unfold the importance 
of the bacterian germ which, according to the dem- 
onstrations of Oliver, Richet and Mitrophanow, have 
a normal existence in the blood, lymph and tissues 
of the body. 

Burdon-Sanderson, Chauveau, Watson, Cheyne, 
Billroth and many others have adduced much in- 
formation which certainly can not do otherwise 
than benefit, even though a great modification of 
the bacterian theory is made necessary. 

Certain it is that during the year, there has been 
developed a strong feeling in favor of Koch's views 
concerning the bacilli and their alleged tubercular 



relations. That these peculiar micro-germs exist 
there can be no longer any doubt. 

But whether they are the cause of the tubercle, or 
whether the tubercle develops fhem, the profession 
has noz made sufficient progress as yet to justify an 
unequivocal statement. 

In Austria there is, existing under the leadership 
of Koch, a strong belief in favor of the bacilli being 
the cause of the deposit ; while in Prussia, Spina 
leads the opinion that the bacilli are produced by 
the tubercle or the associated conditions which orig- 
inate the tubercular matter. 

If the following statement of Spina be true, then 
there is much uncertainty surrounding the whole 
theory of bacilli being the cause of tubercle. 

"I have examined about 150 mensenteric and 
omental tubercles in the most various stages of their 
development according to Koch's and Ehrlich's 
method, and found bacilli in /wf one case." 

The surgeon is much interested in these investiga- 
tions, because of the important statements made by 
eminent teachers concerning the origin and nature of 
some forms of articular disease, also the peculiar de- 
generation which takes place in bone and glandular 
structures. The interest does not stop with these tis- 
sues; for underneath it all the " germ theory," which 
is thought by many excellent men to be the greatest 
of all causes in engendering infections, inflammations, 
pyaemia, septicaemia, abscess, gangrene, etc., receives 
a support which, if conceded, will tend to give new 
and more efficient reasons for the use of antisepticism 
in practice. Now that so many able and relentless 
workers are seeking information, which promises 
greater accuracy, it may be well not to claim too 
much for remedies which are given with the expecta- 
tion that they shall- ultimately reach the habitation of 
the noxious germ, and there hold mortal combat and 
win a victory for further life in tissue which is threat- 
ened with decay and death. 

It cannot be admitted that practical surgery has 
thus far been directly benefited by Koch's views. 

The condition of the problem of the management 
of wounds and other pathological processes by means 
of the so-called antiseptic methods, suggests a move 
in the direction of greater confidence in the details 
of op>erative procedure and scrutinizing attention in 
extreme cleanliness in the minutae of practice. 

It is difficult, in fact, impossible, to state with pre- 
cision the exact deviation in the direction of, for or 
against the treatment of wounds by the different 
chemical agents during the past year. With many 
the custom is to believe that antiseptic practice in 



130 



ADDRESS OF DR. W. F. PECK. 



[August, 



surgery means the application of carbolic acid in some 
form of attenuation to the cut or exposed suppurating 
surface. 

Different surgeons have used different substances, 
but according to the experiments of Dr. A. T. Cabot, 
of Boston, upon detached dead tissue, it tvas found 
that carboHc acid acted more promptly than any other 
agent in arresting putrefaction and destroying micro- 
organisms connected with the changes of decomposi- 
tion. 

Within the year the antiseptic methods of wound 
manipulation have been regarded as embracing the 
spray, fixed and intimate relations of fresh surfaces, 
rest, pure air surroundings, and, when practicable, 
drainage. 

It was stated by Thornton that the principal danger 
which surrounded the opening of the abdomen was 
from the action of the vicious bacteria. And Spencer 
Wells' unprecedented(?) experience in ovariotomy is 
referred to by Marcy as furnishing almost incontro- 
vertible evidence in favor of the antiseptic practice. 

In this connection the experience of Mr. Lawson 
Tait, where he reports 100 successful ovariotomies with 
but three deaths (none of the antiseptic precautions 
having been regarded), should also be remembered 
by those who can only see progress and success in 
treating wounds on the anti-germ plan. 

Certainly the new experience of Billroth and Es- 
march is commendable, and should be gratifying to 
those eminent operators. But it cannot be success- 
fully argued that the lessened mortality was alone due 
to the use of antisepticism, as practiced by Lister. 
It will be immediately asked, how else can these al- 
leged great changes in practice be explained ? 

If everything that is used to keep a wound clean, 
and to ensure thorough drainage, is called antiseptic 
practice, then no adequate explanation can be of- 
fered. 

Is not the experience of Mr. Keith as wonderful as 
the tabulations of the Vienna and Keil surgeons? 

The experience of the English surgeons, on duty 
with the British troops in Africa during the Zulu and 
Transvaal wars, was such that the antiseptic manage- 
ment of wounds was commented upon with but little 
favor after the records of those campaigns were final- 
ly submitted. 

The rather short campaign in Egypt was character- 
ized by great dissatisfaction in the beginning of the 
war. But after the surgical management had become 
thoroughly organized and freed froni abuses, observa- 
tions were made by good men who had only good re- 
ports to make of the antiseptic practice, which was 
very generally employed. 

While it is admitted that most of the leading sur- 
geons of England are thoroughly wedded to the prac- 
tice of antiseptic treatment of wounds, there are to 
be found not a few excellent teachers and operators, 
who most reverently believe that nature, under wise 
assistance from the surgeon, will do more to save 
limb and life than the surgeon can do, who depends 
upon restricted antisepticism. The writer has opened 
the abdomen, in all, forty-eight times. In forty-six 
instances for the removal of ovarian growths, once 
for an adherent ovary and once for an intestinal ob-. 



struction. In the first fifteen cases there were six 
deaths. The operations were made under the spray 
and the wounds were treated with a carbolic acid so- 
lution. In the remaining thirty-one ovarian opera- 
tions, also in the oophorectomy, and in the case of 
laparotomy, the spray was not employed. The last 
two mentioned cases recovered, and out of the ovari- 
otomies there were four deaths. Has it occurred to 
those who are strong in their advocacy of the anti- 
septic treatment of wounds that in the United States 
there are in active practice among the 52,000,000 of 
inhabitants, about 86,000 medical men, a very large 
number of whom are treating wounds and patholog- 
ical lesions ? Also that many of the wonderful re- 
sults accomplished by these numerous surgeons are 
wrought, not by means of the spray and carbolic 
acid, but by the extraordinary care and attention 
which are given their cases. 

Those who write for the periodicals and report re- 
sults in practice are very few, unfortunately. The 
major operations are being performed in many appar- 
ently out-of-the way places, and results are being 
achieved which would receive the encomiums of the 
renowned in our ranks, did they but know where, and 
upon whom, to bestow them. It is apparent that the 
" lost art" of blood-letting, in the treatment of in- 
flammation, is being reclaimed, and its induction to 
a legitimate position among other remedies of con- 
ceded value is fast taking place. 

Besides reasons derived from clinical experience. 
Dr. Nancrede, of Philadelphia, has observed and 
demonstrated that an accumulation of the oxygen- 
carriers in the beginning of inflammation overloads 
the parts with oxygen, which stimulates unusual amoe- 
boid action of the colorless corpuscles, thus favoring 
cell migration. The lymph spaces, through which 
excessive accumulations of liquor sanguinis is directly 
returned to the blood, become blocked, and as a re- 
sult cell proliferation and stasis takes place. Cell 
nutrition is prevented. Direct withdrawal of blood, 
when performed sufficiently early, unstops the lymph 
spaces, unloads the oxygen, and re-establishes a cir- 
culation, which can carry on physiological nutrition. 

Among the many new and important instruments 
which have been presented may be mentioned the 
universal or compound racket joint which has been 
offered by Dr. Stillman, and which can be adjusted 
at pleasure, and permitting of universal motion. 
Perhaps one of the most important steps that has been 
taken, is the utilization of the electric light, both as 
a means of diagnosis and as an aid in making opera- 
tions in cavities and places where natural light can be 
used with uncertain effect. 

The instruments invented by Leiter, of Vienna, 
and Dr. Nitzel, of Dresden, some of which have been 
well described by Dr. Roswell Park, are well calcu- 
lated to assist in causing much progress in the next 
decade. 

Dr. Thomas Oliver opened an abscess of the liver, 
and then placed the electric light within the cavity, 
thus defining with great certainty and satisfaction the 
size of the cavity and the thinness of the abscess 
wall, on which he states he saw " a greyish red con- 
dition of the wall of the cyst, studded across which 



1883.] 



ADDRESS OF DR. W. F. PECK. 



131 



were numerous yellow-white spots, evidently pus. A 
slight oozing or sweating was also noticed on the wall 
of this cavity." For the attainment of this remark- 
able achievement he employed Swain's lamp, which 
in size is no larger than an ordinary bean. The in- 
terior of the bladder, pharynx, larynx, oesophagus, 
stomach, and ear have been illuminated, thus sug- 
gesting the possibilities in waiting for experimental 
art. 

Prof. Graham Bell has repeated his experiments 
with the induction balance, and has made decided 
progress in locating metallic substances in the tissues 
of the body. Not only has he utilized the electric 
current to locate the lead, but he has demonstrated 
the possibility of determining the distance of the 
substance from the surface. 

His reports are very interesting, aiid for a full de- 
scription of his ingenious instruments they must be 
examined. 

In the direction of exploration and diagnosis of 
intra-vesical pathology, Sir Henry Thompson has 
offered some very valuable information. He makes 
a " limited incision " in the membranous portion of 
the urethra, and with the index .finger passes along 
the track of the separated urethra to and through the 
neck into the bladder, where, by the aid of supra- 
pubic pressure, a free and satisfactory exploration of 
the cavity and walls is permitted. 

This method he has employed in thirteen cases, 
and has removed five tumors, the location and nat- 
ure of which could not have been so well determined 
in any other manner. He also reports a case in a 
female, where he, by dilating the urethra, succeeded 
in diagnosing and removing a polypoid growth. 

The year has greatly added to our previous meagre 
knowledge of surgical procedure in intra-abdominal 
f)athology. 

The statistics furnished, by reason of abdominal 
sections, are becoming increasingly valuable, because 
they show that less hazard is encountered in attempt- 
ing to extirpate tumors, malignant growths, and in re- 
moving the causes of intestinal obstructions than was 
formerly supposed. The operation for removing 
a portion of the stomach or its duodenal connection 
may be said to have been legitimized by the experi- 
ence, much of which has been furnished by the sur- 
geons of continental Europe, since our last session. 

It is not intended to convey the meaning that 
gastrotomy is an operation of very recent origin, but 
rather to state that the feasibility of its commendable 
performance has been mainly proven by the experi- 
ence collected during the interregnum of the Associa- 
tion. 

Dr. Troquart states that there have been performed 
in all, since 1879, so far as public announcement has 
been made, twenty-nine pylorectomies and gastro- 
tomies, thirteen of the operations having been made 
before January, 1882, and during that year. 

Up to January, 1883, there have been performed 
seven additional operations, making in all thirty-six 
operations for the removal of some portion of the 
stomach or duodenum for cancer, gastric ulcers, in- 
flammation arid destruction of colon. 

Three of the operations were for ulcers, and the 



remaining thirty-three were supposed malignant de- 
posits. 

From the information within reach, there were 
four recoveries, all of the remaining cases dying 
within ten days, except one case (Billroth's), which 
died at four months. Unless the greatest discretion 
is shown in the selection of cases for operation, the 
mortality can not be otherwise than very high. 

No less an authority than Billroth states that not 
more than one case out of fifty is suitable for opera- 
tive interference. Evidently his opinion has a good 
retrospective support, when the statistics of Gussen- 
bauer and Van Winiwarter are considered. They 
state that after having examined 903 cases of cancer 
of the stomach in the Pathological Institute in Vi- 
enna, that there were 542 cancers of the pylorus, 370 
of which had adhesions of greater or less extent to 
the contiguous organs. 

Thus far the majority of the operators prefer to 
reach the pylorus by making an incision in the 
median line. There are two very important ques- 
tions to be answered in connection with this operation. 

First. If the cancer, for which nearly all the op- 
erations are performed, is due to a general cause, can 
the surgeon expect the patient to receive other than 
temporary relief from the operation ? 

Second. Will the aggregate life in those cases, 
when the operation is successfiil, be greater than it 
would be in those cases who die as a direct result of 
the operation? 

The history of recurrence of cancer of the stomach 
is yet to be studied in its relation to removal by op- 
eration. But it is hoped, that a justification of the 
ojjeration will only be based upon an experience that 
the average pathological life is longer with the opera- 
tion than without it. 

Laparotomy is an operation which is progressing 
with much favor in America and France. Since 
ovariotomy, with its many complications and risks, 
is becoming rather common, the opening of the 
abdomen to relieve intestinal obstruction, the result 
of temporary misplacement of the bowel, or from the 
abnormal location of the products of inflammation, 
is not only inviting, but operators, who have had ex- 
perience in making ventral sections, proceed with 
less hesitation to search within the abdomen for 
arrested alimentary action. 

As experience increases it will no doubt be shown 
that the tissues involving the coecum and its contig- 
uous relations are much oftener the seat of morbid 
changes, resulting in unabsorbed deposits, than is 
ordinarily supposed. In fact the lymph exudation 
and fibrinous adhesions — the result, perhaps, of an 
unrecognized local inflammation — may serve, in an 
indirect manner, to not only impair nutrition but 
directly imperil the life of the organ and possibly 
that of the body. 

The physician explains that the costal and pul- 
monic surfaces of the pleura may be adhered to each 
other and, in this way, unfavorably affect the fimc- 
tions of respiration. The same statement may be 
occasionally given of an allied pathological condition 
existing within the abdominal cavity, and particularly 
near the ilio-ccecal region. 



132 



ADDRESS OF DR. W. F. PECK. 



[August, 



The following cases have an important bearing 
upon the foregoing allusions : 

Ole Johnson, male, set. 24, single, Norwegian, 
country merchant. He resided on a farm until 1874, 
since which time he has been occupied in a general 
store. His physique was slight, and general health 
only fair. In 1869 he had an attack of typhoid 
fever, but recovered with about the same average 
health. On May 24, 1882, he complained of feeling 
unwell, experiencing slight pains in the abdomen, 
with a sensation of nausea. 

In the morning of the same day there occurred a 
profuse spontaneous action from the bowels. On the 
early morning of May 31 the pain sent him from his 
bed at 4 o'clock. He walked the floor, occasionally 
vomiting, but could not obtain relief by taking " hot 
drops" and brandy, domestic remedies which were 
near at hand. So at 8 a.m. Dr. Fitzgerald, of Grand 
Mound, was called, and observed anxious counte- 
nance, more or less pain, though not severe, temper- 
ature 99 deg., pulse 100 and rather weak, frequent 
efforts at vomiting, which act occasionally succeeded 
in producing a ropy mucus. He gave a hypoder- 
mic injection,, of morphine, which relieved the pain 
for a short time, and influenced a kind of restless 
sleep for only one hour, when the same treatment was 
resorted to again. Efforts were made to evacuate the 
bowels by injections, but without success. A long 
tube extending to the transverse colon was used, but 
the fluid did not bring away fecal matter. Cathartic 
medicines were moderately administered, but no 
movement could be obtained. On May 29 the pa- 
tient's symptoms continued much the same, there be- 
ing pain in hypogastrium, with slight tympanitis, 
pulse no, soft and rather weak; stomach restive, 
with occasional efforts at vomiting, countenance and 
surface indicating decided nervous depression. Tem- 
perature not taken. Nothing passed the bowels. 

Morphine continued as before. May 30 condition 
unchanged, except that systemic depression was be- 
coming still more marked. On May 31 the patient 
showed decided prostration ; eyes lusterless and of 
sloA^ movement, stomach restless and occasional hic- 
coughing, pulse 120 and weak, temperature 100 deg., 
respiration 24, abdomen slightly tympanitic, but 7iot 
particularly sensitive upon pressure ; bowels unmoved. 

Consultation recommended opening the abdomen 
to ascertain the cause of the obstruction, with a fur- 
ther view of dislodging it if possible. Accordingly 
at 6 P.M., by means of kerosene light, the operation 
was made by making an incision in the median line, 
from one inch below the umbilicus to within one inch 
of the pubis, and thus entering the abdomen. A 
considerable portion of the colon and small intes- 
tines were removed, when nothing unnatural was 
found. I passed my right hand down to the region 
of the right iliac fossa, where I found a portion of 
the ileum imprisoned, and not at all tractable. Upon 
more close and minute inspection I discovered that 
the appendix vermiformis had, at its coecal extremity, 
become adhered, and was very firmly attached to the 
fascia and tissues covering the last lumbar vertebra 
on its right lateral body. A portion of the ileum had 
passed under this adherent appendix and ascended on 



both sides, so that the vermiformis acted as a stricture, 
preventing the passage of the contents of the bowels. 
The peritoneum and peritoneal surface of the ileum 
gave but little evidence of inflammation. The ap- 
pendix could not be separated from its vertebral loca- 
tion without running a risk of making more or less 
of a lacerated surface of the adherent tissues, so I 
with common silk passed two ligatures around the 
appendix, one each side of the centre, and then 
divided it. From the free ends I expressed in 
amount from ten to twenty drops of soft pultaceous 
material, after which the parts were carefully sponged 
and the intestines and abdominal cavity well cleaned, 
and the opposing surfaces of the wound were brought 
together with great difficulty, on account of the lat- 
eral retraction of the thin tissues. 

The parts were maintained in position by means 
of silver wire sutures, the abdominal walls being too 
short for the use of ovariotomy pins and superficial 
sutures of silk. Over the wound was placed absorb- 
ent cotton and a bandage. The subsequent treat- 
ment consisted of milk and undisturbed dressings. 
The pain required but little morphine. The bowels 
moved spontaneously in 73 hours after the operation. 
Sutures removed in twelve days, and on the 20th of 
June he rode 12 miles in a buggy, considering him- 
self w^//. The patient's health has been much bet- 
ter since the operation than it ever was before, and 
he has gained largely in flesh, weighing 1 20 pounds 
before operation, now weighs 135 pounds, and looks 
florid and healthy. The appendix must have been 
thus abnormally placed in childhood, or maybe when 
he had typhoid fever. 

Still further illustrative of progressive abdominal 
surgery may be cited a case similar to the above, 
being operated upon and published by Leon LeFort, 
of France : 

In June, 1882, he was called to see a young man 
18 years of age, who in the evening of May 25, 
1882, was seized in the abdomen with severe pain, 
and about midnight the pain became more like colic, 
for which Dr. Tachard gave laudanum and belladonna, 
together with the application of hot poultices, some 
relief therefrom being received. The succeeding 
day (May 26), the pain increased, and accompany- 
ing it there was special sensitiveness of the abdomen, 
also some tympanitis. Castor oil was given but was 
immediately vomited, no evacuation of the bowels 
could be encouraged, but vomiting and retching be- 
came incessant. 

