fºrks, Providence, R, I., ºf FESSOR E. N. HORSFORD, - Marvard University, Cambridge, Mass. sºld Phosphates as therapeutic agents is in keeping with well-known Té has ever been offered to the public which seems to so happily meet the CID PHOSPITATE. It is not nauseous, like most of the preparations of Phos- iſie taste, and with water and Sugar makes a cooling and pleasing drink. No dise, as it is the same Acid that is found in Wheat and other Cereals. If We take more ſº thin is needed, it is expelled with the secretions of the body. cially recommended for Dyspepsia, Urinary IXifficulties, Cerebral and Spinal Paralysis, Men- Fion, Wakefulness, Hysteria, and Nervous Disorders in General. Most excellent results have ºčd its administration for the prostration and nervous symptoms following Sunstroke. We ask the careful attention of all thinking persons to the high character Öf the following testi. donials : tº. {#. Henry, M.D., Editor of the American Journal of Syphilography and Dermatology, New York City, says: “I have, for more than two years, prescribed the Acid Phosphate rather extensively, in a variety of gases where the use Of phosphºrus was indicated, and I assure you with the most satisfactory results. In nervous dis- eases I know of IRO preparation to equal it.” - Adolph Ott, Technical Writer and Editor of the Department of “Physics, Chemistry, and Technology" of the Ger- micrº-Americºt? Cyclopaedict, says: “I have tried several phosphites, and even phosphorus in substance, but none of them with Such marked success as your Horsford's Acid Phosphate.” The statements made by others as to its effects on the nervous system and the brain, I fully confirm. ... Some months l have been enabled to devote myself to hard mental labor, from shortly after breakfast till a late hour in the evening Without experiencing the Slightest relaxation, and I Would now at no rate dispense With it.” John P. Wheeler, FA.D., Hudson, N. Y., says: “I have given it, with present decided benefit, in a case of innutrition of the brain from abuse of alcohol.” & Dr. Wm. A. Harm mond, g now of New York, formerly Professor of Physiology in the University of Maryland, says: “I make use habitually of phosphoric acid and the pliosphases, in the treatment of nervous diseases. I prescribe it eonstantly every day of my life. It is very well known that, in certain cases of paraplegia (paralysis of the lower extremities), and which are dug to paralysis of the spinal cord—to a degeneration of the sub- º: Ofi. goºd—the disease cannot be so effectually cured by any other means as by the administration Of p[108phOru.S. Dr. Fordyce Barker, New York City, says: “There are very often cases where the human system needs, f, ºr its restoration, the administratiºn of the Pºp., The eases that require a phosphatic treatment an e those where the waste of the phosphates is greater than the Supply. The class is very numerous. First, in all those cases of dērangement of the digestive and assimilative organs, where, in consequence of thia derangement, the waste is greater than the supply. The next most frequent is where there is an excessive demand for nerve-power, as in men engaged in professions, and in business excitenlei) is ; noxt, in ex- cessive demands resulting from prolonged lactation ; and another class still, the excessive tax on phys- ical power and muscular effort, without the necessary Supply. R. Ogden Doremus, Professor of Chemistry in the College of Pharmacy of this city, and in the Medical College of the City of New York (formerly called the Free Academy), and in the Bellevue Medical Hospital, says: “I have had, for many years, professional employment in the matter of examining human urine. The amount of the phosphates will be increased in the urine, as the result of abnormal exercise of the body; or where the brain and nervous system are overexcited. This result of the discovery of a greater pro- portion of the pliosphates in urine, after excessive mental labor, has been verified by oxperiments within my experience, and is in accordance with an ordinary knowledge from examinations of urine, insomuch that We teach these facts in Our lectures to medical Students.” William H. Van Buren, ºft. D., - of New York, says: “I have been employed professionally to make examinations of the human urine and have generally found the phosphates in excess in cases where the nerve centres (the brain and spinal cord) had been overworked or subjected to undue labor. The opinion which obtains in the profession and which has been confirmed by my own personal experience, is that there is a received rélation be- tween an excess of phosphates in the urine and intellectual exercise.” Physicians wishing to examine and test this remedy are requested to apply, by letter or otherwise, to the undersigned. II. M. A.MTHONY, Successor to WILSON, LOCKWOOD, EVERETT & CO, G|| Agis, 51 Murray Street, New York City. The Tº tion and CEN Professor DOrū, “The only appalºs tus meeting the de mand of advanced science.” The only one adapted to the wants of Practition- Riºſ ER. of MPROVEMENT3:5. NEW-YORK £º º--------------- -------ºsmºs--- -º-º-º-º-º- É====# Er- *----- ***--": - ***-*. - - opinion of PROF. DoREMUs. The following testimonial from R. O.GDEN DoREMUs, M.D., Professor Chemistry and Physics in the N. Y. City College, and Professor Chemistry and Toxicology, Bellevue Hospital Medical College, refers to the Superior merits of Dr. Kidder's Apparatus:— - “COLLEGE OF THE CITY OF NEW YORK, CoR. LEXINGTON AVE, AND 23D STREET, ** DR. J.EROME IS IDDER : New York, August 9th, 1871. “Dear Sir, Within the past few weeks I have carefully examined the construction of Several forms of your Electro-Magnetic Machines. - “I find that they differ in philosophical principles from any I have before investigated, and that they possess, in addition, many mechanical improvements. “By your ingenious modifications and combinations of the primary current of the Galvanic Battery, accomplished by passing it through helices of wires of differing lengths and thicknesses, I find that the electric effects are materially altered in a manner not accomplished by any other machines. “These variations I have tested by galvano-metric, electro-thermic, and other Scientific instru- nlCIltS. - “I have also experienced the varied effects produced upon the human system in my own person, and have witnessed the same in others, on applying the currents of electricity from the various coils, and through Conductors of graded lengths and sizes. ſ #y “Thus the eye can be stimulated to appreciate various amounts of light without pain; or slight pain may be experienced without so exciting the organ as to perceive light. By changing the flow of the mysterious agent, its influence may be felt at the wrist, in the forearm, or higher up near the shoulder, in addition to all the variations of frequency, direction, and power usually provided for in electro-magnetic machines. - “I confess I was surprised at the agreeable nature of the electric current. Most persons dislike the peculiar sensations experienced from the ordinary machines, and, after a first trial, decline a repetition of it. All Such would appreciate not only the bearable but the pleasant effects produced by your arrangement. - “Thus you have placed in the hands of the skilled physician most valuable modifications of a power which is destined to solve many of the mysteries of our organization, and to relieve many of the ills of life. “In conclusion, I would state that your method of varying the Prºary as well as the Induced currents surpasses all other devices I have studied, as tested by scientific instruments and by physio- logical effects. “I most heartily commend its use to my medical brethren as the instrument for research in this attractive field of medical inquiry. “I have the honor to remain your obedient servant, R. OGDEN DOREMUs, M.D.” Dr. KIDDER manufactures also the most approved Primary Cell Batteries, with improved facili- ties for manipulating the currents, and at reasonable prices. Primary Batteries, with an improved patented arrangement for throwing intensity into quantity, and vice versa. Varied and approved extra appliances for special cases. In order to get the genuine Apparatus, send for Illustrated Cir- gular, with Price-List. Address, - , Dr. JEROME KIDDER, 544 Broadway, N. Y. º Dr. Jerome Kidder's ELECTRO-MEDICAL APPARATUS, ** -- ºr--- Aſſº Sº º Improved forms now offered to Practitioners. Siw Varieties of Faradaic Elec- tricity. For the superiority of Dr. Kidder's apparatus over all others, reference is respectfully given to Dr. Reuben A.Vance, Editor of THE MEDICAL WORLD; Tr. Lewis A. Sayre, the distinguished Surgeon, and many others. Prof. Silliman, of Yale College, New Haven, says: “I have seen and examined experimentally, on several occasions, the Elec- tro-Magnetic Apparatus for medical use made as Patented by Jerome Kidder of New York. This apparatus is capable of producing modified and manifold cur- rents, differing from each other in respect of intensity and quality of Nervous and Muscular effect, as well as in magnetic and electro-chemical power.” * , The convenience and effectiveness of Dr. Kidder's Faradaic Electrical Appa- - ratus, it is known, have advanced the cause of Electrical Medication during the last ten years, and he now adds the most effective arrangements to manipulate and control the currents of primary cell batteries by inventions recently patented. , Office of Dr. KIDDER's ELECTRICAL MANUFACTORY, 3.84 Broadway, New York. Advertisements. Dr. Wadsworth's Uterine Elevator, Or, STEMI PESSARY IMPROVED, The most simple and practical of any ever invented. It is made of a pre- paration of India Rubber that does not irritate at all the soft parts with which it comes in contact, has no metallic material to produce galvanic action, the application of it is simple and easy, and névér fails of keeping the womb in its natural position. . It is strongly recommended by forty, of the first-class physicians in Providence, and by eminent practitioners of medi- cine in every State in the Union. Price to Physicians, $6 OO. A pamphlet, giving a full description of the instrument and of the invention may be had by ad- dressing the proprietor, with stamp to pay postage, or the undersigned, e H. H. BURRINGTON, Chemist and Druggist, Providence, R. I. Also for sale by Qtto & Reynders and Geo. Tiemann & Co., New York; Snowden & Bro., Philadel- §: Max Wocher & Son, Cincinnati; F. S. Siegel, Louisville ; A. M..Leslie & Co., St. Louis; Van chaack, Stevenson & Reid, Chicago; A. A. Dunk, E. Saginaw, Mich. ; Frederickson & Harte, New Orleans, La. WINES AND LI For Medical Use. JAMES LIDGERWOOD, 758 Broadway, New York, IMPORTER OF Fine Wines, Liquors, Condiments, Delicacies, Etc. All goods guaranteed to be strictly pure, and of the very best ſquality. Particular attention paid to orders for the use of the sick-room. Orders by mail carefully packed and promptly shipped. Collection on DECKER BROS., Patern t Plate GRAND, SQUARE,& UPRIGHTPIANOS VVarerooms, 33 Union Sq., Broadway. FACTORY, 322, 324, 326, 328, & 330 W. 35th ST., EXTENDING TO 313, - 315, 317, 319, & 321 W. 34th ST. —º-Q-4— delivery. . “One of the simplest and most truly valuable improvements yet made in the pianoforte is that invented and patented by Decker Bros.”—From the New York Tribune, The Only Journa' of its Kind in the English Language. T H E AMERICAN JOURNAL OF OBSTETRICS DISEASES OF WOMEN AND CHILDREN. E DITED BY B. F. D A W S ON, MI. D., ATTENDING PHYSICIAN TO THE NRw York 8TATE wom EN'S HOSPITAL, ANb To THE NEw York FBrm DISPENS ARY FOR SIGK CHILI) REN. ASSOCIATE EDITORS : * E. NOEGGERATH, M. D., LATE PROFESSOR OF OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN IN NEW YORK. A. JACOBI, M. D., CLINICAL PROFESSOR of DISEASEs or CHILDREN IN THE COLLEGE of PHYSIOIANS AND SURGEoNS, N. Y. -**º-sa- --- -º-eº -º-ººse". Engouraged by the reception which the Journal has already met with from the profession and the medical press, the Publishers have determined to spare no expense to make it take foremost rank with the first-class publications of medical literature. Originally containing but 96 pages, the Journal has been enlarged to 192, making 768 in each volume. The Journal is published quarterly (May, August, November, amd February), and ENTERS UPON ITS FOURTH YEAR AND FOURTH WOLUME With the issue of May, 1871. It is divided into “ORIGINAL CoMMUNICATIONs,” “CorresponDENCE,” “TRANSACTIONs of THE NEw York AND PHILADELPHIA OBSTETRICAL SOCIETIES,” “REvi Ew of LITERA- TUBE PERTAINING TO PREGNANCY, LABor, THE PUERPERAL STATE; Drs EASEs of Wom EN: AND DISEASEs PECULLAR To CHILDREN,” and a complete Review of the Foreign and Domestie Works of value; Lec- tures, Clinical Reports, Operations, etc., will occasionally be inserted. The Three Departments will be equally represented in each Number. Among the contributors of papers in the numbers already issued are: Prof. T. G. THOMAs, College Physicians and Surgeons, N. Y.; Prof. G. T. ELLIOT, Bellevue Hospital Medical College; Prof. W. A. HAMMOND, Bellevue Hospital Medical College; Prof. A. JAcoBI, College of Physicians and Surgeons, N. Y.; Prof. For DYCE BARKER, Bellevue Hospital Medical College; Prof. E. NoFGGERATH, New York Medical College; Prof. BINz, Germany; Dr. EUSTACE SMITH, Physician to the King of the Belgians; Dr. THOMAS ADDIS EMMET, Surgeon-in-Chief to the New York State Women's Hospital; Dr. MANDI, Vienna, Germany; Dr. EUSTAOE SMITH, London, England. Articles will also be contributed in the future numbers by the following eminent Europesn Physi- cians: Prof. BINz, of Bonn; Prof. HENooh, of Berlin; Prof. RITTEE voN RITTERSHRIM, Director of Foundling Hospital, Prague; Dr. SQUIRE, London, England; Dr. HolyIES, London, England; Mrs. KAS- GHEwARowA, M.D., St. Petersburg; Dr. A. STIFFEN, Director Child's Hospital, Stettin; Thomas Mors MADDEN, Dublin, Ireland. - TIEERMCS. One year in advance, postage free....... ... .* * * * * * * * * * * e s tº e º ºn tº s e s a e º e s tº sº e º e s is e º e s e s e º e is $5 00 Single (quarterly) numbers, each........................................................ 1 50 Specimen numbers. . . . . . . .............................................. .............. 75 Wols. 1, 2, 3, 4, from commencement, May, 1868, 4 years, unbound............. * * * * * * * * * * * * 19 00 C LTU IB F. A. T E S. Journal of Obstetrics and Medical World... ... . . . . . . . . . . . . . . ......................... $6 00 {{ {{ “ Lancet .......... * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * s = e s a º s e º 'º e º 9 00 44 {{ “ Practitioner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 00 The four Journals (post-paid), one year................................. . tº gº gº e g g g º º ºs º º º te e 14 00 WILLIAM BALDWIN & CO., PUBLISHERS, Opposr rr Thr Astor House. 21 PARK ROW, NEW YORK. P. O. * 3472. - UNIVERSITY OF NEW YORK, MEDICAL DEPARTMENT, 426 East 26th St., opp. Bellevue Hospital, New York City. T H II: T Y- F I R S T S E S S I O N . 18 7 1 – 18 72. FA C U L T Y O F Rī E.D. 1 C 1 N E . REV. HOWAIRI) CROSBY, D.D., & Chancellor of the Unive?"sity. MARTYN PAIN F. M. D., 1.L.T). Emer? /t/s Professºr of Materia Médica and Therapeutics. - - - JOHN W. DRAPER, M.D., LL.D.. - Jº rifus Professor ºf Chemistry, and Physiology. President of the Faculty. ALFRED C. POST, M.D., - - Professor of Surgery. CHARLES A. B.I. JYD., M.D., I” (ºfessor of Obstetrics and Clinical ..}/id/rāfez y. JOHN C. I} [{APER. M.D., Professor of Chémèsłry. WILLIAM DA l; LING. A.M., M.D., F.R.C.S., Professor of Descriptive and Surgical - . A rºcłłOrºy. HENRY I) RAPE I: , M.D., Professor of Physiology. Registrar of the Faculty. WILLIAM H., THOMSON., M.D., Professor of Materia Medica and Therapeutics. FRIEDERICK D. LENTIE, M.D., Professor of Diseases of Women and Children. EDWARD G. J \ N FW A Y, M.D., - Professor of Physiological and Pathological 4/10/07/?...y. - D. B. S.T. JOHN ROOSA. M.D., Cămăcal Prºfessor of Diseases of the Eye and Ear. ERSKINE MASON, M.I). Adjunct Professor of Surgery. The Collegiate Year is divided into two sessions—a regular Winter Session and a Spring, Summer, and Autumn Session. The latter is auxiliary to the former, and the design of the Faculty is to turni h. instruction to medical students throughout the year. ...Attendance on the regular Winter Session is all that is demanded of the candidates for graduation. Those who attend the other session receive a Certificate of Honor, as having pursued voluniarily a fuller course than usual. The Spring and Summer Session is principally of a practical and clinical charac- ter, and affords part cular facilities to students who have already taken one course in schools where such practical advantages exist to a less extent. The course consists also partly of lectures and ex- aminations on the subjects necessary for graduating in medicine, conducted by the Professors of the regular Faculty and their assistants. The examinations will be addressed to both first and Second course Students. - For the purpose of making the visits to the wards of the hospitals as available as possible, the class is divided into sections. One division at a time is instructed in practical diagnosis, prescrip- tion, and treatment of patients. The course begins in the middle of March, and continues till, the beginning of June, when the Summer Comméncement is held. During the Summer the College Clinics are kept open. The Auturm n or Preliminary Session commences in the middle of September, and continues till the opening of the regular session. It is conducted on the same plan as the Spring and Summer session. The Regular Winter Session occupies four and a half months, commencing on the second of October, and continuing till the middle of February. The system of instruction embraces a thorough Didactic and Clinical Course, the lectures being illustrated by two clinics each day. One of these dairy clinics will be held either in Believue or the Charity Hospital. The location of the College building affords the greatest facilities for Hospital Clinics. It is opposite the gate of Bellevue Hospital, on Twenty-sixth Street, and in close proximity to the ferry to Charity Hospital, on Black- well's Island, while the Hºepartment of Out-door Medical Charity and ihe Hospital Post-mortem Rooms are across the street. The students of the University Medical College will be furnished with admis- sion tickets to these establishments free of charge. The Professors of the practical chairs are connect- ed with one or both of these Hospitals, and students are also entitied to attend all the clinics held by Other physicians in them. * Besides the Hospital Clinics, there are eight clinics, each week in the College building. The Faculty desire to call attention particularly to the opportunities for dissection. Subjects are abundant, and are furnished free of charge, and the Professor of Anatomy spends several hours each day in demonstration in the dissecting room. Fees for the Winter Course. ALFRED L. LOOMIS, M. D.. - Professor of Institutes and Practice of Medicine. Faii Course of Lectures..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $140 00 Matriculation... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 00 Demonstrator's fee, including material for dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 00 Graduation fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 00 Fees for the Spring, Summer, and Autumn Course. Students who have attended the Winter Course will be admitted free of charge. Those who have not attended the Winter Course will be required to pay the matriculation fee and $30; and should they decide to become pupils for the winter, the $35 thus paid will be deducted from the price of the Winter Tickets. - - - For the purpose of assisting meritorious individuals, the Faculty will receive a few beneficiaries, each of whom will be required to pay $43 per annurn and the matriculation fee. For further particulars and circulars, address the Registrar, PROF. HENRY DRAPER, M.D., UNIVERSITY MEDICAL COLLEGE. 426 East 26th St., New York City. - THE EDICAL WORLD. A MONTIILY RECORD OF AMERICAN AND FOREIGN MEDICAL, PHYSIOI,06ICAL, SURGICAL, AND CHEMICAL - LITERATURE, CRITICISM, AND NEWS. VOL. I. NEw York, AUGUST, 1871. No. 2. Or in in a [. ART. I.--—MEDICAL THERMOMETRY. BY EDWARD SEGUIN, M.D., New York. SINCE the proposition of having a medical thermometer and a simple and rapid mode of recording thermometry in private practice has attracted some attention, it may be just and oppor- tune to signalize the connection of this proposition with some others of less recent date, and apparently disconnected, but in reality intentional parts of an intended plan which, once con- nected, would look like what they really are, the segments of an intellectual cycle. In a paper read December 16, 1870, before the New York Medical Library and Journal Association, I urged the necessity of having a thermometer of the surfaces, as we already have one or two adapted to the cavities. Happily, then I was not aware of the discouraging opinion expressed at large against surface-thermometers, by C. A. Wunderlich, in his last book on “Temperature in Diseases,” etc., whose translation by Dr. W. B. Woodman, under the patronage of the New Sydenham Society, London, came out some months later. For, if I had read the opinion of the great thermometrician of the Leipsic Entered, according to Act of Congress, in the year 1871, by WILLIAM BALDw1N & Co., in - the Office of the Librarian of Congress, at Washington, D. C. 42 J/edical Thermometry. |Aug., University—I beg his pardon, of the World—I should pos- sibly have remained contented to not dissent from his authority; but in my ignorance I planned and (with the rare skill and tenacity of Mr. Stohlmann, the instrument-maker) published the instrument almost despaired of by Wunderlich. Acting on surfaces whose temperature depends on a large range of atmospheric and physiologic or pathologic combinations, the surface-thermometer will mark only the difference of tempera- ture between a well and a sick side or part without a pre- fixed standard. Hence the necessity to apply it alternately to the part known or suspected to be diseased, and to an oppo- site or neighboring part whose health is unquestionable ; or, better, to have two of them at least, and apply them by pairs, so that the difference of temperature found expresses in figures the intensity of the disease; that is the standard of the sur- face-thermometer, which has found its application in physiolo- gical experiments, and in medical and surgical diagnosis. In fact, the surface-thermometer is already one of the instruments of positive diagnosis. A few months later, under the circumstantial title, “Where is the Flaw in Life Insurance Companies?” I undertook to demonstrate more thoroughly than I had before the difference between the instruments of physical and those of positive diagnosis, and the necessity of separating them in our mind as well as in our operations. I established this distinction : 1. The instruments of physical diagnosis—stethoscope, oph- thalmoscope, speculum, etc., which give a further reach to our senses. 2. The instruments of positive diagnosis—thermome- ter, dynamometer, etc., which give sensorial results susceptible of mathematical measurements. Where the other signs are uncertain, those furnished by positive diagnosis dispel uncer- tainty, being sure premises to a sound judgment. Then, in reference to the work demanded from physicians by the life insurance companies: - - “Practically, and in general : (a.) The results obtained from the instruments and methods of physical diagnosis are the expression of individual sensory impressions, rendered in the individual’s own language—two elements which necessarily vary from man to man, and whose correctness cannot be veri fied at the central insurance office. (b.) On the other hand, 1871. Medical Thermometry, 43 the results obtained by the instruments and methods of post- tºve diagnosis are expressed by figures and diagrams, which the imagination of the observer cannot alter, nor his power of rhetoric even color ; which will be identical in identical con- ditions, and will sustain among themselves a concordance that bespeaks trutfifulness, and which, moreover, could always be controlled, from whatever distance, by a medical superintendent. (c.) Another practical difference between these methods and instruments of observation, so widely and purposely separated by the appellations of physical and positive, is that the former are decidedly best adapted to the diagnosis of actual diseases, and the latter more pointedly to the prediagnosis (in a certain sense, a prognosis at long range) of the deficiencies of vital functions which threaten longevity, not so suddenly, but more surely than disease itself. And as it is very seldom that a man actually sick asks for the benefit of a policy of insurance (for which physical diagnosis would instantly detect his un- worthiness), it is, on the contrary, of common occurrence that, as soon as a man feels, or his relatives suspect, that his vital powers are imperceptibly but steadily declining, he be- comes an applicant for a policy; the larger because they know he will not live long enough to pay several annuities. On these cases physical diagnoses throw very little light indeed, whilst the instruments of positive diagnosis denounce the fraud with unanswerable evidences.” Though I here labored under the great disadvantage of treat- ing incidentally the question which was foremost in my mind, and principally that of insurances, for which I cared very little, the point at issue became more distinct; and the ther- mometer appeared for the first time in its proper place, at the head of the instruments of positive diagnosis, as the microscope is at the head of the instruments of physical diagnosis. During several years, I had advocated this distinction in the “Prescription and Clinic Record,” a pocket-book which invites almost irresistibly the practitioners' to do with method what has previously been done at random. The “Tecord” was at first a simple registration of the daily condition of the vital signs and prescription. But every new edition brought together in it some of the elements of positivism. The instruments of positive diagnosis and their manoeuvre were explained and 44 Medical Therm ometry. [Aug., illustrated by plates and diagrams; tables were added to mark the results of chemical and microscopic analysis, to show the action of electricity and several classes of medicines upon tem- perature, circulation, respiration, sensibility, and muscular con- tractility; and others to establish the eventual relations of ambient circumstances with the prevalence or intensity of the medical constitution. The slow progress of the sense of gene- ralization in the masses has kept down the further improvements of the “Prescription and Clinic Record.” However, if it has been impeded in its development, it has in turn helped some minds to come to the front. It is yet uncertain what influence the new medical ther- mometry, and its simple mode of registration, will have in winning over to the cause of progress and positivism profes- sional men who otherwise would have felt no interest in the generalities of physic. But it is impossible that those who have chanced to meet these apparently isolated essays do not reflect upon the tendency which they manifest of giving more importance and a wider field of action to medical men and corporations, provided both comprehend their proper place, not only at the bedside, but in society. And to conclude by the special subject which has provoked these reflections: Who knows what medical (human, must I say?) thermometry could do, when the simplicity of its proce- dure, the adaptability of its instruments, the number of its devotees, will permit its application not only to the treat- ment, but to the prevention of disease, and especially to the high supervision of the training of the youth in reference to the dosing of air, moisture, heat, light, food, exercise, studies, in the sickly conditions of the growing stage & Then we will begin to understand that, for physicians, thermometry is not Only knowledge, but social power. - Now, it is easy to see the mental connection of these discon- nected papers. They are united : 1st. By their common ten- dency, which is to give more and more prominence to post- Živism in observation, and to gather the instruments used thereof in a powerful unity; and, 2d. By their object, which is to show to medical men that there are many more employ- ments for their wealth of knowledge than that offered them by their now exclusive functions of sextons of catalysis. Let 1871.] Ulceration from Wound in the Throat. 45 us, therefore, concentrate all our medical capacities upon the enlargement of what is sensible and positive in the healing art, and expand the application of our science of physic to the most general and rapid improvement of our race, by taking the leading part in physiological education. |But, if there is a sure point in this, it is that the feeble call of one must be answered by the hearty concourse of the many. ART. II. A CASE OF UILCERATION INTO PRIMII- TIVE CAROTID ARTERY FROM WOUND OF THE THROAT, TREATED BY LIGATION. BY CHARLES PIELPs, M.D., Surgeon to St. Vincent's Hospital, and Consulting Surgeon to the New York Institute for the Paralyzed and Epileptăc. THOMAS WILSON, aet. 39, born in England, of good constitu- tion, but of very intemperate habits, was admitted to the hos- pital for a wound of the throat, self-inflicted while suffering from mania d potu. The wound had been made with a razor the previous evening, and extended from the larynx upward and backward through the right submaxillary space for an ex- tent of about four inches. The sterno-cleido-mastoid muscle was completely severed, and the sheath of the vessels exposed but not opened. A single ligature was found in the wound, which had been placed before admission upon some small vessel, ap- parently a branch of the inferior thyroid. Although no very large vessel had been severed, it was evident from his blanched appearance and weakened condition that has morrhage had oc- curred to a large amount. His voice was stridulous and scarcely raised above a whisper, his articulation indistinct, his pulse small and feeble, and his general appearance that of a man who had barely escaped death from haemorrhage. The wound was carefully examined, and, its appearance being healthy, was closed with sutures and adhesive straps. Three days afterward the wound was found to have united by the first intention in its posterior third; the rest of the in- cision was granulating favorably. The patient had reacted 46 Ulceration from Wound in the Throat. [Aug., imperfectly from the effects of the former haemorrhage, and was still upon a tonic and stimulant course of treatment; tr. ferri mur., brandy, etc. Upon the twelfth day after admission the wound had united through its whole extent, except at the inner extremity, where was a point, barely the size of the tip of the little finger, dark in color and of sloughy appearance. Upon this morning a little haemorrhage had occurred—a little jet of blood not larger than a thread, which ceased suddenly and spontaneously as it had occurred. The pulse was quick and irritable; the voice, always stridulous, was more markedly so; pain extended along the ramus of the jaw of the affected side, and dysphagia, though without dyspnoea, was present. At half-past four o'clock in the afternoon of the same day, I was in the hospital, and, being suddenly summoned to the ward, found the patient drenched (literally) in blood, and the orderly compressing the wound through a compress which he had applied. It becoming immediately evident that compresses and pressure were of no avail, the dressings and coagula were torn away, and the little finger of the left hand was thrust deep into the wound, which it completely filled. The haemor- rhage was then perfectly controlled, and stimulants were freely administered. The operation for ligature of the primitive carotid was im- mediately performed, the incision commencing at a point one- fourth of an inch below the wound. The ligature was applied at a point below the omo-hyoid muscle, in consequence of the difficulty of manipulation due to the retention of the finger of the operator in the wound. Haemorrhage had been so great, and exsanguination of the patient was so complete, that I did not feel justified in incurring the risk of the slight additional haemorrhage which would attend the change of my own finger as a plug for that of an assistant. The patient reacted immediately, and passed a comfortable night; but the next morning he again began to sink, and died from exhaustion at half-past five o’clock in the evening, twenty- five hours after the operation. Upon autopsy, it was discovered that, from the dark-colored spot at the inner extremity of the wound, a narrow, sloughy track extended quite down to the primitive carotid artery. 1871.] Ulceration from Wound in the Throat. 47 An irregular perforation had occurred through all the coats of this vessel upon its inner and anterior aspect, involving its bifurcation, and making an opening half an inch in its vertical, by three-eighths of an inch in its lateral diameter. There was no indication of a slough having separated, and no abscess; it seemed to have been an ulcerative process of a phagedænic character. The specimen is in the Wood Museum of Bellevue Hospital. This case affords an example of one of the rarest of all forms of disease or injury which may necessitate ligature of the common carotid. Ulceration through the arterial coats, when disconnected with the previous application of the liga- ture, is almost unknown. In a monograph by Dr. James R. Wood, upon the ligature of this vessel, reprinted from the New York Journal of Medicine, for July, 1857, in a list of forty-eight previously unpublished cases, with forty-four others analyzed by Dr. Valentine Mott, none were for a similar cause. This is, probably, the largest published collection, and renders further reference upon this point unnecessary. - This case also afforded an exhibition of the force with which blood may be projected from the common carotid, even where the heart’s action has been already enfeebled by previous hæ- morrhage or other cause. The patient was lying upon his back, and upon the iron bed or cot in ordinary hospital use. I saw the blood, in a volume of apparently half an inch in diameter, projected over the whole length of his body and foot of the bed, upon the floor beyond. I have also had an opportunity of appreciating the force and volume of the blood escaping from a wound of this vessel in one other instance. In the room in which the Burdell murder was committed, the stain of a jet of blood was plainly visible arching nearly to the ceiling, and nearly across the whole length of a wall at least eighteen feet square. It is evident, therefore, that haemostasis, to be of any avail, must be almost instantaneously effected. This, probably, ex- plains the paucity of recorded instances of ligation for carotid haºmorrhage. In traumatic case; it is, of course, likely to be impracticable. But where haemorrhage results from an ulcera- tive process, there are fortunately always prodromata, as in the { 48 Treatment of Amenorrhoea. * |Aug., case above described, which, observed and appreciated, may enable us to avert or control at the instant the source of mortal danger. ART. III. ON THE TREATMENT OF AMEN ORRHOEA. AND DYSMENORREIOEA BY THE USE OF QUIN- INE ENDERMICALLY. BY E. BRADLEY, M.D., Neºu York. SoME time since, I became convinced that many cases of obstinate amenorrhoea and dysmenorrhoea depended upon a malarial poison, and I commenced the use of counter-irritation over the spine, followed by the local application of a saturated solution of quinine. In quite a number of cases, during the past six months, I have used this treatment with marked suc- cess. The method of using the quinine is to first paint the spine over its lower two-thirds with the following, B. Oil mustard, . . . . 3 iii. Alcohol, . . . . . 3 ii. M., using a wide camel's-hair brush, and taking care not to allow the solution to cover a wider space than one or two inches. Then, when the surface is thoroughly red, apply the follow- ing : B. Quiniae sulph., . 3.j. Aquae, . . . . . 3.j. Acid. Sulph. aromat., . . q. S. M. In applying the essential oil of mustard, considerable pain is excited. This immediately ceases, however, on the applica- tion of the saturated solution of quinine. In one case, in which suppression had existed for several months, the patient having had intermittent fever for some time previously, and having been treated by the internal administra- tion of quinine unsuccessfully, after the use of the counter- irritation and quinine locally for about three months, the menses returned, and she felt perfectly well. In another case, there had been great neuralgia of the head and uterus, and it was speedily relieved by this treatment. 1871.] Aneurism of the Innominata. •. 