There existed a small left inguinal hernia, which 
played no part, however, in the case; it being re- 
turnable at pleasure and without difficulty. It also 
appeared that three years before there existed perito- 
neal inflammation. No relief being received from 
the different kinds of treatment employed, and on 
June I decided typhoid symptoms — such as are seen 
immediately preceding dissolution — appearing, an in- 
cision about fifteen centimeters in length was made 
from just above the pubis to near the umbilicus. The 
intestines bubbled out and were carefully examined, 
coil by coil, and then returned. Upon meeting with 
slight resistance when making traction upon a portion 
of the ileum, the hand was passed along the bowel to 



1883.-] 



ADDRESS OF DR. W. F. PECK. 



133 



the right iliac region, where he found a constricting 
ring or band of fibrous tissue, which was thick, 
formed of organized adhesions and encircling the ; 
small intestines for a distance of five centimeters 
from the ccecum. The width of the band was five 
millimeters. The constriction was divided by means 
of scissors and the intestines liberated. There were 
some evidences of congestion, but no decided inflam- 
mation, the life of the tissues not having been com- 
promised. 

The parts were thoroughly cleansed and returned, 
and seven deep silver wire sutures were passed through 
the tissues and fastened on the opposite side by a 
bougie. Superficial sutures were employed to coapt 
the surface edges. In the night of June i the pa- 
tient had a spontaneous evacuation from the bowels. 

On the seventh day the patient subjected the abdo- 
men to undue exertion, when the superficial sutures 
gave way ; they were replaced, and thereafter uninter- 
rupted recovery followed. On July i he was well. , 
General management of the operation was unantisep- 
tic. Health seven months after operation much bet- 
ter than previous health, also loss of inguinal hernia. 

Prof. Pietro Loreta, of Bologna, has performed a 
new operation upon the stomach for stenosis of the 
pylorus — a result of unmalignant ulcerative inflam- 
mation. The operation has in view the stretching of 
the constricted portion by the fingers. The number 
of operations thus far performed are four, with two 
recoveries. The steps of the operation, as reported 
by Dr. Harris, are to reach the stomach, and then, 
mid-way between its two curvatures, make an incision 
through the wall, beginning one and one-fourth 
inches from the pylorus, extending two and three- ; 
eighths inches toward the cardiac end. The index ' 
finger of one hand is then introduced within the 
cavity and carried within the stricture. The corre- 
sponding finger of the other hand follows the finger 
already introduced and is caused to pass through the 
orifice, the dorsal surface of each finger being in 
opposition ; the stricture is then stretched. The 
serous surfaces of the stomach are then united by 
continuous sutures, thus slightly inverting towards 
the cavity the edges of the wound. 

We understand that such an adaptation of the 
wound precludes the possible escape of the contents 
of the stomach. It will be at once conceded that a 
critical study of the history of any given case must 
result in an unequivocal diagnosis, which, when 
made, may finally necessitate a pylorectomy for car- 
cinomatous deposit. ; 

Future reports of this operation will be looked for 
with great interest. While your attention is upon 
the operative part of abdominal surgery, I wish to 
ask you to consider at least one of the causes of , 
fatality. It sometimes happens that when no satis- 
factory clinical reason exists for an untoward result, ' 
the patient unexpectedly and rather suddenly dies. 
Not a few explanations, such as shock, acute septi- | 
caemia, etc., have been offered, but I feel assured '■ 
that neither the direct nor ultimate cause is always | 
found in these assumptions. The following case is [ 
both interesting and illustrative: B. J., set. 19, 
single, native of Iowa. In 1880 there began to de- ! 



velop in the right iliac fossa a tumor, which, in the 
early part of January, 1883, I diagnosed as being a 
multi-locular ovarian cyst. On February 23 I op- 
erated in the usual manner and removed a multi-cyst, 
weighing, approximately, twenty-five pounds. Each 
vessel of the broad jjedicle was separately tied and 
the membraneous surfaces brought together and sewed 
over the vessels thus secured. The abdominal cavity 
and external wound treated in the customary man- 
ner. She recovered well from the depression of the 
operation. The temperature was 99, pulse 102; she 
complained of wanting more air, desiring the win- 
dows raised. At 7:30 P.M., pulse 102, temperature 
100^ degrees. Same feeling about insufficiency of 
air, and spasmodic breathing unabated; 10 p.m., 
pulse 106 and full, temperature loi degrees. 

Quite restless, and wanted something done for her 
breathing, although the windows were well op)en. 
Some tenderness in left iliac. Aq. ext. opi. supposi- 
tory I gr. given. 

February 24 — Restless night, symptoms of difficult 
breathing continued. 7 a.m., pulse 124, weak; tem- 
perature 103}^°. 12 M., pulse 140, weak and small; 
temperature 103 1-5°. 4 p.m., pulse 140, weak and 
small; temperature 102^°. Died at 5 a.m., Febru- 
ary 25. 

Throughout the case unrelenting efforts were exer- 
cised to maintain the strength by both oral and rec- 
tal alimentation. 

Post-mortem examination made nine hours after 
death. The seat of operation was found in a perfect- 
ly satisfactory condition — no foreign material of any 
kind was discovered inside of the abdominal cavity. 
All of the organs were healthy, with one exception, 
viz., in the right ventricle of the heart there was a 
large, white fibrinous (ante-mortem) clot. The ques- 
tion raised by this case may be the means of intro- 
ducing an interesting subject for discussion in the 
Section. What was the cause of the blood clot? 
What influence permitted the separation of the 
fibrine from the other constituents of the blood ? 

The kidneys were not examined before the opera- 
tion. Had they been interrogated, and had albumen 
or casts been found, I do not feel inclined to admit 
that such discoveries would have necessarily deterred 
me from making the operation. At present the at- 
tention of the profession is being particularly called 
to the kidneys in relation to operative surgery, and 
doubtless there is ample room for a profitable inter- 
change of opinions and experience. 

To what extent defective organic action, associat- 
ed with anaesthesia, is due to the insufficient vitality of 
the blood, careful future observation only can deter- 
mine. It is not enough to say that, in any given 
case, death occurred as a result of fibrine collection 
on and around one or more of the heart valves. 

There must be a further cause which influences the 
dyscrasial condition of the blood. Some very inter- 
esting observations have been made by M. Segond, 
concerning the blood-vessels, blood supply and nu- 
trition in limbs upon which amputations have been 
performed. His statements are somewhat at variance 
with the opinion hitherto recognized as conceded, 
since his demonstrations have shown that the diminu- 



134 



ADDRESS OF DR. W. F. PECK. 



[August, 



tion in the size of vessels does not cease when they 
reach the first important division, but go on decreas- 
ing in size and calibre in the entire limb and beyond 
toward the primal distribution. Coincident with 
this atrophic change all of the tissues, including nerves, 
bone and lymphatic glands decrease in size and 
weight, and correspondingly there is lessened function. 
It was also shown by M. Poncet that in a case of am- 
putation of the leg the femoral artery was, within a pe- 
period of ten days, markedly diminished in size. It was 
not, however, observed that the walls of the vessels 
showed any shrinkage. Whether or not these impor- 
tant changes have their beginning in the blood, heart 
or cerebrum, remains to be determined. 

Dr. David Newman, of Glasgow, has performed 
the operation of nephoraphy, it being the first oper- 
ation made in England, upon a woman for floating 
kidney. The renal capsule was stitched to the mar- 
gins of the incision, and deep button sutures were 
passed through the kidney substance, thus fixing the 
organ in its natural position. The patient recovered 
and is now well. 

Dr. William Thompson, of Dublin, has added an- 
other case of ligature of the innominate artery, the 
patient living 42 days. 

It will be observed that but three of the recorded 
cases (Grafe's and Cooper's), including Smith's, 
which recovered, lived longer than Thompson's. 

Dr. Arthur E. Baker, of London, has proposed 
and practiced a novel and apparently successful op- 
eration for varicocele. 

• After washing the scrotum thoroughly he separ- 
ates the veins of the cord from the vas deferens, and 
then passes a needle threaded with twisted silk be- 
hind the veins, after which the veins are permitted 
to drop back, when the needle is returned in front 
of the veins, which are thus secured in the loop of 
the ligature, through the original opening. The 
thread is then made tense and the veins are brought 
close to the wall of the scrotum, and the ligature is 
well tied, cut close to the knot, and then allowed to 
return with the veins to the scrotal cavity. 

This operation differs from a similar operation 
recommended by Dr. Gross in two particulars. First, 
the ligature is silk and carbolized. Second, the strangu- 
lation of the veins is exclusively intra-scrotal. The 
results reported are such as to commend a further 
trial of the operation. 

Two interesting and remarkable operations have 
been made upon the sternum and its contiguous re- 
lations by Dr. Keuster, of Berlin, and Prof. Koenig, 
of Gottingen. 

Prof. Koenig' s case was one of sarcomatous 
growth of the sternum, a considerable portion of 
which had to be removed. In the operation it was 
found that the sarcoma had become adhered, more 
or less, to the post-sternal tissues, including the peri- 
cardium. In the exercise of the necessary force 
in separating the adhesions and inter-communicat- 
ing tissues, both pleural sacs, also the cavity of the 
pericardium were freely opened. The wound was 
dressed antiseptically. On the twelfth day it was 
discovered that one of the flaps had become gan- 
grenous, and underneath, the process of suppuration 



was going on ; so much so that the imprisoned mat- 
ter was forced within the pericardium, thus freely 
surrounding the heart. The patient made slow prog- 
ress, but recovery finally occurred. 

Dr. Kuester's case was one of supposed sarcoma. 
The patient was forty years old, and had a tumor 
about the size of a goose-egg, situated at the sternal 
ends of the cartilages continuous with the third and 
fourth ribs. The tumor was rather elastic but not 
movable. It passed between the cartilages, and 
seemed to have an undefined distribution within the 
thorax. Gumma and aneurism were both eliminated. . 
The operative procedure, made Oct. 27, 1882, con- 
sisted in dissecting the skin and cellular tissue from 
the tumor ; commencing the incision on its inferior 
margin. The next step was in dividing the third and 
fourth cartilages and chiseling away one-half of the 
breadth of the sternum. Thus removing the sternum 
and rib connections, the tumor was discovered to 
have a prolongation extending well down into the 
anterior mediastinum, where there was seemingly a 
basic attachment. In the effort at separation of the 
tumor from the deeper tissues, the right pleura was 
opened and the internal mammary artery was divided. 

The artery could not be reached for a time, so the 
haemorrhage was arrested by acupressure. It is also 
stated that when the cavity of the pleura was invad- 
ed the lung collapsed. The patient recovered rap- 
idly from the results of the operation, and no doubt 
will recover ultimately from his syphilitic pathology. 

These cases are illustrative of bold and scientific 
manipulation, and at the same time they indicate 
how nearly a dexterously handled knife and finger 
may reach the vital organs of circulation and respira- 
tion without compromising life. We will not dis- 
cuss whether either of the operations were absolutely 
necessary, but content ourselves that progressive sur- 
gery is demonstrated in their performance. 

Important additions have been made to our surgi- 
cal literature in monographs, revised editions of some 
of the leading text books, and, in America, the pro- 
fession may be congratulated upon the appearance of 
two important volumes — one in surgery and one in 
anatomy. 

Under the supervision of the Surgeon General's 
office, the late surgeon, George A. Otis, began the 
surgical history of the Rebellion. 

He lived to render his name long famous by com- 
pleting the second part and beginning the third part 
of volume second, of this great and incomparable 
history. While Dr. Otis' untimely death was a great 
loss to surgical science, the head of the army surgi- 
cal department exhibited excellent taste and mani- 
fested wise judgment in appointing Surgeon D. L. 
Huntington to continue and finish this great work. 
The duty has been well performed, and the world is now 
in possession of the most complete record of wounds 
and injuries resulting from war and battle that has 
ever been produced. 

A few references cannot but be interesting to both 
army and civil surgeons. The whole number of 
wounds reported were 253,142, and out of this num- 
ber there were 89,528 connected with the lower ex- 
tremities; 59j376 being flesh wounds, 674 being 



1883.] 



THE PULSE IN AORTIC INSUFFICIENCY. 



135 



classed as incised or punctured wounds. The 30,152 
were gun-shot fractures, and specially located as fol- 
lows : 

Femur, including complications of hip-joint 7.7/6 

Fractures of tibia and fibula (shafts), single or double 10,026 

" complicating knee-joint 3,557 

" involving tarsus, metatarsus, and phalanges 8,793 

Total number 30,152 

The relation which 89,528 sustains to the whole 
number shows that 35.3 per cent, were wounds of 
the lower extremities, an experience comparing very 
closely with the percentages furnished by surgical 
reports of wars and campaigns in other countries. It 
is shown that in 3.4 per cent, of the cases both lower 
limbs were injured. The left in 53.1, and the right 

in 43-5- 

The collected number of amputations at the hip- 
joint were 66, the recoveries being 11, thus furnish- 
ing a mortality of 83.3 per cent. Of the 25 primary 
amputations there were 3 recoveries. Intermediary 
amputations, there were 23 cases and no recoveries ; 
secondary amputations, there were 9 cases and 2 
recoveries, and of the re-amputations, 9 cases with 6 
recoveries. There were ^;^ cases of primary excision 
of the hip-joint with but one recovery, and of the 
secondary excisions of the hip-joint there were, in 
all, II cases with 3 recoveries. It is stated that 
about 60.6 per cent, of the cases of gun-shot in- 
juries of the knee-joint complicating bone were fatal. 
One-fourth of the whole number were not treated by 
operative interference. 

Dr. Harrison Allen, of Philadelphia, has produced 
a part of what promises to be an excellent treatise 
on human anatomy, including medical and surgical 
relations. Already there has appeared four parts, 
the fifth and sixth parts to be ready for distribution 
by October i. 

A real and most substantial advance is being made 
in surgery in connection with railway corporations. 
Many of the leading lines have introduced into their 
system of management surgical departments, the ob- 
ject of which is two-fold : First. It enables the 
company to more economically manage its financial 
affairs. Second. It ensures to those who may be 
unfortunate enough to receive injuries, the certainty 
of receiving the most complete surgical skill. The 
ultimate benefits which are certain to accrue to the 
profession are the accumulation of a vast amount of 
statistical information which will be of great service 
in neural pathology. Because it is a well known fact 
that many cases, the result of alleged railway acci- 
dents are finally subjected to judicial proceedings, 
when the statements of the plaintiff are too often be- 
lieved by the jury, when the allegations are not sus- 
tained by the systematic expressions of injured tissues 
and organs. 

The instances are exceedingly rare where real path- 
ology, the result of accident, does not fail to receive 
corresponding endorsement by the surgeon. On the 
other hand, the surgeon often finds himself unable to 
satisfactorily interpret the unharmonious descriptions 
of symptoms furnished by the person who sees a mon- 
ied equivalent at the end of a well established "con- 
cussion" (?) of the brain or spinal cord. After the 
rendering of a judgment, and the payment by the de- 



fense of assessed damages, the most marvelous and 
previously stated permanent disabilities recover under 
questionable circumstances. 

The retransformation of fat cell into normal gland- 
ular structure ( ! ), the rapid change of atrophied and 
wasted nerve filament into normal tissue ( ! ! ) occurs 
with inconsistent rapidity, and the teachings of his- 
tologists and pathologists are abrogated and special 
therapeutics, of miraculous origin, receive praise and 
credit which can but cause science to blush. 

The surgical bureaus of these corporations will, by 
their collected experience and tabulations, be quali- 
fied so as to be able to furnish much valuable infor- 
mation to both judicial and popular tribunals. Then 
justice to pathology and rewards to individuals will 
receive fairer and more honorable administration. 



THE REALITY, MECHANISM, AND DIAGNOSTIC SIC- 
NIFICANCE OF DIMINUTION OF RETARDA- 
TION OF THE PULSE IN AORTIC 
INSUFFICIENCY. 



BY A. T. KEVT, M.D. 



[Read to the Section on Practice of Medicine and Physiology.] 

Dr. Henderson^, in 1832, first emitted the idea that 
the interval between the heart's impulse and the arte- 
rial pulse IS prolonged in aortic insufficiency. Since 
him others, and among them the principal authori- 
ties on diseases of the heart, have accepted the view. 
Flint says "that it characterizes certain cases in 
which the regurgitation is excessive, is not to be de- 
nied*." Walshe writes: "This retardation may, 
with care, be detected in many, but unquestionably 
not in all, cases of that disease. Possibly, where no 
morbid retardation can be discovered, the failure 
may depend not on its absence, but on its being car- 
ried to such extremes that the arterial pulse produced 
by one cardiac systole is nearly synchronous with the 
next^." As late as 1877, M. Tripier, in a publica- 
tion*, advocated the reality of this exaggerated delay 
of the pulse in aortic insufficiency. 

The observation appeared incontestable. The 
hand perceived the shock of the heart, and the finger 
the radial pulse, the interval between the events be- 
ing noted as much longer than in health. And the 
explanation of th"e accepted phenomenon came with 
show of reason, through the reverse arterial current 
and lowered arterial blood-pressure (classical) of free 
aortic regurgitation. The view of an abnormal delay 
of the pulse, thus supported by observation, reason, 
and authority, seemed an established fact in the clin- 
ical history of this lesion. 

Nevertheless the idea is wholly erroneous, and the 
pulse, so far from being unduly retarded on the sys- 
tole of the ventricle, is really greatly precipitated on 
that event in large aortic insufficiency. Correction 
of the prevailing error, and demonstration of the 
true chronometric relationship between the heart and 
pulse, is due to the graphic method. Traces of the 
heart and an artery taken simultaneously, show neatly 

1 Edinburgh Medical and Surgical Journal, Vol. xx%'ii, 1832. 

2 Flint's Diseases of the Heart, 1859, Pag^ 14' • 

3 Practical Treatise on Diseases of the Heart and Great Vessels. 
American edition, 1862; page 72. 

* Revue Mensuelle, t, per, p . 19 . 



136 



THE PULSE IN AORTIC INSUFFICIENCY. 



[August, 



the beginning of cardiac systole and the beginning ot 
the arterial pulse, and the space separating these be- 
ginnings marks definitely the interval between the 
events. Thus the normal interval between the heart 
and different arteries being ascertained, the modifica- 
tion of the interval by disease is readily noted. 

In this manner Francois- Franck experimented on 
patients affected with aortic insufficiency, and first 




presented his results to the Societe (ie Biologic in 
March, 1878. He formulated thus the conclusion of 
his researches : " /« large, pure aortic insufficiency 
the retardation of the pulse on the beginning of the 
systole of the heart is very notably diminished. ' ' Co- 
temporaneously with Franck I also was studying, in- 
dependently, by means of the simultaneous graphic 
method, the influence of different forms of valvular 
disease on retardation of the pulse. I had demon- 
strated that the pulse is abnormally delayed in mitral 
insufficiency, and reflecting as to whether this delay 
might be contravened by any concomitant condition, 
I arrived at a conclusion which was afterwards pub- 
lished in the following words : ' ' Nevertheless, the 
phenomenon, though constant in pure mitral incom- 
petency, will probably be found wanting in cases of 
this lesion complicated with an open state of the 
aortic valves ; for in the latter condition the base of 



the arterial column rests against the sides of the ven- 
tricle, instead of against the aortic valves, and is ad- 
vanced with the first movement of ventricular con- 
traction, thus insuring a short interval between car- 
diac systole and arterial expansion. * * * 
The idea that aortic insufficiency produces delay of 
the pulse is certainly erroneous^" 

In March, 1880, opportunity presented for tracing 
a case of undoubted aortic insufficiency. The result 
is shown in figure i*. The cardio-carotid interval 
measured only 1-32 second, and the cardio-radial 1-12 
second. 

Still referring to my own researches, I have proved 
diminution of delay of the pulse in other cases of 
aortic insufficiency, and have been able, also, to re- 
produce the same result on the schema. By way of 
illustration, simultaneous tracings from the schema are 
here presented. Fig. 2 shows traces from the ventricle 
and aorta, with valves intact. The impulses were 
given to the ventricle at successively increasing 
arterial pressures. It will be noticed that after the 
first pair of waves, at which the pressure was in equili- 
brium and the waves are synchronous, the interval 
between the ventricular impulse and arterial wave 
increases with the arterial pressure. Thus, with the 




pressure at 30 inches (water manometer), the interval 
is 1-15 second, at 50 inches i-io second, and at 65 
inches 2-15 second. These traces represent normal 



1 Cincinnati Lancet and Clinic, March 22, 1879. 

2 Boston Medical and Surgical Journal, September 30, 1880. 



1883.] 



THE PULSE IN AORTIC INSUFFICIENCY. 



137 



action and lengthening of the cardio-arterial interval 
under augmentation of arterial pressure. 

Fig. 3 shows the result of a repetition of the same 
experiment, only with the important difference that 
the traces were taken with the aortic valve removed, 
in representation of large aortic insufficiency. Here 



^^FTT^^^^^H l^^l 



the ventricular and aortic weaves are synchronous 
throughout, and, besides, show a perfect parallelism 
of form. 

Franck also experimented on animals, producing 
in them artificial insufficiency of the aortic valves, 
and proved the same diminution of the pulse-retarda- 
tion observed as in man. 

Thus experiments on man, on animals, and on the 
schema all concur in proving diminution of delay of 
the pulse in aortic insufficiency. The testimony is 
ample and complete, and establishes the fact beyond 
question. The acquisition is one of the triumphs of 
the graphic method, and affords a striking illustration 
of its power to redeem from error which otherwise 
had been perpetuated, and reveal the truth which 
otherwise had not been known. 

THE MECHANISM OF THE PHENOMENON. 

Our next inquiry relates to the mechanism of the 
phenomenon. The conditions concerned that influ- 
ence the measure of the delay of the pulse are, (i) 
states of arterial blood-pressure; (2) states of the 
arterial coats as to elasticity or stiffness ; (3) modes 
of ventricular contraction ; and (4) relative states of 
ventricular and aortic blood-pressure. 

I. It has been found that, other things being 



equal, the rate of propagation of the pulse wave 
tends to increase with increase, and decrease with de- 
crease of arterial blood-pressure. Recent investiga- 
tions, however, show that such modification from 
such cause is small at best, and frequently fails to 
manifest. In aortic regurgitation the mean arterial 
pressure is usually diminished, yet not unfrequently, 
when the lesion is well tolerated, the pressure main- 
tains, or even rises above, its normal level. This 
cause, then, of modification of pulse transmission, 
would operate either against, or inadequately for, the 
production of the greatly abbreviated interval. 

2. No fact in this relation is better established than 
that the velocity of the pulse wave is proportional in- 
versely to the elastic extensibility of the arterial 
walls. In aortic insufficiency great expansion of the 
arterial walls is a notable phenomenon. This is due 
to the enlarged and hypertrophied ventricle sending 
into the arterial system at each systole a large volume 
of blood, which distends the vessels, and in diastole 
escaping backwards permits corresponding retreat of 
the walls. The walls themselves may not be more 
relaxed or extensible than ordinary, and the fact is 
the coats are often pervaded with atheromatous ma- 
terial, rendering them less yielding than in normal 
condition. However, in the absence of indurative 
changes, the parieties under the strain become dilated 
and thinned, and more yielding, unless fortified by 
developing hypertrophy of the muscular layers. Then 
no constant stiffening of the arterial walls obtains in 
aortic insufficiency on which can he predicated the 
very early appearance of the pulse in this lesion. 
But even if the walls were of brass, this cause of 
quickened transmission could not of itself account 
for the great precipitation of the carotid pulse, inas- 
much as the reduction considerably exceeds the en- 
tire transmission interval between the heart and car- 
otid point. 

3. The mode of ventricular contraction, as quick 
or slow, exerts a marked influence on the amount of 
delay of the pulse. My own recent experiments have 
shown this, but they have also shown that the modi- 
fication is confined alone to the presphygmic 
interval of the systole of the ventricle. Con- 
trary to the conclusion of some other observers, 
my results demonstrate that the velocity of the pulse- 
wave is not in the least modified by the quickness or 
slowness of ventricular contraction. The ventricular 
presphygmic interval is notably shortened by a quick 
and lengthened by a slow contraction of the ventricle. 
In aortic insufficiency, although the coexisting hyper- 
trophied left ventricle contracts with corresponding 
energy, there is no evidence that its initial systole is 
quicker than in normal action. Then mode of 
systole, notwithstanding its modifying potency, can- 
not certainly be invoked in explanation of the phe- 
nomenon in question. 

4. It is the excess of blood-pressure in the aorta 
over that in the ventricle at the beginning of 
systole that measures with certainty the interval be- 
tween the beginning of ventricular contraction and 
that of the aortic pulse. When the aortic valves 
are intact this interval lengthens with increase and 
shortens with decrease of this excess ; and if the pres- 



138 



THE PULSE IN AORTIC INSUFFICIENCY. 



[August 



sures should be in equilibrium the two events will 
begin simultaneously. (See fig. 2.) But when the 
aortic valves are permanently open the pressures in 
the ventricle and aorta are always in equilibrium at 
the beginning of systole (the two cavities being in 
one), whether the mean pressure be low or high. In 
consequence of this oneness or equilibrium of pressure 
the heart's impulse and aortic pulse will be synchron- 
ous. (See fig. 3.) 

The transmission interval between the aortic orifice 
and point of observation of the carotid pulse is com- 
paratively short, not averaging more than half the 
duration of the cardio-aortic or presphygmic interval. 
Thus, by my measurements, the first averages .026 
second, and the last .054 second, with pulse-rate at 
75. In permanently patulous aortic valves the larger 
presphygmic interval is practically obliterated, while 
only the smaller cardio-carotid transmission interval 
remains as the delay of the carotid pulse on the 
heart. 

The above is the true explanation, and, if allowa- 
ble to say it, to the writer is due the credit of its 
first recognition and announcement. Franck at first 
did not grasp the mechanism of the phenomenon he 
had proved, but vainly endeavored to account for it 
by the theory of accelerated transmission of the pulse 
wave. His later deliverances, however, on this 
point, are in perfect accord with the true rationale 
here set forth. ^ 

It is easy to explain the fallacy of an exaggerated 
delay of the pulse on the systole of the ventricle in 
aortic insufficiency. The enlarged ventricle suddenly 
filling from both the aorta by reverse, and the auricle 
by direct flow, communicates a shock so marked as 
to be mistaken for systole. This impulse occurring 
in the first part of diastole, and preceding the arterial 
pulse at such distance, gives the impression of enor- 
mous delay of the pulse. In figure 3 the length and 
steepness of the diastolic ascents show how easily the 
diastolic impulse would be taken for the systolic beat. 
The fallacy arose from an error of observation, 
which the graphic method was needed to correct. 

THE DIAGNOSTIC VALUE OF THE PHENOMENON. 

Excessive diminution of delay of the arterial pulse, 
notably the carotid, is a sign of the highest impor- 
tance in large aortic insufficiency. No other condi- 
tion, or combination of conditions, except one to be 
considered, is capable of producing such marked pre- 
cipitation of the pulse on the heart. The exception 
consists in the combination, found only in fever, of 
quick systole and tendency to equilibrium of ventric- 
ular and aortic blood-pressures, these conditions also 
invariably associated with frequent pulsations. The 
febrile condition, then, with quick cardiac systole, 
frequent pulse, and low arterial blood-pressure, is 
capable of reducing the cardio-carotid interval, the 
same as aortic insufficiency, to the value of the trans- 
mission time. These factors, when present, are well 
declared, and in their absence the graphic sign is 
pathognomic of the lesion in question. In positive 
value it outranks diastolic basic murmur ; which, as 
well known, may originate in the aorta without re- 
gurgitation, or again with only slight regurgitation, 

1 Compt. Rend, de la Societe de Biologie, 27 Janvier, 1883. 



which takes place in the first part of diastole, whilst 
the altered valves are falling into position of closure. 
Besides, there is difficulty sometimes in distinguishing 
between aortic regurgitant and mitral direct murmur 
of the first part of diastole. 

As to default of this sign, in large aortic insuffi- 
ciency it never fails, except perchance in the presence 
of an extensible aneurism of the first part of the 
aorta. The fact that an aneurism with yielding 
walls produces delay of the distal pulse has been well 
established in these recent years. Then, in a case of 
large aortic insufficiency, complicated with a yielding 
aneurism of the ascending aorta, the precipitating 
effect of the valvular lesion would be more or less 
counterbalanced by the retarding effect of the aneur- 
ismal pouch, and the carotid pulse would observe, 
or approach, the normal amount of delay. If aortic 
aneurism be eliminated, the presence of abnormal 
precipitation of the carotid pulse is conclusive, in any 
case, of an open state of the aortic valves. 

From this declaration it is plain that the writer 
does not admit, with Frangois- Franck, default of the 
sign in the presence of concomitant cardiac valvular 
lesions. Co-existing aortic stenosis would give the 
characteristic sloping ascent, but the beginning of 
the pulse would be in no wise delayed. This has 
been demonstrated on man and the schema. Mitral 
regurgitation co-existing, auricle, ventricle and aorta 
would constitute one cavity, with blood-pressure in 
equilibrium at the end of diastole, and the blood 
would be as promptly sent forward into the aorta as 
in pure aortic insufficiency. Nor could mitral con- 
traction, if present with aortic insufficiency, cause 
any delay of passage of blood from the ventricle, as 
the pressure in the latter at the end of diastole 
would always be equal to the aortic pressure. Hence, 
whatever the cardiac complication, there is no fail- 
ure of abnormal precipitation of the beginning 
of the pulse as a sign of permanent aortic insuffi- 
ciency. 

But the fact must not be lost sight of that this sign, 
so positive and constant in large aortic insufficiency, 
will fail to manifest in the form of incomplete lesion, 
in which the valves permit of regurgitation in the 
first part, but effectually close in the last part, of 
diastole. In this state of things, when systole begins, 
the valvular barrier and excess of aortic blood-pres- 
sure being present, time is lost in overcoming the 
resistance, and abnormal precipitation of the pulse 
fails to occur. However, default of the sign in in- 
complete insufficiency is more than compensated in 
diagnostic import, in that the absence of abnormal 
pulse precipitation in a case, of aortic regurgitation, 
certainly diagnosticated by the ordinary physical 
signs, would indicate a partial and not complete in- 
sufficiency of the valves ; and, aortic aneurism ex- 
cluded, would be conclusive of this distinction. 

In resume : 

I. Abnormal diminution of the retardation, or, in 
other words, abnormal precipitation of the arterial 
pulse, notably the carotid, on the systole of the ven- 
tricle in large aortic insufficiency, is a fact positively 
established, the phenomenon depending purely upon 
extinction of the normal ventriculo-aortic, or pre- 



1883.] 



ACUTE INFLAMMATION OF THE LUNGS IN YOUNG CHILDREN. 



139 



sphygmic interval. Hence the phenomenon becomes 
an important diagnostic sign of this lesion. 

2. The presence of the sign is jKjsitive evidence of 
the existence of the lesion, provided only there is no 
quick febrile movement in the case. 

3. Default of the sign does not occur in the pres- 
ence of concomitant cardiac lesions, but occurs only 
in the presence of a yielding aortic aneurism. Hence, 

4. Absence of the sign is positive evidence of ab- 
sence of the lesion, provided only there is no aortic 
aneurism in the case. 

5. If the diagnosis of aortic regurgitation is other- 
wise certain, absence of the sign, aortic aneurism 
eliminated, is jxjsitive evidence of the incomplete na- 
ture of the insufficiencv. 



ACUTE INFLAMMATION OF THE LUNGS IN YOUNG 
CHILDREN UNDER SIX YEARS OF AGE. 



BY A. PATTOX, M.D., OF VIXCENXES, IXDIAXA. 



£Read to the Section on Diseases of Children at the session of the Ameri- 
can Medical Association, June, 1883. 

That acute inflammation of the lungs in young 
children is marked by different phenomena, and runs 
a very different course from what it does in older 
children and adults, all medical writers agree, so far 
as I am informed. The division of the lungs of 
young children into lobules instead of lobes, and the 
minute size of the air vesicles, together with their 
highly membranous and vascular condition, would 
necessarily lead to important peculiarities in their 
diseases. From these and other causes children do 
not have true lobar inflammation of the lungs until, 
by the progressive incorporation of elementary parts, 
the lungs at:ain a state of development that will admit 
of higher degrees of inflammatory action. It is 
afiirmed by high authority that infants under the age 
of one year seldom if ever have inflammation of the 
lungs in any known form. They are, however, liable 
to have catarrhal fever and acute bronchitis, but 
nothing that resembles pneumonitis. During the 
second year, and especially in the dentition p>eriod, 
they are apt to have such a complication as is styled 
inflammation of the lungs. This, however, is very 
different, both in pathology and symptomatology, 
from true pneumonitis, but is equally apt to prove 
fatal. As the child grows, and its respiratory system 
develops into a higher state of perfection, it becomes 
subject to other forms of lung inflammation. Of 
course, the age at which this state of advancement 
takes place cannot be determined positively, as it 
depends partly on the vigor and health of the child. 
Some authors place the age at six years, others at five, 
and one thinks true lobar pneumonitis may occur as 
early as three years. As a general rule, children are 
not liable to have true pneumonitis until they are five 
or six years of age. The question then presents, 
What form of inflammation of the lungs do children 
have from infancy up to the ages just mentioned ? 

The older writers claimed that they had lobular 
pneumonitis, while later writers have named the dis- 
ease catarrhal pneumonia. But as there are several 
forms of inflammation of the lungs in young chil- 



dren, it would probably indicate a sounder view of 
the pathology to name each kind in strict accordance 
with its nature and cause. 

Before the wonderful discoveries in auscultation 
made by Laennec and others, there was but little dis- 
tinction made between bronchitis and pneumonitis. 
They were both styled inflammation of the lungs. 
This dark era, however, has given place to the reign 
of the bright sun of science that has cast its effulgent 
rays into the deepest recesses of the respirator)- sys- 
tem, and reveals to the ear of the experienced aus- 
cultator every abnormal sound and diseased condition 
of the lungs. He can say here is the mucous rale of 
bronchitis, there the crepitating sound of pneumonia. 
A little higher up is hepatization, and in a spot not 
larger than a ten cent piece is softening of the hepa- 
tized lung. 

While this is grandly true in the lung diseases of 
the adult and children over six years of age, we have 
to admit that in younger children we are compelled 
to rely more upon symptoms and less upon physical 
signs in the investigation of their diseases. It is true 
that by inspection, application of the hand, mensu- 
ration, percussion, and auscultation, we can decide 
some very important clinical questions as to the seat 
and nature of the lung diseases in young children. I 
regard it as far safer and better to study closely the 
s)Tnptomatology of children's diseases, and not rely 
too implicitly upon physical signs. 

If a child has fever, heat of skin, loss of appetite, 
and a cough that is attended with cries of pain, we 
may know there is inflammation about the Ivmgs, 
either in the bronchia, pleura, or lobules. 

If we see the case at or near the commencement of 
the disease, we may conclude we have acute bronch- 
itis to contend with, but which may, and doubtless 
will, extend to other tissues of the lungs if not ar- 
rested. If the disease extends no farther than the 
large bronchia, we need expect no serious results. 
But, unfortunately, the tendency is to pass into the 
minute vesicles, producing vesicular pneumonitis. 
Then we have a very dangerous disease to contend 
with. This may be styled one of the forms of inflam- 
tion of the lungs in young children. Another com- 
plication that is apt to occur during the progress of 
acute bronchitis, is acquired atelectasis, or collapse 
of one or more groups of lobules. This is caused by 
tenacious lymph plugging up an air tube, which pro- 
duces complete occlusion, cutting off" the air to the 
adjoining lobules, which necessarily causes their col- 
lapse. This is a source of danger in two wa}^s — by 
lessening the lung capacity, and developing lobular 
inflammation. We now have another form of lung 
inflammation, which may extend from lobule to lobule 
until a fatal termination results. 

A still more serious complication is hyp>ostasis, or 
passive congestion of that part of the lung that is 
most pendent favoring gravitation of the blood. This 
condition acts as a foreign body, which in most cases 
develops another form of inflammation of the lungs. 
This takes place as a result of weakened action of the 
heart, and a tendency in the blood to coagulation, 
favored, of course, by the child maintaining the same 
I position. Another, and perhaps a more frequent 



I40 



ACUTE INFLAMMATION OF THE LUNGS IN YOUNG CHILDREN. [August, 



complication, is the extension of the inflammatory 
action from the bronchia directly to the lobules, con- 
stituting broncho-pneumonitis. This is the catarrhal 
pneumonitis of a late author, but as it is a conse- 
quence of the bronchitis, it would, in my opinion, be 
more proper to style it broncho-pneumonitis. If 
acute inflammation of the lungs in young children 
only occurred as a consequence of bronchitis, it 
would be most fortunate for the little sufferers. But 
such is not the case. Rubeola, pertussis, variola, re- 
mittent fever, and even difficult dentition, are very 
apt to become complicated with inflammation of the 
lungs in young children, and often lead to a fatal 
termination. 

One writer, Grisolle, says that in seven-eighths 
of all cases of gastritis, five-sixths of all cases of 
cancrumoris, one-third of all cases of enteritis, 
measles, and whooping-cough, one-fourth of small-pox, 
one-seventh of continued fever, one-sixth of all cases 
ot acute inflammation of the brain, one-fourth of 
diseases of the heart, one-sixth of cancer and organic 
diseases of the liver, cirrhosis, and Bright's disease, 
there occurs this most dangerous complication — 
pneumonitis. It often occurs after amputation, and 
in extensive wounds, burns, etc. 