49 In another case of dysmemorrhoea, with obstinate constipa- tion of the bowels, the patient was entirely cured, and has not suffered from constipation since. I am well aware that many physicians are of opinion that the quinine could not be absorbed unless the cuticle was broken. In this connection, let me say that, in no instance where it has been used, under my observation, has there been any rupture of the cuticle; and I feel confident that the quin- ine was not only absorbed, but that it had a very decided effect in bringing about the cure. i. There seems no good reason why quinine should not be absorbed through an unbroken skin, as well as mercurials or belladonna, and bitartrate of potash applied (in solution) over the kidneys in cases of uraemia, several cases of which latter have come under the writer's observation. In the first case mentioned, the patient had had intermittent fever for some time, and it had not yielded to the internal administration of quinine, and the amenorrhoea seemed, beyond doubt, to be due to the malarial poison. After three months' continuous use of the counter-irritation, daily followed by the quinine locally, the menses returned, and the intermittent fever was cured; thus furnishing the most positive proof that the quinine must have been absorbed in order to break up the chills, and also that it aided very materially in bringing about the menses. This subject is to me one of great interest, and, if I succeed in inducing the profession to give this method of treatment a thorough trial, I feel assured that they will be perfectly satis- fied with the results, and that many a suffering patient will thank them for having used it. - ART. IV. — A NEURISM OF THE INNOMINATA TREATED WITH IODIDE OF POTASSIUM AND OXY GEN. * * BY GEORGE H. BUTLER, M.D., New York. MR. M., aged about 50, of a robust habit and good constitu- tion, had been suffering with aneurism of the innominata for more than a year when he first sent for me. I first saw him 5() * .. Aneurism of the Innominata. [Aug., on the 8th day of April, 1871. At that time the aneurism was very large, extending greatly down the chest, and filling out the space behind the clavicle, pressing out, in a measure, the upper ribs and upper portion of the sternum, extending over to the trachea and oesophagus, and pressing upon them so as to interfere with respiration, and causing difficult deglutition. Swallowing of fluids became much more difficult than solids; the fluids being regurgitated through the nose in any attempt at deglutition. The pressure on the upper portion of the right lung was so great as to cause considerable congestion. There was a good deal of cough with considerable rusty sputa. The head and face were greatly congested, and the greater part of the time he remained in a state of semi-delirium, incident to the pressure on the veins interfering with the return of the blood from the brain. There was a slight oadema of the limbs of the left side first, which gradually extended to the right side and face, which increased slowly to his death, but never became So great as to interfere with his movements or to incon. venience him much. His appetite was so bad that he could not be induced to take any nourishment, and he could sleep scarcely at all, not more than a few minutes of a troubled, dreamy sleep at a time, waking with a start and vacant stare. He suffered much from a severe pain over the apex of the left lung. The aneurism was increasing perceptibly. He had been taking iron with other treatment, but failed rapidly of late. The iron was continued, and oxygen pre- scribed, with the view to improve the appetite. This treat- ment was continued for a few days, with the application of a sinapism over the region of pain, but, finding no improvement whatever, the iodide of potassium with tinct. digitalis was added. The iodide was given with the view to correct any undue acidity of the blood (which I have found to interfere materially with the assimilation of the oxygen when present in any degree), as much as for its alterative effects; but, as the result proved, I am induced to attribute to it much of the bene- ficial results which followed almost immediately on adopting this method of treatment. The patient began to improve; the pain disappeared entirely in a few days; the appetite improved rapidly, so that in a short time he was able to take as much food as in health. To use his own expression, “he couldn’t 1871. Aneurism of the Innominata. - 51 get enough to satisfy himself.” The delirium disappeared en- tirely, and the nearest approach to its return were troubled dreams on a few occasions just before his death. His sleep was sound and refreshing; and the size of the aneurism gra- dually decreased, so that at the end of six weeks there was a marked diminution in its size. His swallowing became easy, and as natural as in health, both of solids and fluids, and his breathing much less difficult, though never quite free from embarrassment. He went on improving gradually for some weeks, keeping quite comfortable, and almost warranting the hope that he might make a partial recovery, but on June 7th he died suddenly, just after having sat up in his chair, exactly two months from the day I first saw him. I am convinced that the decided improvement in this case could not have been in any degree due to a coincidence in the treatment with any change taking place, but entirely de- pendent upon the iodide and oxygen, because at one time there was an intermission of the iodide and oxygen to give place to a diuretic treatment on account of the oedema, but, as the old symptoms began to show themselves, the iodide and oxygen were recommenced. Although this is only one case, and one too far advanced at the beginning of the treatment to hope for any degree of success, I cannot but consider it of great interest and worthy of trial in other cases, especially when we con- sider the case which Dr. Balfour exhibited to the Edinburgh Medico-Chirurgical Society, treated with the iodide without the oxygen. wrim- TIE Medical Department of the University of the City of New York has gained an additional representative in the Medical Board of Bellevue Hospital, in the person of Dr. E. G. Janeway, formerly curator to that institution, who has been appointed to fill the vacancy caused by the resignation of Dr. T. Gaillard Thomas, Professor of Obstetrics, etc., in the College of Physicians and Surgeons of this city. WR regret to learn that Dr. Freeman J. Bumstead, the well- known professor of venereal diseases in the College of Physi- cians and Surgeons, has retired from practice, and proposes to spend some years in retirement in Europe. 52 Stricture of the Wasal Duet. Aug. - ART. V.-STRICTURE OF THE NASAL DUCT, AND ITS TREATMENT. BY W. W. SEELY, A.M., M.D., Cincinnati. STRICTURE of the nasal duct is a trouble that every one meets with so often, that any new suggestion for its relief can be treated with some degree of satisfaction. I propose in this brief paper to discuss some general princi- ples in regard to the subject, and the operations affected by them; then, after speaking of the other operations, add a report of some case, and some remarks directly bearing upon the latter. We are all interested in arriving at the quickest and best solution of the problems that are continually before us. This is an end not attained in any department by the labors of the few, but by the merits of the many. Such is the universal law, and nowhere is it more true than in the departments of medicine and surgery. Certain foundation principles have long been laid which are accepted by all as the true ones, and most of the difficulties presented and discussed are in applying them to particular CàS62.S. In the subject immediately before us, I shall assume that the principle underlying the treatment of stricture of the nasal duct is the broad one of conservation, and consequently the course to be followed is the restoration of the parts to the natural condition as nearly as possible. The operation for obliterating the lachrymal sac by any of the various methods—actual cautery, caustics, etc.—has always struck me as being an opprobrium not only to special but general surgery, because it violates the principle I have assumed, and, so far as I am able to see, has only the one poor excuse in its favor—the failure of the other means to make the results conform in a perfect manner to the prin- ciple. I am not unaware that it has strong advocates, and am likewise not unaware that those advocates are those who 1871.] Stricture of the Wasal Duct. 53 would, in order to settle the difficulties, rule out all discussion by, first, ignoring the underlying principle, and, second, by claiming that the results are a matter governed by latitude and longitude. º To come, now, to the arguments used by those who practise obliteration, we find their assertion—which, of course, is more or less true—that attempts to restore the natural passage fail. Their method cannot fail in destroying the parts secondarily affected, and so they rid the patient of one of the sources of physical and optical annoyances, the formation of abscesses, the accumulation of matter in the eyes, and consequent inflam- mation. They also claim, when this end is accomplished, the tears afford little trouble. Every one is ready to grant that the first result is obtained, and, also, that, after all the irritation has disappeared, the flow of tears is reduced to the minimum ; but, when we have reached this point, we are only in the presence of the true problem. - Results claimed and results actually obtained are often two quite different things; but, even if we grant all that is claimed by the advocates of obliteration (that which I, for my part, am quite willing to do), their position is a bad one, for there is still left an annoyance from the tears, and their operation can never remove it. All progress is at an end. I listened to a most ani- mated discussion in one of the clinics in Paris in 1867, that ended by the advocate of obliteration taking refuge behind the assertion, undeniable of course, that his opponent did not cure all of his patients; not denying the principle, remember— simply the want of uniform success in acting upon it. This, as I have said, ends progress. The same arguments I have used against obliteration could be still more forcibly used against extirpation of the lachrymal gland, so strongly urged by Z. Laurence, at the Ophthalmolo- rical Congress, in Paris, in 1867. By this process we add a new element. We subject the patient to an absolute risk not only of losing his eye, but his life soon. Ignoring all principles and accidents, I claim that such a proceeding is unjustifiable, even when both canaliculi had been destroyed by an injury. The genius of Mr. Bowman merits the greatest credit for ( **.. 54 Stricture of the Masal Duct. [Aug., inaugurating a plan of treatment based on a sound principle, thus bringing this part of ophthalmic surgery on to an ad- vanced ground. - - - I am willing to grant that his method is attended by fail- ures, though they are partly probably not the fault of the method, in and of itself strictly considered, but indirectly, that it is tedious, and patients fail to do their part. However, I cannot but feel that the next improvement upon this method was an important step in advance. Weber seized the idea that the stricture should not only be overcome, in a measure, but that the canal should be restored to its original size, which Bowman's method and instruments could not do. Again, his treatment of the lining membrane at the same time was an added advantage. From a comparison of what I saw in the clinics abroad with what I have seen at home, I cannot but feel that the plan of wearing the style, instead of introducing it every day for five or ten minutes, is vastly in advance. And I might state the arguments to be : - 1. Granting that a few minutes dilatation each day, or twice a week, does good, it follows that a longer dilatation will do more, provided the pressure of the instrument produces no irritation. 2. Such dilatation, if my first proposition is correct, shortens the time of treatment. 3. There are less pain and inconvenience to both patient and operator. To show that no irritation exists, and thus furnish the con- ditions for establishing my first argument, I simply adduce the results in the scores of patients who have submitted to the operation. * - I can only recall a single case of too much inflammation to interfere with the treatment, and that was caused by an attempt to use a rubber style instead of a silver one. For some time, I adopted the plan of inserting a style, and not removing it till it was perfectly loose, then immediately insert- ing another larger, and not treating the mucous membrane till the largest size was worn. It seemed to me that in this way the time was much shortened. I found abroad they simply ignored this plan of wearing the style, replying, when 1871. Stricture of the Wasal Duet. 55 asked if they had tried it, “No ; our patients wouldn't sub- mit.” I have never found very strong opposition from patients. On the contrary, they are usually so anxious to get rid of the annoyance that they would submit to anything. Even with all the advantages, over the other methods, of wearing the style (and I regard them great), I certainly have been quite ready to adopt any new plan that promised a more rapid cure, with less annoyance to both patient and myself. I think every one has felt that cases came till they grew tired and quit, and, certainly, if some more radical plan could be de- vised, it would meet with general approbation. I propose to report twenty-five cases, treated on what I regard as that more radical plan—devised and practised by Stilling of Cassel, and followed by Warlemont, editor of the Annales d'Oeulistique, who reported twenty cases successfully treated by the Stilling method. Those who have not access to Stilling's pamphlet, “Ueber die Heilung der Verengerungen der Thraenenwege mittelst der inneren Incision. Ein neues Operationsverfahren,” will find a lengthy extract in the Annales d'Oeu/istique, of May and June, 1868. As will be seen from what I have said of the dilatation method, I by no means agree with Stilling in his arguments against all the previous methods, that they are irrational and insufficient. The principle is the same, and I fear the gentleman has never tried the process of having the patient wear the style, as the best of the dilatation methods, and which few cases can resist. I have even restored one case where the bones of the nose had been broken and the nose flattened by the kick of a horse, and when it had been decided by several, after careful exploration, that no trace of the canal was left. The smallest of Bowman's probes had been used, but it required a hair probe to enter the opening, which I, after great perseverance, found. - By gradually increasing the size of the probe, the patient finally wore a number larger than Bowman's No. 8, and has, so far as I am aware, never been troubled since. So, without at all agreeing with the words of Stilling, “irrational” and “ insufficient,” with which he condemns all other methods, I cannot but feel that his operation is an improvement. 56 Stricture of the Masal Duet. |Aug., It commends itself by the bold application of the treat- ment of urethral strictures to those of the lachrymal pas- sages, and in using the same arguments regarding an analogy between the urinary and lachrymal passages as established. He adopts the ideas of those surgeons who make use of no after-treatment after urethrotomy. Hence he says, the elastic bundles of the corpus spongiosum of the urethra, like the sub- mucous fibres, retract after their continuity is destroyed by a longitudinal incision, and leave the wound gaping. If the cure is then left to nature, the wound, held apart by the elasti- city of the histological elements mentioned, becomes insensibly filled with a non-contracting connective tissue, and the canal becomes larger. He strongly insists, upon those very grounds, on non-interference after the operation, as this produces suppu- ration and the formation of yellow cellular tissue, which soon takes on cicatricial contraction, and re-establishes the closure. So much for the author's views. In my cases, I have not fol- lowed strictly the rules laid down by Stilling, probably not being sufficiently convinced of the “analogy” he has insisted upon ; and possibly some of the tedious cases have been due to this fact. Out of the twenty-five cases in which I have practised this method, I have had five that gave me trouble, that is, I had either to resort to a second operation or to dilatation, or the patient left before the treatment was fairly tried. So far as I know, the cases have been successes; but it requires time to give the ultimate results in such an operation, for that only settles the question of relapses. In a large number of the cases, the results were most striking, and those were particularly among my first cases, which happened to be the most favorable. In one or two, when I thought to follow up the treatment with dilatation, I felt that I had gained so much time by my incisions, and do not now regard it anything but gain if it becomes necessary to resort to dilatation. I have only had two unpleasant results, so far as the escape of blood into cellular tissue goes, thus producing an ecchy- mosed eye. The accident, of course trifling, except as regards the appearance, occurred both times by the patient holding the head down in the basin to bathe the eye. I have found that, when one operation is sufficient, the time 1871.] Stricture of the Wasal Duct. - 57 for entire relief of the epihora has varied from a few days up to three months; the former were those favorable cases, without any very great dilatation of the lachrymal sac. The average length of time has been about three weeks. So far as my experience has gone, in strictures in children it is particularly adapted, for all dilatation in these little people is hardly to be thought of. To make the passage of the knife as easy as possible, I dilate the stricture or strictures, as the case may be, with a pretty large probe, and in this way I find the operation is not much more formidable than the ordinary dila- tation. So I only give chloroform to children and sensitive patients. - Thus, then, for this operation, I think there can be safely claimed : a. A wonderful abridgment of time in a large number of CàS62S. * b. An adaptation to all but a small percentage of strictures. c. That, even where it apparently fails, the duration of the dilatation is shortened. cº BELLEVUE HOSPITAL.-Several improvements have been effected in this institution, this season, which will be of interest to those physicians and students who propose visiting the city during the coming winter. The old amphitheatre has been completely demolished, the main (central) building raised one story higher, and surmounted by a Mansard roof. The effect of this will be to double the capacity of the theatre. A steam elevator for the use of patients required at the clinics is in pro- gress of erection. From this date all medical students will be required to enter the hospital from First Avenue. A new staircase for their special accommodation has been built, and hereafter the students of the University and College of Phy- sicians will be upon the same footing as regards hospital facili- ties with those of Bellevue College. All the improvements will be completed during September. VOL. I.-5 5S Early Symptoms of Cerebral Disease. [Aug., §t{tttti'ſ 3rtitſeg, THE EARLY SYMPTOMS OF CEREBRAL DISEASE. BY REUBEN A. VANCE, M.D., Physician-in-Chief to the New York Institute for the Paralyzed and Epileptic, etc. IT is a fact greatly to be deplored that the early symptoms of cerebral disease, unlike those of other bodily organs, are almost invariably overlooked by the sufferers, and permitted to pass uncared for until the time arrives when medical inter- ference is of no avail. While the burden of this negligence must always remain with the unfortunate patient, still it is an undoubted fact that, were medical men generally as prone to seize upon and investigate the obscure cerebral symptoms brought to their notice as they confessedly are of those per- taining to the lungs or kidneys, we should doubtless see a marked diminution in the number of cases of incurable brain- disease which are now so prevalent. To dismiss patients presenting head-symptoms, with the statement that their troubles are due to disorder of the stomach or liver, is a very convenient way to cover up ignorance, while it always leaves a loop-hole for the excuse that the patient could not understand the nature of the complaint were it explained to him. Not long since, a gentleman of this city, of great wealth and high social position—one accustomed to using his brain inordinately when necessary, and upon other occasions prone to alcoholic excesses—presented himself to his physician with the com- plaint that he could not sleep, and was suffering intensely from headache. These symptoms had been present for several months, and were accompanied by dimness of vision, difficulty of speech, burning pain in the abdomen, and momentary lapses of consciousness. The physician—a man eminent in the profession—subjected Mr. It to a thorough examina- tion, and announced that there was no difficulty with either iungs or heart, no enlargement of any of the abdominal vis- cera, and that he could discover no abnormal ingredients ims the urine, and finally dismissed him, saying that all his symp- 1871.] Early Symptoms of Cerebral Disease. 59 toms were due to disordered digestion, for the relief of which he prescribed an ordinary tonic mixture. Mr. R continued his ordinary avocations, and within a fortnight had an epilep- tiform convulsion, which left him paralyzed in his left side. While it is not the province of any one to say that proper directions or the best medical treatment could have prevented the occurrence of this unfortunate attack, yet no one who has had anything to do with similar cases can pretend to say that the physician who does not lay before such a patient the dan- gers of continued mental excitement fails in the performance of his duty. To permit an individual presenting such symp- toms to continue his ordinary avocations, is fully as bad prac- tice as it would be for a surgeon to allow his patient with acute synovitis of the knee-joint to undertake a pedestrian toll I’. - Aside from patients presenting such unmistakable symptom as were complained of by Mr. R , there are many others in whom, while the brain is mainly at fault, the symptoms of general bodily debility are so well marked that they obscure the evidences of cerebral disease. In the introduction to the second volume of his admirable “System of Medicine,” Dr. Tºussell Teynolds says: “Tubercular meningitis has been mis- taken for typhoid fever, and vice versé, abscess of the brain has been confounded with malarial poisoning; and, again, tumors of the brain have been regarded as diseases of the stomach ; while all the symptoms of cancer of the stomach have been explained away by the fiction of ‘spinal irrita- tion’” (p. 2). It will occasionally happen that a patient, after visiting a number of physicians, will return with a list of names for his disease as numerous as his medical advisers. In a case of cerebral softening recently under the care of the writer, the lungs, heart, kidneys, liver, and brain had each been declared to be the sole seat of the disease from which the patient was suffering, by five physicians of this city, all of whom had been consulted within a single week. The same thing, with but slight variations, occurred in the case of a little boy, an epileptic, the son of a prominent homoeopathic physician here, who was brought to me by his mother, only in this instance the diagnosis had been made by irregular practitioners. - * - 60 Early Symptoms of Cerebral Disease. [Aug., In view of such facts, it is of the utmost importance that attention should be paid to the subject of the diagnosis of cerebral diseases, with the special object of detecting those early indications of brain disorder which occur while it is yet possi- ble to employ therapeutical resources with the utmost certainty of Success. The late Dr. Marshall Hall—and who had better opportunities for judging whereof he spoke?—says: “A use- ful work might be written on the subject of insidious and impending diseases, with the view of making their first or antecedent symptoms known to the public, and of thus sug- gesting the care and means necessary for their prevention.” The physician too often discovers, when investigating the history of an advanced and incurable case, that unequivocal cerebral symptoms have existed and been partially observed during the early stages, without exciting any apprehension on the part of the patient or his friends. If such circumstances cause regret among non-professional persons, how should the physician feel who through inadvertence allows those golden moments for treatment to pass unimproved ? “The brain—the most important and exquisitely organized of all the structures of the human body, the physical instrument of intelligence, centre of sensation and source of volition, the repository of nervous power—is permitted to be in a state of undoubted disorder without exciting any attention until some frightfully urgent, alarming, and dangerous symptoms have been manifested, and then, and not till then, has the actual extent of the mischief been appreciated, the condition of the patient recognized, and advice obtained for his relief. “Other deviations from health, as a general rule, are not so neglected. In affections of the stomach, liver, bowels, lungs, and skin, the first symptoms of approaching disease are in most cases immediately observed, and the patient without loss of time seeks the aid of his physician. But when the brain is implicated, and the patient complains of persistent headache associated with some slight derangement of the intelligence, disorder of the sensibility, illusions of the senses, depression of spirits, loss of mental power, or modification of mobility, is not his condition in many cases entirely overlooked or studiously ignored, as if such symptoms were signs of robust health, instead of being, as they frequently are, indications of cerebral 1871. Jarly Symptoms of Cerebral Disease. 61 disorder, requiring the most grave and serious attention, prompt, energetic, and skilful treatment?” ” While disposed to agree with these remarks of Dr. Winslow in the main, yet I must say that, accepting as true the accounts given by a large number of patients and their friends, the medi- cal attendant, in many cases, must bear a certain amount of responsibility for neglecting these early symptoms. Múch of this is to be ascribed to that method of teaching which places disorders of the nervous system in the class of “symptomatic” diseases, and ascribes as their immediate cause a vitiated con- dition of the blood, which is to be recognized by an examina- tion of the urine. Without entering upon the discussion of this question, I would simply direct attention to the fact that very many cases of cerebral disease are directly due to exces- sive mental exertion; that this mental exertion affects the structure and function of the brain, by diminishing or increas- ing the amount of blood flowing through the cerebral vessels, in the same manner that anger causes flushing, and fear, pallor of the face. The long continuance of mental excitement pro- duces over-distension, loss of contractility, and partial paraly- sis of the muscular walls of the blood-vessels of the brain, and the hyperaemia and stasis so resulting are the immediate and direct causes of those cerebral symptoms which it is our present purpose to consider. - Prominent among the early symptoms of commencing brain disease are those due to modifications of the mental tone. The ability to direct the full powers of the intellect for any consid- erable period to the careful examination of any subject, how- ever simple, is impaired—the attention is weakened. The feel- ing of general well-being which attends the proper performance of all the bodily functions is altered to such an extent that any exertion, whether of body or mind, is painful, and that distress- ing condition of ennui, commonly designated “low spirits,” is continually present. The memory, especially for recent events, is impaired, and the ability to express their thoughts clearly in conversation, or to correctly appreciate what they read, is seri- ously disturbed from a tendency to substitute, in the one case, different words, having a similar sound or appearance, and, in * WINSLOW, “Obscure Diseases,” etc. 62 Early Symptoms of Cerebral Disease. [Aug., the other, from a mental inertia which indisposes them to give the proper attention to what they say and see. The power of acting quickly and decisively is much weakened, and a change of character ensues which is readily recognized by the patient’s friends. An individual suffering from incipient brain-disease may present as its earliest symptom a peevish, fretful, irritable disposition, and a vacillating judgment strongly at variance with his behavior in health. The thoughts become confused and succeed each other without logical connection, while the power of forming correct ideas of subjects even the most simple is very materially weakened. In the majority of cases, well- marked delusions are rare at this early stage, yet illusions of the senses are very common, and generally make a strong im- pression upon the patient’s mind. Generally preceding, and always occurring coincidently with these mental difficulties, symptoms due to the disordered phe- nomena of sleep and dreams will be developed. These are essentially a diminution in quantity below the natural and healthy standard of the former, and an alteration in the cha- racter of the latter. Instead of the period of repose lasting the natural time and being followed by the feeling of rest which succeeds healthy sleep, the patient is troubled with wakeful- ness, and his nights are an almost constant vigil. What little sleep is procured is disturbed by painful and distressing dreams, and the morning finds the patient as unrefreshed as the evening left him. One peculiarity of the disturbed sleep of a patient in this condition is the fact that he cannot always separate in his thoughts the imaginary events of his dreams from the real occurrences of the day. Several ludicrous inci- dents due to this cause have lately come to my knowledge. The altered sensations of the sufferers declare themselves either in the form of pain limited to the head or generally dif. fused over the body, vertigo, or in the abnormal functions of the organs of special or common sensation. The headache of cere- bral disorder in this stage is unaccompanied by manifest accel- eration of the pulse or any indications of pyrexia. It may be either superficial or deep-seated, and in the former case gene- rally follows the course of some of the Superficial nerves. The vertiginous symptoms likewise present no specific characters. The special senses most commonly affected are those of sight, 1871.] Early Symptoms of Cerebral Disease. 63 * hearing, and touch—taste and smell being implicated more rarely. The visual powers may be altered in many different ways, but, generally, this sense is either diminished or pervert- ed. In the former case, the patient will complain that he can- not see as acutely as formerly, that objects become blurred and confused, while any attempt at close examination will be attended with pain seated deeply within the head. In read- ing his paper, the lines will run together, and in place of separate words and distinct sentences he will see a mass of devious threads at the point where he directs his sight, while on the outskirts of the visual field everything will appear normal. In observing a white wall, patches of various colors will intrude themselves, while an achromatic fringe will sur- round the gas-flame. Rooms which are brilliantly lighted for others will appear dark to him. Luminous spectra and spots will fill the visual field, and the inability to banish them by closing his eyes will cause him not a little trouble. This irri- table condition renders him exceedingly liable to optical illu- sions, and, as the disease becomes more advanced, hallucina- tions, due to cerebral irritation, will manifest themselves. These occur long before the mental symptoms have reached the state when these false interpretations of real objects (illusions) or purely imaginary creations (hallucinations) are accepted by the mind as true, thus creating real delusions. The same series of phenomena can be traced when we examine the symptoms due to aberrations of the sense of hearing. The earliest symptom will be a diminution in the acuteness of this sense, and subse- quently an alteration in the character of the sensations it con- veys. The slight deafness which primarily ensues may be con- founded with an indisposition on the part of the patient to pay attention to what is going on around him. As the disease pro- gresses, tºnnitus aurium will be developed. These almost im- perceptible sounds soon become magnified until the patient is greatly distressed by the continuous din. Succeeding this will be a period when the sounds assume definite form and resem- ble voices in conversation. Should the disease be sufficiently advanced, the patient will become suspicious, declaring that he can hear the voices of those conspiring against him, and he will not hesitate to declare that his best friends are in the plot. In like manner, the symptoms due to alterations of the nerves of 64 Early Symptoms of Cerebral Disease. [Aug., the integument are as various as the sensations they can con- vey in health. The most common of these are feelings of numbness within circumscribed areas, and localized sensations of pricking and tingling, commonly expressed by the term “pins and needles.” Feelings of burning alternating with sensations of extreme cold occur, either generally diffused over one side of the body or limited to the extremity of a single limb. The feeling that a foreign body is continually in con- tact with certain portions of the organism is a common and very distressing symptom. There are a number of indications of cerebro-spinal disorder presented by the nerves of touch which never declare themselves in consciousness, and are not complained of by the patient. They are to be recognized by the employment of the aesthesiometer, the value of which will be dwelt upon shortly. ! The implication of the motorial power may vary in result from the production of the merest sense of fatigue to the most complete paralysis of voluntary motion. The distribu- tion of this lesion, like the affections of sensibility, may be con- fined to one point, or it may implicate one lateral half of the body. To implications of the motorial power are to be as- cribed many symptoms which at first glance appear to be due to other causes. It is the partial paralysis of one or more muscles of the eye which, by disturbing the axis of vision, causes diplopia; while the implication of the muscular struc- tures of the internal ear have much to do with the early de- velopment of tinnitus aurium. The difficulties of articula- tion which are among the earliest evidences of cerebral disease are due, in many cases, to want of power in the muscles of the vocal organs, while the peculiar staggering gait is always due to the same difficulty with the organs of locomotion. When the unfortunate sufferers have been men engaged in sedentary and clerical pursuits, subsequent investigations have shown that, for months before anything wrong was suspected, an alteration in their handwriting due to this cause was plainly to be seen. - While it is convenient to separate the symptoms in this manner, and consider them under the general headings of lesions of mind, sensation, and motion, it must be remembered that, as a clinical fact, we always find them conjoined. Different 1871. Farly Symptoms of Cerebral Disease. 65 cases run different courses—no two are exactly alike—but all cerebral diseases present in varying degrees of prominence the symptoms we have here so briefly enumerated. Cases occur continually in which it is necessary to push to the utmost all available means for acquiring a knowledge of the condition of the cerebro-spinal centres. When speaking of the symptoms due to altered conditions of the nervous fila- ments distributed to the integumentary structures of the body, the remark was made that many of the modifications wrought by cerebral disease were not declared in consciousness, and, therefore, formed no part of the history of the case. This is the fact, save in those rare instances where by accident the patient discovers the peculiarity to be mentioned. The nerves of the integument may be modified in one of three ways: their functional activity may be increased—hyperasthesia ; di- minished—anaesthesia ; or altered so as to cause the peculiar condition technically known as analgesia or dysaesthesia. The patient will not fail to become conscious sooner or later of the existence of any one of these conditions, except anaesthesia. Tac- tile sensation may be abolished for long intervals without the individual being aware of the fact. In the early stages of cere- bral disease, careful observation demonstrates the fact that this endowment of the skin may be implicated at a period prior to the appearance of any other pathological process which the physician can recognize. Such being the case, it is of the greatest moment that in any patient suspected of having brain- disease the condition of the tactile sensibility be investigated, and any alteration from the natural standard carefully noted. This necessity has led to the invention of instruments for the determination of the cutaneous sensibility. Dr. Sieveking, in 1858, described an instrument for this purpose,” which he called an aesthesiometer. He stated that the classes of cases in which it would be found useful are: - “1. In actual paralysis, to determine the amount and extent of sensational impairment. “2. As a means of diagnosis between actual paralysis of sensation and mere subjective anaesthesia, in which the tactile powers are unaltered. * Brit, and For. Med.-Chin'. Rev., January, 1858, p. 215. 66 Early Symptoms of Cerebral Disease. [Aug. “3. As a means of determining the progress of a given case of paralysis, for better or for worse.” The value of this instrument in cases of diminished sensi- bility depends upon the fact that the capability of distinguish- ing two impressions, made simultaneously, varies in different regions of the body according to the distance they are apart. For instance, the two points of a pair of compasses can be dis- tinguished at about the sixth of an inch apart when applied to the end of the finger, while upon the back of the hand only one point is felt, though they are an inch apart. The com- passes contained in any draughting case answer admirably in any instance where it is necessary to employ an instrument for the purpose of measuring the sensibility. In practice, it is unnecessary to pay attention to the elaborate tables which re- cord what purports to be the absolute sensibility of the different regions of the body, for each and every individual examined will be found to present variations from these standards. In investigating disease, the capital fact to be borne in mind is, that the comparative sensibility of corresponding situations on the two sides alone affords diagnostic indications. In health, the two sides are almost alike as regards sensibility—the left side being a trifle the most sensitive, according to my observa- tions. In cases of impending cerebral disease, we will occa- sionally find that, while the sensibility on one side remains normal, there will be such marked anaesthesia of the opposite side that the points of the aesthesiometer will have to be separated four and five times as far as on the healthy side before the patient can distinguish the two points. It is unnecessary to dwell upon the diagnostic significance of so grave a fact as this. There remains one method of interrogating the cerebro- spinal axis which, while it is certainly our last discovered resource, yet bids fair to rival them all in the precision of its results and the ease of its application. This is the ophthalmo- scope. From time immemorial, the fact that too much or too little blood within the brain was competent to produce the same symptoms has been well known. Equally well known was the fact that the treatment applicable in one condition was contraindicated in the other; and, although there existed a multitude of rules for distinguishing between an anaemic and 1871.] Early Symptoms of Cerebral Disease. 67 a hyperamic condition of the brain, yet it was not until the Ophthalmoscope was employed for this purpose that the phy- sician was enabled to demonstrate in a given case the exact condition of the blood-supply of the cerebral organs, and to direct his remedial measures in a proper manner. In the diag- nosis of incipient brain disease, and especially that state of cerebral congestion which in the majority of cases precedes at- tacks of apoplexy and paralysis, the ophthalmoscope is invalu- able. “As the retinal vessels are direct continuations of an important branch given off by the internal carotid within the cranial cavity; as both arteries are supplied by that nerve— the sympathetic—whose function is to regulate the diameter of the vascular trunks to which it is distributed, and whose controlling influence is manifested by an increase in the size of the retinal vessels by influences—as emotional activity—com- petent to increase the quantity of blood within the brain, as well as by the fact that they diminish in size under the opera- tion of medicines which have the power to produce cerebral anaemia—no inference can be more plain to my mind than that, in cases where there is no local disease to affect the vascularity of the eye, the condition of the retinal vessels must be taken as indicative of the blood-supply of the brain.” ” The ophthalmoscope enables the physician to separate the functional disorders from the organic diseases of the intra- cranial Organs, and is thus of the greatest value in prognosis. The alterations in the size, shape, color, vascularity, and appear- ance of the optic discs, the certain indications of structural changes within the skull, are widely different from those irre- gular dilatations of the retinal vessels which, with an increase in size and number of vascular trunks, denotes a hyperaemic con- dition of the brain. In a certain proportion of cases, spots of extravasated blood can be seen in the retinal structures, while in others minute aneurisms and well-defined disease of the walls of the vessels are plainly apparent. The marked appear- ances of the intraocular structures symptomatic of cerebral disease are so numerous and so varied that it is impossible to enumerate them all and keep this article within due limits. * VANCE, “The Ophthalmoscope in the Treatment of Epilepsy,” New York Medical Journal, February, 1871. (38 Jeeviews. [Aug., In conclusion, I would again urge the importance of early and careful investigation of every case presenting symptoms of cerebral disturbance, feeling confident, as I do, that it is only by prompt treatment in the very beginning of such affections that the present disproportionate excesses of brain diseases can be checked.