No doubt, the leading factors in the development 
ot this complication in so many forms of disease are 
hypostasis and hyperinosis, especially in the adult. 
In young children obstruction of the air tubes, caus- 
ing atelectasis, is no doubt a frequent cause of this 
pneumonic complication, as well as hypostasis. As 
all the forms of pneumonitis in young children to 
which I have referred are secondary to bronchitis, 
or some other form of disease, we may justly style it 
as an accidental complication, and never idiopathic. 
It is not by any means an easy thing to determine 
just when this complication begins or where it is 
located. ' True, we may by percussion find dullness, 
indicating either passive congestion, atelectasis, car- 
nification of the lung, or inflammation of the lobules, 
which may have assumed an imperfect form of hepati- 
zation, but we cannot say certainly which condition 
it is. Fortunately, however, it is not very important 
to diagnose these abnormal conditions accurately, as 
the treatment is the same in all, in young children, 
varied, of course, by the gravity of the symptoms, 
stage of the disease, and such other conditions as 
should influence treatment in the adult. I do not 
underrate the value of auscultation in this form of 
lung trouble, as we may be able in some cases to de- 
tect the crepitating sound of pneumonitis, but it is an 
uncertain guide. When I do employ auscultation, I 
do not pounce down upon the poor trembling child 
with one of Camman's double stethoscopes like the 
unicorn upon the frightened gazelle, but quietly 
apply the ear to the little sufferer's chest, which is a 
better method than most stethoscopes — I mean for 
young children. A far better stethoscope than 
Camman's or any hollow tube is one made of solid 
hard wood, which transmits sound with more rapidity 
and far more accuracy than the hollow tube. Sound 
in air travels at the rate of 1.190 feet per second, 
while in hard ash wood it travels at the rate of 15,314 
feet per second. (Norton's Natural Philosophy.) If 



we use a tube we get a double sound, the first reach- 
ing the ear through the hard wood or rubber, the 
other by the air in the tube, which is calculated to 
produce confusion. When the tubes are inserted 
in both ears we have a still greater source of con- 
fusion, as the hearing power in most persons is not 
equal in both ears. 

If we observe the symptoms closely, we will be 
able to determine, by the increased frequency of the 
pulse, the frequency and irregularity of the respira- 
tions, the moaning of the little sufferer, and the 
higher temperature and tight cough, that a dangerous 
lung complication has supervened. We must not 
conclude that because young children do not have a 
true form of pneumonitis, there is no danger 
from the kind of inflammation of the lungs they do 
have, for it may be safely affirmed that three-fourths 
of all deaths before the age of six years are caused 
either directly or indirectly by inflammation of the 
lungs and acute bronchitis. Then the question of 
treatment becomes a very important one, indeed. 

In devising methods of treatment iu all diseases, 
we should be guided by sound views of pathology 
and an accurate knowledge of the action of the rem- 
edial agents we employ. Any other practice is em- 
pirical, and not in any sense scientific. In the dis- 
cussion of methods I may differ with some of our 
highest authorities. But if I give good, sound, sci- 
entific reasons for my plans of treatment, they ought, 
at least, to secure your thoughtful and serious con- 
sideration. 

Most, if not all, authors advise that the heart's 
action of these delicate young patients should be 
moderated by such powerful nervous sedatives as 
aconite and veratrum viride. This I must regard as a 
dangerous practice, for the reasoil that the tendency 
in all cases of inflammation of the lungs in young 
children is to debility and depression of the vital 
powers. The imperfectly decarbonized blood in 
cases where the lungs are seriously disabled is itself a 
powerful poison to the great nerve centres, tending- 
to a weakened action of the heart and a lowering of 
the vital powers, leading towards a fatal result. Any 
medicines that weaken the action of the heart, as do 
aconite and veratrum viride, favor capillary engorge- 
ments, hypostasis, abscesses, suppuration, and gan- 
grene. And, as the disease so certainly tends in the 
direction of these alarming complaints, we should do 
nothing that is calculated to lead to these very 
results. The old practice of bleeding and tartar 
emetic was not more dangerous than the one just re- 
ferred to. Opiates are advised to relieve pain, 
cough, and restlessness, and alcohol is highly recom- 
mended to sustain the vital powers and to stimulate 
the heart to more vigorous and energetic action. I 
object to both these agents upon the same ground — 
they prevent the elimination of carbonaceous matter 
through the lungs, prevent the excretion of urea and 
other impurities through the kidneys, thus favoring 
the course of the disease by holding these poisons in 
the blood and determining them to the brain and 
great nerve centres, producing impaired vital powers, 
and leading directly to the worst forms of cerebral 
complication, as delirium, convulsions, and coma. 



1883.] 



RADICAL CURE OF HERNIA BY A NEW OPERATION. 



141 



A special objection to alcohol is that it favors coagu- 
lation of the blood, leading to embolism and hypos- 
tasis — and the still more potent objection, that it in- 
creases hyperinosis, which must necessarily develop a 
higher degree of inflammatory action, involving con- 
tiguous tissues in the consuming flame. 

If these agents are objectionable because they favor 
the progress of the disease, a most important question 
presents itself: What is best calculated to arrest the 
disease ? If a building is on fire the first thing is to 
destroy the combustibility of the burning material. 
This principle holds good in inflammation. Subdue 
as speedily as possible its main supporters. It is ad- 
mitted that in pneumonitis, either in adults or young 
children, there is hyperinosis before the pneumonitis 
is developed, and this constitutes the main factor in 
the disease. Destroy the excess of fibrine, and you 
have the disease under control. If there was no 
hyperinosis in inflammation of the lungs in young 
children, as some contend, we would only have the 
mildest form of catarrhal fever. I admit that it is 
far less than in older children and adults, but there 
is quite enough to produce the most disastrous results 
and destroy life. The many forms of embolism, the 
plugging of the air tubes by coagulating lymph, pi o- 
ducing atelectasis, the inflammation resulting from 
hypostasis, and the extension of the inflammation 
from the bronchia to the lobules, and from lobule to 
lobule and from tissue to tissue, are unmistakable 
evidences of hyperinosis, or excess of fibrine in the 
blood. 

It is admitted by all writers on the subject that the 
exudate is sufficiently fibrinous to produce an imper- 
fect form of hepatization in most cases. This is 
another proof of hyperinosis. How to efficiently 
meet this indication is an important question. The 
observing housewife long ago discovered that if she 
had a tough bird to deal with, by applying bicarbo- 
nate of soda in liberal quantities at night the bird 
would be nice and tender for breakfast. The alkali 
had dissolved the fibrine in the bird, which is just 
what we want to do in the blood of the pneumonic 
patient. In mild cases I begin with the benzoate of 
soda, as a cough syrup. If, however, the case is 
threatening, I use the more powerful agent, ammonium 
carbonate, in doses of one to three grains, dissolved 
in water and syrup, and give every two to four hours. 
This destroys the tenacious quality of the mucus 
secreted by the bronchia, and causes it to be thrown 
off in the usual way, and not to adhere to the walls of 
the air tubes, interfering with the respiratory func- 
tions. This form of medication should be kept up 
throughout the attack, as it will prevent those dan- 
gerous complications to which I have frequently 
referred in this paper by reducing the excess of 
fibrine. Another remedy, which accomplishes me- 
chanically the same result in removing the tenacious 
mucus from the bronchia, is an emetic of sulphate of 
copper or alum. This is a valuable means of relief, 
ana should not be overlooked. 

This ammonium carbonate is not only a powerful 
defibrinizer, but is equally a decarbonizer, whichi is 
effected by its chemical action and the elimination 
of this poisonous agent through the kidneys and 



lungs. It is also a safe and very efficient stimulant 
— far safer and better than alcohol in any form. 
Another valuable procedure is heat and moisture in 
the form of a flax-seed or corn-meal poultice, applied 
to the entire thorax, and kept up with great regula- 
rity. This is a thousand times better and safer to 
relieve cough, pain, and restlessness than opiates. 

A remedy that has a tendency to expand the 
capillary vessels and prevent congestion and gangrene 
is eucalyptus, a medicine that I have found very use- 
ful in pneumonic inflammation of young children. 
If there is any malarial complication we must not fail 
to give quinine ; and if there are signs of weaken- 
ing of the heart's action we may give with advan- 
tage tincture of digitalis, which is our most reliable 
heart tonic. If a counter-irritant is needed, we may 
employ a very mild croton oil liniment, or mustard 
mixed with the poultices may be used instead. 

Mild aperients or enemata may be given as required. 

The limited time allowed me forces this paper to 
be only suggestive, and not by any means exhaustive. 
If, however, it should encourage a spirit of inquiry, 
and a more thorough investigation of the pathology 
and treatment ot the inflammatory diseases of the 
lungs of young children, I will be fully compensa- 
ted for the labor and thought devoted to its prepara- 
tion. 



THE RADICAL CURE OF CERTAIN FORMS OF HERNIA 
BY A NEW OPERATION. 



BY REUBEN A. VANCE, M.D., CLEVELAND, O. 

Professor of Operative Surgery and Clinical Surgery in the Medical De- 
partment of the University of Wooster. 



[Read to the Section of the American Medical Association on Surgery and 
Anatomy.] 

The study of nature's method of curing an oblique 
inguinal hernia, shows there are two important pro- 
cesses at work — one, a band of adventitious tissue 
about the neck of the sac constantly tending to con- 
tract and close the abdominal opening at the inner 
ring ; the other, the return to place of the two layers 
of transversalis fascia, the separation of which orig- 
inally permitted the viscera to protrude, and the re- 
union of which forms a valve strong enough to pre- 
vent a recurrence of the hernial protrusion. Both 
processes must operate if the patient is to be cured. 
The frequency with which these measures are inter- 
fered with by local conditions, explains why so few 
patients with hernia recover spontaneously. 

Trusses, by keeping the viscera in place and allow- 
ing the structures about the neck to contract, favor 
the cure of the lesion. The same is true of certain 
surgical operations. A moment's consideration of 
the anatomy of oblique inguinal hernia, and a glance 
at the pathological processes in operation in such 
cases, will show why so few are permanently cured, 
despite the perfection of nature's processes for the 
accomplishment of that end. The neck of the sac 
can not contract, for it is almost constantly distended 
by some part of the abdominal viscera. The dis- 
placed folds of transversalis fascia cannot return to 
their proper position, for the same reason. Not only 



142 



RADICAL CURE OF HERNIA BY A NEW OPERATION. 



[August, 



this ; abdominal pressure tends to dilate the hernial 
orifice, while the protruded viscera force the inner 
ring downward and towards the middle line. Never- 
theless, the surgeon can readily return the hernia, and 
place the parts in such position that nature can em- 
ploy her reparative powers to best advantage. Ex- 
amine an oblique inguinal hernia in the dead body, 
and it will be found that by proceeding in a certain 
way the sides of the inner ring — it matters not how 
largely it may be dilated or how far displaced — can 
be brought together. To do so, however, traction 
must be made upon the segment of the circle next 
the median line, so as to draw it downwards and out- 
wards. This proceeding converts the ring into a slit, 
the long axis of which is directed downward and in- 
ward. One or more stitches properly inserted will 
hold the parts in this position. The anterior and 
posterior walls of the inguinal canal can be brought 
in apposition in the same way. Finally, the pillars 
of the external ring can be transfixed and united by 
suture. The closure of the internal ring, and its 
conversion into a simple slit ; the union between the 
anterior and posterior walls of the inguinal canal thus 
brought about; and finally, the attachment of the 
pillars of the external ring, combine to transform the 
former open passage way of the inguinal canal into a 
firm, unyielding valve, that renders hernial protrusion 
an impossibility. Imagine these steps taken on the 
person of one suffering from oblique inguinal hernia. 
Would not the parts be placed in the best possible 
condition for such union as would result in a radical 
cure of the hernia ? Experience abundantly attests 
that such is the fact. That the reparative processes 
may be understood in their completeness, it must be 
borne in mind that peritoneum differs from integu- 
ment or mucous membrane, in that to procure union 
it suffices to press serous surfaces together, while to 
unite either of the others the severed edges must be 
brought together, and retained in apposition until ad- 
hesion occurs. Consequently the peritoneal surfaces 
at the inner ring, in the canal and between the pillars 
of the inguinal outlet, when apposed in the manner 
described above, adhere and blend together within a 
few hours ; in time the marks of the oblique slit at 
the inner ring disappear by the gradual contraction 
of the band of adventitious tissue that marked the 
neck of the hernial sac ; the formerly separated folds 
of transversalis fascia are brought together and firmly 
blended by the same process, while the union of the 
serous walls of the inguinal canal, and the attachment 
of the pillars of the external ring, complete the steps 
that mark the re-establishment of such a valve as 
alone can make this weak portion of the abdominal- 
wall sufficiently strong to resist the tendency to pro- 
trusion of the abdominal contents. 

I will mention in this connection that I now have 
a patient preparing for an operation for the cure of 
right inguinal hernia, who formerly had double her- 
nia of that character. In this case the left external 
ring and inguinal canal are still open, protrusion is 
prevented by contraction of the neck of the old skc, 
uniting the folds of transversalis fascia. Here we 
have one of nature's conservative provisions effecting 
a cure ; occasionally this process is prevented by dis- 



placement of the. band of adventitious tissue at the 
neck, instead of the opening between hernial sac and 
peritoneal cavity closing and the continuity of the 
transversalis fascia being re-established, thus curing 
the hernia, the constriction is forced into the canal, 
and a partial diaphragm is formed between the neck 
and fundus of the hernial sac. Although cases similar 
to the one above alluded to, demonstrate that the 
transversalis fascia is the main element in preventing 
hernia, yet experience shows that it is desirable in 
operating for the cure of rupture to obliterate that 
portion of the sac in the inguinal canal as well as 
close the internal and external rings. Devise some 
plan for carrying the inner portion of the transver- 
salis fascia into contact with the outer, at the internal 
ring, and the other steps in the attempt to convert 
the open inguinal canal into a resisting valve are easy 
of execution. The following method has been very 
successful in my hands : 

Place the patient in a recumbent posture, reduce 
the hernia by invaginating the scrotum, determine 
the situation of the internal and external rings and 
the axis of the inguinal canal. Mark these boun- 
daries on the skin with tincture of iodine, and then 
draw a short line at right angles to the axis of the 
inguinal canal, from the upper and inner to the 
lower and outer border of the internal ring. Next 
force the unarmed end of a Dowell's hernia -needle 
through skin, fascia, aponeurosis of the external 
oblique, and tissues intervening between the latter 
and the parietal layer of the peritoneum, into the 
abdominal cavity, locating the puncture at the lower 
and outer end of the short line drawn at right angles 
to the axis of the inguinal canal. 

Carry the end of the needle cautiously upward and 
inward, in the direction of the just-mentioned short 
line, until its point is about half an inch beyond the 
border of the inner ring ; then force the point 
straight through all the structures above it and make 
it penetrate the skin. The end of the needle here- 
tofore in the surgeon's hand is charged with a strong 
strand of silk, and in the further manipulation of the 
instrument great care must be exercised that none of 
the abdominal viscera be needlessly injured. The 
threaded end of the needle is passed into and out of 
the abdominal cavity, but the instant its point passes 
beyond the upper ^nd inner border of the sac, its 
course is changed, and instead of drawing the thread- 
ed end out, the latter is forced downward through 
the tissues of the inguinal canal by the side of, but 
without the lower and outer border of the internal 
ring, and then into the same canal in aponeurosis, 
external oblique, subcutaneous fascia and integu- 
ment, the needle made when first introduced. Thus 
the strand of silk enters and leaves by the same canal 
so far as the structures between the aponeurosis of 
the external oblique and the skin are concerned, but 
below that all is different. In effect, a noose is 
thrown from the fixed layer of transversalis fascia to 
the movable one, and the latter with its peritoneal 
envelope and intervening adventitious tissue of the 
neck of the sac, is drawn downward and outward, 
and so fastened in its new position as to obliterate 
the internal ring without injuring the spermatic cord. 



1883. 



MEDICAL PROGRESS. 



143 



A single suture used in this manner initiates repara- 
tive processes that alone suffice to prevent hernial 
protrusion. 

The first suture is introduced, but not tightened ; 
its extremities are left in care of an assistant, and the 
needle is again threaded for use. Its insertion for the 
second suture is peculiar, and is in imitation of Dow- 
ell's plan; the integument and all loose subcutaneous 
tissue are elevated between the thumb and fingers of 
the right hand, if the patient has left inguinal hernia, 
the point of the thumb just touching the line mark- 
ing the axis of the inguinal canal. The needle is 
grasped in the left hand, and its unarmed end is 
thrust through the duplication of tissues, its point en- 
tering about midway on the line marking the axis of 
the inguinal canal. As soon as the point appears 
through the fold of skin it is grasped and the armed 
end drawn into the tissues. This manoeuvre carries 
the end of the needle armed with silk into contact 
with the aponeurosis of the external oblique ; the 
needle is now so manipulated that this extremity is 
forced through the aponeurosis into the inguinal ca- 
nal over the spermatic cord, through the posterior 
wall of the canal and thence out of the abdominal 
wall at the point the curvature of the needle causes it 
to emerge. The unarmed end follows, but is not 
permitted to come further than the surface of the 
aponeurosis of the external oblique, the direction of 
the needle is reversed, its point kept close to the sur- 
face, of the aponeurosis and finally brought out at the 
opening through skin and superficial fascia it made 
when inserted. This makes a noose that can, in ob- 
lique hernia, simply bring the posterior wall of the 
inguinal canal into contact with the anterior, or in 
cases of long standing in which the internal opening 
is displaced, attach the margins of the pillars of the 
external opening, as well as approximate the surfaces 
of the canal. 

A third suture is carried into place in the same 
manner, but it is inserted into the pillars of the ex- 
ternal ring just above the level of the cord, and its 
extremities emerge from an opening at the lower end 
of the line marking the axis of the canal. During 
these manipulations the index finger of the operator 
invaginates the scrotum and occupies the inguinal 
canal, in which position it can guide the needle in 
its passage through the parts about the internal ring 
and inguinal canal. The sutures passed, they are 
carefully tightened, beginning with the one first in- 
troduced, and the influence of each estimated by the 
finger in the canal before being finally fastened. A 
medium sized key separated from the abdominal wall 
by four folds of antiseptic gauze, should be used to 
receive the ligature knots. Some point on the ring 
of the key will do to support the knot on the first 
suture, the handle of the key will bear the others. 
The patient had better be anaesthetized with ether 
for this operation, as the surgeon can then proceed 
leisurely with his work. After the ligatures are secured 
the patient should be removed to his bed, and for the 
next week maintain the recumbent posture. At the 
end of seven days the bandages are removed and the 
ligatures taken out. Should any local tenderness 
develop, the surgeon should at once control it with 
rubber bags of ice. 



I have operated in 32 cases by Dowell's method ; 
in the 19 cases in which I have used the procedure set 
forth above, the result, so far as the present condition 
of the patient is concerned, is all that could be de- 
sired. 



MEDICAL PROGRESS. 



Operations on the Kidneys. — Nephrectomy. — 
Mr. J. Knowsley Thornton gives the record of 
three successful cases of nephrectomy in the Lancet. 
The first was published June, 1880, but is again 
given in connection with the others. It was per- 
formed on a child of seven, who had suffered with 
swelling of the abdomen since she was two years 
old. The diagnosis of renal tumor having been 
made, an antiseptic aspiration was performed, result- 
ing in the removal of six pints and a half of rather 
dark and cloudy urine. Two months later the 
tumor had re-filled and the left kidney was removed 
through an incision in the median line to the left of 
the umbilicus. Bichloride of methylene was the 
anaesthetic used. The ureter was found to be merely 
a thin fibrous cord. Wound healed by first intention 
on the sixth day, and the patient was running about 
the ward on the fourteenth day. 

The second case was in a woman of 26, who, after 
her third pregnancy, eleven days after labor, suffered 
from inflammation in the right iliac fossa, followed 
by pain and swelling in the left leg. Six weeks after 
delivery pain persisted in the right side, which was 
spasmodic and along the course of the ureter to the 
right thigh. A fluctuating tumor of considerable 
size was found in the right loin, and the urine was 
loaded with pus, ammoniacal and offensive. The 
kidney was cut down upon through the loin, and 
Mr. Thornton notes the much greater amount of 
haemorrhage as compared with the abdominal section, 
and the very imperfect knowledge to be obtained as 
to the condition of the kidney. A sacculated kid- 
ney was found, with very offensive pus ; two drainage 
tubes were mtroduced ; the greater part of the wound 
closed and antiseptic dressings applied. The second 
day after the operation the bladder urine was free 
from albumen. The urine soon showed signs of car- 
bolism, and on the fifth he changed to eucalyptus 
gauze, but in a very short time pus soaked through 
sixteen layers of the gauze and teemed with bacteria. 
Ultimately the wound healed fairly well, but the 
temperature rose, pain increased, the appetite failed, 
and thirty- five days after the first operation the kid- 
ney was removed through the abdominal walls by an 
incision along the outer border of the right rectus 
abdominis. After removal the wound was sponged 
with tincture of iodine, and as there was still 
some oozing, perchloride of iron was applied, a 
drainage tube was used, the wound closed, and the 
end of the ureter brought outside and fastened with a 
pin. The kidney weighed i lb. 2^ oz. The 
wounds healed completely on the eighteenth day, 
after which the patient passed from a pint to a pint 
and a half of healthy urine daily. The constitutional 
disturbance was decidedly less after the nephrectomy 
than after the nephrotomy. 



144 



MEDICAL PROGRESS. 



[August, 



The third case was in a woman, aet. 58, suffer- 
ing from a large, fluctuant tumor in the right side of 
the abdomen, containing pus, which had been re- 
moved four times by aspiration ; pus in the urine, 
and chronic bronchitis was present. The operation 
was through the abdomen to the outer side of the 
right rectus abdominis. The kidney was first tapped 
and twenty pints of pus removed. The kidney was 
enucleated with difficulty, and the cut ureter attached 
to the outer edge of the wound. After all the su- 
tures were fastened a sponge was missing ; some were 
then removed, and the sponge found in the bottom 
of the capsule, causing the operation to last three 
hours. The kidney weighed 4 lbs, 7 oz., consisting 
of two large chambers, with a round opening be- 
tween them. The cause of all the mischief was a 
small, umbrella-shaped stone, its front being firmly 
wedged into the mouth of the ureter. There were no 
complications, the wound healed slowly, and two 
months later she was strong and well. 

Mr. Thornton, at a meeting of the Royal Medical 
and Chirurgical Society, also reported a case of a 
woman get. 37, who suffered from a fluctuant tumor 
of considerable size, in the right side of the abdo- 
men, with a red, tender and pointing swelling in the 
right loin, which was freely incised, discharging fluid 
with an immense quantity of cholesterine, was drained 
and treated antiseptically, healing in about six weeks. 
Two months later the wound opened, and again dis- 
charged, healing slowly ; this accompanied an attack 
of gout in both feet. Two years later she was oper- 
ated on by Mr. Thornton for right ovarian tumor, 
which was removed. While the abdomen was open 
he examined the kidneys and ureters. The right kid- 
ney was large and sacculated, and its ureter was much 
enlarged, especially at the pelvis rim. The left kid- 
ney and ureter appeared quite normal. The recov- 
ery after ovariotomy was rapid, but in six weeks the 
swelling on the right returned and discharged as be- 
fore. Six weeks later there was a similar discharge 
from the left iliac region. Fifteen months later the 
wound in the right side again opened, and discharge 
went on for fourteen months, without apparently af- 
fecting her health at all. Two months had elapsed 
since its last closure, and she is in excellent health. 

Dr, Henry G. Rawdon at the same meeting report- 
ed a case of nephrectomy with lateral cystotomy for 
rupture of the kidney, consequent upon a fall, in a 
boy aet. 12. The right kidney was removed on the 
seventeenth day by lumbar incision ; on the twenty- 
first day lateral cystotomy was performed, and a free 
drain for the urine established. Death took place on 
the fortieth day from pyelitis and circumscribed sup- 
puration of the left kidney. 

Sir T. Spencer Wells reported the removal of an 
enlarged cancerous kidney, in a man get. 58, with 
death on the fifth day. He dwelt on the importance 
of uniting, in all cases of nephrectomy by abdomi- 
nal section, not only the divided peritoneal coat of 
the anterior abdominal wall, but also the divided 
peritoneal covering of the kidney. 

Prof. J. Marshall gave a case of traumatic suppu- 
rating hgematoma, connected with the left kidney, 
in a girl of 13, which was treated by puncture and 



drainage for a little over three months with recovery. 
The fluid withdrawn contained 5.5 per cent, of urea, 
whereas the urine contained from 2.4 to 3.6 per 
cent. Although there was no history of hgematuria, 
the urinous odor given off on boiling the fluid, and 
the high percentage of urea it contained, pointed to 
a possible laceration of the kidney itself 

Mr. Berkeley Hill, in a woman, married, get. 26, 
suffering for some years from attacks of pain in the 
right hypochondrium, with vomiting, found a soft, 
fluctuating swelling in the right lumbar, and partly 
in the umbilical and iliac regions. The urine con- 
tained pus and albumen. After aspiration had been 
performed, resulting in the withdrawal of 4^ oz. of 
pus, the swelling rapidly enlarged, was laid open and 
found to be a distended kidney, from one of the 
recesses of which he extracted an irregular calculus, 
weighing 64 grammes. Urine ceased to discharge from 
the wound 31 days after the operation. There has 
been no return of pain, the kidney can be felt as a 
tender, firm mass and there is still pyuria. 

Affection of the Eyes Associated with Nor- 
mal Menstruation. — Dr. M. Landesberg of Phila- 
delphia gives two cases in the Centralb. fur prakt. 
Augenheilkunde . The first is a case of herpes of the 
cornea, in a girl of 15, who 7 months before had 
menstruated for the first time ; the flow returned 
regularly and was normal in duration and degree, 
with some pain in the back and head as premonitory 
symptoms. She was seen at six succeeeding mens- 
trual periods, when each time there was a recurrence 
of the eruptions, after it had disappeared entirely dur- 
ing the intervening period, with one exception which 
is noted. At the first period at which she was 
seen, the eruption affected the right eye, with a slight 
injection of the left ; at the second period, both eyes 
were affected ; at the third, both ; at the fourth, the 
right only, but the condition persisted up to the 
time of the fifth, when it was increased in severity; 
at the sixth, the right eye alone, and at the seventh, 
both eyes were free. The family removed and the 
case was lost sight of 

The second case was in a negro girl of 14, strong, 
well built and in good general health. Her menses 
were established 10 months previously, were regular 
and without trouble. Among the premonitory symp- 
toms were blood pressure in the head, noises in the 
ears, sparks before the eyes, and an unusual feeling 
of warmth in the whole body. Twice nose bleeding 
had taken place with the commencement of the 
menstrual flow. She was brought before the doctor, 
to ascertain what was the matter with her right eye, 
of which at several periods in the last few months 
she had complained of the loss of sight ; this it seems 
was coincident with the onset of the menses, improv- 
ed with its close, and in 8 or 10 days perfect vision 
returned ; this had already occurred three or four 
times. The right eye was strongly injected, with a 
normal cornea and iris, S="igQ Jaeger 10, Field of 
vision free. With the ophthalmoscope, aqueous humor 
red, and at the base of the anterior chamber a thin layer 
of dark red blood. After dilatation of the pupil, the 
vitreous humor was clear, there was a slight venous 



1883.] 



MEDICAL PROGRESS. 



US 



hypersemia of the retina, and a marked curving of 
the vena ophthalmica superior. The left eye was 
normal. The blood was reabsorbed and normal vision 
restored in about lo days. 

Two days before the next menstrual period, Oct. 
20, the eyes were again examined and found to be 
normal. The girl complained of blood pressure in 
the head and of pains in the back. The ears felt 
warm, the face was heated, the breasts were hard, 
and the nipples turgid ; perspiration was marked. 
Oct. 21, increased blood pressure in head; ears and 
face hot : hands warm and moist ; ciliary vessels of 
the right eye strongly hypersemic. 

On the evening of Oct. 22, appearance of the 
menses coincident with a dark red cloud before the 
right eye. Twenty-one hours later an examination 
showed the following : Right eye, marked venous 
hyperaemia of the conjunctiva of the eye-lids; aqueous 
humor red. At the base of the anterior chamber a 
thick layer of bright red blood ; at the fundus of the 
eye venous hyperaemia. 8.='".^ Jaeger 8. Field of 
vision free. Left eye, normal. Spontaneous resorp- 
tion of the blood and return to normality inside of 
eight days. At the following menstrual period the 
same condition and course was observed. At the 
December menstrual period the same condition was 
repeated. April 5, the girl was three months preg- 
nant, and the right eye had remained normal since 
the December period. 

Spontaneous Development of Gas in the Blad- 
der. — M. F. Guiard has collected a number of these 
cases which he reports, in detail, in the pages of the 
Anndl. des Malad. des Organes Getiito-Urinaires, 
with the conclusions that, where there is no abnor- 
mal communication between the urinary passages 
and the alimentary canal, the phenomenon is very 
rare. Its clinical symptom is the escape of gas 
through the penis, and seems to be connected with a 
special fermentation of the urine, which is only ob- 
served in those cases of glycosuria that have been 
submitted to catheterism. The sugar, under the in- 
fluence of particles of ferment introduced by the in- 
strument, has resolved itself into alcohol and car- 
bonic acid. This, then, is a symptom of glycosuria, 
but it seems to have no value in prognosis of itself. 

Prolapsus of the Rectum Treated by Injec- 
tions OF Ergotine. — M. Jette has treated with suc- 
cess sixteen cases by the use of ergotine in solution 
with cherry laurel, i gramme to 5 grammes, inject- 
ing 15 to 20 and 25 drops every other day. The 
needle is introduced about 5 millim. from the renal 
orifice, parallel with the walls of the intestine, and 
should penetrate to the depth of 2 to 4 centim. into 
the thickness of the sphincter fibres. The injection 
should be introduced gradually on account of the pain 
it produces. The pain is at first very severe and lan- 
cinating, then becomes dull and constant, lasting for 
several hours. The treatment may take a it\\ days or 
several weeks to effect a cure. With a feeble dose 
there is a frequent desire to go to stool and to urin- 
ate, with strong doses there is a spasm at the neck of 
the bladder, dysuria, or a retention of urine for eight 



or ten hours. In a few patients Vidal has noted ver- 
tigo, a tendency to syncope, a painful sense of con- 
striction about the heart, with a hard, firm and some- 
what slow pulse. The later injections are more ac- 
tive than the first, and seem to indicate a cumulative 
action, as in digitalis. Vidal uses this means also, as 
applied to old haemorrhoidal tumors, which protrude 
and are accompanied by paralysis of the sphincter. 
The tumor is forced either from its cutaneous or 
mucous surface, becomes duskv and tender, but is very 
favorably modified without forming abscesses. — 
Therap. Contemp. Med. et Chir. 

A Case of Urethral Calculus. — Cultivator, aet. 
36; admitted to hospital for obstruction in the passage of 
urine, which had been passed with great difficulty and 
only in drops for the past five days. History of 
chronic gonorrhoea of two years duration, but none 
of stricture. On examination the penis was swollen 
and oedematous, and a hard, painful tumor, the size 
of a small orange, was found just in front of the 
scrotum. A No. 6 silver catheter was passed into the 
urethra, but its progress was impeded at the seat of 
the tumor, and its contact with a stone evidenced by 
the metallic click and a grating sensation. He was 
placed under chloroform, an incision about i^ 
inches long was made over the inferior wall of the 
urethra, and a stone measuring 23^x11^x1 inch, 
weight 980 grains, was removed. In six weeks 
time, with the use of carbolized dressing and cathe- 
terism, the wound was represented by a minute fistula. 
The stone was a uric acid calculus. — Indian Medical 
Gazette, Calcutta. 

Death Following a Rectal Injection of Sol. 
Acid Carbol. — A case has recently been concluded 
in the High Court of Calcutta, to which the Indian 
Medical Gazette devotes considerable space, and 
where a boy of five had been suffering from bloody 
diarrhoea and the presence of thread worms. The 
physician who was called to relieve this condition 
injected 18 ounces of a i in 60 solution, represent- 
ing 1 44 grains of carbolic acid and warm water. A 
few minutes were occupied in administering the in- 
jection, during which the child felt no pain ; but 
while the enema was being retained by pressure the 
child's head dropped on one side, and there was a 
state of complete collapse, and it remained uncon- 
scious for six hours, with total loss of reflex power. 
Artificial respiration, the battery, injections of oil 
and of milk, and twice of ammonia, were employed 
until some reflex action was induced. Four hours 
later the child became conscious and partook of 
liquid food, but five and a half hours later still — that 
is, fifteen hours and a half after the administration 
of the enema — the child died in convulsions. Three 
or four attacks occurred, which were not violent or 
prolonged. There was no post-mortem held, and 
the physician was found guilty of causing death by a 
rash and negligent act. 

Sponge Grafting. — Dr. de Lautour, in the Austra- 
lian Medical Journal, gi\es a case of a se\ere burn 
in a child of four years, where a thick band of cica- 



146 



MEDICAL PROGRESS. 



[August, 



tricial tissue extended across the back of the 
knuckles, across the thumb, extending far down and 
also up above the wrist. The hand was bent back- 
wards, and the fingers back on the hand, and the 
thumb dislocated backwards. He divided the cica- 
trix at intervals of one-half to three-quarters of an 
inch (the cicatrix was generally the thickness of the 
little finger), and dissected up a little from the bot- 
tom of each incision, so as to loosen the cicatrix. 
The dislocation was then easily reducible, and the 
hand and fingers easily brought into their natural 
position. A splint was applied to the palmar sur- 
face, retaining the parts normally, and there was a 
gap in each incision of about one-half an inch. In 
each of these gaps he fitted a piece of sponge (fine 
Turkey sponge, washed in a solution of iodine, then 
of salicylic acid and borax, and then in a solution 
of salicylate of soda), allowing the sponge to over- 
lap, in order to provide for possible shrinking. The 
sponge was retained in place by strips of salicylated 
isinglass silk plaster, and the whole dressed with dry 
lint, on which was spread an ointment of eucalyptus 
•oil and vaseline, 5i to Si- The grafts ad- 
hered, the granulations grew through the sponge ; 
there was some suppuration, the granulations as they 
grew pushing out the discharge in front of them. 
They ultimately enclosed the sponge, and a new cica- 
trix grew over the top, leaving an elongated cica- 
trix and the thumb in its natural condition. Nine 
months later the original cicatrix had somewhat con- 
tracted, and the grafts show quite distinct from the 
plain fibrous band. In commenting on his case. Dr. 
de Lautour expressed it as his intention in his next 
case of enucleation of the eye-ball, after removing 
the eye-ball, to insert a piece of sponge within the 
capsule of Tenon, and stitch the conjunctiva over it, 
as calculated to make an excellent stump. 

Obstruction of the Bowels ; F^cal Vomiting : 
Recovery. — Mr. George R. Eraser, l.r.c.p.e., of 
Wark-on-Tyne, Northumberland, writes : 

'' On April 11, at 10 p.m., I was hurriedly sent for 
to visit a lady, aged about 45, who was said to be 
suffering from ' cramps of the stomach.' She was in 
bed, vomiting frequently, and complained of intense 
pain of the stomach and bowels. Her pulse was 
little affected, her tongue clean, her temperature 
normal, and her bowels had been freely moved 
twenty-four hours previously, after the use of aperient 
medicine. I prescribed bismuth with hydrocyanic 
acid, and also a full dose of tincture of opium, under 
the impression of having to deal with a case of acute 
gastralgia. The treatment had no marked effect, 
for, upon visiting her five hours after, I found 
she had passed a restless and sleepless night. The 
pain was sometimes acute, and the nausea and vom- 
iting recurred frequently. I was shown a hand- 
basin containing upwards of a pint of distinctly faecal 
material which she had just vomited, and her breath 
had also a strongly fascal odor. The real nature of 
the case was now apparent. On careful examination 
I could ascertain no cause of strangulation ; no ex- 
ternal hernia, nothing abnormal within reach by the 
rectum, and no abdominal tumor existed, and faecal 



impaction could not be looked upon as probable. 
Copious injections failed to bring a trace of faecal 
matter from the bowels, and only served to show 
that obstruction was complete. The abdomen was 
distended, and the pain, as already noticed, often 
most severe. The early appearance of foecal vomit 
j was remarkable. In all the circumstances I ascribed 
j the symptoms to a twist, or to an intussusception at 
! some point in the course of the small intestines. If 
I due to intussusception, might not the purgative taken 
by the patient have had something to do with its 
production ? We know that invagination is apt to 
arise from causes that produce increased irritability 
of the bowel. The stercoraceous vomit enabled me 
to form an early diagnosis, a point of the greatest 
moment in these cases, as it enables us to adopt a 
rational course of treatment. Better leave such cases 
entirely to nature, than administer a single dose of 
drastic medicine. No time was lost in placing the 
patient under the influence of opium. The drug was 
given as tincture, but generally in the form of powder, 
frequently repeated and continued throughout the 
attack ; and no food of any kind was taken, for 
which, indeed, the patient expressed no desire. Ice 
was not procurable, but cold spring-water and soda- 
water were enjoyed in small quantities, frequently 
repeated to allay thirst. The effect of the opiate 
was soon apparent. Vomiting became less frequent, 
no doubt from the influence of the drug in control- 
ling intestinal peristalsis, and the patient became 
comparatively easy and had some rest. The char- 
acteristic vomit continued to recur at much longer 
intervals. Occasionally the rejected material was 
merely a greenish fluid, consisting, no doubt, of the 
water swallowed mixed with bile. The symptoms 
were now less acute, but distension increased. Warm 
fomentations were constantly applied, and injections 
given occasionally. On the third day she was seen 
in consultation by Dr. Ridley, of Gateshead, who 
suggested operative means, or at least tapping, for 
the purpose of relieving the tympanites, which was 
now becoming extreme, and that possibly the bowel 
might right itself. Her friends, however, were averse 
to any form of surgical interference ; and the treat- 
ment was continued as hitherto, with the addition of 
nutritive enemata, and the free use of belladonna 
liniment to the abdomen, as recommended by Dr. 
Ridley. The opiate maintained its soothing influ- 
ence, but the symptoms became more urgent. Hic- 
cough was constant in the evening ; tongue red and 
dry; pulse 134; temperature not taken. She had 
another good night, and in the morning looked de- 
cidedly better than on the previous evening. She 
had two attacks of faecal vomiting during the day, 
but rested well. It was now the fifth morning, and 
the last upon which sickness and stercoraceous vomit 
appeared. Her pulse was good, and her expression 
cheerful. In the afternoon she informed me that 
* something had liberated itself in her inside,' and 
that she was passing wind since I saw her last. A 
liquid motion followed soon after from the bowels, 
which contained a few firmer pieces of faeces of the 
size of hazel-nuts. From this date her improve- 
ment was uninterrupted. She soon regained her 



1883.] 