— Michigan University Medical Journal, July, 1871. it tº it? §. THE CHANGE of LIFE IN HEALTH AND DISEASE. A. Practical Treatise on the Nervous and other Affections incidental to Women at the Decline of Life. By Edward John Tilt, M.D. From the Third London Edition. Philadelphia: Lindsay & Blakiston. 1871. 8vo, pp. 292. - Comparing the present edition of this work with the second, pub- lished thirteen years ago, it may be said to be rewritten, so much has been added, and that, too, of substantial value. The reader will find in it a good deal of practical information concerning perplexing ailments which constantly baffle skill, that he will look in vain for elsewhere. This is particularly so of that portion on the disorders of the ganglionic nervous system, and the importance of distinguishing them from those of the cerebro-spinal axis, their various relations being abundantly illustrated by clinical facts. Though Dr. Tilt's style does not become more compact as he grows older, it is always gossiping and lively, and his books are pleasant as well as instructive reading. What he has to say he says to the purpose; his pet theories he does not hesitate to state and even dwell upon, and, if we are not always at one with him, neither are we disposed to quarrel with him about them, seeing that they do not take away from the practical teachings of his writings. The exceptional credit must be given to Dr. Tilt, that, unlike most gynaecological special- ists, he has always insisted that medicine should be one and indivisible —that we should look upon the diseases of the womb as we do upon diseases of any other part of the body, and treat them by the same remedies. r The first five chapters of this treatise are devoted to the physiology and pathology of the change of life, and are founded on tabulated esti- mates of the symptoms and of the diseases of five hundred women who were at the change of life, or who had passed the menopause. The next three take up the nervous affections to which women at the change of life are liable. These are perhaps the most valuable in the book, as we have already intimated; and we especially ask attention to the sixth chapter, which treats of the disorders of the sympathetic system, which are discussed under the not very correct name of gangliopathy, given to a condition where, more or less, debility is associated with paralysis, 1871. Jeeviews. 69 hyperasthesia, or dysaesthesia of the solar plexus and the central gan- glia of the sympathetic system. Diseases of the brain and neuralgic affections are well handled, and the mental state of women at the criti- cal period fully enquired into. Chapter IX., on the “Diseases of the Re- productive Organs,” has been much enlarged, indeed recast, and much pains have evidently been taken to render it as complete as possible. It contains a large amount of important matter, some of which is quite new. Diseases of the gastro-intestinal organs are the subject of Chapter X., and those of the skin of Chapter XI., and both are good. We can cordially recommend Dr. Tilt's book to the attention of our readers. THE MEDICAL REGISTER OF NEw YoFK AND WICINITY, for the year commencing June, 1, 1871. Published under the supervision of the New York Medico-Historical Society. A. E. M. Purdy, M.D., Editor. New York : Wm. Wood & Co. 1871. The “Register” of the present year compares favorably with any of its predecessors in typographical execution and general appearance, and in the more important aspect of being singularly free from errors. It is an almost impossible task to prepare a roll of physicians as extensive as this without including some unworthy names, or, what is much more serious, omitting some deserving ones. The gentlemen composing the society under whose auspices the “Register” is published desire to avoid mistakes of this nature, and endeavor always to notify those gentlemen against whom charges have been preferred, in ample time to permit a complete investigation before the yearly volume goes to press. Should errors occur notwithstanding these precautions, it is the duty of the party aggrieved to bring the matter before the publishing committee at once, and, in case any name has been unjustly onlitted, they will issue supplementary numbers making the necessary correction. The profes- sion can therefore rely upon the accuracy of the present volume, and rest assured it is what it purports to be—“a list of physicians in the city and county of New York and vicinity, who have not violated the Code of Ethics of the American Medical Association and the Medical Society of the State of New York.” EFFECTs of CEREBRAL LESIONS ON THE TEMPERATURE OF THE BODY.—Bruck and Günther (Pflüger's Archiv., iii. 578) find that an ele- vation of temperature is more surely produced when puncture is made in the anterior part of the pons or posterior part of the medulla than after separation of the medulla from the pons. Hence they conclude that the elevation of temperature is to be considered as the effect of irritation rather than paralysis of an inhibitory centre, as Tscheschichin supposes. -Jour. Anat. and Physiol. - - - 70 Miscellaneous. [Aug., iſłłigitti ſãºt to tig, AMPUTATION OF REDUNDANT SCROTUM IN THE TREATMENT OF WARI- CoCELE.—In an able article upon this subject, in the July number of the Journal of Syphilography and Dermatology, Dr. M. H. Henry, Surgeon to the Department of Venereal and Skin Diseases, New York Dispensary, describes the instrument which he has devised for the double purpose of controlling the hamorrhage and serving as a guide to the operator. The following extracts, with the accompanying illustration, will give an idea of the instrument, and the manner in which it is to be used : “The instrument which I have called SCROTAL FORCEPs consists of two parts. “The main part of the instrument, Fig. 1, has two double-curved blades, made of steel, ten inches long, sufficiently heavy to give strength **śs ºr . and admit of pressure without injury when used. The handles, a, are large enough to admit finger or thumb without Cramping. “The lower half of the instrument be- low the joint, b, is fenestrated in both blades; the coapting surfaces are evenly notched, to prevent the tissues from slip- ping—affording, according to experience, a more secure hold on the Soft parts, with less pressure and less injury than Smooth surfaces. The fenestra afford the surgeon the facility of inserting all his ligatures before dividing the parts, should he elect this method of bringing the edges together; the thickness of the upper blade from the line of insertion of the ligatures leaving ample tissue to assist union, and, if the incision be a clean one, the equal pressure or tension will prevent, as far as any effort or care can control, ulceration through the stitches before union has taken place. The curve in the blades is made according to natural lines, which it is desirable to follow in removal Of the scrotum. “The handles are curved so that, while they maintain a direct median line, they do not interfere or press on the genital parts, besides giving additional security and compactness to the whole. The screws in the handle and the end of the blades, c, give additional security during the opera- tion, without the aid of an assistant. “The extra blade, Fig. 2, is made of steel, nickel-plated, and is maintained in - the right blade of the forceps by two small pins and the slight tension put on the spring of the metal. It is easily inserted with a little pressure, and removed as easily by inserting the 1871.] Miscellaneous. 71 nail or the handle of any instrument between the two blades and dist lodging it. “When the operator prefers the glover's or running stitch, the extra blade is used as a guide in the amputation of the parts. When this is accomplished, by displacing the blade, a free border is exposed—about the sixth of an inch in thickness—and in a minute or so the wound can be stitched perfectly without any inconvenience. The forceps are, of course, not removed until this is accomplished. . . . - “Defore the operation, the patient should have free evacuation from the bowels, to avoid the necessity of getting up or being disturbed for twenty-four hours after the operation. & “Besides the forceps, which I have already described, the only instru- ments necessary are—a pair of large, strong scissors with flat blades, or blades curved flatwise ; needles, with either silk or fine silver wire for sutures; a few acupressure needles; a few serres-ſines, and some adhesive plaster. Before any anaesthetic is administered, the patient should be carefully examined, and the forceps applied while in a standing position ; this will enable the surgeon to lift up the testes, and afford him the best opportunity to decide the exact portion of scrotum to be removed. If this precaution be taken, there is no danger whatever of his removing too much tissue. I am satisfied there is much more danger of his not cutting off enough. The patient being placed in a recumbent position, his thighs well separated with folded towels, the forceps are applied by placing the blades in front and under the anterior portion of the scro- tum, and held in a direct median line. The end of the forceps being close to the perinaeum, the scrotum is engaged between the blades of the forceps. Care must, of course, be exercised not to include anything more than the scrotum. As soon as they are adjusted, and the proper amount of tissue to be removed engaged between the blades, the screws should be tightened and the part removed. “Although I have described above a method of operating through the fenestra, I prefer the operation with the extra blade, with this exception, that instead of the running stitch I use the ordinary interrupted sature; while it is not so quickly performed, it offers great advantages, if it should subsequently be found necessary to divide one or two stitches in case of haemorrhage or in case of severe oedema. If the running stitch be used, and either of these last-named features should present it- self, if any division whatever be made in the course of the running stitch, there is danger of breaking up through the entire course of the wound, whatever union may have taken place. If the interrupted suture be used, however, each stitch, being independent of its neighbor, affords facilities, under these circumstances, which I think are of no small value.” CASEs of CANCER TREATED witH CUNDURANgo.—Professor D. W. Bliss, M.D., the gentleman who has so thoroughly identified himself with this new remedy for cancer, contributes to the New York Medical Jour- mal, July, 1871, a report of three cases of carcinoma, two of the breast and one of the womb, which he has treated with a decoction of cundu- rango. The case in which the improvement was most marked is quoted in full: - “Mrs. Matthews, the mother of Hon. Schuyler Colfax, had been the victim of mammary cancer for a long period, which had already assum- ed secondary and constitutional symptoms in a marked degree. On the 29th of April last, I placed her on the decoction of cundurango, and had the gratification of observing an early and decided change for the better º Miscellaneous. [Aug., in both the local and general conditions. One of its almost immediate effects was the relief of pain, and a free diaphoresis, characterized by an odor distinctly observable of the infusion itself. Upon the return of Mrs. Matthews to her place of residence in Indiana, I still continued to direct her treatment, and furnished the requisite supplies of the medicine. & “On the 9th of May, just thirteen days after the commencement of the new remedy, her husband addressed me a letter, from which I make the following extracts: “‘The stony condition of the tumor has given place to softness. This morning I notice about one-third of the surface has turned from a scar- let to a white color, and it has commenced suppurating, as though the thing were dead, and coming out. The whole tumor is very much flat- tened, the discharge is different and not near so offensive. The greatest improvement is in her complexion. From a tallowy, puffy-looking, and somewhat bluish skin, she is regaining her old, natural look, the skin shrinking, becoming wrinkled and clear. “‘I am so happy in the prospect of a cure that I feel like a new man, as though a ton of lead had been lifted from my heart. Is it not a little singular, it has not had any perceptible effect on her nervous sys- tem & Her digestion is good, and she begins to feel that she will get well." “On the 14th of the same month, Mr. Matthews writes as follows: “‘This is the seventeenth day since I commenced the use of cundu- rango; shall cease for a few days and note carefully the effect. When I began the treatment, Mrs. Matthews's breast was almost as hard as a stone, about four inches in diameter, the cancer itself two inches in diameter, with raised edges, hard and scarlet-colored, bleeding profusely at the slightest touch, emitting an odor of the most sickening and dis- agreeable kind, discharging a brownish, cancerous, limpid fluid; the countenance bloated, tallowy-looking, with a bluish pallor of the whole face; the lips turned blue at the least exertion, so that I have been very much alarmed, fearing a rapid crisis and dissolution; at the same time, the tumor itself enlarged with fearful rapidity, so much so that I could notice the growth from day to day. “‘Now all is changed—the countenance has resumed its old, familiar look; she moves about with great sprightliness, the blue of the lips no longer indicating fatigue or effort. The granular swelling under the chin is gone; strength increasing; the tumor itself much flattened and decreased in protuberance; the color changed to a white, maturating sore; the limpid cancerous discharge ceased, and in its place a healthy discharge of white matter much less offensive; the hardened glands are soft to the touch, the whole symptoms indicating most plainly to me that the treatment has, so far, neutralized the poison of the blood, and that another short campaign with cundurango will ensure a complete cure.” “On the 2d of the present month, I visited Mrs. Matthews at South Pend, and was indeed astonished at the rapid change which had taken place. The tumor had become soft, the color natural, the secondary glandular deposits had all disappeared. The improved complexion, muscular firmness, and elasticity of spirits, all pointed to an early and complete recovery.” In the two remaining cases, one a Mrs. Handy, of M Street, Washing- ton City, and the other a lady of the family of Mr. Gorham, Secretary of the United States Senate, the cancerous nature of the disease was un- doubted, and its progress far advanced. In one instance, the supply of the remedy is exhausted, and in the other the case only came under 1871. Miscellaneous. - 73 treatment, June 1, 1871, yet Dr. Bliss states that decided improvement has been obtained in both cases. It is a fact deeply to be deplored that the quantity of the drug experi- mented with was so small in the first instance. From this circumstance alone may arise the painful doubts and uncertainties which surround the therapeutical effects of the remedy. It is barely possible that the good effects obtained by one physician, and the negative results in the hands of others, may be due to a difference in the quantity or quality of the drug with which they were supplied. Dr. Bliss is entitled to a suspension of judgment until such time as the arrival of a supply of cundurango shall enable others to verify or contradict his conclusions. In the meantime, there is no physician who will not hope to see similar results obtained by all who shall investigate the subject. SUGAR IN THE LIVER,-Prof. John C. Dalton, M.D. (N. Y. Medical Journal), as the result of a series of experiments in which portions of the liver were removed from twenty dogs and immediately examined for sugar, arrives at the following conclusions: “1. Sugar exists in the liver at the earliest period at which it is possible to examine the organ after its separation from the body of the living animal. “2. The average quantity of sugar existing in this liver at this time is at least two and a half parts per thousand. “3. The liver-sugar thus found does not belong to the arterial blood with which the organ is supplied, but is a normal ingredient of the hepatic tissue.” DIPHTHERITIC MEMBRANES.—The Medical Archives, July, 1871, con- tains the following views of Dr. Letzerich, translated from the German by Dr. Pflaum, of Pittsburg, Pa.; “Diphtheritic membranes, taken from a large number of children who suffered from diphtheritis faucium et laryngis, showed, upon ex- amination, after having been slightly hardened in a solution of chromic acid, according to the different stages of inflammation, different stages of development of a fungus (hygodesmus-fuscus?) upon and within the mucous membrane. At first there are to be found, in the adhering mucus, roundish, strongly shining granules; later, yellowish or brown- ish ones. From these shoot out very thin and tender filaments, which often form a very dense cluster, and penetrate the epithelium in such a way that the spots where they penetrate most are visible on the cell membrane. With their increasing exuberance, the epithelia decay more and more, and these filaments, at first without form, are later plainly visible, penetrate the mucous tissue deeper and deeper, and convert its structure into a compact homogeneous “amorphous' mass; from which is seen to project on its free edge a number of long thallus filaments, lined with roundish granules containing spores, which sometimes form large and close sods. The growth, maturity, and shedding of the spores go on steadily and rapidly, and can produce infection of the contiguous. mucous membranes. “The penetration of those little organisms into the epithelial tissue corresponds to the preliminary, so-called catarrhal stage, their growth into the depth of the mucous tissue, and their exuberance within, to the properly diphtheritic stage of the disease. VOL. I.-6 74 Miscellaneous. [Aug., “The violent infectiousness of the sputa of diphtheritics, which fol- lows from such a condition of the membranes, renders necessary a very careful destruction of everything expectorated with caustic alkalis. For local application, the author recommends energetic cauterizing of all the faucial part and, what is still better, the rubbing off of the infiltrated places of the mucous membrane with powdered alum, and for the larynx the inhalation of pulverized lime-water; internally, the use of liq. potass. carbon., and especially of ferr. sulph. (0.3–0.5 grn. : 105 grs.)” TUBERCULosis.-In the Alg. Weiner Med. Zeit. of June 13, Dr. Koer- ner says that ideas on tuberculosis have recently made great progress. Until lately the opinion has been pretty steadfastly entertained that tu- bercle is a diseased product which arises in the body in certain diseased conditions, calls forth dangerous accidents, and brings the individual attacked into great danger. No satisfactory explanation has been given of the nature of tuberculosis, and we find not uncommonly great differ- ence of opinion on this matter among different physicians. Whilst a few were inclined to look on it as a clearly local disease, the majority recognized in tuberculosis a constitutional disease. Some even went So far as to speak of the specific character of tuberculosis. Niemeyer's teachings are expressed by this formula: “Phthisis is never of itself tuberculosis. The phthisical are in danger of becoming tuberculous. In- filtrated tubercle is a chronic catarrhal inflammation, which ends in cheesy material.” Dr. Koerner cannot completely share these views of the eminent physician recently deceased. Infiltrated tubercle is account- ed for, and merely cheesy infiltration is considered as the origin of phthisis, whilst tuberculosis is narrowed to one diseased process, in the wake of which tubercle granulations follow, and these are regarded as tumors or heteroplastic formations. Phthisis and tuberculosis, however, are in such near relationship that a pure phthisis is as rare as a pure primary tuberculosis, whilst it is almost a rule that phthisis gives evidence of tubercle, and that, on the other hand, tuberculosis shows pneumonic infiltration with cheesy material i.e., phthisis. The separation is an artificial one. The theory makes the supposition of tendency necessary. Upon this, weighty questions may be proposed which obtain no good solution: Why does phthisis often go on a long time without fever ? When and wherefore does fever commence 2 How is this fever connected, on the one hand, with phthisis, and, on the other, with tuberculosis? Why does the fever of tuberculous patients as a rule continue and become the most dangerous of all the symptoms? From all of this it seems that the new school does not give such good account of the symptoms as the old. In Dr. Koerner's opinion, Rokitansky's pathology is the correct one in this question. From that teacher's lessons, it follows that tubercle is the result of a want of higher power of formation through the tendency towards ulceration with con- secutive destruction of tissues. The constituent new product of tubercle does not, according to this view, possess the power to become a well- organized cell, so as to live. There is very little gained for clinical un- derstanding of the matter, if only these primary granulations are named tubercle, which arise from the connective tissue directly, whilst those diseased products, which, according to Rokitansky, were the foundations of tuberculous infiltration, are to be described as cheesy infiltration. If the miliary granulations were capable of living, they would do the constitution but little harm. It is well known that increase of the con- nective tissue may continue a long time in the organism without doing it much injury. The very same want of power of living, the unavoid- ble destruction which makes tubercle one of the most important of all medical enquiries, happen also to these diseased products 1871.] Miscellaneous. 75 Which happen to those infiltrations of the lungs which are named gela- tinous, acute, or instertitial pneumonia. As characteristic marks of the Cheesy masses, there must be pointed out clinically their want of vitality. Could these products of disease rise but to the level of vitality, there were surely never any necessity of describing these products so minutely. Hence, from a clinical point of view, the question appears of minor im- portance, whether the matrix of this inevitably dying mass be the con- nective tissue, the epithelium, or other part of the organism. Even the Question as to how the exudation is formed, whether it arises from the blood or through fissiparous or endogenous growth, in this sense, is of less importance than it is in the eyes of the microscopic anatomist. There are even many things too subtle to be made use of at the bedside for the finding out of the disease under which the patient is suffering. The clinical enquirer, before all, must not forget that diseased products cannot take place without anomalies in nutrition, and that exudations are got rid of either by means of resorption or evacuation, or, by the in- fluence of the nutrition, are raised to the height of vitality, or finally that they fall into destruction by ulcerating. As to clinical utility, Dr. Koerner does not think that the division between tuberculous in- filtration and gray granulation is of much service. On the contrary, he opines that the chief requisite for forming a correct judgment upon the pathology of tuberculosis resides in the question, How comes it that organic products, from wherever they arise, become unfit to live, and fall away by molecular ulceration ? In the Medical Times of June 10, Dr. Powell makes some observations on this ever-interesting and all-impor- tant question. The pneumonia, he says, of phthisis is of the catarrhal variety, seen so well in whooping-cough. “The various primary diseases, broncho-pneumonia, crupous pneumonia, and chronic tubercle, pleurisy, etc., upon which pulmonary fibrosis supervenes, are thereby marked by clinical features of great interest and significance for prognosis, but sometimes the fibrosis is so extensive as to become, whatever its origin may have been, the essential disease. Such cases have been very con- veniently classed by Dr. Andrew Clark under the term fibroid phthisis.” Tubercle is now known to be a morbid growth of the lymphatic gland class (Sanderson), and a mere hyperplasia of gland tissue normally minutely disseminated through the organs of the body. The experi- ments in animals and the advocacy of Niemeyer certainly tend to show that tubercle is much more commonly a secondary disease than has been supposed; although it would be highly injudicious to deny hereditary predisposition to tubercle altogether. Dr. C. Theodore Williams, in his paper read before the Royal Medical and Chirurgical Society, in January, 1871, said that in 1,000 cases of phthisis, forty-eight persons had brothers, sisters, first cousins, or parents consumptive. It thus appears that, even making allowance for alterations in terms and views, fewer people die of hereditary consumption now than formerly. “It may be, of course, that traditional opinion has simply been erroneous in regard- ing consumption as so strongly hereditary, but it is perhaps nearer the truth to say that under the influence of superior hygienic conditions, since sanitary science has become so much popularized, hereditary pre- disposition, as strong and real as ever, gets fewer opportunities of being nursed by neglectful hygiene.” This is an acute remark, but only shows how little the hygiene of the poorer classes is attended to, as the pro- portion of the needy classes which die of phthisis is very much higher in London than it is among the rich.-Doctor. RAPIDITY OF CONDUCTION IN MOTOR NERVES.—Helmholtz and Baxt (Monatsbericht der Berlin Acad., 1870, 184), in their new researches on the rapidity of conduction in motor nerves, use the same method as 76 Miscellaneous. - [Aug., before, the arm being immovably fixed in plaster of Paris, and the median nerve irritated first above the elbow and then at the wrist. The contractions which are thus produced in the muscles of the ball of the thumb are registered by Marey's myograph. Instead of using a revolving cylinder, the curves were registered by Fick's plan on a glass plate attached to the bob of a pendulum, which in the middle of its swing caused a spark from an induction coil to irritate the nerve. They found that a higher temperature increases the rapidity of conduction in human nerves as well as those of the frog. Conduction is quicker in the upper than in the forearm, and this seems to depend on unequal conduction in the nerves themselves independently of any difference between the tem- perature of the parts. When the nerve was irritated by shocks quickly following one another, the contraction of the muscle was no more pow- erful than when only one was employed, unless an interval of more than ###th of a second intervened between them. Constant currents, espe- cially descending ones, readily produced tetanus in the muscle, during which oscillations lasting '09 of a second took place in it. Place (Pflüger's Arch., iii. 424), in a research undertaken along with Van West, found by Helmholtz's method the rapidity of conduction in motor nerves to be 50–60 metres in a second, the mean being 53, a much greater rapidity than Helmholtz had found in motor nerves (33 metres), and very nearly the same as that he had found in sensory ones. When the irritation was applied high up, near the coraco-brachialis, they found a rapidity of 35:26 metres. The rapidity of conduction in the forearm they found to be much greater than in the upper arm, it being 56–62 metres in the former, and only 12–14 in the upper.—Jour. Anat. and Physiol. ELECTRo-THERAPEUTICS IN STRICTURE.--Upon the invitation of Sir Henry Thompson, M. Mallez lately employed the galvanic current, in conformity with the well-known views he entertains on the subject, on a patient in University College Hospital. - For some time past, the application of the galvanic current for the solution of tumors has occupied the attention of the profession in this country, and MM. Mallez and Tripier have paid the subject a like atten- tion in France. M. Mallez, in explaining his method, said that he relied more upon the chemical effects produced on the tissue to be resolved by the contact of the negative pole of the battery he was about to employ, than on the caustic effect which would result from the application of the positive pole, or the approximation of the two. The battery employed consisted of chloride of silver and zinc plates, and the agent was a solu- tion of chloride of zinc. The action of the battery was regulated by means of handles, which controlled its powers very effectively. The patient, a young man, had a stricture, which admitted a No. 3 catheter, situated about the bulb of the urethra. He also had a fis- tula in perinaeo. The rheophore connected with the positive pole of the battery being snapped on the patient's thigh, M. Mallez introduced into the urethra a bougie containing a platinum wire, which was passed into the stricture. To this the negative pole of the battery was attached, and the action of the battery kept up for some minutes. The patient at first experienced slight uneasiness in the urethra, and subsequently a burning sensation in the thigh, but not severe. M. Mallez explained that ordinarily the application of the galvano-caustic gave rise to no haemorrhage, but on this occasion haemorrhage had been produced by the preliminary examinations he was obliged to make on seeing the patient for the first time, and continued to say that usually no examination of the urethra was made for some days after the galvanic application. For the sake of demonstration, however, he would, in this instance, show the 1871.] Mºscellaneous. 77 result. M. Mallez attempted to pass into the patient's urethra a larger bougie, but unsuccessfully, although subsequently Sir Henry Thompson passed two or three instruments of increasing sizes. Sir Henry Thomp- son stated that an opinion must not be formed by this case, and prom- ised to give M. Mallez other opportunities to test his method of treat- ment. We anxiously await the result of further investigations on this important subject.—Doctor. DR. G. KRAUs, OF VIENNA, ON THE TREATMENT OF VENEREAL DISEASE.-In the Alg. Wien. Zeit. of June 20, 1871, Dr. Kraus says that there is no doubt that ulcers may be communicated to the lips by ends of cigars, pipes, or surgical instruments, and also by the finger of the nurse who has some form of syphilis. A case of infection of the last- named kind is given by the writer. In the year 186—, he was called to the house of a respectable family in Leipsic, and shown the niece of the lady of the house, a girl of ten years, who, as the lady expressed herself, had for some time suffered from a great irritation in the genital organs. The girl had been on a visit at the house for some weeks, and partici- pated in the lessons given by a young man, aged twenty, to the children of the house. He found both of the lips of the vulva very Oedematous, chancres on either side, and mucous papules at the anus. The teacher was discharged, and he was found to have syphilitic affec- tion of the penis. A mercurial course of several weeks was given, and the syphilis in the girl disappeared. Wenereal ulcers cause frequent excoriations, ulcers, and swellings of the glands, phymosis, and paraphymosis. When patients are not very cleanly, it is not seldom that we notice in the vicinity of venereal ulcerations excoriations, and even contagious ulcers arise; this is especially the case among women, on account of the configuration of the female genitals, which causes the secretion from the chancre to easily attain any excoriated part of the perinaeum or inner part of the thigh or anus. Communication from one lip of the vulva to the other is common. Strict attention to cleanliness, frequent sitz baths, covering of all excoriated parts with plaster or lint, or sprink- ling with starch, powder lycopodium, or oxide of zinc, careful covering up of ulcers, and separation of these from healthy parts by means of lint and linen rags, with frequent touching with nitrate of silver, assist the searing over of ulcers. In the year 1858, there were in the K. K. Algem. Hospital, in the department for syphilis, 263 patients (male and female) taken in with forms of chancre; among these 97 had inflamed buboes (89 men and 18 women). From this statistical fact it is apparent that buboes are far more frequent among males than among females, inflamed and suppuratory.—Doctor. ANIMAI, WACCINATION.—The House-Physician, New York Dispensary, Dr. Frank P. Foster (Medical Gazette), considers the following proposi- tions as well-established : “1. Vaccination with bovine virus is at least as successful as that with humanized virus, and in our experience it has been more so. 2. There does not appear any valid reason for looking upon vaccinations with lymph procured from a succession of bovine inoculations as inferior, in the protection conferred against small-pox, to those with humanized virus, or with virus direct from cases of spontaneous cow- pox. On the contrary, in the case of the inoculated bovine disease, we can always be sure as to the precise period of the disease, and conse- quently, in taking lymph, can choose the time when it is most energetic, whereas we can seldom or never assign a precise date to the origin of a spontaneous case, and, indeed, must very rarely have an opportunity of 78 . - Miscellaneous. [Aug. seeing such a case until after the proper time for taking lymph has passed. 3. Vaccination with bovine virus certainly does not entail a risk of any greater degree of inflammation than is commonly met with in the use of the humanized stock. 4. Animal vaccinatic n enables a careful vaccinator to be positively certain that he runs no risk of unwit- tingly conveying syphilis in vaccination. 5. The amount of vaccinal efflorescence considered necessary to constitute an effectual prophylactic against small-pox is, with bovine virus, attainable with a decidedly de- creased amount of traumatism. 6. As is now generally admitted, ani- mal vaccination is a great addition to our sources of vaccine, and fur- nishes a safeguard against ‘ vaccine panics.” On this account alone, if on no other, it should be steadily maintained.” THE FIRST STAGE OF SYPHILIS.–In the Centralblat. f. d. Med. Wissen. of Feb. 11, Dr. Sigmund says that the first stage of syphilis embraces the time of the eruption on the skin and mucous membranes. The bear- ing of this truth he explains in two paragraphs: 1. It is not correct to say that in some cases the skin affection is wanting, and that further on forms of more developed syphilis appear without secondaries; 2. In about half of the cases of syphilis, the disease is completely at an end after the first stage is past. There is no such thing as latent syphilis; the dyscrasia is recognizable or does not exist. Clinical experience now shows us that the dyscrasia sometimes gets cured without any therapeutic remedy; and also that there is no existing treatment which can hinder the appearance of the first stage of the disease. He thinks, however, that internal reme- dies may prevent the appearance of the tertiary symptoms, or, at any rate, make them appear more rarely. He admits that this is denied by many persons, but his experience of many years makes him believe that he is correct in saying so. He uses mercurial ointment for some time in the eruptive period. The value of iodide of potassium, says Sigmund, con- sists in its antiphlogistic action on the lymphatic glands, in the ease it thus gives to all pains, whether in the head, limbs, or in whatever part of the body they occur. During the use of this remedy for several months the appearances of the first stage of syphilis fade away, as indeed takes place when no internal remedy is made use of. Chlorate of potash is of no use in syphilis, says Sigmund, and chromate of potash also is worse than useless. The “decoctions” are useless also. And as syphilis is a chronic disease, let us not omit hygienic remedies. INFLUENCE OF THE NERVOUS SYSTEM ON THE TEMPERATURE AND CIRCULATION.—R. Heidenhain (Pflüger's Archiv., iii. 504) was led to re- searches on this subject from experiments made with a view to deter- mine the temperature of the brain in different conditions. He found that the brain always possesses a higher temperature than arterial blood, and that this difference is markedly increased on stimulation of sensory nerves. There is a fall of temperature in the arterial blood, but this does not take place if the spinal cord is severed from the medulla oblongata. Along with the fall in temperature there is increase of the blood-pressure. He believes that the fall of temperature is not due to mere disturbance of the circulation effected through the medulla. He finds (in opposition to Dogiel and Kowalesky) that with the rise in arterial pressure, the pres- sure in the veins is also increased, and also the velocity of the blood-current. Hence he concludes that, as the fall of temperature is not due to slowing of the blood-current through the influence of the sensory nerves on the medulla, it must be due to increased radiation from the surface. He finds a confirmation of this view in the fact that, when the body is immersed in a cold bath, the internal temperature rapidly sinks on irri- tation of sensory nerves, while the reverse is the case in a warm bath where no radiation from the surface is allowed.—Jour. Anat, and Physiol. 1871. Miscellaneous. . . 79 RELATIVE VALUES OF THE METRICAL SYSTEM OF WEIGHTS AND MEASUREs AND THose of THE UNITED STATES PHARMACOPOELA.--Weights: One milligramme is equal to ºf grain nearly ; one centigramme is equal to grain nearly; one decigramme is equal to 13 grains nearly ; one gramme is equal to 15% grains nearly ; one decagramme is equal to 154 grains nearly ; one hectogramme is equal to 1,543 grains nearly; one kilogramme is equal to 15,432 grains nearly. Measures of Capacity : One millilitre is equal to 15% grain-measures of water; one centilitre is equal to 154 grain-measures, or 3 fluid drachms nearly ; one decilitre is equal to 1,540 grain-measures, or 3; fluid ounces nearly; one litre is equal to 15,406 grain-measures, or 24"; pints nearly ; one cubic centimetre of water at its maximum density weighs 15% grains nearly, and is # of a fluid drachm nearly. . . Measures of Length : One millimetre is equal to sº; inch nearly; one centimetre is equal to # inch nearly ; one decimetre is equal to 31% inches nearly ; one metre is equal to 39, inches nearly ; Hºg metre is equal to 1 yard nearly. TREATMENT OF CROUP BY INHALATION OF GLYCERINE.—A German physician, Dr. Stehverger, recommends the treatment of croup by the inhalation of pure glycerine through one or other of the well-known forms of atomizing apparatus. He was led to try this remedy for croup from observing its good effects in cases of hoarseness and loss of voice. After application, the cough becomes more free and moist, and children are enabled to sleep almost immediately upon being relieved by the inhalation. It is, however, believed to be of importance to make use of the remedy early and frequently, as, if delayed, it may have no effect whatever. If the glycerine be pure, it may be used unmixed; if not, it should be diluted with a little water. The inhalations are repeated, according to the necessity of the 'case, at intervals of from half an hour to an hour and a half, and for about fifteen minutes at a time. The effect of the glycerine in this case is supposed to be due to the fact that the secretions of the mucous membrane are thereby increased, and tume- faction reduced.—Harper's Magazine (Scientific Record). CHLORAL IN TETANUs.