MEDICAL PROGRESS. 



147 



usual health, and has since remained perfectly well. 
" Invaginations are said to be of frequent occur- 
rence, giving rise to temporary derangement of the 
bowel, and they are also believed to become soon 
disentangled by the normal peristaltic movements. 
If this were a case in point, the favorable result was 
probably due to the free use of opium. Had pur- 
gatives been used fatal strangulation would, I think, 
have inevitably supervened. A timely diagnosis 
would render the purely medical treatment of these 
cases more successful than it has hitherto been." — 
British Medical Journal. 

Galium Aparine as a Remedy for Chronic Ul- 
cers. — Dr. F. J. B. Quinlan, M.D., Dubl., F.K.Q.C.P., 
Physician to St. Vincent's Hospital, Dublin, has 
treated cases of chronic ulcer with great success, by 
means of poultices made from " Cleaver's " {galium 
aparine). Respecting a very bad case of senile ul- 
cer. Dr. Quinlan writes: "We had now come 
nearly to the end of April, and our failure in this 
case was complete. It appeared to me that now was 
the time to try the galium aparine, which was begin- 
ning to peep out in all the hedgerows about Dublin. 
An ample supply for this and other less severe cases 
has since been kept up, and it has been used with 
the most marked success in the following manner. 
Grasping in the left hand a bundle of ten or twelve 
stalks, with a scissors held in the right hand, the bun- 
dle is cut into junks about half an inch long. These 
are thrown into a mortar, and pounded into a paste. 
This paste, which has an acrid taste and slightly acrid 
smell, is made up into a large poultice, applied to the 
. ulcer, and secured with a bandage. It is renewed 
three times a day. Its action appears to be a slight 
steady stimulant, and powerful promoter of healthy i 
granulation. Its effect in this most unhopeful case 
was decisive and plain to all. Healthy action ensued, 
and has since steadily continued ; and, after a month ; 
of treatment, both ulcers have been reduced to con- 
siderably less than half their original size. If this : 
action continue, which I have no reason to doubt, : 
the cure will be accomplished within a measurable 
and short period. The patient is in the ward, and 
anyone can see the great amount of new dermatisa- 
tion which has been effected during the month." Dr. 
Quinlan was equally successful in several other cases. \ 
He continues : 

•* A difficulty at once suggests itself as to its gen- • 
eral employment; viz., that in winter and spring it ; 
is not to be had at all. It appears to me that this ; 
difficulty can be effectually met by the method of 
ensilage, by means of which green food for cattle has, i 
for the last few years, been kept perfectly sweet and j 
fresh by burying it in silos under the ground. This 
plan is generally known, but all particulars about it | 
can be learned in the pamphlet of Mr. Thomas 
Christy, f.l.s. (Christy and Co., 155 Fenchurch 
Street, London, E. C). In the case of the galium, 
the process would consist of cutting the herb very 
fine, ramming it down by screw-pressure into a glazed 
earthenware jar with an air-tight cover, and burying 
it in the ground. Thus secured from air, moisture, 
and heat, it would be likely to keep through the win- 
ter. One of my pupils, Mr. M. Pierce, has already 



laid it thus down, and will report the result to me. 
This plan, if successful, might be extended to other 
pharmaceutical herbs ; for I have always had the idea 
that green herbs are more powerful than dried ones. 
Indeed, the late Mr. Donovan, of this city, used to 
maintain that, to make tincture of digitalis properly, 
the alcohol should be brought to where the foxglove 

I was growing, and the live plant plunged into it. — 

\ British Medical Journal. 

! Puerperal Affection's of Mother and Child. 
\ — The transmission of puerperal affections from 
I mother to child through the milk seems to be shown 
i in a striking manner in this paper. Dr. Gaulard first 
I discusses a case where a puerperal affection is the re- 
i suit of exposure to erysipelas, and secondly a case 
I where puerperal lymphangitis gives rise to erysipelas. 
! The first case is of a woman confined by the doctor 
! while attending a number of cases of facial erysipe- 
! las. Eight days after her confinement she is seized 
\ with symptoms indicative of puerperal uterine lyni- 
'. phangitis, which results in an abscess of the broad 
ligament, which discharges itself through the rectum. 
The second case was taken a few days after confine- 
; ment with symptoms of puerperal lymphangitis, but 
; continued to nurse her child, which appeared healthy 
with the exception of a redness of the eyelids, for 
which slightly astringent lotions were used to prevent 
, a possible invasion of ophthalmia. The umbilicus did 
' not cicatrize, and very shortly an erysipelatous red- 
i ness invaded the pubic region, scrotum, thighs, legs, 
: feet, buttocks, and lumbar region, not at any time 
' passing beyond the umbilicus. The child at the 
I same time suffered from fever, insomnia and diarrhoea. 
The scrotum, which was affected by some effusion 
into the tunica vaginalis, became darker, and finally 
sphacelated — the slough separated, leaving a bare 
wound, which took on a healthy appearance. The 
child took the breast with avidity, but soon vomited 
all the milk taken in ; the diarrheea became very fre- 
quent, and the stools of a very unhealthy nature, so 
that it was decided to take the child from the mother 
and give her to another nurse, when all of these 
symptoms disappeared rapidly. The mother was al- 
lowed to give her breast to the nurse's child, an in- 
fant of four or five months, vigorous, healthy. It 
soon took on this marked redness in different parts of 
the body, of a fugitive nature, appearing and disap- 
pearing suddenly in one or the other region, without 
the general health being apparently affected. The 
mother's milk examined carefully presented nothing 
abnormal, and the child, after entire recovery, was 
returned to its mother's breast, who nourished it sat- 
isfactorily. — Gaulard. Bulletin Medical du Nord. 
Mars. 1883. 

Imperforate L'rethra. — Male child ; aged thirty- 
six hours : position of meatus well marked ; sexual 
organs well formed. A stylet failed to find the canal ; 
puncture of the bladder at the pubes caused the dis- 
charge of about two ounces of urine. It was found 
necessary to make an exploratory incision on the in- 
ferior surface of the penis to search for the canal, 
which was supposed to be obliterated near the glans 
penis. — M. Folet, Soc. Cent, de Med. du dipr. du 
Nord, Bulletin Medical du Nord. 



148 



EDITORIAL. 



[August, 



THE 



Journal i American Medical Association. 



PUBLISHED WEEKLY. 



The Editor of this Journal would be glad to receive any items of 
general interest in regard to local events, or matters that it is desirable to 
call to the attention of the profession . Letters written for publication or 
containing items of information, should be accompanied by the writer's full 
name and address, although not necessarily to be published. All com- 
munications in regard to editorial work should be addressed to the Editor. 
Subscription Price, including Postage. 

Per Annum, in Advance j5,oo. 

Single Copies lo cents. 

Subscriptions may begin at any date. The safest mode of remittance 
is by bank check or postal money order, drawn to the order of the under- 
signed. When neither is accessible, remittances may be made at the risk 
of the publishers, by forwarding in registered letters. 
Address 

Journal of The American Medical Association, 

No. 65 Randolph Street, 

Chicago, Illinois. 

SATURDAY, AUGUST 11, 1883. 



LOST MEMBERSHIP. 



Editor of the Journal of the American Medi- 
cal Association : 

What has been the course of the Association in the 
case of members who have failed to keep dues paid 
up? Does payment for one year restore them to 
active membership, or must all arrears be paid? 
Will subscription to The Journal secure the privileges 
of membership at the next meeting to a member now 
in arrears? Respectfully, 

The foregoing letter of inquiry was received a day 
or two since, and as the questions it contains have 
been asked many times during the past year, we think 
it may be profitable to give them a public answer. 
The course of the officers of the Association in 
relation to members not paying their annual dues, 
is clearly defined by the following provisions of the 
constitution and by-laws : "Any permanent member 
who sha\\ /ail to pay his annual dues for ^kree succes- 
sive years, unless absent from the country, shall be 
dropped from the roll of permanent members, after 
having been notified by the Secretary of the forfeiture 
of his membership. ' ' Any member " in arrears for a 
period of not more than fkree years, can retain his 
membership, by paying to the Treasurer the wko/e 
amount due. When one has been a member 
and has allowed his dues to remain unpaid more than 
three consecutive years, and has received notice from 
the Secretary, that his membership in the Association 
'\% forfeited, there is no provision in either constitution 
or by-laws for his reinstatement by paying any 
amount of previously unpaid dues. 

On the contrary, having forfeited his membership 



and received official notice of the fact from the Sec- 
retary, he is in the same position as though he had 
never been a member. The only way for him to 
regain membership, is, to obtain from his State or 
local Society an election as delegate, attend the 
annual meeting of the Association and register as a new 
member. Simply subscribing for the journal of the 
Association does not secure any privileges of member- 
ship in the meetings of that organization. 



Annual Meeting of the British Medical Asso- 
ciation. — The fifty-first annual meeting of this As- 
sociation was held in accordance with the previously 
published programme, in Liverpool, from July 31 to 
August 3, inclusive. The New York Medical Record 
of August 4 contains a very brief abstract of the 
proceedings, received by cable dispatch. The meet- 
ing is represented to have been largely attended, and 
the work done in the several Sections varied and im- 
portant. Among the guests in attendance from other 
countries was Dr. Austin Flint, Sr., President of the 
American Medical Association, who was received 
with great cordiality. In a letter from him, dated 
July 4, he expressed much interest in the current 
year's work of our own National Association and its 
culmination at the next annual meeting in Washing- 
ton. He will soon be home, and, if his efforts are 
promptly sustained by the officers of Sections and 
prominent members of the profession throughout the 
country, the next meeting will show an amount and 
quality of work which will bear favorable comparison 
with the work of any of the national medical organ- 
izations of Europe. 



Yellow Fever and Cholera. — No evidence has. 
come to hand that either of these diseases have made 
advances, or appeared in new places since the previ- 
ous issue of this journal, and there is a strong prob- 
ability that the latter will not extend beyond its 
present boundaries this season. Should the remain- 
der of this month and September be accompanied by 
unusually high temperature, in the South Atlantic 
and Gulf States, there will be more danger of the oc- 
currence of yellow fever, in spite of the most vigi- 
lant quarantine influences. 



Distant Appointment. — We learn that Dr. 
Charles Fremont Dight, Assistant to the Chair of 
Pathology and Practice of Medicine in the Univer- 
sity of Michigan, has been elected Professor of 
Anatomy and Physiology in the Medical College at 
Beirut, Syria, in Asia. He is expected to enter upon 



c883.] 



CINCINNATI LETTER. 



149 



his work the coming autumn. He is now visiting 
the principal medical centers of Europe. We wish 
him long life and much usefulness. 



Necrological Report. — Dr. Toner, Chairman of 
the Standing Committee on Necrology, presented to 
the recent meeting of the Association a voluminous 
report. To prevent absorbing too much space with 
that kind of reading in any one number of The Jour- 
nal, we have thought it better to give a few of the 
Biographical Sketches in each number. 



CORRESPONDENCE. 



OPIUM POISONING. 



Editor Journal of the American Medical Asso- 
ciation : 

The treatment of opium poisoning by atropine has 
been too long and successfully practiced to need the 
support of any new clinical facts, still there are modi- 
fications of the treatment which may merit notice, 
inasmuch as it does not always happen in emergen- 
cies of this class, which the physician is called upon 
to meet, that he finds a salt of atropia accessible. In 
such cases he is not without resources if his pocket 
medicine case is ordinarily well equipped. 

A few days ago a two-days-old baby was given 
one-fourth grain of morphine by mistake. I saw it 
nine hours later, when at first sight, it seemed to be 
dead, as the friends believed it to be. Deeply cya- 
notic, it showed no sign of respiration, and the pulse 
at the wrist was absent, as indeed it remained, except 
at short intervals, for many hours. 

Having no atropine, I immediately injected subcu- 
taneously five minims of tr. belladonna, followed by 
an equal amount a few minutes later. By my direc- 
tion an infusion of coffee was prepared, containing 
two tablespoonfuls to the cup, which was given hypo- 
dermically, a syringeful every ten or fifteen minutes. 
Within half an hour the worst of the cyanosis had dis- 
appeared. A pulse came temporarily to the wrist 
still earlier; respiration came with gasps, although 
wide apart. The contracted pupil dilated to more 
than its normal size, remaining so for three hours, 
when it began to contract again. The belladonna 
was then used as before, with a drop of digitalis, as 
the pulse was again absent from the wrist. As before, 
both pupil and pulse responded, and all symptoms 
improved, but an hour later the injection was repeat- 
ed. Coffee was given subcutaneously throughout the 
day ; artificial respiration was kept up when cyanosis 
returned, as it did many times, and frequent chafing 
of the extremities. 

By midnight it was quite sure that the child would 
recover, but consciousness did not return until noon 
the next day, forty hours after the morphine was 
given. 

I have questioned whether in this case the tincture 
of belladonna did not serve a better purpose than the 



atropine would have done, adding to its antidotal 
effect that of a stimulant to the heart, which seemed 
needed quite as much as anything else. Undoubt- 
edly not a little of the final and unexpected result 
was to be attributed to the other means employed, 
but they are to be regarded only as important auxili- 
aries, the most striking results having been attained 
before they were employed. J. R. Barnett. 

Neenah, Wis., Aug. 9, 1883. 



CINCINNATI LETTER. 



[For The Journal of the American Medical -Association.] 

It has been the intention of your correspondent to 
have written ere this, and now fully agrees with 
Perseus, when he wrote : 

" Unhappy he who does his work adjourn, 
And to to-morrow would the search delay, 
His lazy morrow will be like to-day." 

From day to day has this pastime been adjourned 
only to find it much more easy to do so on the mor- 
row. True, there has been little to write about. We 
are having a remarkably quiet summer and very little 
sickness. A cynic at my elbow claims that it is on 
account of so many of the profession being out of 
town ; it remains to be seen whether that theory is 
any ways good when our new Board of Health is 
under full headway. Our Democratic council mort- 
gaged itself by selecting a Board, composed of five 
saloon-keepers and an advertising, so-called, doctor 
— all solid Democrats, — and they l\ave likewise shed 
a halo around their august body by selecting an old- 
time politician, a chronic place-seeker, who at one 
time was in the lumber business, as the Health Offi- 
cer. I should say that, for appearance sake, they did 
offer the position to that valuable statistician, phy- 
sician, and gentleman. Dr. Thomas Minor, knowing 
full well that he would decline. Dr. Minor had the 
office once, a few years since, much to his regret, as 
his private business suffered considerably, though he 
won golden laurels in the estimation of the public 
for the thorough manner in which he performed the 
duties of the office. His annual reports were models, 
and are frequently quoted to-day. The present Board 
is illegal. The Superior Court was authorized by the 
Legislature to appoint a Board, but through some 
delicate question in their (the lawyers') code, they 
declined. We are anxiously awaiting the meeting 
of the Legislature, when the guillotine will fall and 
the Board will be gracefully cremated. In the 
meantime we stand with bated breath and scan the 
mortality reports. So far there has been no marked 
increase over this time last year. 
^ New York, it is noted, is to have a crematory fur- 
nace. Not to be behind our Eastern brothers, Cin- 
cinnati, too, is taking the initiatory steps towards 
having one. Cremation is growing in favor fast 
here, partly on the score of economy, but principally 
on that of health. Like all reforms, it has its 
strong advocates and strong adversaries, the latter 
are in the minority, however, and no doubt be- 
fore many years the ceremony will be thought noth- 
ing more of than the ordinary funeral of to-day, 
with its long array of carriages, flowers, and costly 



ISO 



CINCINNATI LETTER. 



[August, 



casket. There was the reverse of that, however, in 
the funeral of Dr. Jno. A. Warder, who died at his 
suburban home a few weeks since of paralysis. He 
was a member of the Society of Friends, and had 
always believed the practice of that body in its sim- 
plicity in all things should be lived up to, and so 
directed for his own funeral. A coffin the plainest 
of the plain, a ceremony after the form of his re- 
ligious society, private in nature, the family only be- 
ing present ; a funeral cortege consisting of a wagon 
and one carriage, the rest of the family coming to 
the city by train, and meeting the remains at the 
cemetery, where the burial was privately held. It 
caused some comment by some of the members of 
the Forestry Association, and of course they had to 
rush to the daily press, as they were foiled in the 
effort to palm off a lot of set speeches, that would be 
asked to go for orations. If a few more men of the 
ability and standing of Dr. Warder would follow his 
example, and their families show the same good sense 
as his did, all this " pomp and circumstance " of the 
last rites of the dead, which in the main is show, 
would be materially done away with, as it is hoped 
cremation will assist in. 

The new Journal, as the organ of the American 
Medical Association, is well received here. It starts 
out well, and hopes are entertained that when the 
wheels are all well oiled smooth running will be en- 
joyed. There is certainly one advantage ; you cau 
have it bound in any form and colored binding yon 
wish, by that means giving some "life" to your 
library, and not be compelled, as heretofore, to ac- 
cept the transactions in black, making your shelves 
look like the inside of a mortuary, that mournfnl 
color predominating to such an extent. 

We were highly gratified and edified to have the 
American Surgical Association meet here some few 
weeks since. Much good work was done, and we 
felt highly complimented to think we should have 
such a distinguished body among us. We have had 
nothing of the kind since 1867, when the American 
Medical Association met here. , There was so much 
hilarity on that occasion — "Old Crow," "Amon- 
tillado," "Vino dePasto," to say nothing of "Pom- 
mery Sec." — (which caused a good many hicks) — 
flowing like water ; that there was no opportunity for 
any person to read a paper. There were several 
commenced, but soon a motion was made to adjourn, 
as the Association had an invitation to visit a famous 
wine cellar — a steamboat ride — a reception, or some- 
thing else of a like nature. As that motion was al- 
ways in order, the reader would have to stop and 
hear it carried, while there was nothing for him to 
do, but to look amiable over the disappointment in not 
having the opportunity to give the members the results 
of six months work in preparing his paper, and hand 
it over to the Publication Committee, to appear in 
somber hued transactions without discussion. Never 
since that date, have there been enough votes in the 
Executive Committee to have that Convention come 
among us again. There was more hospitality than 
meeting, but that was on account of our being so 
near Kentucky, and while we are proud of our hos- 
pitable name, we would like to show some of the mem- 



bers, who have found since then what we can do, 
and those who met with us before, how we are able to 
extend a welcome now. We will guarantee a royal 
time. The ladies are prettier ; the houses finer; 
the suburbs more beautiful ; the attractions in the 
city and the doctors more numerous — to make no 
mention of what can be done in a musical line ; or 
what can be shown in the way of hospitals and medi- 
cal schools. If we were complimented in having the 
Surgical Society here, you may rest assured, we 
were chagrined at the silent manner in which they 
were treated by that "Great American Medical Com- 
piler," published once a week here — not one word 
was made mention of their sessions. Various theories 
were advanced, but nothing definite was known un- 
til " 77ie Clinical Brief and Sanitary News,''^ a 
monthly for July, comes with an editorial explana- 
tion. The editor takes the " two leading editorials 
from the Lancet and Clinic, of June 9," one of 
which is on how " catgut ligatures are falling in the 
estimation of surgeons," occupying four lines. 
The other is a " correction," in which three lines of 
their valuable space is occupied — commenting on the 
above. The editor of the ^^ Brief,'''' says: — "The 
importance of the above editorials, added to the fact 
that the editorial space in the C. L. and C, is limit- 
ed, we trust will be accepted by the distinguished 
surgeons from all parts of the United States, who have 
been in convention assembled in this city for a num- 
ber of days, and have just adjourned, as ample apolo- 
gy for the non-appearance of any notice of their pro- 
ceedings. There is also this apology : Had the Con- 
vention held its meetings in the hall over the office 
of the Cincinnati Lancet and Clinic, and not in Col- 
lege Hall, reports might have been , prepared, and 
space for their publication found, but as it was, the 
Convention was too far away. The next meeting of 
the surgeons in this city should be held in Brother 
Culbertson's hall. We desire to benefit Brother Cul- 
bertson, and admonish the surgeons." 