--M. Benasson relates a case of traumatic tetanus occurring in a lad thirteen years of age, to whom he was called the third day after the appearance of the symptoms. He found him in a state of almost complete opisthotonos, and determined to try the effects of chloral, and by about the thirty-fifth day the patient had com- pletely recovered. The entire quantity of chloral administered amounted to 180 grammes, commencing with 4 grammes in the twenty-four hours, which almost immediately procured him the sleep he had been so long utterly deprived of. The dose was gradually increased to 8 and 10 grammes in the twenty-four hours.-Med. and Surg. Reporter. PoisonING BY CARBOLIC ACID.—Dr. Gerrard reports in the Lancet a case from Jamaica, in which a sailor was poisoned by carbolic acid. It appeared that the captain kept in a cupboard in his cabin two bottles similar in appearance, but one of them containing rum and the other. carbolic acid. It is supposed that the deceased, searching for the rum, drank from the carbolic acid bottle instead, as it was found half-way out of the cupboard, but with the cork in it. When discovered, he was comatose, with contracted pupils and intermittent pulse, stertorous breathing, and frothing at the mouth. There was also a peculiar livid appearance about the eyelids, lips, and ears. The odor of carbolic acid was present. Medical aid was obtained, but death followed within 80 Miscellaneous. [Aug., 1871. three-quarters of an hour of the supposed time of his taking the poison. It was said that the deceased, whilst searching for liquor on a previous voyage, had swallowed some lamp-oil in mistake for rum,_Med, and Surg. Reporter. - MEDICINE AND SURGERY of MoDERN TIMEs.-We extract the follow- ing from the excellent address of Dr. W. H. Phillips, the retiring presi- dent, delivered before the Northwestern Ohio Medical Association, at its annual meeting at Celina, Ohio, June 1, 1871 : “Let me ask your indulgence while I examine a very few of the mo- dern triumphs in medicine and surgery. In practical medicine, nothing has been more conducive to its real advancement than the recent im- proved means of physical diagnosis. The implements devised for these purposes by ingenious men, and the principle of their intelligent appli- cation, form no inconsiderable portion of our studies at the present time. By these means we have much less to infer, for the knowledge we have thus gained is more positive. We thus make available our senses in appreciating morbid conditions, and especially do we magnify and extend the range of our senses of seeing and hearing. By the stethoscope we are enabled to hear all the normal and abnormal sounds of the heart and lungs, and by the pleximeter we measure and estimate the size, loca- tion, the relative density, and other physical properties affecting the organs of circulation and respiration. By the microscope we are enabled to diagnose hitherto obscure diseases of the kidneys, lungs, skin, and mucous membrane. By it we can determine by the forms of the cells between benign and malignant tumors, and thus acquire definite and precise information in regard to the character of many diseases while they are in their incipient and curable stages. “By the urinometer and thermometer we are enabled to determine approximately the amount of destructive metamorphosis of tissues that occurs within a given time, and thus with great certainty estimate the amount of waste that is going on in the system in many obscure diseases, and thus account for many phenomena otherwise unaccountable. By the ophthalmoscope we examine the internal tunics of the globe of the eye, and by the condition of the blood-vessels of the same we can judge of the relative amount of blood that is circulating in the brain, and in this manner we are enabled to diagnose many of the most grave dis- eases of the brain and nervous system. We can thus, by actual sight, ascertain whether these diseases are due to anaemia or hyperamia— whether in the brain there is circulating too little or too much blood.” HYPODERMIC USE OF ERGOT IN UTERINE DISEASE.--Dr. Von Swiders strongly recommends subcutaneous injection of ergot in uterine affections, especially chronic metritis and metrorrhagia. Severe bearing-down pains are said to be often produced, coming on in from a half to one hour. His formulae are, where a rapid effect is desired : Aqueous extract of ergot, 2-5 parts; rectified spirits and glycerine, each 7:5 parts;–Aqueous extract of ergot, 2 parts; rectified spirits, 5; glycerine, 10 parts. Where a slower and slighter action is desired : Aqueous extract of ergot, rectified spirits, each 2-5 parts; glycerine, 12-5 parts;–Aqueous extract of ergot, 1 part; rectified spirits, 1:5; distilled water, 4:5; glycerine, 3 parts.--Wiener Medizinische Wochenschrift, January, 1871. ; Advertisements. INSTRUMENT-MAKERS TO THE {J. S. Navy; Bellevue, New York City, and New York State Woman’s Hospitals, and Hospitals in charge of the Commissioners of Public Charities and Correction. - IMPORTERS AND MANUFACTURERS OF EVERY DESCRIP- TION OF F U E E E R G O O D S. SURGICAL, DENTAL, ORTHOPAEDIC, WETERINARY, CHIROPODIST’S, TAXIDERMIST’S, AND ENTOMOLOGIST'S INSTERUMENTS. Trusses and Abdominal Supporters in great variety; Suspensory Bandages in all shapes and styles; All kinds of Instruments to enable the “Deaf.” to hear; The latest and most approved Appara- tus for Deformities; Electro-Magnetic Machines and Galvanic Batteries in the most compact form; Electro-Magnets and Galvanic Batteries combined; Crutches in all kinds of wood. We have on hand all the latest American Instruments, and are constantly receiving from our Agents in France, Prussia, and England all the latest models and inventions in Surgical Art. GooDs IMPORTED OR MANUFACTURED TO ORDER. º Send for Price-Current. 150 WILLIAM STREET, N. Y. 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This standard Journal of Medicine and Surgery has now reached its twenty-sixth year of re- ir, a - tion, *ś. the º * * º º need º the ###$hé. º: never-faijing energy of its Agent in bringing it before the profession, it has º far exceeding that of any other similar Journal throughout it. Union. now reached a circulation Its pages are generally opened with L E C T U R E S (Handsomely Illustrated), Delivered by distinguished members of the profession throughout the Wor º rivalled supply of matter in § e world, followed by the usual un 1. Original Papers. 5. Editorial Articles. 9. New Inventions. 2. Hospital Report8. - 6. Reviews. 10. Foreign Gleanings, 3. Rºilº the Medical $. §§§ §§§ 11. Miscellaneous Correspondence. O'CietleS. - . New Hemedies Introduced 12. NeWS º 4. Medical Annotations. into Practice. etC. Items, Medical FactS, etc., THE LANCET is the oldest and most Practical Medical Journal published in the Engli - is the national British organ of Science in its relations to the łº, frame; and .# ºße; philosophy finds fresh and learned treatment in its ºglumns. THE LANGET is edited by a corps of the most distinguished physicians of the metropolis, and numbers among its contributors the best medical and surgical talent of Europe. The price of THE LANCET is ONE COPY TO ONE ADDRESS, $500 PER ANNUM. Subscriptions are º in advance. The postage on THE LANCET is 6 cents a quarter, or 24 gents a year, payable in advance at the office of delivery or at this office. Address all communications to WM. C. HERALD, 52 JOHN ST., NEW YORK. THE LANCET and Medical W9I'ld, 9ne year. . . . . . . . ..... . . . . . . ,-,-, ... . . . . . . . . . . $5 50 44 * Journal of Obstetrics and Diseases of Women and Children, one year, tº a 9 00 The three journals combined, one year, º º tº º & tº e º tº º 10 00 TāTöUa Year.I tºº $3& * Nº t . . . . | , . .'; Subscriptions invariably in advance. . . . [15 Cents per Copy, ãº-º-º-º-º-º: | ! # : f § : n || OTI ºil a | A MoSTIILY Jourt.NAL OF - º º | AMERICAN AND FOREIGN MEDICAL, PHYSIOLOGICAL SURGICAL, # AND CHEMICAL LITERATURE, CRITICISM, AND NEWS, { : 3. EDITED JSY REUBEN A. VANCE, M.D. ; : i - ºŠºº! ESvar.cº6 i -2.º\º. } C§ Y. § s ...” $| OCTOBER, 1871. |, §: - -- –––––– — —- –—- - -— — — — — — — —- - - |É | |: trº # º § . . . . . . . . . . . : º, Nºrr > N rive # , || || ". . . . . CONTENTS, ..: ' ' T2A (; F. I’AGE ORIGINAL COMMUNICATIONS: SELECTED ARTICLES : § 3. { $: ; : § § f Art. ...—The Clinical Thermometer, - A New Ovariotomy Clamp, DIR. DR. McELRoy, . . . . 121 T}AWSON, . . . . . . . 149 § § { tº-3 Art. II.-Notes on the Treatment of Gunshot Wounds, as Practised in {EVIEWS: Berlin. DR. RANKIN º º , 138 + = g * | X I (N - ELW ELI–A Medico-Legal Treatise on Art. III.-Lethargus, DR. BAILEY, . 139 Malpractice and Medical Evidence. 15: 15 | Art. IV.-Bromide of Sodium, DR. CLYMER, . e - e - . 141 : § : { 3. 3 * ºn • 3-2 s BARNEs—Obstetric Operations, i § ses in Hypodermic Medication, I | Dr. VANCE, * * * * - | : 143 See 2d page of cover. &: ſ: } $ % 3. : r # NEW YORK : % WILLIAM BALDWIN & Co., PUBLISHERS, } 21 T2AlèIX ROW . I.O.ND ON TRüBNER & CO. - | - - + | - % - : x ,3 2' ſ: S., :* - ^-X- — S. 3G 3); % ... - \\..'ſ ~...~ r—- “------- § & | % § 3. § 3. *N. e g:=::::::::::::::::::::::::::::sº-ºººººººººº-ºº-º-º-º-º-º:555 gººgºº, sº gº sº jºiºsº º a gº tº ſº sº ºr ºf - - PAGE. PAGE I. OPIGINAL COMMUNICATIONs. 1. The Clinical Thermometer, 2. Notes on the Treatment of Gun-Shot Wounds, as prac- tised in Berlin, . . 138 3. Lethargus, e . 139 4. Bromide of Sodium, . 141 5. The Prevention of Abscesses in Hypodermic Medication, . 143 II. SELECTED ARTICLEs. A New Ovariotomy Clamp, . . 149 III. REVIEWS. 1. A Medico-Legal Treatise on Malpractice and Medical Evidence, . 153 2 2 (3 . Obstetric Operations, . 153 IV. Misceraseous. • Contagion of Scarlatina and Small-pox, . . . 154 . The Antiseptic Treatment of Wounds, . 155 . Phantom Tumor, ... 156 . The Course of Epithelioma, . 157 . The Galvanic Current as a . Means of Resorption, . 157 . The Radical Cure of Hernia, . 158. 7. Some Further Additions to Therapeutics, . . 159 . Liebig on Germany and France, 160"> * : * ºf º *... } º - ºi º Was awarded a Silver Medal at Paris International Exhibition, twenty-seven competitors. 1867, heading Is prepared from selected Livers, and bottled at Lofoten Islands, Norway. Was awarded a Gold Medal at Bergen International Exhibition, 1865. Is the purest, and for limpidity, clearness, and delicacy of taste and smell is superior to any. - Is highly recommended by the Medical Societies of Norway and England. * is more readily assimilated and more readily digested than any other Cod Liver . Oil. . . - Was awarded the First Prize and the only Medal at London International Exhi- ‘bition, 1862. tion, 1868. Is recommended by high medical authorities in Europe and America. . . .. Was awarded First Prize, the only one awarded, at Stockholm Great Exhibi- W. H. Schieffe/im & Co., AVezy York, Sole Agents for United States and Canada. PHYSICLANs who RECEIVE this number, and who wish to subscribe, will oblige by remitting the amount of subscription, with their names, at once. In consequence of the unexpectedly large demand for Back numbers of THE WoRLD, the numbers for July aré entirely exhausted. Those who have received already the July number, as a specimen copy, will much oblige the Publishers by returning the same, if they do not wish to subscribe, and they will get a copy of any future number in exchange. THOSE WHO wish to pl Address will IAM BALDWIN & Co., Pt + 2. Park Row, New York. P. O. Box 3472. 'eserve complete files should make early application. Publishers, ? ~ Contents of The Medical World for July, 1871, I. ORIGINAL COMMUNICATIONS. 1. The Physical Diagnosis of Brain Disease.—DR. VANCE. 2. The Value of Torsion as a Haemostatic.—DR. PHELPs. 3. Cutaneous Eruptions Caused by Wearing Red Flannel upon the Skin. —DR. DE MARMON. 4. Osteo-Sarcoma following a Fracture of the Fibula.--DR. BRADLEY. II. SELECTED ARTICLES. Abstract of Lectures on the Internal Diseases of the Eye.—DR. J. SOEE- BERG WELLs. III. REVIEWS. - “Dynamics of Nerve and Muscle.” By DR. CHARLEs BLAND RADCLIFFE London. IV. MISCELLANEOUS. 1. Eucalyptus Globulus. 13. Elimination of Nitrogen. 2. A Substitute for Lint. 14. Rupture of the Uterus. 3. Abnormal Lacteal Secretion. 15. The Action of the Bromides. 4. Drs. Wilks and Anstie. 16. Pathology and Treatment of Dia. 5. Treatment of Epididymitis. betes. 6. Affections of the Eye from Small- 17. Treatment of Fractures. pox. - 18. Hydrate of Chloral. 7. Glasgow Surgery. 19. Chromic Acid in Sore Mouth. 8. Diaphoresis in Scarlatinal Dropsy. 20. Heat of the Body. 9. Treatment of Aneurism. 21. Transfusion of Blood. 10. Belladonna in Tonsillitis. 22. Injuries of the Head. 11. External Application of Remedies. 23. Influence of Alkalies upon Urea, 12. General Paralysis of the Insane. 24. Transplantation of Bone. *- w Contents of The Medical World for August, 1871, I, ORIGINAL COMMUNICATIONS. 1. Medical Thermometry.—DR. SEGUIN. 2. Ulceration into Primitive Carotid from a Wound of the Throat treate by Ligation.—DR. PHELPs. - 3. The Treatment of Amenorrhoea and Dysmemorrhoea by the Use of Quinine Endermically.—DR. BRADLEY. 4. Aneurism of the Aorta treated with Iodide of Potassium and Oxygen. —DR. BUTLER. 5. Stricture of the Nasal Duct.—DR. SEELY. II, SELECTED ARTICLES. 1. The Early Symptoms of Cerebral Disease.—DR. VANCE. III, REVIEWS. - DR. TILT—“Change of Life.” DR. PURDY –“ Medical Register.” IV. MISCELLANEOUS. - • 1. The University of New York. 10. Conduction in Motor Nerves. 2. Dr. Bumstead. 11. Electro-Therapeutics in Stricture. 3. Bellevue Hospital. 12. Treatment of Venereal Disease. 4. Cerebral Lesions & Temperature. 13. Animal Vaccination. 5. Amputation of Redundant Scro- 14. First Stage of Syphilis. * , tum. - 15. Influence of the Nervous System. 6. Cancer and Cundurango. 16. System of Weights and Measures. 7. Sugar in the Liver. 17. Treatment of Croup. 8. Diphtheritic Membranes. 18. Chloral in Tetanus. 9. Tuberculosis. 19. Poisoning by Carbolic Acid. CONTENTS The Medical World for September, 1871. •-Q- e— . I. origiNAL coxſwunications. IV. MISC EIf, AN E OUS. 1. Phenomena. Noted in a Case of 1. Winter Resorts for Consump- Epilepsy, . . . . 81 tives, . * & e . 114 2. Hypodermic Injections, . , 89 2. Fox on “Skin Diseases,” . . 117 3. The Use of the Seton in Simple 3. Changes in the University Med- Suppurating Bubo, . . 91 ical College, . g tº . 117 4. Clinical Examination of Urine, 93 4. “The Physiology and Patho- - logy of Scars,” . # . 118 II, SELECTED ARTICLES. 5. Diabetes Mellitus, . * . 118 Extract from a Paper on the Philo- 6. Treatment of Psoriasis, . . 118 sophy of Intermperance, º ... 102 7. Infantile Diarrhoea, . , s . 118 - 8. Correction, tº d * . 119 8. The Cause of Diabetes Melli- III. REVIEWS. tus, º º gº ſº . 119 Wear and Tear; or, Hints for the 10. Hypodermic Injection of Mer- Overworked, & * e . 111 cury for Syphilis, . & . 120 DR. S. W. BTUTLER'S Half-Yearly Compendium of Medical Science. Published January and July. Over Three Hundred pages in each number. Good paper—good type. The most complete abstract of the medical journalism of the world published in the English language. None other does justice to American medical literature. Its fourth year began January, 1871, and it is the most successful medical enterprise thus far ever started in this country. Subscrip. tion price, Three Dollars per annum, including postage. The Physician's Daily Pocket Record. Admitted to be the best Physician's Visiting List and Pocket Manual published. It contains many new features, among which are: A list of New Remedies; Doses of Medicines by Inhalation, Hypodermic Injection, Suppositories, etc.; Classified List of Medicines, with doses and prices; Tables for Examination of Urine, etc. : Fee Bills, etc., etc. ſº It is perpetual, being good for a year from date of purchase. Tº A Patent Self-closing Clasp, or the Ordinary Tuck, at the option of the purchaser. Tº This work is growing in popularity —its sale ºncreasing rapidly. 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This apparatus is capable of producing modified and manifold cur- rents, differing from each other in respect of intensity and quality of Nerpoºls and Museular effect, as well as in magnetic and electro-chemical power.” - The convenience and effectiveness of Dr. Kidder's Faradaic Electrical Appa- ratus, it is known, have advanced the cause of Flectrical Medication during the last ten years, and he now adds the most effective arrangements to manipulate and control the currents of primary cell batteries by inventions recently patented. Office of Dr. KIDDER'S ELECTRICAL MANUFACTORY, 544 Broodway, New York. DNIVERSITY OF NEW YORK. MEDICAL D EPAFTMENT, 426 East 26th St., opp. Bellevue Hospital, New York City. TH II: TY - F I R S T S E S S I O W, 1871-1872. FA C U L T Y O F M E D : C E M E . REV. HOWARD CROSBY, D.D.. Chancellor of the University. MARTYN PAINE, M.D., LL.D., Emeritus Professor of Matéria Médica and Thérapeutics. JOHN W. DRAPER, M.D., LL.D., Emeritus Professor of Chemistry and Physiology. President qf the Faculty. ALFRED C. POST, M.D., - Professor of Surgery. CHARLES A. BUDD, M.D., WILLIAM DARLING, A.M., M.D., F.R.C.S., Professor of Descriptive and Surgical Aſlator?!y. HENRY DRAPER, M.D., Professor of Physiology. Registrar of the Faculty. WILLIAM. H. THOMSON., M.D., Professor of Materia Medica and Therapeutics. FREDERICK D. LENTE, M.D., Professor of Diseases of Women and Children. EDWARD G. JANEWAY, M.D., p Professor of Physiological and Pathological Aft(t\0???!/. D. B. St. JOHN ROOSA, M.D., Cºmical Professor of Diseases of the Eye and Ear. ERSKINE MASON, M.D., Adjunct Professor of Surgery. The Collegiate Year is divided into two sessions—a regular Winter Session and a Spring, Summer, and Autumn Session. The latter is auxiliary to the former, and the design of the Faculty is to furnish instruction to medical students throughout the year. _Attendance on the regular Winter Session is all that is demanded of the candidates for graduation. Those who attend the other session receive a Certificate of Honor, as having pursued voluntarily a fuller course than usual. The Spring and Summer Session is principally of a practical and clinical charac- ter, and affords particular facilities to students who have already taken one course in schools where such practical advantages exist to a less extent. The course consists also partly of lectures and ex- aminations on the subjects necessary for graduating in medicine, conducted by the Professors of the regular Faculty and their assistants. The examinations will be addressed to both first and Second course students. For the purpose of making the visits to the wards of the hospitals as available as possible, the class is divided into sections. One division at a time is instructed in practical diagnosis. prescrip- tion, and treatment of patients. ... The course begins in the middle of March, and continues till, the beginning of June, when the Summer Commencement is held. During the Summer the College Clinics are kept open. The Autumn or Preliminary Session commences in the middle of September, and continues till the opening of the regular session. It is conducted on the same plan as the Spring and Summer session. The Regular Winter Session occupies four and a half months, commencing on the second of October, and continuing till the middle of February. The system of instruction embraces a thorough Didactic and Clinical Course, the lectures being illustrated by two clinics each day. One of these daily clinics will be held either in Bellevue or the Charity Hospital. The location of the College building affords the greatest facilities for Hospital Clinics. It is opposite the gate of Bellevue Hospital, on Twenty-sixth Street, and in close proximity to the ferry to Charity Hospital, On Black- well’s Island. while the 'epartment of Out-door Medical Charity and the Hospital Post-mortem Room.8 are across the street. The students of the University Medical College will be furnished with admis- sion tickets to these establishments free of charge. The Professors of the practical chairs are Connect- ed with one or both of these Hospitals, and students are also entitled to attend all the clinics held by other physicians in them. Besides the Hospital Clinics, there are eight clinics each week in the College building. The Faculty desire to call attention particularly to the opportunities for dissection. Subjects are abundant, and are furnished free of charge, and the Professor of Anatomy spends several hours each day in demonstration in the dissecting room. - Fees for the Winter Course. Professor of Obstetries and Clinical Midwifery. JOHN C. DRAPER, M.D., Professor of Chemistry. ALFRED L. LOOMIS. M. D., Professor of Institutes and Practice of Medicine. Full Course of Lectures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $140 00 Matriculation... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 00 Demonstrator's fee, including mafería] for dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 00 Graduation fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 00 Fees for the Spring, Summer, and Autumn Course. Students who have attended the Winter Course will be admitted free of charge. Those who have not attended the Winter Course will be required to pay the matriculation fee and $30; and should they decide to become pupils for the winter, the $35 thus paid will be deducted from the price of the Winter Tickets. For the purpose of assisting meritorious individuals, the Faculty will receive a few beneficiaries, each of whom will be required to pay $43 per annum and the matriculation fee. For further particulars and circulars, address the Registrar, PROF. HENRY DRAPER, M.D., UNIVERSITY MEDICAL COLLEGE, 426 East 26th St., New York City. THE EDICAL A MONTHILY IRECORD OF 0 RLD. AMERICAN AND FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL, AND CHEMICAL I,ITERATURE, CRITICISM, AND NEWS. VOL. H. N Ew York, OCTOBER, 1871. No. 4. 49 rig in a . ART. I.- THE CLINICAL THERMOMETER . ITS LESSONS AND TEACHINGS TENTATIVELY EXPRESSED IN NUMBERS. Report of Committee on Wew Remedies to the Muskingum County Medical Society, March Sessions, 1871. [Rewritten, and Clinical Illustrations appended, and communicated to THE MEDICAL WoRLD.] BY Z. C. McELROY, M.D., Zanesville, 0. THE annals of science contain no record more brilliant than the demonstration of the narrow range of temperature in the human body in a physiological condition, as well as the boun- daries within which life is alone possible for any considerable length of time. - Like many other great truths, these make their way to the masses very slowly. More than a century since, an Austrian teacher, De Haen, insisted on his pupils using the thermome- ter, an instrument of precision, to determine the exact degrees of heat in so-called fevers. The labors of various observers in Germany, France, England, and America, in our own times, have completed the demonstration, but still the instrument is Entered, according to Act of Congress, in the year 1871, by WILLIAM BALDWIN & Co., in the Office of the Librarian of Congress, at Washington, D. C. 122 The Clinical Thermometer. [Oct., only in the hands of the few. Nor need this occasion any sur- prise so long as the records of the instrument are held to indi- cate more or less definitely or vaguely the presence or absence of certain specifically different pathological states, or so-called distinct entities of disease. Temperature, as approximately indicating the existence, in any given instance, of certain definite and widely different so- called diseases, as a block of isolated knowledge, can never become a reliable guidance to practitioners of the ars medend. The obscure interspace between the naked or concrete facts of temperature and the totality of organic life must be explored and illuminated, before the records of the thermometer are awarded their proper significance and importance in diagnosis, prognosis, and therapeutics. This exact or physical science has not done, probably never will do, possibly never can. The blocks or masses of knowledge known as anatomy, physiology, pathology, therapeutics, and organic dynamics are more or less separate, as it were, disconnected, with more or less obscurity resting on the interspaces which separate them. That they are parts of a symmetrical unity there cannot be a doubt. But, up to this time, observers and investigators show much hesita- tion in even attempting to explore the confessedly obscure regions between them. Philosophy, more flexible, and with its wider scope of vision, may be appealed to to aid in arrang- ing them in the order of their genesis, development, and mu- tual dependence. The light thus thrown into these obscure interspaces is strong enough to assure that, in linking them together, the reality can be neither widely departed from nor altogether lost. Thus, in the order of genesis, matter and force must have a pre-existence. Matter must, by force, be worked into organic forms of structure capable of evolving a function, as essential conditions of physiology. Physiology must precede pathology, both in genesis and development; and pathology precede and create the necessity for therapeu- tics. Organic forms of structure must be lost, departed from, or broken up, as necessary conditions for operative surgery. And all are needful preliminaries to, and factors of, organic dynamics. What, then, is the proper interpretation of the varied thermal states of the human body as shown by the thermometer ? The 1871.] The Clinical Thermometer. 123 efforts of empiricism to connect supposed specifically different pathological states with certain degrees of temperature have, up to this time, clearly ended in failure; precisely in the same way, and to the same extent, that the search for a perpetual motion—i.e., a machine which shall create its own power, and thus keep in motion for ever—has been a failure. The first, because there are not now, never have been, and never can be, in one human body, any specifically different diseases, so-called, or pathological states; or, for that matter, no human body ever did have any disease, as popularly and, to a large extent, pro- fessionally understood. The second, for the reason that chan- ges of matter are the inexorable conditions for the manifesta- tion or evolution of force, alike in the organized and inor- ganic realms of nature. Science, strictly, succeeds no better; for it is shy of any conclusions which cannot be physically demon- strated. Not that there are no conclusions which are true but those that can be physically demonstrated; for there are ideal truths and conclusions which are true, which, in the nature of things, are incapable of physical demonstration: as, the law of gravity. But, by coupling shy science with wider, flexible, and more comprehensive philosophy, solutions of the problem are reached which give rise to the mental conceptions cor- rectly representing the whole of the phenomena to the mind. Thus, it is a demonstration of exact science, verified by the labors of many observers, that the temperature of the human body in a physiological condition is very narrow, perhaps not to exceed one degree either way from 98° Fahr., ranging from the equator to either arctic zone. This applies to observations on the sheltered portions of the body, generally in the axilla, and in a state of repose. Certain contingencies, as violent ex- ercise, etc., temporarily elevate it ; and other contingencies, as fear and fright, temporarily depress it. But the important fact of its excessively narrow range is fully demonstrated. To what, then, is the thermal state or states due 2 Shy science, in reply, points to changes of matter as the only known source of force (heat). Philosophy, with wider vision, confirms the statement of science; and further adds, that in organic life temperature is wholly due to retrograde chemical metamorphosis, and, with almost absolute certainty, to the retrograde metamorphosis of solid tissue. 124 The Clinical Thermometer. [Oct., The narrow range of temperature of the human body in health, or physiological condition, evidences a fixed rate or velocity of changes of matter; and most likely a definite rate or velocity in both the interests of repair and waste; the for- mer fixing or storing up, and the latter evolving, force, or Organic dynamics. It is a further demonstration by empiricism as well as science, that organic instrumentalities perform their function at the expense of their substance. So much work, so much waste—waste of Solid tissue; that is, the molecular forms of structure of tissue disintegrated, and the material reduced to simpler chemical states. Physiology, therefore, includes, as factors, definite materials; definite molecular forms of structure or design, capable of performing a function, and varying for each function ; and definite velocities of repair and waste—that is, again, histogenesis and histolysis. Pathology can only con- sist of modifications of the physiological velocities of repair and waste, above or below, or changed from, the physiological standard, whose unit is motion ; or changing, changed, or lost molecular forms of structure or design; one, two, three, or all, may be included. - Therapeutic, remedial, or hygienic agencies can only act, in fact can do nothing more, nothing less, or nothing different to a human body, old or young, sick or well, alive or dead, than to promote, retard, or change the velocity of the chemical changes of matter in either or both the interests of repair or waste, whose unit is simply motion, and includes the direct or indirect breaking up or destruction of the molecular forms of structure or designs of human bodies, or any organized existences. The temperature, therefore, simply measures or indicates the velocity of the chemical changes of matter taking place in the human body in either physiological or pathological condi- tions, and can be tentatively expressed in numbers. What, then, is the lesson the thermometer teaches as a clini- cal instrument ' Though an instrument of precision, it utterly fails to identify temperature with any separate entities of dis- ease; and for the very satisfactory reason that there are none. Of what use is it, then, to me at the bedside? A solution to this enquiry has been patiently and laboriously 1871.] The Clinical Thermometer. 125 sought for by me for my own guidance, with results which it is my present purpose to submit to my fellows of the Society. I early discovered that, to be of any use to me clinically, its teachings must be expressed in numbers. Watching my own clinical cases closely, carefully noting results, and then com- paring them with the recorded results of the labor of others; and further aided and guided in my investigations by the isolated masses of knowledge known as physiology, pathology therapeutics, and organic dynamics, the following conclusions were reached. Taking the physiological standard (98°Fahr.) as a unit, the degrees above it indicate an increase in the velocity of mole- cular changes in a regular geometrical ratio up to 110° Fahr., which is the extreme limit of possible life; though personally I have never known or observed a body heated up to 108° to live for many hours after, for the reason, as it appears to me from a careful study of the factors of organic life, that at this velocity of molecular changes in organic structures, molecular forms of structure are broken up or lost. A temperature of 108° Fahr. and above is a tornado among the delicate molecu- lar forms of structure; ending with results similar to those following a tornado in the physical world, which certainly de- molishes in its progress in densely populated countries many of the forms of structure erected or caused to grow by man for purposes of utility or beauty, as buildings, fences, trees, etc. (See Table on following page.) In the table, the numbers affixed to each degree of variation above and below the natural standard, or physiological line of temperature, indicate the relative danger to the molecular forms of structure up to or down to the points at which they are lost; and may be regarded as fractional parts of a whole number merely, but in my own mind they are regarded as milestones or other monuments, marking progress to a definite end, viz., death. The important feature to bear in mind is the geometrical ratio—that with each degree of elevation the speed is doubled, and, therefore, danger to life is increased, in the same ratio, from danger to molecular forms of structure; for function is the expression, index, or language of molecular forms of structure; and life a consent of a number of functions to a common end in any individual life or body. Clinically, a 126 The Clinical Thermometer. [Oct., A TABLE Fixing tentatively the value in numbers of variations of temperature in the human body above and below the physiological line or standard ; the num- bers indicating relatively increasing and decreasing velocities of chemical changes, whose unit is simply motion, in molecular forms of structure, the points at which they are lost, and the relative danger to life between these extremes; and, in connection with the rational symptoms, furnishing an almost unerring index, or guide, to remedial management. The degrees on the clinical thermo- y meter scale may be regarded as mo- SECTION FAHRENHEIT’S THERMO- numents, or milestones, as it were, r METER. and the tentative numbers in the table opposite to them as marking the re- ** gular geometrical increase or decreage CLINICAL SCALE. of motion—chemical changes in living tissue — towards loss of molecular forms of structure, and death. MOLECULAR FORMS OF STRUC-| 110 2048 2048 TURE LOST. --" DEATH. 109 1024 1024 108 512 512 tºº FORMS OF PROBABLE DEATH, 107 256 256 106 12S 128 105 64 64 104. 32 32 103 16 j6 102 8 8 & 101 4 4 - Q 10() alº 3 PATHOLOGICAL, 99 –– 1 - 4 HUMAN BoDY, 98-in- ---------- ----------- PHYSIOLOGICAL. - 97% 1 –– pºw 2 97 _3_| | *_ PATHOLOGICAL. 96% 4 4 96 8 8 95% 16 16 95 32 32 94% 64 64 ----------- ---------------- -—— 94 . 128 | 128 ––– 93% ; 256 | 25t, LOSING MOLECULAR FORMS OF 93 § 512 512 * STRUCTURE, — 5 || -- ------------ PROBA8LE DEATH. 92% | | | 1024 1024 — ; – ------------- MOLECULAR FORMS OF STRUC- 92 # 2048 2048 TURE LOST. ---ºº-º-º-º- ; ------ - -------- – DFATH. 1871.] The Olºnºcal Thermometer. 127 temperature of 104° or above for any considerable time gives me much anxiety. And, according to my observations, the function of the kid- neys—that is, the molecular forms of structure whose function is the elimination of that portion of tissue débris in which is stored up the most force for mischief in the body when retained —fails first. The results of tissue metamorphosis, other than that escaping at the lungs, skin, and bowels, representing or storing up the largest amount of force, being retained, rapidly puts an end to all repair, and are the direct and indirect means for producing subsequent pathological phenomena, as haemorrhages, ulcerations, coma, convulsions, and ultimately death. Below the physiological standard, the ratio of danger to molecular forms of structure is double that for elevations above. To obtain that unity which can alone express truth was much more perplexing to me than fixing on the ratio above. It was however, ultimately ascertained that, by introducing half-degrees as units for depressions of temperature below the physiological line, the ratio of increase and decrease of the velocities of mole- cular work would be the same for variations both above and below it. But the number of cases in which the temperature falls below is few compared with the many whose range is above the physiological standard. With these explanations, the section of thermometer scale is submitted for your consideration. It embodies the results of a most careful study of the teachings of the thermometer, clini- cally, in my own hands, as well as from the published obser- vations of others, I have marked with pen these numbers on the thermometer I use daily, and find inexpressible satisfaction in heeding their instructions. As an instrument of precision for therapeutical indications, its teachings substitute simplicity and certainty for doubts, hesitations, tryings, and complexi- ties in the remedial management of pathological states. As organic instrumentalities perform their functions at the expense of their molecular forms of structure, so, in like man- ner, function must always be held to be the index, language, or expression of molecular forms of structure behind it. Changed or lost function has behind it either changes in the velocities of molecular work, or changing, changed, or lost molecular forms of structure. Our perception of sound or 128 The Clinical Thermometer. [Oct., light—particular motions in matter—merely depends wholly on the molecular forms of structure of the ear and eye. And precisely to the extent of variation from the physiological velo- city of chemical changes in their molecular forms of structure, or changing, changed, or lost molecular forms of structure, are these perceptions modified or lost. And no therapeutics, no remedial measures, surgical or otherwise, have ever restored molecular forms of structure once clearly lost or changed. And hence, the sole power of the physician or surgeon lies simply in promoting, retarding, or modifying motion, the unit of the chemical changes in the molecular forms of structure on which function depends. By the aid of these fundamental truths, then, a study of the numbers on the scale opposite to the degrees of temperature can hardly fail to throw light on the obscure interspaces between the naked facts of temperature, rational symptoms, and reme- dial indications in any given case in pathology. Thus: a case with temperature of 107, respirations 35 to 50 per minute, pulse 140 to 180, without bowel complaint or other active elimination, can hardly be benefited by the ex- hibition of so-called “stimulants,” as opium, alcohol, ether, etc. —agents which are understood or supposed to increase, tempor- arily, vital force or energy, even though the patient is con- sidered to be in a state of great “exhaustion.” With chemical changes taking place at such a velocity above the physiological line as indicated by the numbers opposite on the scale, and in the table the amount of tissue metamorphosis or débris is correspondingly large, and the molecular forms of structure on which life and function depend in the most imminent jeopardy, the sole scientific indications are to retard motion or chemical changes with elimination. The dose or doses of such agents, to be of any advantage, must necessarily be large, in correspondence with the velocity of motion to be retarded. Veratrum viride fulfils these indica- tions when given in doses large enough to retard motion promptly with elimination—that is, vomiting. For this pur- pose, a teaspoonful of tincture or fluid extract, repeated every half-hour till these effects are obtained, is altogether safer than smaller doses at wider intervals; for, under such cir- cumstances, time is everything. Gelseminum retards the velo- 1871.] The Clºvical Thermometer. 129 city of molecular work, but does not bring about elimination of the results of tissue decay or disintegration. To fully meet the indications, it would have to be supplemented by other agencies facilitating the downward career of effete matter and its exit from the body, as chlorate of potassa, with neutral salts from fixed acids, as the sulphates of magnesia, Soda, or potassa, made more agreeable to the taste and more efficacious in therapeutic effects by an addition of free fixed acid, corre- sponding with that of the salt used, as sulphuric and possibly other agents. With molecular waste proceeding at such velocities, and the retention of the results of tissue metamorphosis, repair is simply impossible. Therefore, food is of much less consequence than the means to check the excessive motion and bring about elimination. There need to be no fear of “depressing effects” in proper attempts to retard within safer limits such a tornado in organic life by veratrum viride. And when safer velocities are reached, with elimination duly proceeding, food is relatively of more importance than any therapeutic agents “good for typhoid fever,” or any other name for such a condition. With a physiological temperature, pain or acute suffering, if persistent, must be held as due to past changes or loss of molecular forms of structure. And if elimination of dead matter is proceeding normally, the so-called “stimulants,” as alcohol and opium, chloral, etc., are indicated, and when given are followed with much certainty by, at least, temporary relief. For ranges of temperature below the physiological standard, there is in carbonate of ammonia a genuine “stimulant,” in- creasing the velocity of molecular work and aiding in bringing it up to the physiological standard. But no therapeutic agents alone can be relied upon here, as with temperatures above the physiological standard. Free heat in very hot water, frictions to the surfaces, oxygen gas, artificial respirations, etc., become the leading agents and measures to increase the velocity of molecular work, so as to preserve molecular forms of structure. In fulfilling the indications of remedial management, or carrying them into effect, as pointed out by the thermometer, it will be seen that the mental conceptions cover the whole of the phenomena, external and obvious, as well as internal and, 130 The O/ºcal Thermometer. [Oct., therefore, less obvious; and the otherwise obscure interspaces between the means and the end to be accomplished are suffi- ciently illuminated to impart confidence and certainty to remedial proceedings. - It is much to be regretted, because so much to the disadvan- tage of medical science now, that, in common with other branches of knowledge, its facts have not been sifted from the traditions, superstitions, hypotheses, and dogmas blended with them, and placed on a solid foundation of observed and experi- mental fact, Baconian philosophy, and induction. On such a basis, its status in the scientific world, as well as among the people, would be very different from what it is to-day. Many gentlemen in the profession indulge themselves on after-dinner occasions in laudations of the “advances and improvements” of medical science. But when these vaunted “advances and improvements” are subjected to strict scientific investigation, they are all found to be administrative, and not fundamental and philosophic. Outside of naked anatomy, there is but lit- tle exact science concerning the human body and human life. Detached facts there are in prodigal profusion in reference to physiology, pathology, dynamics, and therapeutics, but they are arranged, if arranged at all, around ideals which have been transmitted from the remotest antiquity, which have no really higher claims to incorporation with a science of life than any other traditional dogmas. Take, for example, “disease,” the central idea of pathology, and a student will search in vain in the most modern systematic works for a definition. Yet the term is interwoven with professional, ecclesiastical, civil, and political literature from a period long antedating present chronology. As understood by the great bulk of the people, professional and non-professional, as a something foreign to the body which has gained access to its interior, and is, there- fore, a special entity, varying, as catalogues of symptoms, Sub- jective and objective, vary, it has no claims higher or more authoritative or scientific for its acceptance at the hands of either than tradition. Yet men occupying prominent posi- tions in the profession are found adding, the present year 1871, to the many hundred “specifically distinct entities” of disease already described and recognized in systematic works, by publishing minute descriptions of new varieties not hereto- 1871.] The Clinical Thermometer. 131 fore recognized ' If there is such a thing as “disease,” as com- monly understood, but not as defined by Webster, why do not modern technical writers about it define it other than by enumerating prominent symptoms? Yet the belief in the existence of the separate entity of “disease” is as wide as the belief in a Supreme Being or Deity among mankind. It is, indeed, a most mischievous traditional dogma, which van- ishes at the slightest touch of exact science. On the same footing and in the same category is the “Vital force, or forces,” to which the phenomena of life are supposed to be due. Like “disease” per se, it is merely traditional—a myth of a non-scientific age, pure and simple. Exact science now demonstrates that all life, vegetable and animal, exists mainly for its own preservation, perpetuation, and multiplica- tion, and, in the acts of decay and performance of function, stores up the necessary force for these purposes in one or more of the chemical compounds then formed. In the human body, this material is gathered up by the lymphatic system. The thirty or forty classes of remedial agents, having as many different modes of operation; the “causes of so-called “diseases’; as well as all the so-called poisons,” are, unfortu- nately, also merely traditionary, having little or no relation to or foundation in the facts to which they refer—at least, no scientific relation. - . Like all other organized existences, the human body, when reduced to its simplest elements, shows that it is composed of: 1st. Materials; definite alike, in number and proportion, at all geographical points. 2d. Molecular forms of structure and physical contour or design, with capacity to perform a function, and in the act of decay providing for their own reproduction from new mate- rial; thus ensuring through life personal identity, physical and spiritual. 3d. Chemical changes in material, whose unit is motion ; storing up force during ascent to design; and evolving force, as the dynamics of organic life, during retrocession to simpler chemical states. . Arranging the facts of life on these solid bases, physiological, pathological, dynamic, and therapeutic, as the facts of other sciences are connected together by Baconian science and phi- 132 The Clinical Thermometer. [Oct., losophy, all present mental conceptions connected with “dis- ease” or “diseases,” “causes of diseases,” nature, purpose, and modes and objects of remedial management, pass away; there are no places for them, as there is none in science for any mere traditions. The facts of life, gained by observation and worked out experimentally, show that there are in human bodies at all geographical points of the earth's surface a definite number of elementary materials—inorganic materials; that they exist in definite proportions; that to evolve any of the phenomena of life they must be worked up into definite molecular forms of structure or designs, capable of performing definite functions; the most important of which, beyond all doubt, is providing for their own reproduction and perpetuation from new mate- rials, as they momentarily waste in the performance of func- tion during the life of any one individual; that to bring about these results chemical changes in matter must take place, whose unit is simply motion by matter, at a fixed or definite rate or velocity, as experimentally determined by thermal observations. These things show that a human body consists of, and can only consist of, definite materials; definite molecular forms of structure or design for each function; and definite rates of motion by matter ascending into or descending to simpler chemical states, from chemical conditions in molecular forms of structure or design. Further, all experiments and observations up to this time concur in showing that matter and force cannot, by any means known to man, be either created or annihilated. Nor, on the other hand, can matter be combined in the molecular forms of structure or design, of either vegetable or animal life, except by force, or rather by modes of force, stored up for this ex- press purpose by previously existing molecular forms of struc- ture or design, in one or more of the chemical compounds formed in the acts of decay and performance of function. Experiment and observation again unite in demonstrating that, by very many apparent means, the rate or velocity of motion of living bodies can be interfered with—i.e., promoted, retarded, or changed—by innumerable physical conditions and agencies; and that that is the sole power of remedial art, med- 1871.] The Clinical Thermometer. 133 ical or surgical, chemical or mechanical; that is, to promote, retard, or change motion in chemical changes by matter ascending to, while in, or descending from the complex combi- nations in which it exists in living tissues. Yet, around false ideals of physiology, pathology, therapeu- tics, and organic dynamics, modern medical authority recog- nizes thirty or forty different classes of remedial agencies, designated by the fantastical nomenclature of tradition. The phenomena now designated as “disease” are results, not causes, of previous modifications of molecular forms of structure or design, by modes of force in chemical combina- tions of matter, solid, fluid, or gaseous, introduced from with- out, or chemically formed within, living bodies. And exact science cannot otherwise regard them than as, in the main, salutary, in that, as in fevers (so-called), they are the evidence that the removal of substance—matter—is proceeding, whose molecular form of structure, or design, has been so modified that it can no longer either provide for its own reproduction or perform a normal function as an incident of its decay; while in so-called local and chronic “ diseases” the phenomena are mainly due to more or less permanent modifications of struc- ture or designs in structure, as in the apparent “indigestions,” coughs, bowel complaints, etc., with alterations, consequently, of sensibility or pain; or complete loss of design, as in amne- sias, or aphasias of special or general sensibilities; or mechan- ical motion, as in local or general paralysis. There is, it is true, an imperfect recognition of these condi- tions in medical works during the last two centuries, in the division or classification of “diseases” into “structural” and “functional *; or in limiting the term “diseases” to “struc- tural,” and applying “disorders” to conditions supposed to depend on modifications of “function” only. But disappointment will be the end of any search for a recognition in the literature of the profession, in the present or past, that remedial agencies in the hands of the profession have not and cannot restore a lost design or reproduce lost molecu- lar forms of structure; or that their sole power, however widely their effects appear to differ, simply lies in modification of the simple unit of force—motion. But, nevertheless, the facts accumulated from observation and experiment during the 134 The Clinical Thermometer. [Oct., past twenty centuries all go to show that the sole power of remedies is over motion. For, if a form of structure capable of performing a function and providing for its own reproduc- tion could be made now, or ever had been made in the past, by means of therapeutics or remedial agencies, the physician would rise at once to equal dignity and power with the Creator, and mankind would have no use for a revelation or religion. Let the profession declare authoritatively that by any or all means or measures whatever their sole power is to influence motion—i.e., chemical changes of matter, ascending to or descending from molecular forms of structure of living beings— and medicine at once rises to the dignity of an exact science; and the profession will command the respect and confidence alike of the learned and unlettered world outside of it; which it certainly does not do now, as evidenced by the diametrically opposite “schools” and “systems” of medicine; together with the various “isms,” and “pathies,” and patent and propri- etary medicines, numbered only by legions, coming momenta- rily into existence, and running careers whose length is simply measured by the “business capacity, tact, and energy” brought to bear in putting them on “the market,” to disappear, at longest, within a few years, both from commercial markets and men’s memories. The following cases, treated since this report was read to the Society, are appended, to illustrate the practical working at the bedside of indications, drawn from the temperature mainly, for remedial management of variations from the physi- ological velocity of motion, dropping out of consideration all mental conceptions ordinarily conveyed by or connected with the term “disease.” Maggie R., aet. 3. May 23, 1871, 7 o'clock A.M.–Has been sick a good deal of her life; more unwell than usual for a couple of days; had a very bad night, could not sleep; has not vomited, nor has she had any bowel complaint; is very easily startled; is very restless, hardly lying still a minute at a time; had last year, the parents say, “lung fever,” and they think she is getting it again. Temp. 107; respirations 40; pulse very rapid, but, owing to her restlessness, could not be counted; chest in a perfect tumult. Diagnosis: Motion in chemical changes in the interest of waste, proceeding at a velocity alto- 1871.] The Clinical Thermometer. 135 gether unsafe for the preservation of her molecular forms of structure for a few hours only; with retention of tissue débris. The indications for remedial management are simply to promptly retard motion, and eliminate the retained results of tissue decay, as human beings have no greater enemies, so to speak, in nature than the results of the decay of their own structures. Prescription : Tinct. ver, viride, 10 drops every half-hour till she is made sick. Parents are notified that she is on the verge of convulsions, with more probabilities of death than recovery. 10 o’clock.-Has had five doses of veratrum; temperature dropped down to 104; pulse and breathing still very rapid; has not been sick; to have water, but no food, as repair is im- possible at the rate of motion evidenced by the temperature since morning. Continue veratrum viride. 12 o'clock.--Temp. 103; more quiet; no vomiting; pulse down to 80 ; breathing much slower. Discontinue medicine. To have nothing but water. 3 o'clock.-Became sick soon after 12, and has vomited very severely, the parents think; lies very quiet now ; no motion from bowels, and has passed no water since morning. She is to be placed on chamber and asked to pass water. Temp. 102; breathing and pulse not counted. No medicine until her stom- ach settles; then to have portions of Saline mixture (Rochelle salts, bicarb. potass., and jalap) to move her bowels. 9 P.M.–Stomach retains water and Saline mixture, but no motion from bowels; has passed water. Temp. 102. To have warm bath, Dover's powder, and continue saline mixture till bowels move. 24th, 8% A.M.–Maggie slept a good deal, and is much better. To have, as her bowels have not moved, Saline mix- ture and saline chlorate potass. as a drink until they do. To have milk to drink to-day. Bowels moved during forenoon ; very fetid; continued chlorate potass. during the day; had bath, and Dover's powder, at night; rested much better; and made a rapid and good recovery in a week; taking citrate iron and quinine mixture to promote motion in interest of repair; began to relish food third day, and has not been sick since (Aug. 30), and the parents think she is now better than ever before during her life. She had some cough for three or four 136 The Clinical Thermometer. |Oct., weeks, which I attributed to what is called “whooping-cough,” induced by a mode of force having a very slow rate of motion, but nevertheless “changing molecular forms of structure '' in its progress. Aug. 15, 9 A.M.–Geneva L., aet. 1 year, is very loose in bowels, passing bloody slime ; very restless and peevish ; hangs on her mother all the time. Temp. 101. Pulse quick, but not counted. Diagnosis: Motion in interest of repair re- tarded ; in the interest of waste accelerated, some portions of tissue not being reproduced in lower bowels, permitting blood to escape, with retention of results of tissue changes. Parents, though greatly alarmed at the appearance of blood in stools, are told she will not be sick long. To have castor-oil every twelve hours, so long as passages smell bad or show blood. 5 P.M.–Geneva better; oil has operated, and she has ceased to pass blood. As she nurses a good deal, the mother to take mixture elix. vitriol and quinine; Geneva to have paregoric to make her sleep, and castor-Oil in morning. Aug. 16.—Geneva much better. Has had castor-oil; no other medicine to be given to-day if her bowels move. 4% P.M.–Bowels have moved; no blood; do not smell so bad; better in every respect. To have elix. bark and iron. Aug. 17.—Lively as a little cricket—case dismissed. Aug. 28, 7 P.M.–Willie S , aet. 3 years. Ate a very hearty dinner to-day, and soon after threw up what he had eaten for both breakfast and dinner; has been sick at stomach all afternoon; dozing, waking up, and vomiting. Is now asleep. Temperature 99%. Pulse and breathing not counted. Diag- nosis—motion in the interest of repair retarded ; in the interest of waste accelerated, with retention of results of tissue decay. To have injection—tepid water and soap, as his bowels have not moved; and at bed-time, two teaspoonfuls heavy mag- t nesia. 29th, 8 A.M.–Vomited several times after leaving him last night. Had the magnesia, but bowels have not moved. Has had some breakfast, and is very pleasant this morning, amus- ing himself with toy-books. No medicine, unless bowels fail to move by noon; in which event, to have more magnesia. 5% p.m.—Bowels have moved freely; Willie is at the table taking supper—case dismissed. 1871.] The Clinical Thermometer. 137 The purposes of this paper may be summed up in the fol- lowing conclusions: 1st. That the clinical thermometer, in connection with pre- vious history and present rational symptoms, in any given case whatever, inasmuch as it reveals the actual condition of motion —that is, chemical changes in the material of molecular forms of structure, or design, or material, ascending to or descending from forms of structure—the only thing pertaining to a human body, well or sick, alive or dead, which any remedial measure or agent whatever can influence—is, in the hands of the actual working practitioner, who can for the time being forget all mental conceptions connected with “disease,” as popularly and professionally understood, an instrument of as much precision and certainty as any employed by civil engineers or mechanics in our own times. - 2d. That the clinical thermometer, considered singly, holds the first and highest place among all the means at the command of the actual working practitioner for making positive diag- nosis based on the actual condition of molecular work, or motion, in the living body, in pathological states with ranges of temperature above or below the physiological standard. 3d. In like manner, the clinical thermometer, considered singly, holds the highest place among all the means at the command of the actual working practitioner for making cor- rect prognosis in pathological states with ranges of tempera- ture above or below the physiological standard 4th. That the clinical thermometer, considered singly again among the means at the command of the actual working prac- titioner, holds the highest place for unerring therapeutical guidance in all pathological states with ranges of temperature above or below the physiological standard. 5th. That the numbers in the table or on the thermometer Scale opposite to those marking degrees of temperature, repre- sent, tentatively, the value of variations of temperature in pathological states ranging above or below the physiological standard, reference being had to the points at which molecular forms of structure are losing, or lost—and consequently, death. VOL. I.-11 138 Motes on the Treatment of Gunshot Wounds. [Oct., ART. II.—NOTES ON THE TREATMENT OF GUN- SHOT WOUNDS, AS PRACTISED IN BERLIN. BY FRANK H. RANKIN, M.D., N. Y., Late Surgeon in the Prussian Army. IN the military barracks, lately located on Tempel Hofer- feld, near Berlin, and used during the late German war, the following were some of the principal remedial agents used in the treatment of simple and suppurating gunshot wounds. As a disinfectant, and at the same time as a means for cleaning wounds and washing out burrowing abscesses, a weak solution of permanganate of potash was almost invariably used. The strength of the solution kept in the barracks was 1 part of permanganate of potash to 60 parts of aqua ; and of this solution a sufficient quantity (about 3 iij. or 3 iv.) was used in a couple of quarts of lukewarm water, to give the water a light claret color. Wounds which dis- charged much pus were cleansed with this solution two or three times a day, by means of an “irrigator,” to the free end of the india-rubber tube, running from the bottom of which was attached a flexible india-rubber nozzle, about three inches long, which could be inserted into the burrowing abscesses, and into the suppurating track of the ball, and thus all parts of the wound were thoroughly cleaned, the force of the stream of water being easily regulated, by elevating or depressing the “irrigator,” which is held by an attendant; each patient being provided with a separate nozzle, thus avoiding the in- oculating of healthy wounds with the foul, unhealthy pus from unhealthy Ones. If the strength of the potash solution is too strong, it will frequently act as a cautery, and destroy the new granulations which may have formed. By a few of the sur- geons a weak solution of carbolic water was used instead of the potash solution. I may also mention here that it was the custom of most of the surgeons to require their attendants and assistants, who may have assisted in dressing unhealthy wounds, to wash their hands, as well as all instruments used, in a weak solution of this potash, before going from one patient to another. On wounds in general, stumps after amputation, etc., carbolic oil or carbolic water on charpie was in general use ; the 1871.] Lethargus. 139 strength of the oil or water being from 2 to 4 of carbolic acid to 100 of water. - On wounds of diphtheritic or suspected gangrenous character, a strong solution of camphor wine was used, with marked success in “cleaning up the wound.” When the discharge was of an offensive character and the pus of an unhealthy color, a solution of chlorate of lime (1 to 25) was used. Gangrenous wounds were cauterized with chloride of zinc. The wound, after being thoroughly cleaned, the undermined edges freely slit up, is completely filled with pledgets of cotton, soaked in a saturated solution of chloride of zinc ; the patient being first put under the influence of chloroform, and the zinc solution kept on the wound fifteen minutes by the watch, then taken off, and charpie soaked in olive-oil laid over the wound. In two or three days a suppurating mass would come off, leaving a beautifully clean surface. After-treatment consisted of camphor wine or carbolic oil. It was extremely rare that it was found necessary to apply the chloride of zinc twice on the same wound. Up to the 1st of March there had been 72 cases of gangrene under treatment, of which only two died of the gangrene. The tourniquet was used in no case at the barracks by Esmarch, König, Fisher, or Williams, who were the consulting surgeons; digital compression being invariably used when necessary to compress an artery during operation. Torsion was occasionally used for stopping bleeding from small arteries in plastic operations, but, I believe, never for arteries of any size, the ligature being used for large arteries. ART. III. LETHARGUS. BY TH O M A S H. B A I L E Y, M.D., Surgeon Wautical School-Ship “Mercury.” THIS singular and invariably fatal malady, peculiar to the negroes of certain districts on the western coast of Africa, has never, I believe, been noticed in the medical journals of this country, which is not surprising when we consider that a knowledge of it is practically unimportant to the profession 140 Lethargus. [Oct., outside of the districts where it occurs. As a curiosity, how- ever, in the form of a disease, it cannot fail, I think, to interest the medical faculty of our country. I therefore lay before you, in brief, facts gathered concerning this disorder during my stay on the western coast of Africa. (Through the kindness of Dr. Robert Smith, colonial surgeon at Freetown, Sierra Leone, I was enabled to see in the hos- pitals under his charge a number of cases of lethargus. As the name implies, the principal—and, in fact, only— symptom that presents itself is lethargy; and one case is essentially a stereotype of all. The patient, usually a male adult, is seized without any pre- monitory symptoms with a sensation of drowsiness, which conti- nues rapidly to increase in spite of all efforts to throw it off, until he sinks into a profound and seemingly natural sleep. This continues for about twenty-one days, when death takes place. Throughout the course of the disease the patient preserves a quiet and peaceful countenance, may be easily aroused for a short time, will take nourishment, and generally answer a few questions in a perfectly rational manner. The pulse, respiration, and temperature remain normal throughout, the pupil is neither dilated nor contracted to any noticeable extent, and the urine and faeces are voided with comparative regularity. With the exception of the abnormal tendency to sleep, nothing exists to denote disease. Many careful post-mortem examinations have been made by competent men, but nothing of an abnormal character has been found. Dr. Smith informed me that every remedy that could possibly be of any avail had been used without any appa- rent beneficial effect. They sleep on, and quietly glide into eternity in spite of professional skill. 1871. Bromide of Sodium. 141 ART. IV.—BROMIDE OF SODIUM. BY MEREDITH CLYMER, M.D. WHATEVER may be the real therapeutic value of the bromide of potassium in the treatment of epilepsy and other disorders of the nervous system, it has come to be generally acknowledged that its prolonged use is often attended with serious incon- veniences, and even dangers, as dulness of the mental facul- ties, loss of memory, great muscular feebleness of the lower extremities, etc. I have heard many epileptics declare that they would rather suffer from their fits than from the condition brought on by the doses of bromide of potassium necessary to Suspend their attacks, or lessen the number of them. It is, therefore, a matter of some moment to those who treat nervous disorders to find a remedy of that efficacy so largely claimed for the bromide of potassium in some affections. There is reason to believe that in the bromide of sodium a happy substitute has been found that will fully meet every indication for which the bromide of potassium has been given, while it is much better tolerated by the system, and free from the objections which are justly urged against the latter. For some time past, I have habitually used the bromide of sodium in all disorders of the nervous system where before I prescribed the bromide of potassium, and, so far as my own experience goes, speak positively to this point. I have given it in a num- ber of cases of epilepsy continuously for months without any of the unpleasant symptoms which so constantly follow the prolonged administration of the potassium salt, excepting the eruption, and with the best results in mitigating or suspending the paroxysms. Dr. Decaisne has given the bromide of sodium for a year without its producing the systemic Saturation so frequent during the long and continu- ous exhibition of the bromide of potassium. According to Nimias, of Venice, this latter salt accumulates in the various organs, the brain, spinal cord, lungs, liver, etc., and is neither readily eliminated nor assimilated (see THE MEDICAL WORLD, July, 1871, p. 31). Soda is the alkali found throughout the body, and in all the secretions, and would naturally be more readily absorbed and appropriated than the potassic salt. 142 Bromide of Sodium. [Oct., Another point in favor of the use of the sodic rather than the potassic salt, and which, so far as I know, has not yet been mentioned, is the fact of the depressing influence of the salts of potash on the heart when they are largely or long given. No such effects are alleged to follow the continuous use of the salts of soda. The taste of the bromide of sodium is much less unpleasant than that of the bromide of potassium, being very like common salt, and it may be used to replace the latter, mixed with the food, as with bread and butter, eggs, in milk, etc. Hence it is of more easy administration than the bromide of potassium, to the taste of which some persons have invinci- ble repugnance, and increasing with its use. It is of the first importance that bromide of sodium should be perfectly free of all impurities, particularly of iodine. Larg— er doses of the hydrated salt are required than of the anhy- drous, for it crystallizes with four equivalents of water. Ac- cording to Dr. Morin (Comptes Rendus of the Académie des Sciences, January and April, 1870), anhydrous bromide of sodium contains 11 per cent. more bromide than bromide of potassium. Dr. M. and Balard, the discoverer of this salt (1826), give the following table of the approximative amount of bromine in the corresponding quantities of bromide of so- dium and bromide of potassium : BROMINE. Bronſide of SoDIUM. BROMIDE OF Pe'PASSIUM. Grammes. Grammes. Grammes. 3-33 4:33 5:00 6'66 8.66 10:00 10:00 13:00 15:00 13:33 17-33 20:00 16-66 21'66 25.00 20:00 26.00 30.00 The doses of bromide of sodium are about the same as those of bromide of potassium. In epilepsy, I usually give 20 grains three times daily, and have rarely gone above that amount. It sometimes seems to cause or encourage constipation. No. 4 EAST TwP:NTY-NINTH STREET, NEw York, September 19, 1871. 1871.] The Prevention of Abscesses. 143 ART. W.—THE PREVENTION OF ABSOESSES IN HYPODERMIC MEDICATION. WITH A DESCRIPTION OF AN INSTRUMENT FOR THE INJEC- TION OF STRY CHNIA. BY REUBEN A. VANCE, M.D., Physician-in-Chief to the New York Institute for the Paralyzed and Epileptic, etc., etc. EIGHTEEN months ago, in an article published in the Journal of Psychological Medicine, I wrote as follows: “A grave objection to hypodermic medication, and one that is of great weight with many practitioners, is the danger of abscesses forming at the point where the solution is thrown into the cellular tissue. I have seen this accident follow the use of morphia, and have known its occurrence after hypo- derinic injections of chloral; yet, although my experience with strychnia employed in this manner has been quite extensive, I have never seen anything of the kind result from its use. I am of the opinion that a concentrated solution, of which it is necessary to use but a small quantity, is less liable to cause this accident than one requiring the introduction of a larger amount of liquid.” ” Since publishing the above, my experience in hypodermic medication has been much more extensive than ever before, yet I have no reason to dissent from the opinions I then ex- pressed. It is true that other elements than the mere degree of concentration of the solution containing the remedy are to be considered, but what I then thought was established on that point subsequent experience has confirmed in every respect. It is to be borne in mind that the hypodermic method requires the subcutaneous injection of a varying amount of fluid, commonly of an irritating nature, and generally of an acid reaction. Under such circumstances, it is not at all sur- prising that abscesses should occasionally result from its employment, despite the utmost care and attention on the part of the physician. Yet, as a matter of observation, it will be noticed that one practitioner will adopt this method of treat- ment and never meet with an accident of this nature, while a * VANCE: “The Treatment of Paralysis by means of Hypodermic Injec- tions of Strychnia,” Journal of Psychological Medicine, April, 1870. 144 The Prevention of Abscesses in [Oct., less fortunate neighbor will have his practice attended by the most unfortunate and disastrous results. There is something more than mere chance in these widely different results, and I believe that a careful examination of the course pursued by each will, to a certain extent, furnish a satisfactory explanation of the failure in the one case, and the success in the other. There are four circumstances which are of the utmost importance for the safe and successful employment of hypo- dermic medication. They are as follows: 1st. The quantity of fluid injected, 2d. The degree of acidity of the solution, 3d. The kind of needle employed; and, 4th. The size of the syringe, and the method of manipu- lation. Prominent among the circumstances which concur to bring about unfavorable results must be mentioned a solution that is too dilute. The injurious effects which result from this cause are chiefly due to the mechanical distension of a large quantity of liquid. This, by rupturing the smaller blood-vessels, per- mits subcutaneous extravasations of blood, and, by separating a large surface of cellular tissue, and exposing it to the action of a foreign fluid, furnishes conditions admirably adapted to induce inflammatory action. Another circumstance—one more potent for evil than the former—is a solution too strongly acid. In the article before cited, I recommended a solution of strychnia, made with dilute phosphoric acid, as being much better than one made with Sul- phuric acid. It is certainly true that a smaller quantity of the former is as effectual as a larger amount of the latter, yet I have latterly discarded all solutions in which a mineral acid is used as a solvent, and now employ one made with acetic acid. This, being an organic acid, does not seem so irritating to the tissues in which it is thrown, while its solvent power is cer- tainly as great as that of either of the others. A solution can be made with acetic acid which will be as strong and last as well as either of the others, and which will yet be much less strongly acid in its reaction. From this it will be seen that, other things being equal, acetic acid is the best solvent that can be employed. The kind of needle used is also of great importance. 1871.] Hypodermie Medication. 145 Judging from analogy, we should be inclined to think that the nature of the materials entering into the composition of the needle would be of interest when the subject of the causation of abscesses is under consideration. The liability of all steel instruments to become tainted and poisoned from long usage is a fact well known to surgeons and instrument-makers, and it is a matter of some surprise that attention should not have been sooner drawn to this same liability on the part of the needles to be found in the hypodermic syringes in ordinary use. That, in certain instances, needles used by the writer have become poisoned he is thoroughly convinced, and that certain abscesses which he has seen result from the employ- ment of these same needles were due to their poisoned state he is equally certain. No amount of attention on the part of the physician will enable him to keep a steel needle bright, clean, and in good condition when the solution he uses has an acid reaction. The inside will be corroded in all cases, and sooner or later the outside will get into the same state. For constant employment (especially where strychnia is administered) a steel needle, unless changed once a week, is decidedly unsafe. The material possessing the greatest advantages of which it is possible to make a needle is gold. This metal, as is well known, is admirably adapted to withstand the influence of both strong and weak acids, and never corrodes. It is, therefore, entirely free from the danger of becoming poisoned, and thereby producing abscesses. Of fully as much importance as any of the points mentioned is the size of the syringe and the method of manipulation in performing the operation of injecting the solution. The syringe should be so small that, when charged with the liquid to be injected, and armed with the needle, the end of the piston can rest against the hypothenar eminence of the right hand, while the extremity of the needle should project about half an inch from between the ends of the first and second fingers, in which position it can be retained by a moderate pressure with the thumb. The accompanying illustrations will show the proper size for this instrument. The syringe, properly prepared, being held in this position, the operator, with the thumb and forefinger of his left hand, pinches up a fold of skin over the pronator muscles of the 146 The Prevention of Abscesses in [Oct., forearm of either side of the patient, places the point of the needle against the loose end of the skin so elevated at a dis- tance of half an inch or so from the fingers holding it, and then, with a quick shove, forces the needle through the integu- ment, and by partially closing his hand drives the piston home, evacuates the contents of the syringe into the subcutaneous cellular tissue, and at once withdraws the needle. By this method of manipulating the syringe, the operation can be per- formed in less than five seconds, and is almost absolutely pain- less. I have in this manner occasionally injected Strychnia into the arm of a child of Mr. Hendricks, of Westchester County, without arousing the child from its sleep. The popular aversion =º-º-º-º-º: =====E======E=S # s Tºº-- ~<= #. # F - *= C ºf łł |. * > * marily practised, the operation is certainly not pleasant, this is and especially so of strychnia. It is impossible to hold them that is always attended with more or less movement of the *********- * - #||\\\\}=ſ Zºº * º to hypodermic medication arises in great degree from the general belief that the operation of injecting the solution is a very painful measure. When it is remembered that, as ordi- not so very strange. The hypodermic syringes in general use are bulky, hard to manage, imperfectly constructed, and entirely unfitted for the employment of strong solutions of any remedy, in the manner above described ; and, when not so held, it is necessary to retain the cylinder in one hand after the needle is inserted, while the other manipulates the piston—a measure point of the needle, and consequently with a greater or less disturbance of the cellular tissue—a very efficient means of producing abscesses. 1871. Hypodermic Medication. 147 During the past four years I have been using a single syringe —one manufactured by Luer, of Paris—which, notwithstanding some minor inconveniences, was, until lately, the best instru- ment I ever saw. Some time since, at my request, Mr. Stohl- mann (of Geo. Tiemann & Co.), the well-known instrument- maker, after several fruitless endeavors, finally produced an instrument which I must say I consider faultless. Its actual size is denoted by the accompanying illustrations. The cylin- der is so constructed as to contain twenty minims; the handle of the piston is so graduated that as small a quantity as one- eighth of a minim can be injected at a single sitting. This is accomplished by a guard which can be fixed at any distance from the extremity of the piston-rod ; and, as the graduation enables us to divide a minim into eight parts, this apparently infinitesimal amount can be thrown into the cellular tissue with absolute accuracy. The case enclosing the syringe like- wise contains two gold (14 carats) needles, a small bottle with a glass stopper (retained by a metallic shield), and a small wire. The latter is for the purpose of keeping the needles clean, while the bottle is designed to contain the solution of strychnia. The case containing these articles (as can be seen by the wood- cut showing its actual size) is so small that it can be carried in the vest-pocket of the physician. - The solution of strychnia which my experience has taught me to consider best is one containing a grain of the drug to one drachm of water, the solution being effected by the addition of a small quantity of dilute acetic acid. The following is the formula which I have furnished Mr. Mittendorf, the pharma- ceutist (Twenty-first Street and Fourth Avenue), who for the past few years has supplied me with the solution that I have employed in my private practice : 2 B. Strychniae sulph., grs. j. Acid. acet. dil., TIl j. Aquae ad 3.j. M. S. Ft. Sol. This formula will be found especially convenient by those who supply themselves with the above case. The quantity called for by the above prescription will just fill the bottle which it contains, while the strength of the solution is well 148 The Prevention of Abscesses. [Oct., adapted to the subdivisions of the syringe. Thus, one minim of the liquid contains one-sixtieth of a grain—the usual dose with which it is customary to commence the treatment of any case of paralysis. Should it seem desirable to begin with a Smaller quantity (and this is frequently the case), as minute a dose as the four-hundred-and-eightieth part of a grain—equiva- lent to one-eighth of a minim—can be employed. This is ac- complished by the means we have already alluded to in describ- ing the syringe. . We have known some confusion caused by inattention to one little precaution on the part of the operator, which should always be attended to before injecting any substance whatever —that is, to be careful that there is no air in the barrel of the Syringe at the time the puncture is made. Should there be, the physician is compelled either to withdraw the needle and expel it—which is looked upon as an awkward procedure by the patient—or to go ahead and inject it into the cellular tissue—an act which is not entirely free from danger. The necessity for either procedure can be obviated by a little care on the part of the physician. Prior to puncturing the skin, let the physician reverse the syringe (with the needle in place), and while the needle is di- rected upwards, press gently upon the piston until all the bubbles of air have passed out of the needle, and a steady, clear stream emerges from its point. Then, reversing the in- strument again, the absence of bubbles at the transparent por- tion of the cylinder will show that all the air has been expelled. The guard can then be brought to the proper position, the needle inserted, and the injection made without the remotest possibility of anything but the specified amount of liquid pass- ing beneath the skin. After the needle is brought out, the guard should be screwed back, and the remaining liquid in the cylinder forced through the needle for the purpose of cleaning it. 1871.] A Wew Ovariotomy Clamp. 