Some of our experts with the microscope anticipate 
much pleasure and profit in visiting your friendly city 
to attend the American Society of Microscopists. 
One member expects to take some beautifully pre- 
pared specimens of the present rage, " the bacilli." 

The different medical schools here have out their 
new announcements — each trying to outdo the others, 
at least it has that appearance to one on the outside. 
The Miamis have at last awakened to the fact that it 
might be to the advantage of their school to have 
some young life in the Faculty, and consequently have 
recognized the ability of some of the graduates who 
have been in practice a few years, by giving them sub- 
ordinate positions, with big promises — it remains to 
be seen whether or no they make them good. There 
is a general impression that the transfusion of " new 
blood ' ' has been performed so late that it is hardly 
possible to aid in the desired resuscitation. They 
met with an irreparable loss when Prof. William H. 
Mussey, their National man, was taken from them by 
death, now nearly a year ago. The restrictions of the 
Association of Colleges were more than they wanted to 
stand ; so they kicked over the traces, dashboard and 
all, and are now out entirely, eating husks and pray- 



t883.] 



SOCIETY PROCEEDINGS. 



i5» 



ing for richer pasturage. The Ohios have the lead, 
as they have had for many years. There is lots of 
push and energy in the executive officers and Faculty, 
and they spare no exjjense to matriculate the stu- 
dent, and more than give him his money's worth in 
the way of clinical advantages. The dean compli- 
mented the new college, or rather the new Faculty of 
the old, Cincinnati College of Medicine and Surgery 
not long since, by expressing fears that they (the 
Ohios) would find them (the Cincinnatis) "a thorn 
in their sides," or words to that effect, as " they now 
had a new, hard-working, harmonious Faculty, who 
would make themselves heard from." The last ses- 
sion — which was the 48th since the college was organ- 
ized — the first under the new Faculty, certainly looks 
as though they would be a splinter of some magnitude 
in the pectoral muscles of the other schools. There 
is one paragraph in their announcement which reads : 

" Believing that without purity of character no one 
should receive a passport to the sick-room, the Fac- 
ulty will refuse to recommend any candidate for 
graduation whose moral character is under a cloud, 
and the Trustees will publicly revoke the diploma of 
any graduate of this institution who may be convicted 
of using his profession for criminal purposes. ' ' 

This certainly speaks well for the new Faculty, and 
is worthy of commendation. They took charge of 
an institution that was in the "slough of despair," 
and by their lives and acts are regenerating it with a 
rapidity that is phenomenal. 

Drs. Dawson and VVhittaker, who have both suf- I 
fered the severe pangs of grief in losing their wives ■ 
recently, are, with many others of the profession, out 
of the city. But this must close, or there will be 
nothing left for my next. Protoxide. 



SOCIETY PROCEEDINGS. 



CHICAGO MEDICAL SOCIETY. 



The Chicago Medical Society held a regular meet- 
ing July 16, at which time Dr. H. D. Valin read a 
paper of much scientific interest, on "Mechanical 
Equivalent of Animal Heat," and forming part of a 
manual of biology which he is writing. It gave the 
normal temperatures of various species of cold and 
warm-blooded animals, of certain plants which pos- 
sess a temperature of their own, of hybernating ani- 
mals, and referred sleep to certain changes of tem- 
perature. The relation of heat to growth was con- 
sidered one of correlation, though not one of causa- 
tion, as Carpenter had suggested. The slight effect 
of heat on proto-organisms, and its powerful absorp- 
tion by mammals, was referred to the elementary 
composition of each, etc.. Dr. Valin's theory being 
that heat absorption increased as the atomatic weight 
of the elements exposed to the heat, and that the 
higher animals contained more of the heavier salts. 
He also believed that radiant heat became animal 
motion in the organism, though the larger part of 
animal motion resulted from oxidation, or combus- 
tion of food. The mechanical equivalent of heat, 
as calculated by Dr. J. R. Mayer, and ascertained 



by Joule, was stated, but that was no longer the unit 
in use. The unit now taken as the standard was 425 
kilogrammeters, which is equivalent to a kilogram of 
water heated one degree C, or raised 425 meters 
high. This, in English figures, was a pound of water 
raised one degree C. The heat units of various 
substances in combustion were then stated, and 
the writer claimed an inverse ratio between 
these numbers and the atomic weight of the 
substances. The experiments of Him on human 
power of work were given, by which it was shown 
that man at work consumes five times as much oxy- 
gen as during rest ; that it requires the combustion 
of 9 ounces of carbon in the human body to 
maintain work and life for 24 hours, and that a unit 
of heat is produced by man in 15 seconds, while a 
unit of heat in man required the combustion of 11 
grains of coal, in an engine it required 9)4, and in 
the open air the same quantity of heat resulted from 
the combustion of 2]/^ grains of charcoal. The 
views peculiar to Dr. Valin were that the adipose tis- 
sue was the coal-bin of the human engine, and should 
not be allowed to accumulate unduly, but be reduced 
by active work in order to maintain health ; that vi- 
tality was proportioned to the height of the tempera- 
ture in any organism ; that the heat of certain fevers 
often appeared as mechanical work in the form of 
violent delirium, and then was no longer appreciable 
as heat ; that the endurance of cold was a mechan- 
ical work in the body which generated an equivalent 
of heat ; and that active bodily work abstracted heat 
from the body, and quieted the mind in mania. But 
as the machinery of an engine becomes heated by 
friction and the furnace by contact, so human tem- 
p>erature rises a degree during work, and that was a 
measure of the work done. A rise of temperature in 
the brain most likely would give an index of the me- 
chanical work of thought, but this was more easily 
measured by the plethysmograph, which records the 
increase of the circulation in the brain during 
thought. 

Dr. W. L. Axford read "notes" of a case 
ofbi-lateral dislocation forward of the fourth cervical 
vertebra, that had fallen under his care. The 
accident occurred in the month of March, 1883, 
to a little girl 8 years of age. The extent of the dis- 
location was ?5 of an inch, and no fracture occur- 
red, nor was there any injury to the cord. Drs. E. 
Andrews and J. G. Kiernan had seen the case, and 
verified the diagnosis. During the past six months 
the child had made almost a perfect recovery. The 
treatment consisted in the "let alone" method. 

At no time were there marked paralytic symptoms, 
but the rotary movements of the head were somewhat 
interfered with, and the head was thrown forward 
and had assumed a more fixed position. 

Dr. C. T. Fenn reported a case of "Acute Hepatic 
Abscess," with Mistaken Diagnosis, Free Opening, 
Death, Autopsy, occurring in a boy 14 years of age. 
It is related that two years ago he received a kick of 
a horse over his right side, his forearm intervened, 
and the injury caused him no serious trouble at the 
time, although he fainted, and ever since he had been 
subject to pains in the side. He had been an ap- 



152 



SOCIETY PROCEEDINGS. 



[August, 



prentice in a blacksmith shop, and on June 19, 1883, 
quit work, complaining of headache and pain in his 
right side, and suffering from " cold." On the sec- 
ond day he had a feverish pulse, hot skin, bad odor 
to his breath, coated tongue, pain in his head, neck 
and limbs, and especially under the right breast. 
Gave tr. opii deodor. , kali chlaursaures in glycerine, 
and aqua distil, and at night applied emp. cantharis 
4x5 to the right side across and above the short ribs. 
On the third day the fetor was corrected, the pain in 
the side gone, but thirst and headache, and the 
tongue remained the same; tympanitis, with rapid 
pulse, high temperature, and a tendency to cough, 
which would cause pain in his side, were present. 
On the fourth day he uttered a slight cough with ev- 
ery breath. There was decided flatness over (as Dr. 
F. thought) the lower lobe of the right lung, extend- 
ing from the nipple downward. Poultices were ap- 
plied from this time continually. Tympanitis and 
perceptible bulging of the right side were noticed. 
Constant rest on his back caused extreme discomfort, 
with perceptible shortening of the breath. On the 
fifth, sixth, and seventh days the temperature of the 
body was high, the pulse over 100 during the day, 
with an increase at night. No tendency to any 
movement of the bowels. The urine is somewhat 
darker than normal, but skin and conjunctiva unaffect- 
ed. Patient had to sit up to obtain rest from the pain of 
lying so long on his back. In this position the heart 
.was noticed beating between the second and third 
ribs. Dullness on the right side extended to one and 
a half inches above the nipple. The cough is still 
somewhat troublesome, but by using salicylate of soda 
it seemingly now is beginning to subside. There is a 
dark, moist coat upon the tongue ; has marked thirst ; 
tympanitis, with no movement of the bowels. Large 
enemae being introduced daily, were retained. He 
loathed beef tea, but found satisfaction in tea, 
coffee and lemonade. On the eighth, ninth, tenth 
and eleventh days the treatment consisted of ano- 
dynes, nutriment and poultices. On one of those 
days he evacuated the bowels copiously, the contents 
being dark, thin and offensive. The tongue cleaned, 
and remained so. On the twelfth day the patient 
appeared much improved. The lateral fullness was 
reduced. He slept and ate with evident benefit. We 
discontinued the poultices, and he sat for most of the 
time in his chair by day. On the fourteenth day he 
grew worse — the dullness which had been lowering in 
his side increased to its former stand. He perspired 
freely, and it was quite disagreeable ; had chills and 
exacerbations of fever at night. On the fifteenth 
day Dr. D. T. Nelson was invited to see him, for the 
purpose of assisting in surgical interference, should 
the diagnosis be confirmed, which was "pleurisy, 
with effusion." Dr. Nelson used the aspirator at a 
point about a third of the way from the median line, 
in front, to the spine, and between the eighth and 
ninth ribs. Pus was directly perceived, and a free 
opening was made, followed by a copious, sluggish 
stream of offensive matter. A drainage tube was in- 
serted, and the opening was dressed with cotton, 
soaked in carbolized glycerine. Before this was done, 
however, a finger was introduced directly into the 



wound, and there were discovered smooth, soft walls, 
apparently held together by strong trabeculae. From 
position of the opening it was concluded the lung 
was broken down at the site of the large abscess. 
The prognosis was looked upon as almost hopeless, 
considering the rapid development. The amount of 
fluid which escaped at the time of the operation and 
during the night was at least a pint. On the sixteenth 
day he was greatly relieved. The cavity was washed 
freely with carbolized water, which was returned al- 
most clean. Slept well the two nights following. 
Eighteenth day, the external wound was clean and 
dry ; the carbolized water could be iujected five or 
six inches and immediately be returned almost clean. 
Reasoning on the assumption that this had been an 
abscess of the right lung, I thought it quite strange 
that the only constitutional symptoms were those of 
septicaemia. The internal treatment was tonic, sus- 
taining, fever mixtures, expectorant and anodyne. 
By the twenty-first day, as the chills had recurred, 
with bad nights, extreme heat, and the attempts at 
cleansing the interior were unsatisfactory, and think- 
ing what new resort to undertake, the patient was 
seized with a rigor on the twenty-second day, from 
which he did not rally, and died. 

Autopsy twelve hours after death. Body had been 
surrounded by ice ; was distended, and purple ap- 
pearance of face, neck, chest and abdomen as if de- 
composition was quite advanced. Incision from top 
of sternum to three inches below umbilicus exposed 
contents of the chest. The lungs were both found 
to be healthy, and crowded up to occupy but half 
their normal space. The heart was beneath the sec- 
ond and third ribs. The liver extended across the 
body on a line above the level of the nipples. The 
stomach and intestines were inflated with gas and aid- 
ed in forcing the liver higher up. The opening to 
the abscess was directly over the thickest portion of 
the liver, and about one-third of the organ seemed 
to be involved ; the rest appeared healthy. The per- 
itoneum was not inflamed. The spleen was softened. 
No other observations were made, and it was not easy 
to see how the abscess had its origin. Could it be 
traceable to the injury received twu years ago, and 
then acute symptoms of three weeks' standing arise ? 

Dr. W. H. Curtis asked the author of the paper if - 
diarrhoea had been present any time preceding his 
sickness ? Answered, No. 

Dr. D. R. Brower asked if any jaundice was pres- 
ent during the patient's illness. Answered, No, but 
immediately after death the surface turned yellow. 

Dr. L. H. Montgomery inquired of Dr. Fenn 
what the difference in the treatment would have been 
had the diagnosis of the case proved to be an abscess 
of the liver? Answered, None, and this was one of 
the reasons why the case was reported to-night, as 
well as its comparative rareness. 

Dr. W, L. Axford asked if the edges of the liver 
had grown to the walls of the abdomen ? Answered 
negatively. 

Dr. H. D. Valin remarked that one year ago he 
saw a case of hepatic abscess. Twelve years pre- 
viously the patient (a man), had malaria. There was 
no diarrhoea, but decided motion of the heart was 



t883.] 



SOCIETY PROCEEDINGS. 



153 



noticed. There was no jaundice. The inflamma- 
tion was of nine to eleven days duration, when 8 
ozs. of pus were evacuated by an opening into the ab- 
scess. In two weeks the patient recovered. 

Dr. Curtis had met four cases of abscess of the j 
liver, which is not of frequent occurrence in the tem- i 
perate zone. In brief, they are as follows : The 
first was an Indian boy, who was taken sick and the 
abscess pointed to the ribs. A free incision was 
made, and a knotted lump of lumbricoid worms 
(large as a man's fist), was first discharged. Then 
offensive pus followed. The wound was cleansed 
thoroughly for several days and the boy recovered. 
In this case the lumbricoides was the cause of the ab- 
scess. 

Second case occurred in a chronic drunkard who ' 
had chronic liver trouble. The man sickened, and a ; 
diagnosis of an abscess of the liver was made. A 
free opening in his side by the knife resulted in the | 
abscess discharging itself. Adhesions to the walls of 
the abdomen were found. Recovered. j 

Third case occurred in a women 62 years old. i 
She had marked jaundice, and marked symptoms of \ 
septicaemia, and in two weeks purpura set in. The [ 
abscess ruptured into the lung and she expectorated 
pus freely. She rallied and partly convalesced, but > 
chills and fever supervened and her life was de- 
spaired of. It, however, gave away again into the 
stomach, and a large quantity of pus was vomited, I 
when she finally recovered. At 16 years of age, an | 
incision was made in her right side, from which a | 
number of gall stones were removed, and the cicatrix | 
still exists. j 

Fourth case : Railroad president. Had been i 
under his care for ten days, when he proposed aspir- I 
ation, but his friends concluded to take him to New ■ 
York for further advice. This was accordingly done, | 
and there operated upon in the same manner, re- 
sulting in recovery. 

Dr. A. R. Brower presented a heart having the 
following lesion : 

The case was one of endo-carditis, with roughen- 
ing of the mitral valve, and no murmur was present 
when the patient (a woman), was alive. The endo- 
cardial trouble began with a puerjjeral fever of a ' 
year previous. The valve was perfectly sufficient is j 
the reason why there was no murmur. Had it been ' 
insufficient a murmur would have been discovered. | 
An embolism had formed, but with the stethoscope j 
no possible abnormal condition of the heart could ; 
be detected. She also had chorea, and great short- ■ 
ness of breath. No murmur could be detected after j 
exercise, or after laboring under excitement. The 
patient was anaemic and emaciated. Thinks it rare 
to find on record a case of mitral lesion, as this case 
is, and with the other conditions, and no murmur to 
be heard. 

REPORT OF PROCEEDINGS OF THE AMERICAN 
SOCIETY OF MICROSCOPISTS IN CHICAGO, | 
BEGINNING AUGUST 7, 1883. | 



The first session of the sixth annual meeting of 
the Society began Tuesday morning, with an address 
of welcome by Prof. Lester Curtis, President of the 



Illinois State Microscopical Society, and a response 
by Prof. McCalla, of Fairfield, Iowa, President of 
the American Society of Microscopists. The annual 
report showed the condition of the Society to be 
encouraging, and called attention to the important 
papers which had been prepared for the present 
meeting. The Executive Committee, through Prof. 
D. S. Kellicott, of Buffalo, N. Y., Secretary of the 
Society, recommended the election to membership of 
fifty persons. These persons, together with about 
fifty more who were chosen at later sessions, materi- 
ally increase the strength of the Society. 

After discussion a motion was passed, which pro- 
vides that hereafter no one shall be elected a member 
unless the admission lee of S3 and the annual tax of 
$2 accompany the application. 

The offer of the Chicago Times to publish a com- 
plete report of the meeting was accepted. ■ 

It was decided to amend the by-laws so that here- 
after papers accepted by the Society may be published 
in any reputable journal, provided that credit be 
given to the Society. 

In the afternoon session Dr. F. M. Hamlin, of Au- 
burn, N. Y., read a paper on 

THK MICROSCOPICAL EXAMINATION OF SEMINAL STAINS. 

The ordinary method of examination, essentially that 
of Koblauck, which consists in soaking the stained 
cloth or object in water and examining the sediment 
deposited from the water, has led to such poor results 
that Dr. Hamlin has discovered and recommends the 
following method : A small piece of the suspected 
cloth about an eighth of an inch square, is placed on 
a slide moistened with water, and after soaking a 
short time a cover is applied. In the case of cotton, 
the ends should be frayed, and with colored woolen 
stuffs the suspected parts should be scraped off with 
a knife. Hairs may be cut off and examined in the 
same way, but care must be used not to lose the crust 
which contains the sperms. They will be seen in 
all cases between the meshes of fibres, or clinging to 
the threads or hairs, and successive examinations of 
different portions will reveal any if present. The 
superiority ot this method to the common one is well 
shown by comparing the results obtained by treating 
a known stain in both ways. The frequent failure of 
the ordinary method is probably due to the breaking 
down of the fragile sp>ermatozoa when the embedding 
crust is dissolved. The specimens may be tempora- 
rily preserved by ringing them, and probably by the 
use of carbolic acid they may be kept for a long 
time. 

In the discussion of the paper. Dr. Henry Gradle, 
of Chicago, stated that he had frequently stained 
spermatozoa in the same way as he stained bacteria. 
When seeking for them in urine he dries a drop on a 
cover glass and stains with an aniline color. By 
successively adding drops and drying he increases 
the chance of finding the germs when few in number. 
He has found that they readily take up aniline colors. 