149 setected articles A NEW OVARIOTOMY CLAMP. ALSO APPLICABLE FOR OTHER SURGICAL PURPOSES. BY B. F. DAWSON, M.D., NEW YORK. Attending Physician to the Wew York State Women's Hospital, Outdoor Department; to the New York Free Dispensary for Sick Children : Assistant to the Clinque for Chil- dren at College of Physicians and Surgeons, Wew York. THE operation of ovariotomy is rapidly attracting increased attention, and, while but a short time since it was performed by a few surgeons, we now hear of its being undertaken by many young and inexperienced physicians with the boldness of old ovariotomists. Notwithstanding, however, the frequency with which the operation is performed, and the consequent progress made in the procedure itself and the after-treatment of the patient, yet it cannot be denied by any one who studies the subject but that much, very much, remains yet to be learnt, before it can be classed amongst the perfected operations of surgery. Even yet, some of the eminent ovariotomists of Europe and this country are at variance as to many of the most important points in the operation ; for instance, as to the treatment of the pedicle, whether it is best to ligate and return it or not into the peritoneal cavity; to clamp it, and keep it external to the abdominal wound; or to dispense with both ligature and clamp, by substituting the écraseur, the actual cautery, or laceration. The proper treatment of the abdominal incision is also a mooted question, the majority advising immediate and perfect closure, while a few, and not the least distinguished, advocate the practice of leaving a small opening, to allow the exit of septic gases and material, and the advised washing out of the peritoneal cavity.” Although there exists such difference of opinion in regard to the treatment of the pedicle, yet the majority of the dis- tinguished ovariotomists are becoming more in favor of clamp- ing the pedicle than of ligating it, and some have given the * See Prof. E. R. Peaslee's paper on “Injections into the Peritoneal Cavity after Ovariotomy,” in The Am. Jour. of Obstetrics, etc.,Vol. III., No. 2, p. 300. 150 A Wew Ovariotomy Clamp. [Oct., most conclusive proofs of the former in the statistical results of their cases (Spencer Wells, Thomas, Atlee, etc.), by far a greater number so treated recovering than where the various forms of sutures are used, and the pedicle returned into the abdomen. The advocates of the latter method, as well as those in favor of the clamp, have been active in endeavors to perfect each detail of the individual methods, and have given us as results varieties in ligatures as regards material and application, and clamps of different principles and special peculiarities. As it is not my purpose in this paper, however, to discuss the various methods of treating the pedicle, but only the ap- plication of the clamp, and especially one possessing new prin- ciples, I will pass immediately to the subject. The object of all clamps is to so compress and retain the ovarian pedicle as to perfectly control all haemorrhage, either temporarily until the ligature is passed, or permanently, with- out the latter, as the operator may desire. - With one exception (Atlee's clamp), the principle of action of all clamps is the same—compression of the pedicle between two parallel arms of steel, which are brought in co-aptation by two screws, or a hinge and screw combined. Such instruments compress the tissues in but two directions, and thus allow them to spread more or less between the bite of the clamp, and this very spreading of the pedicle is somewhat essential for the proper closing of the clamp. Now, two great objections seem to me to be attached to this spreading of the pedicle: 1st, it must somewhat prevent (per- haps only in a slight degree) perfect ligation of the pedicle by any of the various ligatures, for, after ligation, that portion be- tween the ligature and clamp is spread out in a fanlike man- ner, and therefore offers unequal resistance to ligation; and, 2d, if the clamp only is used, the pedicle expands transversely to the wound, and thus prevents sufficient approximation at the point where it is situated. The above conclusions have been arrived at after having been present and assisted at Some sixteen operations for ovariotomy, performed respectively by Drs. T. Addis Emmet, T. G. Thomas, E. R. Peaslee, Joseph Kammerer, John Byrne, and Stephen Merritt. 1871.] A Wew Ovariotomy Clamp. 151 To overcome one of these objections, Dr. Washington L. Atlee, of Philadelphia, has recently invented a clamp “to limit, within certain points, the expansion or spreading of the pediele when the blades of the clamp are screwed to- gether.” By his clamp the ped- icle is compressed in four directions, and thus made to occupy a very Small space in the ab- dominal wound. This one has certainly great advantages over other instruments, but, as its mechanism is somewhat complicated, there is yet Q an opening for further § * improvements. § # * I will therefore call š º ż e - § {º attention to a clamp § {} º of entirely new action * \# * tº } % which I have recently * } had made, and the me- #3% chanism of which is ex- alſº ceedingly simple. gº The principal fea- º “º tures of this clamp are: 4. % 2% 1st. It compresses the e o :-(? % pedicle in a uniform º manner and into as 4. stmall a compass as may b. be needed; 2d. The compressing force is exerted by a single screw ; 3d. Its application around a pedicle is quick and exceedingly simple; 4th. With it a ligature can be passed directly around the compressed portion of the ped. icle, and be made more secure than with other instruments; 5th. Ecrasement could be performed if it were desirable. In the accompanying woodcut, the clamp is seen locked, and * Am. Journal Med. Sciences, April, 1871, p. 370. 152 A Wew Ovariotomy Clamp. [Oct., in the act of compressing a pedicle, if we imagine the wheel (b) to be turning. By the turning of this wheel the slide (c) is slowly pushed up towards the joint (e), and thus the tissues are constricted to any requisite degree in an elliptical manner. In applying the clamp, the arm (d) is to be opened by un- screwing the nut (f), and then passed around the pedicle and closed again, and made fast as before, the slide (6), having pre- viously been screwed back towards the handle. If it should be determined to ligate the pedicle, the clamp is to be armed, beforehand, with the ligature, by passing it be- tween the lower blades of the slide and the arms of the instru- ment, which is then applied; by this means the ligature is enabled to engage the pedicle as tightly as may be desired, and without any strain being brought upon it until the clamp is removed. If the clamp is to be used instead of the ligature, after suffi- cient compression of the pedicle, the handle (a) and the wheel (b) are to be removed by unscrewing them, which renders the clamps much lighter and perfectly flat, so that no inconvenience is caused by its resting on the abdomen. The dotted outlines (g) in the cut show the arm of the clamp opened ready for application, and needs no particular explana- tion. Besides the purpose for which this clamp was originally de- signed, it may advantageously be used in the removal of haemorrhoids, portions of the tongue, penis, scrotum, and ex- traneous growths. The entire instrument is so light, compact, and small that its case may be carried in the vest-pocket without inconveni- ence. It is manufactured by G. Tiemann & Co., 67 Chatham Street, New York.--American Journal of Obstetries. 1871.] Jeeviews. 153 it tº it dºg, &m-tºmsºmºmºr A MEDICO-LEGAL TREATISE ON MALPRACTICE AND MEDICAL EVIDENCE, comprising the Elements of Medical Jurisprudence. By John J. El- well, M.D., Member of the Cleveland Bar. Third edition, revised and enlarged. New York: Baker, Voorhis & Co. 1871. That Dr. Elwell should be compelled to enlarge and revise his second edition, is due more to the fact that great interest is felt in this subject by both lawyers and doctors, than that his treatise on “Malpractice and Medical Evidence ’’ is a work sought after for its merits. To those who are acquainted with Dr. Elwell's reputation for ability and research, this statement may appear singular, but those who have studied his work will bear witness to its correctness. Diffuse, uninteresting, and uncertain, this treatise will serve to cast an additional mist about a subject that is now an approbrium to both law and medicine. A work that will com- bine the science of the one profession with the judgment of the other is still a desideratum, and nothing is gained from compilations which blend in one heterogeneous mass the unjust and unscientific quibbles and technicalities of average judges and average medical witnesses. OBSTETRIC OPERATIONS, including the Treatment of Haemorrhage. By Robert Barnes, M.D., London, F. R. C. P., Obstetric Physician to and Lecturer on Midwifery and Diseases of Women and Children at St. Thomas's Hospital, etc., etc. With additions by Benj. F. Dawson, M.D., late Lecturer on Uterine Pathology in the Medical Department of the University of New York. Second American Edition. New York: D. Appleton & Co. 1871. Pp. 503. 87 illustrations. There is no work treating of this subject, with which we are acquaint- ed, that will at all compare with Dr. Barnes's “Obstetric Operations.” The additions by Dr. Dawson very materially increase the value of the work for the American practitioner, and, as he has had the good judg- ment to insert the views of one of the most successful and popular teachers of obstetrics in this country, we doubt not that this volume will become what it should be—the standard text-book of Obstetric Opera- tions. - One point that will strike the reader, is the accuracy and good taste of the illustrations—the latter quality being something rare in obstetrical publications. The publishers have done their part well, and in general appearance this book will compare favorably with the elegant editions with which English publishers have lately favored the profession. VOL. I.-12 154 Miscellaneous. [Oct., § ig telliºn to tig. **** CoNTAGION OF SCARLATINA AND SMALL-Pox.—Dr. T. T. Pyle (British Medical Journal) contributes the following: “At the present moment, when the public mind is agitated by doubts as to the necessity for vaccination on the one side, and by the fear of catching small-pox on the other, it may not be amiss to bring forward a few simple facts illustrative of the manner in which contagious diseases are spread abroad, and indicative of the means by which they may be prevented by timely care and attention. I maintain that it is by the neglect of a few very simple rules that our population is decimated by these infectious diseases; and we shall never check their progress until medical attendants and the heads of families are careful in carrying out a system of isolation on the appearance of fever in their villages or in their houses, and also in carefully tracing the virus-bearer so as to catch and imprison him until he is thoroughly disinfected and has ceased to be a pest to society. For these reasons, I call attention to this important subject, and venture to relate the following cases which have come under my observation in my own family and practice. “I shall begin by a case of scarlet fever that took place in my own house in the latter part of 1870. My eldest child, Ethel, aged eight years, went to play with her little cousins for two days consecutively, and, on the evening of the second day, she awoke from her sleep with violent vomiting, and complained of pain in her throat. Two days after this, the eruption of scarlatina appeared. She had a rather severe attack; but, I am thankful to say, passed through the disease without any very formidable symptoms. It appeared that the housemaid at her cousins' house, about a week or so before, had suffered from sore-throat and excessive vomiting and prostration : she had been confined to bed for a couple of days, but was afterwards able to go about the house and perform her duties, though extremely weak. I made every enquiry where the child could have caught the infection. I had myself not attended any case of scarlatina for several months before that period. The laundress had not washed any clothes except for our family and the family of a patient of my own, whose children were quite healthy; and the only conclusion that could be arrived at was that this housemaid had had a slight attack of scarlatina, and gave it to my little girl, who, perhaps, was rather in a condition to receive it, having just been con- valescent from an attack of bronchitis. “The second case I can trace very clearly. Miss M., a governess from a school in Sheffield, came to Sunderland for the Christmas holidays, and consulted me for a chest affection. On her next visit to me, about ten days afterwards, she was very depressed, and gave the following reason. Before leaving the school at Sheffield, a favorite pupil took Scarlet fever; she nursed the child throughout its illness till its death. A few days after her return home, she wore the same dress that she had while she attended on her pupil. One of her little brothers took scarlet fever, and died within a few days. Three or four of the other children in the house also took the disease, but she herself never had the least symptom of it. “The third case occurred at a colliery village some few miles from this town, and one over which I have the medical supervision. The resident medical gentleman informed me that there had not been a case of scarlatina in the place for more than a year before. The village con- tains somewhere between three and four thousand inhabitants. When 1871.] Miscellaneous. 155 I was first called to see the child, the rash of scarlet fever was well developed, and the parents could give me no idea how the disease could have been caught. The drainage was excellent, the children were well fed, and the air good, being on the sea-coast. This child ran through the course of the disease in a mild form, and recovered. By very careful inquiry I discovered that a relative of the parents had sat up all night in Sunderland a few days before this period, nursing a neighbor's child that had been ill and delirious, but, as they stated, merely with a very bad Sore-throat. Before leaving this case, I ought to state that I took every precaution to prevent the spreading of the disease in the village. In spite of my efforts, some of the friends visited the house, and the fever appeared in two other houses in the place, in one of which three cases of Scarlatina occurred, and in the other house one case. By impressing on these people the great importance of preventing any communication whatever with their friends, I was gratified to find that my instructions were fully carried out; and no other cases broke out except in the house where the first case was discovered. A brother of the child first affected was not at home when the fever appeared, and I ordered that he should be kept away for some time. After seven weeks, and when the child affected had become convalescent, the other child was brought home. I could not clearly ascertain if it had worn any of the clothing of the affected child; but, a few days after its return, it had a mild but distinctive attack of scarlet fever. I am happy to state that since that time, now several weeks ago, no fresh case of scarlatina has occurred in the village. “The following case will illustrate the direct contagion of small-pox, which is now occupying so much attention. It occurred at the same colliery village, and was brought from Hartlepool (a town distant about twenty miles) by a man in the desquamative stage, or, as they expressed it, ‘red raw,’ after the disease. He was invited to the house for change of air, and stayed about a week. Two days after he left, one of the children who had never been vaccinated, and whom the man had fondled a great deal and frequently had to play with him, took the confluent form of small-pox. The other children in the house had also not been vaccinated, but the resident surgeon and public vaccinator for the dis- trict at once had them vaccinated. They did not take the disease; and, by a proper surveillance of the house, and preventing any communication with it, no other cases have yet appeared.” THE ANTiSEPTIC TREATMENT or Wounds.--Dr. E. W. Drummond contributed the following article to the British Medical Journal, July 1, 1871: “Among four cases in the practice of the Liverpool Royal Infirmary (illustrative of the treatment of wounds on the principles laid down by Mr. Lister), published in the Journal of May 6, is one of strangulated hernia, in which the wound healed in three days. Having recently treated an almost identical case, with the result of perfect union by first intention, I think it not unworthy of mention. “K. S., aged 30, a member of a family hereditarily disposed to hernia, has been the subject of the oblique inguinal form for six years. I was summoned at six o'clock on the morning of May 3, 1871, the hernia having become suddenly strangulated. Having failed with the taxis, I performed herniotomy, the patient having been chloroformed by my friend Mr. Bromley. I opened the sac, and returned a knuckle of intes- tine and a large portion of omentum. At six P.M., I closed the wound with three silver wire sutures and strips of emplastrum saponis, placed a pledget of wet lint over the wound, and applied the usual bandage. 156 Mºscellaneous. [Oct., Next day, she had passed a good night, and was doing well. The fol- lowing might, the patient was attacked with abdominal tenderness and purging. I saw her at six A.M. on the 5th, and ordered two grains of opium immediately, followed by grain doses every hour. At nine A.M., the pain was almost gone, and the purging was arrested. At seven P.M. (forty- nine hours after operation), I removed the dressings, and found perfect union by first intention. The patient got up on the fifth day. “This case shows that at least equally good results may be obtained without as with antiseptic precautions. I found the carbolic acid dress- ing in use in the York County Hospital in the summer of 1865, but was unable to see that it possessed any special virtue. Ever since the publi- cation of Mr. Lister's views, I have carefully carried out the more ela- borate treatment which he suggests in almost every case under my care, including amputations, resections, excisions of tumors, etc.; and the balance of evidence in my mind has been generally in its favor. For example, I removed recently a large fatty tumor by two semi-elliptical incisions eleven and a half inches in length. The wound, closed by fourteen silver wire sutures, and treated antiseptically, healed through- out in four days, without a drop of serum or pus. I am unwilling, there- fore, to place myself among the number of those who disbelieve totally in the antiseptic treatment; but I cannot help thinking that the time has arrived when we may look for some authoritative settlement of the guestion. In medicine, and in a lesser degree in surgery, the tendency has ever been to exaggerate the benefits of new methods. We are all prone jurare in verba magistri—ever, let us hope, laudably anxious to be the pioneers of a new era in our art Can we not, by treating parallel cases with and without carbolic acid dressing, definitively decide whether, on the one hand, the antiseptic method is all its enthusiastic advocates believe it to be, or, on the other, save ourselves from the opprobrium of unduly vaunting a means of treatment which will not stand the test of experience?” PHANTOM TUMoR.—Dr. J. S. Dorsey Cullen, of Richmond, Va., con- tributes to the Virginia Clinical Record the following interesting case: “The patient had, for four or five years, suffered greatly from disten- sion of abdomen, pain in the ovarian region, great nervous disturbance, constipation, and retention of urine. “Before entering the hospital in 1868, her symptoms simulated ova- rian disease so much in the eyes of her medical attendants that the operation of ovariotomy was seriously contemplated, and was only post- poned to gain her consent. “It became evident on careful examination that the distension of the abdomen was not owing to the presence of an abdominal tumor, but was one of those phenomena seen so often in hysterical females. Its eccentric changes of form and dimension at different hours of the day, its tym- panitic character, the absence of any well-defined body within its walls, its entire freedom from uterine attachments—these and many other symptoms not necessary to mention served to eliminate in the discussion the question of uterine or ovarian disease. “Besides the tense and distended abdomen, there were other and painful symptoms which pointed to uterine, vesical, and gastric causes. There was constant nausea, with bloody and stercoraceous vomiting, intense pain over the stomach and between the scapulac, with retention of urine. Her nervous system with all of this was wrought to its highest pitch of excitement, so much so that the mind at times gave way under it, and she became almost demented. “This condition of affairs went on for thirteen months or more, 1871.] Mºscellaneous. 157 increasing in severity each day, until death by inanition and exhaustion put an end to her misery. - - “The treatment had, whilst under the present medical officer, been directed to the relief of the gastric troubles, which seemed to stand out prominently as the chief cause of her suffering. To this end, bismuth, nitrate of silver, ice, cooling drinks, blisters, etc., were perseveringly tried. Her urine was drawn off every two or three hours by the catheter, and her bowels relieved by enemas. Concentrated and nutritious diet was given her, a little only of which could be retained. “Autopsy showed the uterus and its appendages to be perfectly free of disease, and the abdominal cavity innocent of a tumor. The mucous membrane of the stomach was only slightly inflamed, and had no appear- ance of ulceration.” *:: THE Course of EPITHELIOMA.—Dr. Reid, in the Glasgow Medical Journal, closes an article on this disease as follows: “In accordance with this view, the development and course of the disease would be in somewhat of the following order: “1. An increase of epithelial cells, with more or less irritation and hyperaemia of the neighboring parts. The increase of epithelial cells, and consequent hypertrophy of the glands in this variety (the subcuta- neous), takes place at the expense of the connective tissues, which are partly displaced and condensed, and partly incorporated with the gland tissue. “2. A proliferation and degeneration of the nuclei, increasing the volume, and at the same time obscuring the original glandular type. The cuticle yields to the pressure exerted by the softened and partially disintegrated mass, which is discharged in the form of brownish crusts. The ulcerated surface may either imperfectly cicatrize or remain as an open sore covered with a loose scab. The part discharged is soon replaced by others in an equally advanced condition, which are, in turn, thrown off to be replaced by others. In this way there is a succession of discharges at a shorter or longer interval, the ultimate result being an extension of the ulcer. Whilst this process is going on in the centre, new elements are added to the circumference, and the area of the disease extends with that of the ulcer. At this early stage the aggregation of hypertrophied glands resembles a small, well-defined tumor, which in the later stages is represented by the cancroid deposit at the margin of the ulcerated surface. The imperfect cicatrization of the early stages, and the permanently ulcerated surface in the later stage, covered with a brownish crust, appear to be due to the infiltration of the connective tissue with epithelial and other elements.”—Medical and Surgical Reporter. PROF. DR. ScHwBIGGER, of Göttingen, has been called to fill the chair made vacant by the death of the lamented Graefe-Vienna Med. Presse. THE GALVANIC CURRENT As A MEANS OF RESORPTION.—Dr. Ludwig Seeger (Vienna Med. Presse).-The galvanic current has a marked influence on the capillary circulation of cyanotic parts of the skin. A minute after the application of the current (the zinc pole), the cyanosis gives way to a hyperaemic condition. As a hyperamic condition of the skin is pro- duced by the galvanic current, so is it to be supposed that this positive current towards the surface equally affects the deeper parts as it does the surface. In consequence of this disturbance in the circulation, the neighboring parts are brought into action, and when this process is often repeated resorption takes place. “º The author uses as an electrode on the zinc pole a metallic brush, 158 Miscellaneous. [Oct., which is applied over the spot to be irritated; the other pole is applied over the plexus, or source from which the suffering part receives its nervous supply. The electrode brush is alternated with the ordinary electrode, and is applied only for a few minutes at a time. Two cases are then given in point. A young woman, aet. 22, was taken sick a few days after confinement, with acute pain in the left hypogastrium, and shortly afterwards appeared a hard, painful swelling, of the size of an egg, near the left abdominal ring. Urine rich in albumen. Diagnosis: perimetritis cum albuminuria in puerpura. Not- withstanding the successive use of cold, cataplasm, quinine, iron, iodid. potass., no change for the better appeared in the exudation. At the time the electricity was first applied, the tumor extended from the mons veneris, and along Poupart's ligament, obliquely upwards, outwards, and backwards to under the quadratus lumborum muscle. Skin transparent, and in spots reddened, with scarcely any elevation in temperature. Thigh flexed on the body at an angle of 45°, and allowing of no motion. The galvanic stream was applied every two days, the positive pole over the spinal column and sympathetic, and the negative over the tumor. At the same time patient took infus. cinchona. After third application pain diminished; patient able to turn, by her own strength, on her left side. Fifteenth application : exudation markedly diminished; patient able to sit up. Thirtieth application : no albumen in urine ; is able to go about with crutches, and move her limb quite freely. Fortieth applica- tion : exudation not visible; by firm pressure has a little dull pain; patient goes about without support. Fifty-second application : , girl completely healed, and looks the picture of health. - CASE II.-F. K., act 17. After a severe attack of scarlet fever, fol- lowed by pneumonia, complained of pain by urinating, and at the same time there appeared in the perinaeum and along the course of the urethra a painful elastic swelling; ten days after, complained of tension and pain on the inner side of the right thigh, and at the same time great sensitiveness of the scrotum, and inflammation of the superficial and deep inguinal glands. As the pain and swelling in the inguinal region in- creased, the swelling on perinaeum and scrotum disappeared. At first, cold applications were used. Patient became reduced in strength and flesh; fever; pulse 120. Purp. ferri. iodid. with aq. laur. ceras. was given, and iodid. potass. and glycerine for several weeks rubbed over the part. At the time galvanism was first applied, the patient was in the following condition: Pulse 90; a hard, painful, immovable tumor on the inner side of the right thigh, extending to the middle of the anterior surface of the thigh ; skin over tumor not abnormal; temperature slightly elevated; circumference of diseased limb 9 ctm. greater than the un- affected. Active movement of the limb impossible; with passive move- ments the pelvis also moves with it. Positive pole applied on spinal column, and negative with metallic brush electrode over the tumor, as in the former case. After tenth application, the circumference of thigh diminished 3 ctm., and the tumor 5 ctm. in length; patient feels much better, and has more command of his movements. Twentieth applica- tion, size of tumor much reduced, patient able to go about room with crutches. Twenty-ninth application, swelling no more visible, patient able to go about without crutches; feels strong and well, and dismissed as healed. Patient was seven weeks under treatment with electricity. THE RADICAL CURE OF HERNIA.—Dr. Vans Best proposes a simple operation for the rādical cure of hernia that requires neither the invagi- nation of the parts, nor the use of plugs or buttons, whether of india- rubber or split shot. The steps of the operation are these : He uses a 1871. Mºscellaneous. 159 rather long-handled, flat naevus or hacmorrhoid needle, well bent (quite a semicircle) from shoulder to tip, of one and a half inches in diameter, not too wide, and sharpened on both sides from one-third of an inch from the point. This needle, with a plain dissecting forceps and strong salmon-gut, is all that is required for the operations. After chloroform has been fully given and the hernia reduced, the thigh must be ad- ducted and flexed. The finger, as usual, is introduced quite within the internal ring, carrying the integument in front of it up the canal, whilst an assistant draws the skin of the abdomen firmly over towards the opposite groin. The threaded needle is then passed close to the finger, a small piece of wax having been moulded on its point (instead of a canula): the handle of the needle is raised, and the point pushed through the internal pillar and the abdominal parietes, close within the internal ring. The portion of gut on the convex side of the needle is seized by the forceps of the assistant, and the needle, still threaded, withdrawn through all the structures except the temporarily invaginated skin. The finger being carefully maintained in situ, the gut on the con- cave surface of the needle is slightly pulled by the assistant, while that already seized is firmly held. This facilitates the turning of the needle, and transfixion of the outer pillar (Poupart's ligament). This being ac- complished, the skin of the abdomen is drawn towards the crest of the ilium, and the needle passed through the original aperture unthreaded, and the finger and it withdrawn. There is, therefore, one scrotal and one abdominal aperture, the latter directly above the aperture of exit of the hernia. Nothing now remains but to tie firmly home the two ends of the salmon-gut, cut it short, and let it drop into the wound. A pad and spica bandage are applied, a dose of opium is given, and the patient kept in bed until the parts are well matted together. The knot of salmon-gut will either become encysted or come away, it matters little which ; in either case the approximation of the pillars is certain. It is satisfactory to the operator that the assistant should pass his finger up to the internal ring, when he can distinctly feel it grasped as the liga- ture is tightened. It is absolutely necessary that the salmon-gut should be soaked in warm water for five minutes before being used, and that long round thread should be selected. The needle should be threaded from the concave side. Dr. Best states that he has performed the opera- tion three times, twice with complete success; the third patient was refractory.—The Lancet. SoME FURTHER ADDITIONs To THERAPEUTICs—ORGANIC BROMIDEs, METACHILORAL, witH A NOTE ON SULPHUR ALCOHOL.—At a meeting of the Medical Society of London, March 13, Dr. Richardson read a paper with the above caption. After some preliminary matter, he intro- duced some new medicinal bromides, viz., bromide of quinine, bromide of morphia, and bromide of strychnine, and some of their combinations. These bromides are best administered in syrup of the strength—in re- gard to quinine, 1 grain; morphia, one-eighth of a grain ; Strychnine, one thirty-second grain—to the fluid drachm : in compound syrups the same proportionate doses should be maintained. Dr. Richardson had found the bromide of quinine of great use in syphilitic ulceration ; also bromides of morphia and quinine, frequently repeated, in neuralgia; and in a case of diabetes the compound syrup of bromides of quinia, mor- phia, and strychnia had been signally successful. Dr. Richardson also showed a specimen of pure anhydrous chloral, and suggested it as a fluid caustic ; it abstracts water rapidly, and might be of use in cases of soft fungous growths. A specimen of metachloral was then shown—an in- soluble white substance made by exposing chloral hydrate to sulphuric acid. It is isomeric with chloral, and when treated with an alkali is re- 160 Miscellaneous. [Oct., 1871. solved into chloroform and chlorate of the alkali. Administered to inferior animals it seemed to act as a gentle narcotic. Dr. Richardson lastly exhibited a specimen of mercaptan, sulphur alcohol (C2H6S), in which sulphur replaces the oxygen of ordinary alcohol. He stated that, when taken even in minute quantities, it produced great mental depres- sion. This alcohol is exhaled by the breath, to which it imparts a peculiar odor, similar to that met in wasting diseases. From this the doctor suggested a new line of research in diagnosis, viz., the detection of organic sulphur compounds derived from the blood in the air expired by the lungs by diseased persons. Sulphur compounds liberated in the alimentary canal seemed harmless—i.e., were not absorbed—but it was now quite certain that, when some of them are actually introduced into the circulation, even in minute quantities, and are diminishable by ex- halation from the lungs, they produce muscular debility, feebleness of the heart's action, and mental depression. We may therefore infer that the formation of sulphur compounds within the circulation from disease might account for some examples of excessive temporary prostration, for the cause of which we have as yet no satisfactory explanation.—Medical Times and Gazette, April, 1871. LIEBIG ON GERMANY AND FRANCE.-At a recent meeting of the Royal Bavarian Academy of Sciences, Baron Liebig spoke thus of the future relations between Germany and France: “ The Academy seizes this moment to declare openly that there exists no national hatred between the German and Latin races. The peculiar character of the Germans, their knowledge of languages, their acquaintance with foreign people, the past and present state of their civilization, all tend to make them just towards other peoples, even at the risk of often becoming unjust towards their own, and thus it is that we recognize how much we owe to the great philosophers, mathematicians, and naturalists of France, who have been in so many departments our masters and our models. I went forty- eight years ago to Paris to study chemistry; a fortuitous circumstance drew upon me the attention of Alexander Von Humboldt, and a single word of recommendation from him caused M. Gay-Lussac, one of the greatest chemists and physicists of his time, to make to me, a young man of twenty, the proposal to continue and finish, with his co-operation, an analysis which I had commenced. He introduced me as a pupil into his laboratory; my career was fixed after this. Never shall I forget the kindness with which Arago and Thénard received the German student, and how many compatriots, physicians, and others could I not name, who, like myself, gratefully remember the efficacious assistance accorded to them by French men of science in finishing their studies! An ardent sympathy for all that is noble and grand, as well as a disinterested hospi- tality, forms some of the most noble traits of the French character.”— Journal of Chemistry. * A , / … " - - - - Ad '06/'lose ſite'1' is. INSTRUMENT-MAKERS TO THE U. S. Navy; Bellevue, New York City, and New York State Woman’s Hospitals, and Hospitals in charge of the Commissioners of Public Charities and Correction. - IMPORTERS AND MANUFACTURERS OF EVERY DESCRIP- TION OF F. UE BE FR G O O D S. SURGICAL, DENTAL, ORTHOPAEDIC, VETERINARY, CHIROPODIST’S, TAXIDERMIST’S, AND EN TO MOLOGIST'S INSTRUMENTS. 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A MO WTA//, Y JO UAE WA I, OF American and Foreign Medical, Physiological, Surgical, and Chemical Literature, Citicism, and News, EDITED BY REUBEN A. VANCE, p., Physician-in-Chief to the New York Institute for the Paralyzed and Epileptic; Late Attending Physi- cian for Nervous Diseases at the Out-Door Department of Bellevue Hospital, and Assistant Physician to the New York State Hospital for Diseases of the Nervous System; Member of the East River Medical Association. of the Medico-Legal Society, of the Medical jº of the County of N. Y., t C., BºtC. The complete and rather unexpected success which rewarded the efforts of the Editor and Publishers of THE MEDICAL Worſ, D, in their endeavor to supply the Profession with a Monthly Journal which should embrace in a compact form all that was valuable and noteworthy in current medical literature, has induced them to increase still further the scope and bearings of their journal. They now offer: 1. 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Baldwin & Co., 21 PARK ROW, N. Y. Hypodermic Injections of Strychnia, " By * *- REUBEN A. VANCE, M.D., Physician-in-Chief to the New York Institute for the Paralyzed and Epileptic; Late Attending Physician for Nervous Diseases at the Out-Door Department of Bellevue Hospital, and Assistant Physician to the New York State Hospital for Diseases of the Nervous System : Member of the Medical Society of the County of New York, Etc., Etc. The basis of this monograph is an article which appeared in the journal of Psychological Medicine for April, 1870. The method of treatment there described was then unknown to the majority of the profession, and was employed by but few physicians in this country. Since the appearance of that article it has been tested very thoroughly, and the present volume contains the results of the investigations of the author in a field of prac- tice which has afforded him special advantages for determining the value of remedies in the treatment of paralytic and other diseases of the nervous system. Price $2. Sent, postage free, to any part of the United States. The publishers will send a copy of this work and THE MEDICAL WORLD one year, to each new subscriber for that journal, upon receipt of $3. Any person forming a club of five subscribers for THE MEDICAL WORLD, and remitting the publishers $750, will receive a copy of this book free, which will be sent to his address post-paid. WILLIAM BALDVVIN & CO., 21 PARK ROW, NEW YORK Advertisements. F. A. STOHLMANN. ESTABLISHED 1826. ED. 