A well written paper by Prof. Sarah Whiting, of 
Wellesley College, on 

COLLEGE MICROSCOPICAL SOCIETIES, 

was next read. The need of such a society in a col- 
lege, and the means ior making it a success, were 



154 



SOCIETY PROCEEDINGS. 



[August, 



clearly given, and then followed a description of the 
origin and management of the successful Wellesley 
College Society. 

Next followed a paper by Prof. S. H. Gage, of 
Cornell University, on 

CATALOGUING, TABLEING AND STORING MICROSCOPICAL 
SPECIMENS. 

The value of a complete catalogue was emphasized, 
and the advantages of the card catalogue adopted at 
Cornell were pointed out. The following formula 
will indicate what is desirable for convenience and 
completeness : 

An Actual Catalogue Card Written 
According to the Formula. — 

1. Nerve fibers. 

2. No. 31 (Drr. 11), March 21, 
!8o; S. H. G., preparator. 



Formula for Cataloguing Microscop- 
ical Preparations. — 

1. The general name. 

2. The number and date of the 
preparation, and the name of the 
preparator. 

3. The special name of the prepa- 
ration ; the common and scientific 
name of the object from which it is 
derived. 

4. The special object of the prepa 
ration. 

5. The method of hardening, dis- 
sociating, etc. 

6. The special method of prepara- 
ion for the microscope, viz.: cut into 

tections, spread, etc. 

7. The staining agent and the 
time required for staining. 

8. The clearing agent and the 
mounting medium. 

9. The objectives to use in study 
ing the preparation. 

10. Remarks, including references 
to good figures and descriptions. 



Formula for Labeling Microscopical 
Preparations. — 

1. The number and date of the 
preparation (No. 2 of catalogue). 

2. The general name (No. i of cat 
alogue.) 

3. The name of the object from 
which the preparation is derived. 



3. Isolated, medulated nerve fibers 
from the sciatic of the cat (felis do- 
mestica). 

4. This preparation shows well the 
axis cylinder and the nodes of Ran- 
vier. 

5. Dissociated 24 hours in 25 per 



cent, alcohol. 

6. Teased or dissociated 
slide with needles. 



the 



7. Stained over night in picrocar- 
mine. 

8. Cleaned with turpentine and car- 
bolic acid ; mounted in chloroform 
balsam. 

9. Use three-fourths and higher ob- 
jectives (x5ox), 

10. See for figures and descriptions 
Quain's Anatomy, Vol. II., p. 141, 
and Ranvier, Traite d'Histologie, 
p. 723. 

Label Written According to the For- 
mula — 

1. No. 96; 1880. 

2. Nerve fibers. 

3. Cat. 



Tuesday evening. Prof. McCalla delivered the 
annual address. The theme chosen was 

THE VERIFICATION OF MICROSCOPIC OBSERVATION. 

The address consisted in a retrospect of the work of 
the past, and a statement of the means to be em- 
ployed to verify the truths of the present and future. 
Wednesday morning. Prof. T. J. Burrill, of Cham- 
paign, 111., read a paper on 

METHODS OF PREPARING AND MOUNTING BACTERIA. 

The elements of successful staining were enumerated 
as follows : 

I. The organisms should be decidedly and con- 
spicuously colored. 2. The general mass of imbed- 
ding material should be left unstained, or so different 
in color that the organisms can be distinctly seen. 

3. There should be no granular or other precipita- 
tions from the staining material, nor should any 
portion of the latter remain as a coating on the glass. 

4. The color should be suitable for the purposes re- 
quired, and permanent, if the object is to be mounted 
for the cabinet. 5. The process should be as simple 
as possible and free from manipulative difficulties. 

The aniline dyes are most serviceable in staining 
bacteria, and of these dyes methyl violet in aqueous 
solution is most frequently used. There are two ob- 
jections to this stain. It is apt to be fleeting, es- 
pecially if exposed to the light, and alcohol will dis- 



charge the color, hence mounting in balsam is 
impossible. The first may be partly removed by 
making a deeper stain, and then removing the excess 
of color by washing. The second objection is best 
met by using a solution of the violet in glycerine. 
One part of the dye to five parts of glycerine pro- 
duces a successful and permanent stain. 

Suppose one wants to examine the organisms in his 
own or any other person's mouth. He may proceed 
as follows : Secure a little mucus from the tongue or 
teeth, taking care to avoid the remnants of the last 
bread and butter enjoyed. Place the substance on a 
clean glass slip, and if necessary, mix by stirring. 
Make a little spatula of wood a quarter of an inch 
wide, and cut square at the end, with which smear 
a well-cleaned cover glass, after the manner of spread- 
ing blood, by drawing the spatula with the material 
once or twice, side by side, over the desired surface, 
holding the instrument at 30 or 40 degrees from the 
horizontal. Dry in the air or with moderate heat ; then 
pass the glass through a flame somewhat quickly three 
or four times, holding the smeared surface up, and 
from a bottle, through the cork of which passes a 
glass rod, put on a drop of the glycerine violet ; after 
one minute or less wash with water by means of -a 
stream from a wash-bottle, and mount while wet for 
examination, the upper surface being wiped dry. If 
for permanent preservation, see that the cover glass 
and stained material are thoroughly dry; then 
mount directly in pure balsam, or, better in some re- 
spects and not so good in others, in Farrant's solu- 
tion of gum and glycerine. All this can be done 
without putting the object out of hand, and in a very 
short time, and our specimen remain fit for the cab- 
inet, or for re-examinations, months and probably 
years afterward. The use of an alcoholic solution of 
blue or red aniline would, with the same or similar 
treatment, be a complete failure, the whole surface, 
glass and all, remaining smeared with the dye in 
spite of water washing, and che whole color disap- 
pearing with the use of alcohol. With other organ- 
isms, as, for instance, the micrococcus of pear blight, 
the aqueous solutions of red or violet aniline are par- 
tially successful, while methyline blue entirely fails, 
but the strong glycerine solutions of the two former 
give far better results. 

The next hour was to have been occupied by Dr. 
Detmers, of Champaign, 111., with a paper on the 
subject of 

PATHOGENIC BACTERIA, 

but as the paper was not ready he gave a talk on the 
same subject, which led to a sharp discussion. Dr. 
Detmers considered the ordinary classification of 
bacteria, viz. : that ofCohn, as imperfect, and held 
that the genus micrococcus should disappear. The 
forms referred to this genus he believed to be one 
stage in the development of bacilli or other kinds of 
bacteria. In other words, a micrococcus has the 
same relation to a bacterium as a catarpillar has to 
a butterfly. 

He also held that a bacterium may be innocent 
under certain conditions and harmful under others. 
He has often found bacteria in his own blood when 
he was perfectly well, while under other conditions. 



t883.] 



SOCIETY PROCEEDINGS. 



155 



when the bacteria were in a different stage of de- 
velopment, they would probably do harm. 

It was not to be expected that such views, from 
one holding so important a position in the govern- 
ment service, presented without evidence, would be 
accepted without discussion. Dr. Henry Gradle, of i 
Chicago, called attention to the labors and con- j 
elusions of Zopf. While acknowledging the relia- i 
bility of Zopf s experiments. Dr. Gradle considered i 
that the generalization made, namely, that one ! 
germ can be changed to another, was unwarranted. ! 
The more probable conclusion seemed to be that 
germs are genetically related as man and the dog 
are related to the bird in the embryo state. | 

The next paper was bv Dr. G. E. Fell, of Buffalo, I 
N. Y., on 

THE CLINICAL ADVANTAGES OF OZONE AND ITS | 

EFFECTS ON BACTERIA. | 

The author described the practice of Dr. Bartlett, 
of Buffalo, who has for some time treated zymotic i 
diseases with ozone. The success of this mode of '■ 
treatment suggested to Dr. Fell a series of experi- j 
ments to determine the effects of ozone in preventing ' 
the growth or destroying the life of germs. The ex- ; 
periments evidently involved considerable labor, but ' 
it is doubtful whether the results are of great value ' 
on account of ignorance of the labors of others, and [ 
inattention to important details. The results were ! 
varying; in some cases ozone decreased or destroyed j 
bacterial life, while in others no effect was produced. 

The committee on the important subject ot 

NOMENCLATURE AND SIZES OF OCULARS 

presented a report in which they recommended the 
adoption of the following resolutions : 

Resolved, That this society recommends that ocu- 
lars be named by their equivalent focal distances on 
the basis of one inch focus corresponding to ten 
diameters of amplification at ten inches distance, and 
that this nomenclature be employed in the pro- 
ceedings of this society. 

Resolved, That this society recommends the adop- 
tion of the diameter 1.25 inch outside measure as a 
standard size of ocular tubes, with a preference for 
1.35 where larger, and .92 where smaller sizes are 
required, and recommend 0.75 outside measure for 
ocular cap tubes, and 1.50 inch measure for substage 
tubes. 

This report was discussed and finally the subject 
recommitted. At a later session it was brought up, 
but again referred to the committee to be decided 
next year. 

Wednesday afternoon Dr. G. E. Blackham present- 
ed the following resolution, which was adopted : 

" In view of the fact that the Royal Microscopical 
Society of London has seen fit to honor this Society 
by making its President a fellow of the Royal So- 
ciety, it seems fitting that there should be some for- 
mal recognition on our part of the honor thus con- 
ferred by the oldest and most distinguished national 
microscopical society upon the youngest. I therefore 
move, first, that the American Society of Microscop- 
ists recognize and reciprocate the kindly fraternal 
feeling shown by the RoyalMicroscopical Society in 
making our presiding officer an ex-officio fellow ; sec- 



ond, that, as a further evidence of appreciation and 
reciprocal feeling, we hereby elect the President of 
the Royal Microscopical Society and his successors 
ex-officio members of the American Microscopical 
Society." 

Prof. W.'A. Rogers, of Harvard University, then 
presented a paper entitled 

A CRITICAL STUDY OF THE ACTION OF A DIAMOND IN 
RULING LINES ON GLASS. 

The writer first referred to his theory concerning 
the method which Nobert may have employed in the 
production of his test plates. The summary of this 
theory may be given in his own words : 

When a diamond is ground to a knife edge, this 
edge is still made up of separate crystals, though we 
may not be able to see them, and a perfect line is 
obtained only when the ruling is done by a single 
crystal. When a good knife edge has been obtained 
the preparation for ruling consists in finding a good 
crystal. Occasionally excellent niling crystals are 
obtained by splitting a diamond in the direction of 
one or more of the twenty-four cleavage planes 
which are found in a perfectly-formed crystal. A 
ruling point formed in this way is, however, very 
easily broken, and soon wears out. Experience has 
shown that the best results are obtained by choosing 
a crystal having one glazed surface and splitting off 
the opposite face. By grinding this split face a knife 
edge is formed against the natural face of the dia- 
mond, which will remain in good condition for a 
long time. When a ruling crystal has been found 
which will produce moderately heavy lines of the 
finest quality, it is at first generally too sharp for 
ruling lines finer than 20,000 or 30,000 to the inch, 
even with the lightest possible pressure of the surface 
of the glass. But gradually the edges of this cutting 
crystal wear away by use until at last this particular 
crystal takes the form of a true knife edge which is 
parallel with the line of motion of the ruling slide. 
In other words, when a diamond has been so adjusted 
as to yield lines of the best character, its ruling 
qualities improve with use. If Nobert had any so- 
called ''secret," I believe this to have been its sub- 
stance. 

A microscopical study of ruled lines shows that 
there are different ways in which they may be pro- 
duced. Ordinarily an opaque groove, which stops 
the light, is cut by the diamond. Sometimes, how- 
ever, the particles of glass removed by the diamond 
are piled up in a window besides the real line. These 
particles may appear in four characteristic forms : 
{a) They appear as chips scattered over the surface 
of the glass, {b) They appear as particles so minute 
that when laid upon a window, and forming an appar- 
ent line, they can not be separated under the micro- 
scop>e. {/) They take the form of filaments when 
the glass is sufficiently tough for them to be main- 
tained unbroken, {d) They take a circular form. 

The lines best suited to the work of the' micro- 
scopist are evidently not of this character. To pro- 
duce permanently good lines three conditions must 
be fulfilled, i. The glass must be tough. 2. The 
crystal must produce lines which will retain their 
form after the surface of the glass is rubbed. It 



X56 



SOCIETY PROCEEDINGS. 



[August, 



should be remembered that a ruled plate must be 
cleaned by rubbing only in the direction of the 
the lines, and never across them. 3. The line must 
Bot break down upon the lapse of time. 

Passing on to the claims of Mr. Tasoldt, of ruling 
lines one million to the inch, Prof. Rogers made a 
sharp distinction between visibility and resolution. 
In regard to the limit of resolution it must be ad- 
mitted that no advance has been made since the 
resolution of Nobert's nineteenth band. It may be 
possible to go a little beyond 113,000 to the inch, 
but it is safe to say that this is about the limit. The 
visibility of single ruled lines is a distinct problem, 
and it is'proposed to substitute this as a test in place 
of the resolution of lines in close combination. In- 
stead of bands of lines of the Nobert pattern, a 
series of bands is suggested, each having the same 
interlinear unit, but with the lines of each succes- 
sive band finer than those of the preceding band. 
One mickron is a convenient interlinear unit. A 
heavy line should precede the band in order to 
facilitate finding it. 

The paper was closed by showing the intimate re- 
lations between the limits of naked-eye and micro- 
scopic visibility. Lines whose width did not exceed 
one-sixth of a mickron have been seen by the naked 
eye which could not be discovered by the micro- 
scope. 

The next paper was by Prof. A. H. Chester, on 

DRY MOUNTING. 

On account of the great difficulty in successfully 
mounting dry objects, namely, the deposit on the un- 
der side of the cover-glass, Prof. Chester, following 
out a suggestion of Prof. Rogers, has worked out the 
following method, which may he given in the words 
of the writer : 

"The object is fastened to the glass slip in the 
usual way, and a cell built up around it by means of 
one or more tin rings. When the cell is high enough 
so that the cover-glass laid on top will not touch the 
object, a tin ring having a little larger hole is cement- 
ed on, thus forming a ledge on which the cover-glass 
may rest, with room above it for the wire ring, which 
holds it in so firmly that there is no danger of its be- 
ing jarred out. The tin cells are made as described 
at the Elmira meeting last year, by punching rings 
^ from thick tinfoil and afterward stringing the rough 
rings on a mandril that just fits the hole, clamping 
them fast and turning them down until they are just 
the right size outside. After considerable experiment 
I have adopted the following sizes in the various parts 
of this work, using a five-eighths inch cover-glass: 
For the cell-rings a No. 29 punch is used, having a 
diameter of 0.543 of an inch. For the top rings the 
punch is No. 22, with a diameter of 0.505 of an inch. 
This cuts a little larger than its inner diameter, and 
will just admit the five-eighths cover-glass. For the 
outer rim of both a No. 11 punch may be used, 
0.751 of an inch in diameter, and making the rings 
large enough to allow for turning down. The tinfoil 
for the upper ring should have a thickness of about 
0.032 of an an inch. No. 21 of the Birmingham 
wire gauge. Made with a gun-wad punch, the rings 
will have a bevel on the inside, and being set with 



the smaller hole uppermost the bevel will help to hold 
the brass ring in place. The wire rings are made 
from No. 24 spring brass wire, 0.022 of an inch in 
diameter. These rings are easily made by winding a 
wire on a spindle about 0.4 of an inch in diameter, 
forming a spiral spring, every coil of which when 
cut open makes a ring. The exact size of this spin- 
dle is not important, for the size of the spiral can be 
varied by putting more or less strain on the wire, or 
by the rate at which the spindle is revolved. The 
rings should be a trifle larger than the opening in 
cells, so that small pieces must be cut out to make 
them fit exactly when sprung into place. They can 
then be taken out and the cover-glass removed with 
the greatest ease. The cover-glasses should not be 
more than one-hundredth of an inch thick, and sev- 
eral thicknesses of tinfoil may conveniently be used 
for the lower cells. The thinnest I use is 0.005 of ^^ 
inch. For objects requiring less than that I simply 
turn a cement ring on the glass, and then put the top 
cell on that. 

After the reading of this paper there was an expo- 
sition of the methods of work by many of the mem- 
bers of the society. 

Wednesday evening Prof. W. H. Walmsey, of Phil- 
adelphia, read a paper on " Photomicrography," and 
exhibited his apparatus. 

Prof. D. S. Kellicott, of Buffalo, followed with a 
valuable paner on " Parasites in the Gills of a Cray- 
fish." 

At the close of the session many of the members 
accepted an invitation from Prof. Hough, of the Chi- 
cago Observatory, to visit and examine the telescope. 

In the next number of The Journal there will be 
given a report of the remaining sessions of the so- 
ciety. 

REPORT OF THE SECRETARY OF THE SECTION ON 
OBSTETRICS AND DISEASES OF WOMEN. 



Section on Obstetrics and Diseases of Women met 
in Frohsim's Hall. Dr. J. K. Bartlett, of Wisconsin, 
Chairman. In absence of the Secretary, Dr. G. A. 
Moses, of St. Louis, Missouri, Dr. J. T. Jelks, of Hot 
Springs, Arkansas, was appointed Secretary. First 
paper, by Dr. W. H. Byford, of Chicago, on " Intra- 
Pelvic Inflammations of a Chronic Form," was read 
by the Secretary. 

All parties making speeches were requested to fur- 
nish the Secretary with copies of their remarks. 

Next paper was on ' ' Post-Partum Polypoid Tu- 
mors," by Dr. H. G. Landis, of Ohio. 

The paper was ably discussed by Drs. Wathier, of 
Kentucky, and H. O. Marcy, of Boston. 

Next paper was read by Dr. H. O. Marcy, on 
" Restoration of the Perineum by a New Method," 
the doctor exhibiting the pins with which the new 
operation is performed. The paper was ably dis- 
cussed by Drs. Brown, of Detroit, Michigan ; E. W. 
Jenks, of Chicago; H. O. Marcy, of Massachusetts; 
Haw.s, of Detroit; Wathier, of Kentucky; Sutton, of 
Pittsburg; Reamy, of Ohio; Potter, of New York; 
and Watson, of Wisconsin. 

The next paper presented to the Section was by Dr. 
Sutton, of Pennsylvania, on " Enterotomy as a Com- 



1883.] 



REVIEWS. 



157 



plication in Ovariotomy or Oophorectomy." Dr. 
Murdock, of Pennsylvania, discussed the paper and 
confirmed the statements of Dr. Sutton. 

Dr. Jenks, of Chicago, moved the appointment of 
a committee on publication of the papers, said com- 
mittee to be composed of five, of whom the Chairman 
and Secretary shall constitute two. After which the 
Section adjourned. 

SECOND DAY. 

Dr. Bartlett, of Wisconsin, Chairman ; and *J. T. 
Jelks, M.D., of Arkansas, Secretary. 

Section on Gynaecology and Obstetrics. Session in 
Frohsim Hall. Second day, June 6. 

Dr. E. C. Dudley asked permission to transfer 
reading of his paper from this p.m. to first thing to- 
morrow afternoon. Granted. 

Dr. R. Beverly Cole, of California, being absent, 
and his paper on " Subinvolution, Its Causes and 
Treatment," not being on