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D Professor of Physiology; Arthur Mead, Edwards, M.D., Professor of Chémistry; James R. Leam g, M.D., Professor of Practice: Emily Blackwell, M.D., Professor of Obstetrics and Diseases of \ºmen; Mary C. Putnam, M.D., Lecturer on Mate- ria Medica; D. M. Stimson, M.D., Lecturer on Anatomy; Charles E. Hackley, M.D., Clinical Pro- fessor of Diseases of Eye and Ear ; S. M. Poberts, M.D., Clinical Professor of Diseases of Children: R. W. Taylor, M.D., Clinical Professor of Diseases of the Skin ; John Winslow, M.D., Demonstra- tor; Mary Ann Wattles, M.D., Assistant-Demonstrator. & * * , , sº This school offers a very full course, and makes Clinical teaching a prominent part of its in- Struction. The College year consists of two sessions—a winter Session of six, and a Summer SeSSion of three months. The course is intended to extend through three years. There are daily cliniques at the College through the year. Students in this College have admission to the cliniques of Bellevue Hospital, the city dispen- saries, and the New York Infirmary. º e Winter session opens on the first Tuesday of October. For particulars, address the Secretary of the Faculty, EMILY BLACKWELL, M.D. $. Advertisements. . OFFICE OF THE BOARD - FOR THE - - EXAMINATION OF AND LICENSING DRUGGISTS AND PRESCRIPTION f CLERKS IN THE CITY OF NEW YORK, 72 UNION PLACE. All Druggists and Prescription Clerks in the city of New York are hereby respectfully notified that the Board duly appointed in accordance with Chapter 202 of the Laws of 1871 of this State, will meet for the purpose of conducting examinations, daily, between the hours of 10 A.M. and 3 P.M., at their office, 72 Union Place. - - - Druggists will be examined first, and notified in alphabetical order. Due notice will be after- Ward given to prescription clerks. - - The Subjects for examination will be chemistry, poisons and their antidotes, practical pharmacy, and officinal botany, materia medica, prescriptions, and the adulterations of drugs. The office will |be Open daily, from 10 A.M. to 3 P.M. R. O.GDEN DOREMUS, M.D., President. WILLIAM GRAHAM - THEó5ALjff of WEIN, Commissioners. - - C. M. O’LEARY, M.D., W . NEw Yorr, July 20, 1871. LOUIS G. BRANDA, Secretary .* § . Nº . . & w - : 23. 22 \! #; º à | º i § § 392: r à § º: Illustrated Price-list sent on application, to any àddress. T. H. McALLISTER, 49 Nassant Street, New York. [ESTABLISHED 1867.] º | 8 . .. , ; "º ' ' ' ' . . . : . ... º: --- t . ". . . . . . . .: .. - . , | º *. - * . . l º, - * s. ** . . º , “ º . ; º, ſº º .* 2. º ": º sº-º º, ſº º º º ºf mº mº Advertising, Subscription, and General COMMISSION AGENTS Offer their services to the Medical Profession throughout the Country. They make a specialty of filling orders for Physicians, at Manufac- turers’ prices, for any and every article they may require, such as 13ooks, Medicines, Chemicals, Chemical Apparatus, Surgical Instru- ments, Electro-Magnetic Machines, Galvanic Batteries, Microscopes, and Microscopic Accessories. All orders will receive PROMPT ATTENTION, and be sent securely to any part of the United States, C. O. D. ii ON ALL BILLs under $10 the expense of collection must be borne by the purchaser. Address ADVERTISEMENTs. HORSFORDS ACID PHOSPHATE : - (MEDICINAL). Prepared by the Rumford Chemical Works, Providence, R. I., UNDER THE DIRECTION OF PROFESSOR E. N. HORSFORD, Late Rumford Professor at Harvard University, Cambridge, Mass, 4. THE value of Preparations of Acid Phosphates as therapeutic agents is in keeping with well-known chemical principles, and no article has ever been offered to the public which Seems to so happily meet the general want as HoRSFORD's ACID PHOSPIIATE. It is not nauseous, like most of the preparations of Phos- phorus, but agreeable to the taste, and with water and sugar makes a cooling and pleasing drink. No danger can attend its use, as it is the same Acid that is found in wheat and other cereals. If We take more into the system than is needed; it is crpelled with the secretions of the body. It is especially recommended for Dyspepsia, Urinary , 'ifficulties, Cerebral and Spinal Paralysis, Men- tal Exhaustion, Wakefulness, Hysteria, and Nervous Disorders in General. Most excellent results have attended its administration for the prostration and nervous symptoms following Sunstroke. We ask the careful attention of all thinking persons to the high character of the following testi. muonials : M. H. Henry, M.D., Editor of the American Journal of Syphilography and Dermatology, New York City, says: “I have, for more than two years, prescribed the Acid Phosphate rather extensively, in a variety of cases where the use Of phosphorus was indicated, and I assure you with the Ihost satisfactory results. In 11 ervous dis- eases I know of lio preparation to equal it.” Adolph Ott, - Technical Writer and Editor of the Department of “1”hysics. Chemistry, and Technology" of the Ger- man-American Cyclopædia, says: “I have tried several phosphites, and even phosphorus in Substance, but none of them with such marked success as your Horsford’s Acid Phosphate.” The statements made by others as to its cffects on the nervous system and the brain, I fully confirm. ... Some months have been enabled to de v te myself to liard mental labor, from shortly after breakfast till a late hºur in the evening Without e Xperiencing the Slightest relaxation, and I would now at 110 rate dispense With it.” John P. Wheeler, M.D., Hudson, N. Y., says: “I have given it, with present decided benefit, in a case of innutrition of the brain from abuse Of alcohol.” - Dr. Wrm. A. Harm mornd, now of New York, formerly Professor of Physiology in the University of Maryland, says: “I make use habitually of pliosphoric acid and the phosphates, in the treatment of nervous diseases... I prescribe it Constantly every day of my life. It is very well known that, in certain cases of paraplegia (paralysis of the lower extreinitiºs), and which are due to paralysis of the spinal cord—to a degeneration of the 8tub- º º the cord—tlle disease cannot be so effectualiy cured by any other means as by the administration of pliosphorus.” Þr. Fordyce Barker, New York City, says: “ There are very often cases where the human system needs, for its restoration, the administr., ti, in of the phosphates. The cases that require a phosphatic treatment are those where the waste of the phosphates is greater than the supply. The class is very numerous. First, in all those cast's of dera; Ige in ent of the digestive and assimilative organs, where, in consequence of this derangement, the waste is greater than the supply. The next most frequent is where there is an excessive demand for nerve-power, as in men engaged in professions, and in business excitements: next, in ex cessive demands resulting from prolonged lactation ; and another class still, the excessive tax on phys- ical power and muscular effort, without the necessary supply. R. Ogden Dorennus, Professor of Chemistry in the College of Pharmacy of this city, and in the Medical College of the City of New York (formerly called the Free Academy), and in the Bełłevue Medical Hospital, says: “I have had. for i. years, professional employment, in the matter of examining human urine. The amount of the phosphates will be increased in the urine, as the result of abnormal exercise of the body, or where the brain and nervous system are overexcited . This result, of the discovery of a greater pro- portion of the phosphates in urine, after excessive mental labor, has been verified by experiments within my experience, and is in accordance with an Ordin.ry knowledge from examinations of Urine, insomuch that we teach these facts in our lectures to medical students.” +. - Williarm H. Van Buren, M.D., of New York, says: “I have been employed professional y to make examinations of the human urine, and have generally found the phosphates in excess in cases where the nerve centres (the brain and spinal cord) had been overworked or subjected to undue labor. The opinion which obtains in the profession and which has been confirmed by my own porsonal experience, is that there is a received relation be- tween an excess of phosphates in the urine and intellectual exercise.” Physicians wishing to examine and test this remedy are requested to apply, by letter or otherwise, to the undersigned. - WILSON, LOCKWOOD, EVERETT & C0, G'. Ag'ts, 51 Murray Street, New York City. II JoHN Ross & Co., PRINTERs, 27 RosF ST., NEw York. $1 50 a.Year.] : aw i § * | § A M (; NTI [ { ...Y § 3. REUBEN A. § & # & º ---> ^* < g %3 s % g J * - § i Yº ſº # PAGE - §: ORIGINAL CoMMUNICATIONS: £ii Art. I.-On Chronic Hypertrophy of } the Lips, DR. TAYLOR, - - - 161 # Art. II.--Subacute Meningitis Remit- . tent, DR. StJMNER PUTNAM, - - 168 Art. III.-Medical Thermometers, - 172 º : .9 | Sº if §§ ği Art. IV.-A Modification of the AEs- } ; : thesiometer, DR. REUBEN A. VANCE, 174 ği | # ! : SELECTED ARTICLES : - #| A Contribution fo the Surgery of Öğ: Bleeding Vessels, DR. ALEXANDER *š. i OgSTON, - * - - - - 178 #| *, Subscriptions invariably in advance, 㺠No WEMBER, 18; 1. . . . . . . . . ;-) . .'; 5 - … ...-a -- - - - - - - - - - * : * * * * * * * * * * * * * * * * * * , ". . ." . . . . . . . . . ~ *, * * * * * - wº w “A-Y- No. J ( ) l ; IRN AI., OF : EDITED BY VANCE, M.D. CONTENTS. REVIEws : Fox—“ Skin Diseases,” * PROCEEDINGS OF SOCIETIES : 5. AMERICAN AND FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL, AND CHEMICAL LITERATURE, CRITICISM, AND NEWS. PA G F. Pathological Section of Kings Coun- ty Medical Society, Brooklyn. - 184; Judge Bedford's Amendment to the Abortion Law in the Academy of Medicine, - - - * Medico-Legal Society, - MISCELLANE). Us: See 2d page of cover. RECENT PUBLICATIONS, - - : : J, OWDOW. § - -. § 3 -- gºer NEW YORK : WILLIAM BALDWIN & CO., PUBLISHERS, 21 PARIX ROW. TRüBNER & Co. - 188 - - 189 - - 200. sº ' [15 Cents per Copy `ſ; ~ oºfto t & < § c. ſº º Wºº - º º É | ; wº - º º t \. # ; tº t § g § º § º º ; § 3. ºº*3 ; %* º * t X º É § º -::- º º º CONTENTS. PAGE. PAGE. H. O.B.IGINAL COMMUNICATIONS. 3. Medico-Legal Society, . . 189 1. On Chronic Hypertrophy of the Lips, . e . 161 V. MISCELLANEOUS. 1. 2. Subacute Meningitis Remit- . American Journal of Obstetrics, 173 tent, e º e - . 168 2. Ice in Rectum in Retention of 3. Medical Thermometers, . . 172 Urine, . te e & . 173 4. A Modification of the AEsthe- 3. Cholera, . g • • . 189 sionmeter, e * º . 174 4. Cundurango, . . º . 195 II. SELECTED ARTICLES. 5. Condensed Form of Nitrous A Contribution to the Surgery of Oxide Gas, . e - , 196 Bleeding Vessels, . º . 178 6. The Ophthalmoscope and the Sphygmograph in the Study III. REVIEWS. of the Physiological Action Skin Diseases: Their Description, of Medicines, e - . 197 Pathology, Diagnosis, and 7. Dr. Lewis A. Sayre's Treat- Treatment, . . . . 183 ment of Hip-Joint Disease, . 197 IV. PROCEEDINGS OF SOCIETIES. 8. On the Treatment of Syphilis 1. Pathological Section of Kings by Hypodermic Injections of County Medical Society, Corrosive Sublimate, . . 198 Brooklyn, . & - . 186 9. Epilepsy from Use of Absinthe, 199 2. Judge Bedford's Amendment 10. Disinfection, . * - . 199 to the Abortion Law in the Academy of Medicine, . . 188 VI. RECENT PUBLICATIONs. MOLLER'S Purest Norwegian COD LIVER OIL. Was awarded a Silver Medal at Paris International Exhibition, 1867, heading twenty-seven competitors. - Is prepared from selected Livers, and bottled at Lofoten Islands, Norway. Was awarded a Gold Medal at Bergen International Exhibition, 1865. Is the purest, and for limpidity, clearness, and delicacy of taste and smell is superior to any. Is highly recommended by the Medical Societies of Norway and England. Is more readily assimilated and more readily digested than any other Cod Liver ()il. Was awarded the First Prize and the only Medal at London International Exhi- bition, 1862. Is recommended by high medical authorities in Europe and America. Was awarded First Prize, the only one awarded, at Stockholm Great Exhibi- tion, 1868. W. H. Schieffe/in & Co., AWew York. Sole Agents for United States and Canada. º- **". º, IN consequence of the unexpectedly large demand for Back numbers of THE WoRLD, the numbers for July are entirely exhausted. Those who have received already the July number, as a specimen copy, will much oblige the Publishers by returning the same, if they do not wish to subscribe, and they will get a copy of any future number in exchange. - Add THose who wish to preserve complete files should make early application. - TëSS WILLIAM BALDWIN & CO., Publishers, P. O. Box 3472. 2ſ Park Row, New York. *Wakefield Earth Closet THE Greatest Blessing of the Nineteenth Century Is the discovery of the - DRY EARTH SYSTEM, And in connection therewith a practical meth- od of using the same Earth Closets and Commodes. We ask every decent person to aid us in ban- ishing from the earth every vile country privy º-º-º-º-º-º-º---------------K those loathsome, indecent #º pestiferous, health and life destroying structures, ºf the bane of every country ==A community. Every person g thus engaged becomes a Fugilio BºnºrActor. By all odds the most complete and perfect yet invented is the Wakefield Patent, ºf They have been adopted by the Central Park Commissioners, and = 100 ordered for use in the |= Park. |# Applications for Agen- #|É c'es from responsible par- # ties will be considered. # Send for our descriptive Pamphlet, or call and see # the Commodes, at the Of- # fice of the Wakefield Earth Closet Company, ..?6 z) Z2° S. Z., JW". Y. |ESTABLISHED 1867.] - IAM BALDWIN & 60. No. 21 Fark Fow, New York, PUBLISHERs, Advertising, Swºbscº’iption, and General COMMISSION AGENTS, Offer their services to the Medical Profession throughout the Country. They make a specialty of filling orders for Physicians, at Manufac- turers’ prices, for any and every article they may require, such as Books, Medicines, Chemicals, Chemical Apparatus, Surgical Instru- ments, Electro-Magnetic Machines, Galvanic Batteries, Microscopes, and Microscopic Accessories. All orders will receive PROMPT ATTENTION, and be "sent securely to any part of the United States, C. O. D. ON ALL BILLs under $10 the expense of collection must be borne by the purchaser. Contents of The Medical World for July, 1871. I. ORIGINAL COMMUNICATIONS. 1. The Physical Diagnosis of Brain Disease.—DR. WANCE. 2. The Value of Torsion as a Haemostatic.—DR. PHELPs. 3. Cutaneous Eruptions Caused by Wearing Red Flannel upon the Skin. -—DR. DE MARMON. - 4. Osteo-Sarcoma following a Fracture of the Fibula.--DR. BRADLEY. II. SELECTED ARTICLES. Abstract of Lectures on the Internal Diseases of the Eye.—DR. J. SOEE- BERG WELLS. - - III. REVIEWS. . “Dynamics of Nerve and Muscle.” By DR. CHARLEs BLAND RADCLIFFE, London. IV. MISCELLANEOUS. 1. Eucalyptus Globulus. 13. Elimination of Nitrogen. 2. A Substitute for ſaint. 14. Rupture of the Uterus. 3. Abnormal L'acteal Secretion. 15. The Action of the Bromides. 4. Drs. Wilks and Anstie. 16. Pathology and Treatment of Dia- 5. Treatment of Epididymitis. betes. 6. Affections of the Eye from Small- 17. Treatment of Fractures., pox. 18. Hydrate of Chloral. 7. Glasgow Surgery. 19. Chromic Acid in Sore Mouth. S. Diaphorºsis in Scarlatinal Dropsy. 20. Heat of the Body. 9. Treatment of Aneurism. 21. Transfusion of Blood. 10. Belladonna in Tonsiſ litis. 22. Injuries of the Head. 11. External Application of Remedies. 23. Influence of Alkalies upon Urea- 12. General Paralysis of the Insane. 24. Transplantation of Bone. Contents of The Medical World for August, 1871, I. ORIGINAL COMMUNICATIONS. 1. Medical Thermometry.—DR. SEGUIN. 2. Ulceration into Primitive Carotid from a Wound of the Throat treated: by Ligation.—DR. PIELPs. 3. The Treatment of Amenorrhoea and Dysmenorrhoe by the Use of Quinine Endermically.—DR. BRADLEY. 4. Aneurism of the Aorta treated with Iodide of Potassium and Oxygen. —DR. BUTLER. 5. Stricture of the Nasal Duct. —DR. SEELY. II. SE LECTED ARTICLES. 1. The Early Symptoms of Cerebral Disease.—DR. WANCE. III, REVIEWS. X- DR. TILT—“Change of Life.” DR. PURDy –“ Medical Register.” IV. MISCELLANEOUS. 1. The University of New York. 10. Conduction in Motor Nerves. 2. Dr. Bumstead. 11. Electro-Therapeutics in Stricture. 3. Bellevue IIospital. 12. Treatment of Venereal Disease. 4. Cerebral Lesions & Temperature. 13. Animal Vaccination. 5. Amp Itation of Redundant Scro- 14. First Stage of Syphilis. tum. 15. Influence of the Nervous System. 6. Cancer and Cundurango. 16. System of Weights and Measures. 7. Sugar in the Liver. 17. Treatment of Croup. 8. Diphtheritic Membranes. 18. Chloral in Tetanus. 9. Tuberculosis. 19. Poisoning by Carbolic Acid. Advertisements. Shepard & MANUFACTURERS OF Ford's Surgical Instruments, INSTRUMENT-MAKERS TO THE U. S. Navy; Bellevue, New York City, and New York State Woman’s Hospitals, and Hospitals in charge of the Commissioners of Public Charities and Correction. IMPORTERS AND MANUFACTURERS OF EVERY DESCRIP- TION OF R U BBER GOODs. SURGICAL, DENTAL, ORTHOPAEDIC, VETERINARY, CHIROPODIST’S, TAXIDERMIST’S, AND ENTOMOLOGIST's INSTRUMENTS. Trusses and Abdominal Supporters in great variety; Suspensory Bandages in all shapes and styles; All kinds of Instruments to enable the “Deaf.” to hear; The latest and most approved Appara- tus for Deformities; Electro-Magnetic Machines and Galvanic Batteries in the most compact form; Electro-Magnets and Galvanic Batteries combined; Crutches in all kinds of wood. We have on hand all the latest American Instruments, and are constantly receiving from our Agents in France, Prussia, and England all the latest models and inventions in Surgical Art. goods IMPORTED OR MANUFACTURED TO ORDER. tº Send for Price-Current. 150 WILLIAM STREET, N. Y. ºf Will be sent by mail, (post-paid) on application, A P A M P HL ET, containing two articles, by distinguished foreign authority, on “INHALATION OF ATOMIZED LIQUIDS,” WITH FORMUL.A. G.F THOSE SUCCESSFULLY EMPLOYEIO, Also, an article by Dr. J. L. W. THUDICHUM, M. R. C. P., on “A New Mode of Treating Diseases of the Nasal Cavity." WITH HIS FORMULAF. Also, an illustrated description of the best apparatuses for the above purposes, and for producing. Zoca ºf 24naesthesia by Atomization with Ether, by the method of DR. RICHARDSON, of London; or with Rhigolene, as described by DR. HENRY J. BIGLow, in the Boston Medical and Surgical %urnal of April 19, 1866. 24!? our 24tomizing Znstruments are made with the utmost care, with a view to their complete efficiency, convience and durability, and every one is warranted. A Gold Medal has lately been awarded us by the Middlesex Mechanics’ Association, for Atomizing and Surgical Instruments, as will be seen from the following report, signed by a leading New England Surgeon and Physician: ** Z503. Codman & Shatre/e7, 7Rosłoza, .7zzess. One Case Surgical Zastrzemeents azed. 24&omizers. : “The Committee have no hesitation in awarding for this superb exhibition the highest premium. The various other instruments for Inhalation of Atomized Liquids, and for Local Anaesthesia, were all apparently faultless, both in design and workmanship. The exhibitors are regarded as more especially deserving of the highest token of merit for having produced nothing except of their own manufacture.—Go?d .%eda2. (Sighed) - GILMAN KIMBALL, M. D., Chairman.” Also by the Mass. Charitable Mechanics' Association.—Exhibition of 1869.-A Siſa'ez' .7/eda?, the Highest Medal awarded for Surgical Instruments. 1. ;: * :* :: —- sº- -ms- A L S O HTO R. S. A. J., HD : *Cammann's Stethoscopes: *French Rubber Urinals, with valves, male, Disarticulating, . e ſº . $7 oo for night or day, . tº © º . $6 oc. *Knight's Modification, , . o g 9 5o Male, day only, • . . . e . $2 50 to 4 oo. Simple Throat Mirrors, Nickel-Plated, . ‘I. Oo *French Rubber Urinals, female, for day Ophthalmoscopes, Liebreich’s, . . . $5 od to 7 oo only, e g e tº & e & 4 Oo Holt's Dilator, improved, . . . . 2C, OO *Ice and Hot-Water Bags, , . . $2 20 to Io oo Barnes’ “ set of three, with Inflator and *Vaccinators, Whittemore's Patent Auto- Stop-cocks, tº & tº & & g 5 Oo - matic, for Crust or Lymph fresh from Large Ear Mirrors, Troitsche's, . $3 50 to 5 od arm.—Instantaneous, certain, and al- Hypodermic Syringes, , . º e 3 oo to I4 oo most painless (post-paid), g º gº 3 oo. *Miller’s Intra-Uterine Scarificator, in case, *Powder Syringes, g e e * 2 oo. (postpaid) * * tº e iº º OO Laryngoscopes, complete, . . 16 oo to 25 Oo Lente’s Intra-Uterine Caustic Instruments, *Dr. Oliver’s Laryngoscopic Lantern, 4 Oo. $1 25 to 3 5o The same, with Auto-Laryngoscopic Sponge Tents, plain and carbolized, each, .. 25 attachment, . * º & e & 5 od Pinckham’s improved Uterine Scarificator, The same, with ditto and three Laryn- in case, & • • tº º º * 8 oo goscopic Mirrors, in Case, . & 9 oo *Dr. Cutter's Retroversion and other Pessaries 3 oo *Dr. H. R. Storer's Combined Speculum, 6 oo. Gaiffe's Electro-Medical Apparatus, e I5 OO * Send for Descriptive Circular. Amputating, Trephining, Exsecting, Pocket, Dissecting, Throat, Ear, Eye, Uterine, Obstetric, and all other special and general sets of Instruments on hand and made up to order. Trusses, Spinal and abdominal Supporters, Shoulder Braces, Suspensory Bandages, Elastic. Hose, Medicine Trunks and Pocket Medicine Cases, Otoscopes, Endoscopes, Dr. Sayre's Splints for Hip-Joint Disease, Fever Ther- mometers, Respirators, Syringes, Crutches, Universal Syringes, Galvanic Batteries and Apparatus, French - Conical and Olive-Tipped Bougies and Catheters. Skeletons, Skulls and Anatomical Charts on hand; Manikins, Anatomical and Pathological. Models imported to order; prices on application. All Instruments, Implements and Materials used by Dentists, always on hand. Apparatus for Club Feet, Weak Ankles, Bow Legs, Spinal Curvature, and other deformities, made to order. Apparatus for Paracentesis Thoracis, approved by Dr. Bowditch and accompanied with directions kindly furnished by him. ,” Having our Manufactory with steam power, and a corps of experienced workmen connected with our store, we are able promptly to make to order new Instruments and Apparatus, and to supply new inventions on favorable terms. INSTRUMENTS SHARPENED, POLISHED AND REPAIRED, CODMAN & SHURTLEFF, Makers and Importers of Surgical and Dental Instruments, 13 & 15 TEREMONT STEEET, BOSTON. I 2 CODMAN & SHURTLEFF's Amlaim of Himi for |millim, oral Amien &t. By the Atomizer, any medicated liquid may be converted into the finest spray. In this state it may be inhaled into the smallest air-cells, thus opening a new era in the treatment of all diseases of the throat and lungs. THE COMPLETE STEAM ATOMIZER FOR INHALATION, &c. - (See Fig. 15.) J - It consists of the sphere-shaped brass boiler A, steam-outlet tube - -- -Altº B, with packing box C formed to receive rubber packing through #sºft#####s - which the atomizing tube D passes, steam-tight, and by means of **-* ----- : Eğıºğsº ſº which tubes of various sizes may be tightly held against any force of steam, by screwing down its cover while the packing is warm; the safety-valve E, capable of graduation for high or low pressure by the spring or screw in its top, the non-conducting handle F, by which the boiler may be lifted while hot, the medicament-cup and cupholder G, the support H, iron base I I, the glass face-shield J, with oval mouth- piece connected by the elastic band K with the cradle L, whose slot- ted staff passes into a slot in the shield-stand M. M., where it may be fixed at any height or angle required by the milled-screw N. . The waste-cup, medicament-cup and lamp are held in their places in such a manner that they cannot fall out when the apparatus is car- ried or used over a bed or otherwise. All its joints are hard soldered. º- §2.ɺl. It cannot be injured by exhaustion of water, or any attainable pres- I ------ sure of steam. It does not throw spirts of hot water, to frighten or scald the & " ºº its ºf Titº , | nº The Complete Steam Atomizer, For Int/alation, &c. Patented March 24, 1868, and Mar. 16, 1869. Fig. 15, patient. Is compact and portable, occupies space of one-sixth cubic foot only, can be carried from place to place without removing the atomiz- ing tubes or the water, can be unpacked or packed without loss of time. Will render the best of service for many years, and is cheap in the best sense of the word. Price $6 oo. Neatly made, strong, Black Walnut-Box, with convenient handie, additional, $2 50. Brass Parts Nickel-Plated, additional, $2 50. . . . SHURTLEFF'S ATOMIZING APPARATUS (See Fig. 5), for Inhalation, and with suitable tubes, for Local Anaesthesia, and for making direct local applications of atomized liquids for a great variety of - B purposes. [See our Pamphlet.] 2. º: | Ç t The most desirable hand Apparatus. º # Rubbers warranted of very best zuality. Valves imperishable, every one carefully fitted to its seat, and work perfectly in all positions. The Bulbs are adapted to all the Tubes made by us for Local Anaesthesia in Surgical Operations, Teeth Patented March 24, 1868. Extraction, and for Inhalation. Price $4 oo. Each of the above Apparatuses is supplied with two carefully made annealed glass Atomizing Tubes, and accompanied with directions for use. Every Steam Apparatus is tested with steam, at a very high pressure. Each Apparatus is carefully packed for transportation, and warranted perfect. Also, HAND BALL ATOMIZER, No. 5, without face-shield, • * * * * * * * * $3 5o THE BOSTON ATOMIZER, with two glass Atomizing Tubes, * - º e • . 2 50 THE TREMONT ATOM12ER, with two glass Atomizing Tubes, - º º e e º e 2 OO. GLASS ATOMIZING TUBES to fit any of our Apparatus, warranted perfect, each, . . . . 25 NICKEL-PLATED TUBES, for Local Anaesthesia and for Inhalation, each, 75C. to 2 oo RHIGOLENE, for Local Anaesthesia, best quality, packed, e º • g º e e e I OO NASAL DOUCHE, for Treating Diseases of the Nasal Cavity, eight different varieties, each with two Nozzles, packed . e - t e • º $1 20, 1 50, 1 75, 2 oo, and 3 5o N.B.—To save collection expenses, funds should be sent with the order, either in form of draft, post- office order, or registered letter. (For complete illustrated price-list of Apparatus, Tubes, etc., see Pamphlet.) Wm. Baldwin & Co., #ates of Advertising PU ELISHERS, 21 Park Row, New York, Receive subscriptions for every medical journal in the world. 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WE frequently observe temporary enlargements of the lips, which are due to eczema, erysipelas, sycosis parasitica, epithe- lioma, herpes, pustula maligna, and stomatitis, and also to inflammations of the various neighboring organs and tissues, and as a result of the irritation of worms; but these inflam- mations do not very often give rise to any serious or per- manent hypertrophy, and in the larger number of these diseases the morbid process begins in, and is greatest in, the tissues of the derma and mucous membrane. I desire, in this paper, to call attention to a form of hypertrophy of the lips, in which the inflammation begins in its connective tis- sue framework, and which produces a permanent augmenta- tion in its size, and in which the skin and mucous membrane are not involved. I shall also call attention, as a corollary, to certain other forms of inflammation in which the various other tissues and organs are concerned, and in which a permanent hypertrophy results. I do not, however, include the various ulcerative affections of these parts, as they generally involve Entered, according to Act of Congress, in the year 1871, by WILLIAM BALDWIN & Co., in the Office of the Librarian of Congress, at Washington, D.C 162 On Chronic Hypertrophy of the Lips. [Nov., the more superficial tissues. I shall present the history of a case which came under my observation, and which shows well the course of the disease. P. L., aged 22, was born in Ireland. His father died of a fever, when he was quite young, and he does not know of what disease his mother died; but states that she usually enjoyed good health. He never had any severe illness until he was nearly twelve years old, when he had a severe attack of asthma. This troubled him very seriously, so much so that he did not sleep sometimes for many nights. Though quite actively treated, he could only get temporary relief. These attacks had troubled him about a year, when he noticéd that his upper lip gradually swelled, and in two months it had become fully four times its natural size. The physicians who attended him at that time leeched the lip, and ordered poultices to be continuously applied; but they did not materially lessen the size. He continued to have attacks of asthma, and after each attack the lip seemed more swollen than before. After the acute symptoms of the first attack had subsided, the lip was found to be permanently enlarged, and was quite un- wieldy. From that time to this, being a period of about ten years, the lip had become swollen four or five times each year. When it first became acutely swollen, it was very much larger than it has ever been since. He noticed that after each acute attack the lip was slightly thicker than it was previous to it. These attacks came on very suddenly, sometimes seemingly caused by his asthma, other times without any known cause. They lasted generally about a fortnight, and, though not absolutely painful, they caused him considerable annoyance. He had consulted several surgeons in Ireland, and among them some eminent in their profession. They had advised numer- ous procedures; some partial ablation of the lip ; others, the use of the Seton ; others, again, active counter-irritation. His parents would not consent that any operative procedure should be instituted, and preferred the milder measures of counter- irritation and leeching. He says that they applied leeches in considerable number in the first years of his trouble, and it was thought at one time that the swelling was declining; but an acute attack again came on, and all that had been gained was lost. They then tried counter-irritation quite vigorously. 1871.] On Chronic Hypertrophy of the Zips. 163 Still it did not reduce the swelling in the least. A few years ago he came to this country, and, since his residence here, he has suffered much less from the asthma, but his lip has swollen from time to time, but not quite as frequently as it did when he was in Ireland. The surgeons who saw the case in Ireland were not of one mind as regards the cause of the trouble. Some of them explained it as being due to irritation of the upper lip in consequence of the expulsive effort at respiration, and this is the cause assigned by the patient himself. He says that for many days and nights he sat up in a chair, breathing with the greatest difficulty, and that, as his breath came out, it flapped the upper lip backward and forward like a curtain, and he thinks that this first caused it to swell. He came under my observation early in 1871, and when first seen by me his lip was the seat of one of the acute attacks above alluded to. It was irregularly pyramidal in shape, its base being at the vermilion border, and its apex under the nose. In consequence of the extreme swelling, it was puffed out fully an inch and a half in advance of the lower lip, which showed a tendency to subside inwards slightly towards the teeth. In consequence of this everted condition of the lip, considerably more of the mucous membrane lining was seen than could be seen normally. The integument covering it was red and tender, and at its centre it was covered with slight crusts, in consequence of vesication by a mustard plaster, which the patient had applied previous to coming to me. Upon ex- amination, I found that the lip, which was fully two inches thick at its thickest part, or base, presented a tense resistant feel to pressure, and was quite red, and that, though not abso- lutely painful, was quite tender. It had been acutely inflamed then about two weeks. As the tenderness precluded a very minute examination, I ordered a weak lead and opium lotion to be applied, which reduced the acute swelling in about ten days. At this time the lip presented the appearances usually observed when not the seat of an acute swelling. The integu- ment was perfectly normal in color, and, upon careful exam- ination, was not found to be thicker than natural. It blended evenly with the mucous membrane, which was also normal in appearance and to the touch. The mucous follicles were not enlarged, nor did they secrete an abnormal quantity of mucus. 164 On Chronic Hypertrophy of the Lips. [Nov., At the free margin of the lip, which was about one inch in advance of, and which slightly overlapped, the upper lip, it was fully an inch and half in thickness. This thickening could be distinctly felt, until it gradually ceased as the lip merged into the cheek, over the canine fossae above, and as it merged into the continuous integument on each side. Upon firm pressure, a resistant feeling, such as is felt if we pinch a portion of indurated liver between the fingers, was recognized; but, as said before, it was not due to thickening of either the skin or mucous membrane. These latter tissues would, upon pressure, slide over one another, and then it was found that the connective tissue between these two tissues was the seat of the hypertrophy. It was evident that the orbicular muscle was not involved, from the fact that, although the motion of the lip was very much impaired, had it been enlarged it would have presented a clearly marked and readily appreciated enlargement, while the enlargement present was diffuse, and gradually shaded off until it was no longer felt. The physiog- nomy of the patient was very much disfigured by this deform- ity, and it was readily seen that the mobility of the lip was greatly impaired when he talked or smiled. The patient was able to elevate his upper lip by means of the facial muscles, and also to readily open and close his mouth ; but the actions were done much more slowly than they are by other persons. He said that the use of hot drinks and spiced food did not irritate the lip, and he, therefore, could not account for the exacerbations which he so regularly experienced. He remained under my observation some time, during which I did little for him other than administer tonics for a temporary debility, for he would not consent to an operation on the lip. It is evident, from a perusal of this case, that the swelling was originally due to the local irritation, and it is interesting to determine the manner in which it was produced. Accord- ing to the patient’s statement, the lip was quite violently flapped backwards and forwards in his long-continued forced respiration, and, as we know that in violent paroxysms of asthma there is a very much relaxed condition of the facial muscles, particularly of the orbicularis Oris, we can see how easily the cheeks and lips are moved in expiration and inspira- tion; and it may be added that very much the same condition 1871.] On Chronic Hypertrophy of the Zips. 1.65 is observed in deep coma. Now, it is probable that this long- continued irritation of the lip reacted upon its vaso-motor nerves, producing a paresis of them ; the result of this is a hyperaemia, and as a result of that, again, a proliferation of the connective tissue elements. It seems that there was no ten- dency at any time to the production of pus, or that the irrita- tion was not sufficiently great for its production, so that, as a result of the paresis, we have a proliferation of the connective tissue elements in the stratum of that tissue, situated between the integument and the mucous membrane. Now, it seems that this paresis, once begun, showed a tendency to recur at intervals, and thus we account for the oft-repeated swellings of the lip, in each of which attacks more tissue was proliferated, and hence the lip became larger and firmer. We observe the same tendency to frequently recurring inflammations following upon a previous one of acute character, and it is probably to be explained partly by a permanent impairment of the vaso- motor nerve function, and partly by certain tissue changes, due to an altered nutrition. We may cite, as examples of this con- dition, mild and frequent attacks of epididymitis, following upon a former acute attack; acne rosacea, and the predisposition engrafted upon any portion of the integument by an attack of eczema to subsequent attacks; and also a frequently recurring erythema of the cheeks and legs after erysipelas. It is an interesting clinical fact to know that this condition was due to asthma, and one, I believe, which is not generally recognized. My friend, Dr. Willard Parker, whose attention I called to this case, told me that he had met with a similar case, in which the upper lip became very much and perma- nently enlarged in a patient who had suffered severely from whooping-cough ; so that, I think, we are warranted in con- cluding that any disease in which there is violent and long- continued coughing, or in which violent efforts are made in respiration, may induce this condition. Knowing, as we do, the nature of the enlargement and its deep-seated position, it is readily seen how powerless we are for its relief, unless we undertake Operations or procedures which, perhaps, would not remedy the deformity, and might, perchance, render it only more unsightly. There is an enlargement of the upper and lower lips which 166 On Chronic Hypertrophy of the Lips. |Nov., is also occasionally met with, and which, I think, was first described by Prof. R. Volkmann,” of Halle, who has observed five cases of it. In this form, the lip gradually, and without much pain, becomes swollen and hard, and is not as readily moved as before, and the features become greatly disfigured. The inflammation begins in the mucous follicles, which become greatly enlarged, and can be readily seen and felt, and their excretory duct becomes very much dilated. The submucous connective tissue is also involved, consequently the swelling extends as far as the junction of the skin with the mucous membrane. In this form of enlargement, which, from its seat in the mucous follicles of the lip, Volkmann names cheiliffs glandularis apostematosa, or mya’adenºtis labialis, abscesses and furuncular inflammation may supervene. I have never seen a case of it; but, in speaking of my case with Dr. Parker, he told me he had met with a case in an old gentleman which was similar in origin to those described by Volkmann. The upper lip was of an enormous size, the mucous membrane was thickened, and the mucous follicles were greatly enlarged and readily seen. And in this case, besides the deformity, the patient was greatly troubled by the excessive secretion of mucus, which was thick and viscid, and it often glued the lip to the other lip, so that very frequently, in the morning, the patient could not open his mouth until it had been freely bathed with warm water. So great was the annoyance that, as other measures failed, Dr. Parker excised the whole of the mucous membrane lining the lip, allowing the wound to heal by granulation, and the result was very satisfactory to the patient. Volkmann says that three of his five patients had suffered from syphilis; but he does not seem to consider it the cause of the inflammation. His cases were quite obstinate to treatment; two were not improved, but he says that three were cured in from four to eight weeks by iodide of potassium internally, and chlorate of potassa and mild cauterizations locally. It would seem that none of these five cases were as obstinate to treatment as Dr. Parker's case was. There is also an enlargement of the lip which sometimes follows a similar enlargement of the nose, which was first * “Einige Fälle von Cheilitis Glandularis Apostematosa (Myxadenitis Labialis),” Virchow's Archiv., bd. 50, 1870, page 142. 1871.] On Chronic /ſ/pertrophy of the Lips. 167 described by Hebra,” who named it rhinoscleroma, in which the tissues slowly become enlarged and greatly indurated, and as a result there is great disfigurement. The invasion of the lip does not occur in the majority of cases, and the integument, which may either be normal in color or of a dark brown, may be studded with papules. The lesion in these cases is a cell- infiltration of a glio-sarcomatous nature into the papillae and the corium. . There are also two other forms of permanent enlargement of the lips: the one due to varicosity of the veins or arteries; the other due to enlargement of the lymphatics. Besides the dilatation of the vessels, there is a coincident hyperplasia of connective tissue in these cases, which increases the enlargement and renders it permanent. A case of the venous variety has been recently described by M. A. Michalski, occurring at birth in a child. It involved a portion of the lower lip, and was coincident with an arterial erectile tumor of the scalp. This form of enlargement is gen- erally congenital, is not amenable to mild treatment, and pre- sents features by which it is readily recognized. The form of hypertrophy of the lip due to enlargement and dilatation of the lymphatics has been called by Virchowf makrochilie. It con- sists in an extensive enlargement of the lymphatics of the lips, and a consequent hyperplasia of connective tissue. Vir- chow describes a case observed by Billroth, in which large cav- ernous spaces containing lymph and fibrine were seen, together with an increased amount of connective tissue and slight hyphertrophy of the orbicularis oris. The enlargement had existed since childhood, and had been the seat of intermittent acute attacks similar to those observed in my case; but the swelling was of an elastic nature, and thus differed from that of my case. So that my conclusion, upon carefully studying it, was, as I have said, that the enlargement was due to a sim- ple hyperaemia, and that the lymphatics were not actively in- * “Ueber ein eigenthumliches Neugebilde an der Nase—Rhinoscleroma,” Wiener, Medizinische Wochenshrift, No. 1, January, 1870, and American Journal of Syphilography and Dermatology, April, 1870. + “ Tumeur érectile Veineuse de la muqueuse Labiale,” Gazette des Hôpi- tawa, No. 81, 1871. f Die Krankhaftem. Geschwilste, band iii. 492, 493. Berlin, 1867. 168 Subacute Menºngitis Remittent. [Nov., volved in the process. I was, however, struck with the some- what similar clinical history observed in Billroth’s case and in my own. These last two forms of hypertrophy are classed by Virchow under the head of “Angioma,” and the second is probably allied in nature to elephantiasis. From these observations, then, we may conclude that there are five forms of chronic hypertrophy of the lips due to change in the deep structures: the first due to cell-infiltration into the corium and papillae; the second, to an increased development of the connective tissue stratum ; the third, to a hypertrophy of the mucous follicles and the submucous connective tissue ; the fourth, to angiomatous tumors, either arterial or venous; and the fifth due to lymph-angiomatous tumors. A knowledge of these facts, combined with care in the examination of the cases, will undoubtedly lead to an accurate diagnosis. ART. II. SUBACUTE MENINGITIS REMITTENT, BY SUMNER PUTNAM, M.D., Montpelier, Vermont. FEBRUARY 25, 1870.-Robert W , act. fourteen years, was taken with chills or tremulousness after retiring to bed, during which respiration was hurried and noisy, speech unin- telligible, and the mind overpowered ; soon, however, reaction occurred, and he became feverish and delirious through the night. In the morning the symptoms passed off; he rose, dressed, took breakfast, and went about his usual pursuits through the day. During the day, he complained only of hav- ing felt several turns of momentary giddiness, or partial loss of consciousness. Saturday night, the 26th, he was again affected as just described. Sunday, the third day of his attack, he remained in bed, though he would have risen had not his parents objected. Through Sunday, Monday, and Tuesday he remained comfortable, but Tuesday evening was again seized with loss of speech, rapid and noisy breathing, during and after which he could be made to understand but little. Wednesday morning, March 2, I was called to see the patient, and obtained the foregoing imperfect history of the 1871.] Subacute Meningitis Remittent. 169 case. I found the lad with a pulse 70 per minute, skin cool and pale, having complained of headache over the right eye; little or no heat of head; pupils very large, and contracting slowly on exposure to light; conjunctiva not congested ; tongue slightly coated white; no nausea; bowels constipated; free and frequent discharge of urine. Patient calls for food, and promptly puts out his tongue, and correctly answers ques- tions when asked ; but, if left to himself, is constantly calling his attendants, no matter if they are already present; talking, counting, reaching for imaginary objects, and griping those on which he laid his hands. There had been no rigidity about the muscles discovered. Temperature in axilla 98°. Patient was of lymphatic temperament, but has had good health. Had been recently excited in school, and nine months ago received a blow upon the forehead; within two or three weeks had appeared dispirited, and more forgetful than usual. The day before his present attack he made a decided and unusual blun- der about his work, and one of the neighbors had seen him appear in the street as though he had “lost his senses " for a short time. Diagnosis not settled; meningitis, Bright's disease, and obscure chronic brain disease occurred to me. I prescribed foot-baths, sinapasm, a cathartic, and bromide potass. March 3.—Patient had rested but little during the night; was inclined to get off his bed; continually calling his attend- ants, and talking. Temperature 98°. The cathartic prescribed yesterday had not acted, and I ordered one of castor-oil and one drachm turpentine. March 4.—Cathartic has operated well, but does not modify the symptoms. The urine continues free, and is not albumi- nous. Pulse, 80. Temperature 98°. Incessantly calling his friends, talking, counting, etc. Pres. v. gr. Dover's powder, which produced quiet sleep. March 5.-Much the same, except inclined to sleep most of the time. Dover's powders not repeated. March 6, the eleventh day of the disease, says he “feels first-rate”; calls for food; is talkative again. Pupils large and inactive; no nausea; no squinting. Temperature 100°. To have Dover's powder at night if he does not sleep. - March 7.—Was quieted by the powder; will answer some 170 Subacute Meningitis /ēemittent. [Nov., questions correctly, and put out his tongue, but evidently is getting worse; much floccitation and griping with the hands; calls for food, and immediately begins stuffing the bed-clothes into his mouth, but attends yet to his evacuations. Continued the bromide and iodide potass. Applied blisters behind the ears, and gave one comp. cath. pill. March 8.-Temperature 98°. Pill has not acted; gave a dose of castor-oil. March 9–Cathartic has acted two or three times; patient no better, evidently becoming prostrate and emaciated; though with slight assistance he gets to the chair, and occasionally attempts to get off the bed to execute some reverie of his morbid fancy. Temperature in axilla 98°. March 13.−Patient has continued much the same since the 9th until last night, when he became stupid ; respiration fre- quent, and obstructed by mucus; pulse frequent and small. A resort to stimulants seemed to rally the vascular system, but the nervous system became more depressed; intelligence less; evacuations involuntary; right eye bloodshot, pupil larger than its fellow, and immovable. Pulse 120. Tempera- ture 103°. Patient moves very little, lies mostly upon one side or the other; is not palsied. Continued the iodid. pot., renewed the blisters, and gave quinine. March 14.—Patient comatose, pulse frequent and tense. Temperature 104°. No rigidity or spasmodic action, except tremulous rolling of the eyes. Gradually sank, and died on the morning of the 15th, eighteen days after he was taken. On opening the cranium, the vessels were found to be very full and dark, and along their course, between the arachnoid and pia mater, fibrinous matter and pus were deposited. In some places the product assumed the form of small grains. That portion of the coverings of the medulla oblongata rest- ing upon the vascular process of the sphenoid was densely covered with plastic matter. There were, perhaps, two ounces of serum in the arachnoid cavity, with slight excess in the ven- tricles. The central portion of the right anterior lobe of the cerebrum was softened to the extent of an inch or more in diameter, not diffluent, but evidently softened. It may be questioned whether this case was primarily one of meningitis or of softening in the right anterior lobe from embolism, or 1871.] Subacute Menºngitis /ēemittent. 171 other cause of local anaemia, ultimating in meningitis. The post-mortem appearances answer very well to what Niemeyer describes as “tuberculous basilar meningitis,” except the loca- tion of the softening, which in this case could not have arisen from compression by neighboring fluid. The earlier symptoms were not those of tubercular meningitis, but of disturbed cere- bral function, and existed months before the apparent occur- rence of meningitis, which it would seem must have invaded on the night of the 25th of February, in a subacute or remit- ting form. The parents believe they have seen their son occa- sionally put his hand to his right temple and complain of pain, since receiving a blow in that region nine months ago. The neighbors also think the boy has been affected through the winter, at times appearing “not to know what he was about.” Could concussion from a blow have thus resulted, and no marks of long-standing surrounding inflammation have remained Could simply white softening result from concussion ? I regret that sufficient time was not bestowed upon the examination to demonstrate, if possible, the cause of the softening, and if possibly acute tuberculosis existed within the chest or abdomen, though indications of such a state had not existed. That a person should be about the next day after a severe attack of meningitis is very unusual, though Watson and Flint speak of somewhat similar cases, and remark on the frequent obscurity of their invasion, and mention cases that were treated for intermittent fever, gastritis, etc. Niemeyer speaks of remittent types of epidemic cerebro- spinal meningitis, and says occasionally “alternations occur several times, usually with a more or less regular quotidian type.” Again, this case is obscure as regards temperature; only once, until the near approach of death, did the thermometer indicate a temperature above 98°, nor at any time a less degree. Those better acquainted with the use of the instru- ment in disease can perhaps explain why it did not indicate a higher temperature in the earlier stage of the disease. Possi- bly, during the first four days of the disease the temperature might have been higher, though this is doubtful, for his parents did not consider the boy sick enough to employ a physician until the fifth day. - 172 - Medical Thermometers. [Nov., ART. III.-MEDICAL THERMOMETERS. A THERMOMETER is not medical because medical men use it, but if it corresponds to the wants of the medical profession. Thus, a weather-thermometer is not rendered medical because physi- cians have used it for want of more appropriate ones, or even by writing its scale above the point of insertion in the axilla, or because it has been enriched with a self-registering column of mercury; for all that, it remains yet, after as before, a simple weather measurer, starting from the freezing point of mercury or from the melting point of snow; and what are these standards to human temperature, and therefore to human thermometry : -- Thermometers are medical : 1st, If their scale corresponds to the scale of the human blood, as the last and most accurate investigations have established it; 2d, If they are adapted to the various investigations required by modern diagnosis—we have as yet but the fever and surface thermometers—others will certainly be contrived to satisfy the want of positivism in several branches of our art; 3d, If their rendering of the pyrogenetic conditions of diseases is so simple as to be cor- rectly taken, read, and registered by almost anybody left in charge at the bedside during the physician’s absence. The fever and surface thermometers are sometimes made self-registering. This otherwise precious invention of Dr. Aitken does not permit the taking of more than one obser- vation in the absence of the physician—a radical objection to their general use. They mark the acme, but cannot thence descend to the nadir of the temperature. We do want not only the highest and lowest extremes of temperature, but their duration, and the time occupied by the up-and-down marches towards them ; besides, how can we be sure that we have struck One of these extremes with our single observa- tion ? To be effective, observations must be often repeated in many diseases, and must be almost constant in several diseases, and with children, women, and nervous men likewise. To undergo this thermometrical nursing with self-registering instruments would be to add several impossibilities to not a few previous difficulties. And, as physicians themselves have 1871.] - Medical Thermometers. 173 no time to bestow upon this or other nursing, and as serial or continuous observations of temperature have to be taken by delegation, the instruments in use must be equally impressible up and down zero–health—and easy to set, read, understand, and record. • This is the object of the thermometers here represented. They are so simple, and their manoeuvre so easy, that they may be called self-describing. - The following table of temperature, vital signs, and critical periods by Septenaries, has been arranged for the record of the new scale of thermometers, etc. : THE AMERICAN JOURNAL OF OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN.—The last number of this valuable quarterly is now before us, and will compare favorably with any of its predecessors. Its able editor, Mr. Benjamin F. Dawson, has spared no pains to make his journal take a high rank in American medical literature, and it is grati- fying to his friends to see how well he has succeeded. The special province of this journal includes the vast majority of cases which come under the care of the general practitioner, and to that class of medical men we would earnestly commend it. Its contributors are amongst the most prominent physicians who devote themselves to that specialty, and we have yet to see a number which does not contain something of prac- tical value to every member of the profession. ICE IN THE RECTUM IN RETENTION OF URINE.—Dr. Cazenave has, for the last twenty years, used ice in retention of urine, and has never failed in giving relief. He introduces into the rectum a piece of ice of the form of an elongated oval and about the size of a chestnut, which he pushes up beyond the sphincters, and renews every two hours. Almost always in an hour and a half urethral spasm ceases, a certain quantity of urine is passed, and the bladder is emptied without effort by the patient. If in rare and exceptional cases this does not take place, he, besides this, places ice from the anus to the end of the penis, until the urine flows, which it infallibly does. Where prostatic hypertrophy causes the diffi- culty, the good effects of the ice are longer coming on.—The Doctor, 174 A Modification of the AEsthesiometer. |Nov., ART. IV.—A MODIFICATION OF THE AESTEIESIO- METER. BY REUBEN A. VANCE, M.D., Physician-in-Chief to the Wew York Institute for the Paralyzed and Epileptic. SoME months since, in an article treating of the early symp- toms of cerebral disease, I made use of the following lan- guage : “Cases occur continually in which it is necessary to push to the utmost all available means for acquiring a knowledge of the condition of the cerebro-spinal centres. When speaking of the symptoms due to altered conditions of the nervous fila- ments distributed to the integumentary structures of the body, the remark was made that many of the modifications wrought by cerebral disease were not declared in consciousness, and therefore formed no part of the history of the case. This is the fact save in those rare instances where by accident the patient discovers the peculiarity to be mentioned. The nerves of the integument may be modified in one of three ways: their functional activity may be increased—hyperasthesia ; diminished—anaesthesia, or altered so as to cause the peculiar conditions technically known as analgesia or dyaesthesia. The patient will not fail to become conscious sooner or later of the existence of any one of these conditions, except anaesthesia. Tactile sensation may be abolished for long intervals without the individual being aware of the fact. In the early stages of cerebral disease, careful observation demonstrates the fact that this endowment of the skin may be implicated at a period prior to the appearance of any other pathological process which the physician can recognize. Such being the case, it is of the greatest moment that in any patient suspected of having brain disease the condition of the tactile sensibility be investigated, and any alteration from the natural standard carefully noted. This necessity has led to the invention of instruments for the determination of the cutaneous sensibility.” The earliest attempt in this direction was made by Dr. Sieveking, of London, who, in 1858, described an instrument for this purpose which he called an aesthesiometer. This was * VANCE: “The Early Symptoms of Cerebral Disease,” Michigan Uni- versity Medical Journal, July, 1871. 1871.] A Modification of the Aºsthesiometer. 175 simply a modification of the common beam-compass employed by carpenters, and is yet in common use among physicians interested in the pathology of the cerebro-spinal organs. The class of cases in which it is useful were thus enumer- ated by Dr. Sieveking : • 1. “In actual paralysis, to determine the amount and extent of sensational impairment. 2. “As a means of diagnosis between actual paralysis of sensation and mere subjective anaesthesia, in which the tactile powers are unaltered. 3. “As a means for determining the progress of a given case of paralysis for better or for worse.” ” The diagnostic value of an instrument of this nature in cases where sensibility is affected depends upon the fact that the capability of distinguishing two impressions made simultane- ously varies in different regions of the body according to the distance they are apart. “For instance, the two points of a pair of compasses can be distinguished at about the sixth of an inch apart when applied to the end of the finger, while upon the back of the hand only one point is felt, though they are an inch apart. The compasses contained in any draughting case answer admirably in any instance where it is necessary to employ an instrument for the purpose of measuring the sensibility. In practice, it is un- necessary to pay attention to the elaborate tables which record what purports to be the absolute sensibility of the different re- gions of the body, for each and every individual examined will be found to present variations from these standards. In inves- tigating disease, the capital fact to be borne in mind is, that the comparative sensibility of corresponding situations on the two sides alone affords diagnostic indications. In health, the two sides are almost alike as regards sensibility, the left side being a trifle the most sensitive, according to my Observations. In cases of impending cerebral disease, while the sensibility on one side remains normal, there will be such marked anaesthesia of the opposite side that the points of the aesthesiometer will have to be separated four and five times as far as on the healthy side before the patient can distinguish the two points. It is * SIEveking : Brit, and Foreign Med.-Chirurg. Review, J anuary, 1858, p. 215. - 176 A Modification of the Æsthesiometer. [Nov., unnecessary to dwell upon the diagnostic significance of so grave a fact as this.” ” Although it is undoubtedly true, as above stated, that an or- dinary pair of compasses can be made to furnish valuable in- formation in cases where it is necessary to test the cutaneous sensibility, yet it is equally true that such clumsy instruments are rarely to be resorted to. They are certainly not imple- ments for a physician to use, and their employment is not cal- culated to produce a favorable effect upon the patient in regard either to the physician or his investigations. For the purpose of noting the phenomena presented by patients suffering from brain diseases, it is essential to have an aesthesiometer of a compact form and small size—one that can be conveniently carried in the pocket of the physician. This want has led to the con- struction of a number of instruments, many of which possess peculiar merit. * In the last number of the Medical Record, Dr. Alfred L. Carroll described and illustrated an instrument constructed on the general plan of the two-legged compass, but with each free extremity divided into two points, one blunt and the other sharp. This arrangement enables the observer to determine the comparative sensibility to contact and pain at different dis- tances by simply substituting the one pair of points for the other. Dr. Clymer provides himself with two pieces of cork or two small shot, and accomplishes the same result by placing them upon the sharp points of the ordinary instrument when he desires to test the sense of contact without danger of excit- ing that of pain. The accompanying illustrations exhibit an instrument that, so far as portability is concerned, leaves nothing to be desired. Its actual size, when closed, is represented by the first figure, while in the second the manner in which it is to be used is shown by a half-size illustration. When closed, the points are in coaptation, and are received in the case the same as the blades of a knife shut into its handle. When opened and the points separated, the distance between the points is denoted by the position of the slide, which is so arranged as to move over a scale engraved on one arm of the aesthesiometer. The scale is divided into inches and twelfths of an inch. The points can * * VANCE : . c. 1871.] A Modification of the Æsthesiometer. 177 be separated to the extent of six inches. When closed, the instrument is four and one-fourth inches in length. An instrument which, like this one, can be carried in the pocket habitually, will enable a physician to make observations which would otherwise be impossible. For instance, certain remedies have an important influence upon the cutaneous sensi- bility—some depressing, others exalting it. A little careful observation would furnish very valuable information upon these points, and might extend our knowledge of the mode of action of such remedies in a very important manner. Shepard & Dudley. In certain forms of nervous disease, the aesthesiometer fur- nishes important data for prognosis. In a case of hemiplegia recently under my care, treatment was prosecuted for several weeks without the slightest amendment being apparent to the patient or his friends, yet during the whole time improve- ment was going on, for the tactile sensibility in the paralyzed side, as indicated by the aesthesiometer, gradually became more acute, until, finally, the sensibility of the two sides became nearly alike. The subsequent recovery of this patient fully justified the prognosis given from the first, and which was based entirely upon the results obtained with the aesthesiometer. - VOL. I.-14 178, The Surgery of Bleeding Vessels. [Nov., §tlettel'ſ 3rticles, A CONTRIBUTION TO THE SURGERY OF BLEED- ING VESSELS. BY ALEXANDER OGSTON, M.D. IN a former paper (the Lancet, 1869) I adduced a number of experiments bearing on the subject of the comparative strength of arteries secured by ligature, acupressure, and torsion, from which it appeared that ligature was by far the most secure method, resisting the highest column of mercury (114 inches) brought to bear upon it by the dynamometer, while acupres- sure and torsion resisted on an average respectively a column of 23.5 and 13 inches. These experiments were criticised at the time by Mr. Lawson Tait, but I still venture to affirm that they give a fair comparison of the value, as far as security goes, of the different methods. Excepting the assumed normal pressure of blood in living vessels, which was, I believe, stated at too high a figure, the only factor omitted by them is that of the elasticity of, and additional security furnished by, the por- tion of tissue included along with the artery between the pin and wire when acupressure is performed, and which protection accounts for the inner and middle coats of the vessels being, as is alleged, not cut through by this method. These experiments have not been continued as originally intended. They are sufficient evidence as they stand, and they gave place to a new line of experimentation undertaken with a view to improve upon, or add to, our present methods of arresting bleeding from cut vessels. - That none of our present modes is entirely satisfactory can- not be denied. Torsion seems, in some hands, to have given marvellously good results; but, having had no opportunity of witnessing it as applied regularly to large vessels, I can only say, under liability to correction by those who have tried and adopted it, that the small amount of internal pressure resisted by it forms a serious, although the only, objection to its use. In Aberdeen, on the contrary, we have abundant opportunity of studying acupressure, and the result of my own observation 1871.] The Surgery of Bleeding Vessels. 179 is to convince me that it cannot retain the place originally claimed for it in operative surgery. The one real advantage that it possesses is that it allows the wound to be freed from foreign bodies one or two days after operation—doubtless a very important matter, but which can be attained without its employment. The asserted frequency of primary union in wounds treated here by it, and the absence of suppuration in such wounds, are to a certain extent correct. In amputations of the mamma it yields first-class results, primary union and absence of pus being generally achieved; but in other ampu- tations suppuration occurs just as usual, the statements to the contrary being due partly to the great enthusiasm of its advo- cates, and partly to a careful nurse removing, as far as possible, all traces of discharge before the visit of the surgeon. Acupressure has several disadvantages. The pins frequently prevent complete closure of the wound at the time of the ope- ration, and at the edges have to be accurately adjusted at a subsequent period. The removal of the wires requires a con- siderable degree of traction, and, in the employment of the ring-loop, is sometimes a matter of difficulty; while, in at least one recent instance, an acupressed vessel in an amputa- tion wound required, owing to secondary hamorrhage, the sub- sequent application of the ligature. The estimate of acupres- sure I have formed is similar to that of many other surgeons who have given it a trial. - Considering, then, the superior strength of ligatured vessels, it would be a step in advance could the ligatures be applied in such a manner as to retain their superior security, and yet so as to allow of their being removed about the second day after Operation, before the tendency to suppuration has commenced in the wound, and also so as to avoid snaring off the ends of the arteries and the tissue grasped by the forceps in the usual mode of applying them. . - All these advantages are combined in the method I have now to propose—namely, that the bleeding vessels be secured by the knot depicted in Fig. 1, which, if it be run close, and the short end be cut off close to the knot, can be removed by very moderate traction on the long end. The knot, it will be per- ceived, is merely the “thumb or overhand knot,” similar to the first part of the knot ordinarily applied to arteries, with 180 The Surgery of Bleeding Vessels. [Nov., the single exception of a loop of the long end being employed instead of the undoubled cord. Its hold is perfectly sufficient when tied, but I shall afterwards come to discuss its security. zº W º In applying the knot to the flaps of an amputation wound, the following is the method I have adopted : A piece of the strongest ligature silk, well waxed to diminish the risk of slip- ping after it has been tied, has one of its ends passed an inch or thereby through the eye of a curved needle. (A few such armed needles are prepared before the operation.) The bleed- ing vessel being seen, and its course above the orifice estimated, Fl C. .2 the needle is entered from the raw surface of the flap, a quarter of an inch on one side of the course of the vessel and the same distance above the bleeding orifice; then passed down behind the vessel, so as to include it between the needle and the raw surface of the flap; and, having crossed behind the vessel, is brought out a quarter of an inch on the other side of 1871. The Surgery of Bleeding Vessels. 181 its track. The needle is next drawn through, bringing a couple of inches of the thread with it, as in Fig. 3, and it may then be detached from the thread. A loop of the long end, an *Sº inch or thereby in length, is then used to form, with the single short end, an ordinary “thumb knot,” as in Fig. 1, or, if addi- tional security is required, a double knot, as in Figs. 2 and 4. The knotis closed upon the vessel and included tissue by traction on the loop and short end ; the strands of the loop are placed close to each other, so as to lie in contact through- - F | C .4 out and offer no obstacle to removal when the long end is pulled; and, finally, the short end is cut off close to the knot. | Such knots do not slip till traction is made on the long end, which ought to be brought out at the side of the wound next the original point of entry of the needle, and not doubled again over the vessel; and, correspondingly, the loop is laid suitably directed away from the vessel in the direction of the needle when it emerged at the further side of the artery. In small 182 The Surgery of Bleeding Vessels. [Nov., arteries the single knot is amply sufficient; in large arteries, I use the double knot for the sake of security. The ligature is removed, on the second day after the operation, by gentle trac- tion on the long end; and the amount of force required for its removal, while too great to be readily effected by accident, is, notwithstanding, less, even with the double knot, than that needed to remove the wire where acupressure has been employed. . - The advantages of this proceeding consist in the speedy removal of foreign bodies from the wound, and in the fact that no tissue is compressed or strangled by it save the portion lying in the very knot itself. The distal end of the vessel is still in connection with the living parts surrounding it, and its nutrition is not interfered with. The strength of the method is another of its advantages. Wessels experimented upon in the manner given in detail in my former paper resist, when secured with the single knot, from 24 to 70 inches of mercury; and, on an average, 39 inches of mercury, or pressure of 19 lbs. to the square inch, as against 23:5 inches of mercury with acupressure, and 13 inches with torsion. The double knot resists the full column admitted of by my dynamometers—viz., 114 inches of mercury, or 57 lbs. to the square inch. I have tested in animals this application of ligature to cut vessels, and to vessels deligated in continuity, before using it in man, and the results were perfectly satisfac- tory. In man, they have hitherto been equally so. I have at present a stump after Pirogoff's amputation treated in the above way, where the ligatures were removed on the second and third days, and which is healing with as small an amount of discharge as I ever saw obtained, even with acupressure. The disadvantages are that, as in acupressure, some tissue is included along with the vessel; and where structures such as important veins and nerves run parallel to the artery, damage might. be done by their inclusion. Thus it is best suited for amputations; indeed, without further experience of it, I should hesitate to employ it in the deligation of an artery in continuity upon a human subject. I have had no opportu- nity of testing it in that most difficult of all vessels to secure, an interosseous artery in the angle of a flap amputation, but believe that, by laying hold of the bleeding orifice and the 1871.] Jeeviews. 183 tissue surrounding it, and then proceeding, as in a flap, to pass the needle behind it through the grasped mass, it would answer as well as the ordinary ligature.— Lancet. it tº it tug. SKIN DISEASEs: THEIR DESCRIPTION, PATHology, DIAGNoSIs, AND TREATMENT. By Tilbury Fox, M.D. First American from the last London edition. Edited by M. H. Henry, M.D. Wm. Wood & Co., New York. 1871. - It is with great pleasure that we see an American reprint of the very excellent Manual of Skin Diseases by Dr. Fox. The increased attention given to skin diseases by the American physicians, students of medicine, of late years, has rendered a clear and practical work upon this subject absolutely necessary, and we are fully convinced that the work of Dr. Fox will supply the void much better than any one in the market or any other work extant. Not that we think that the work of Dr. Fox is in every particular superior to others, but that it is so practical in char- acter, clear in detail, that it will answer an admirable purpose just at the present time in this country, when the profession are in need of a work of moderate size embracing the rudiments of the branch rather than elaborate and exhaustive treatises upon it. It is true that there are works of greater pretension and scope, some entering more thoroughly into the history, nature, and pathology of diseases of the skin, others devoted to elaborate studies into their etiology and classification; and these works, though useful in their way, and, in fact, absolutely essential to the pro- fessed dermatologist, would only be stumbling-blocks to the general practitioner. So that we repeat, that the work under consideration, which deals principally with clinical descriptions, diagnosis, and treatment, is the one at present needed here. There undoubtedly will come a time for this branch, as there has for that of practical medicine proper, when minute points in pathology in skin diseases will possess an interest for every practitioner, but the study of skin diseases in this country is not generally so far advanced as to require such a treatise—therefore, one bringing out prominently the features just alluded to will be the one at present in demand. We would not be understood as conveying the idea that Dr. Fox wholly ignores pathological research, but that he just introduces enough for a text-book, making it an accessory rather than an essential of his work. . The first two chapters of the work are devoted to general considera- tions of the subject and to the elementary lessons. They are both notice- able for their practical character, and we recommend beginners to thoroughly study that portion descriptive of the elementary lessons; for, 184 Reviews. - [Nov., if it is thoroughly mastered, it will assist the student very greatly in a comprehension of the subject, and will pave the way for greater accuracy in diagnosis. Another feature of this portion of the work is that the idea of specialism in these diseases is not inculcated, but that they are shown to belong to the department of practical medicine, and as such require study by every physician. This view of the subject is of very great importance, for we know of no greater drawback to any department of medicine than that of enveloping it in the mysteries of a specialty. Not that we in the least reprobate the attention specially directed by various observers to any branch, for the good derived from such study is obvious to the world; but we do reprobate the tendency of some obser- vers to separate and elevate particular branches as entities, and not con- sider them subdivisions of the great whole—namely, the practice of medi- cine. We find the etiology of skin diseases very fully treated of, and we find that Dr. Fox, while he fully recognizes the important parts played by external irritants in producing diseases of the skin, also shows in what way systemic influences may tend to their production. The remarks upon this subject are practical and very judicious. As all systematic treatises require for their groundwork a classification, so Dr. Fox has one in his Manual. He modifies the clinical classification of Mr. Wilson, and makes one which is very useful, but, like all others in the as yet immature state of the branch, has its objections. Nevertheless, it has its decided advantages over its original, and at least spares us the infliction of a new one at his hands. In passing, we would allude to one objec- tion to the third class of Dr. Fox, namely, diathetic diseases, under which among others he includes strumous and alphous skin diseases. Now, as there is as yet so much doubt in the minds of many observers of repute as to the really diathetic origin of these diseases, and the subject is now in reality subjudice, we think that its recognition and adoption in a scheme of classification does not in the main tend to accuracy. Indeed, in Dr. Fox's later writings—namely, his Lectures upon Eczema—we think we perceive a modification of views upon the influence of diathesis in pro- ducing diseases of the skin; consequently this matter, we think, will undergo reconstruction in a future edition. We must also call attention to the conciseness and completeness of Chapter Fifth, which treats of, in a general way, diagnosis, prognosis, and treatment. The limits of this review preclude a general analysis of the contents of the book, and therefore we shall confine ourselves to some of its more general and important features. , - - The subject of eczema is in the main well and clearly treated of; but it must be remembered by the reader that it is written under the influ- ence of Dr. Fox's views upon eczema. Dr. Fox, as is well known, is an ardent champion of the great Willan, and stands at the present day nearly alone in the views which he entertains about eczema. We find that his definition of this disease is somewhat limited, and that it ex- cludes impetigo and lichen as varieties of it. Indeed, Dr. Fox insists upon the discharge feature of eczema as being a sine qué mon, and is 1871.] Jºeviews. . 185 fearless in his statement that each typical case of eczema begins as a vesicle. If, then, we only consider a given skin disease as eczema which, besides its other varied features, presents at one period of its existence the peculiar discharge, we must admit that, in that view, Dr. Fox has dealt well with his subject. He, like Willan, considers that this disease runs its course in three forms, namely, eczema simplex, eczema rubrum, and eczema impetiginoides. In accordance with the modified views on eczema, this answers a good purpose; but we are at a loss to see the necessity of treating impetigo as a separate disease while we have animpeti- ginous form of eczema fully described. With these differences in views as to doctrinal points, we must praise the general description of the disease and the directions for treatment. . We regret to see psoriasis classed as an alphous disease upon so bare a pretext as that the scales of psoriasis are white. Indeed, we look upon this as an unwise adaptation of one of Mr. Wilson's scholastic vagaries, which, if adopted in each disease, would render the study of skin dis- eases in this country a dead letter to the greater number of practitioners. We also regret the continuance of the use of the word lepra, and would prefer the use of the term psoriasis as the one recognized and understood by every one. Such an important class of diseases as those of vegetable parasitic origin we should expect would be fully and carefully treated, especially as the author has studied them so faithfully for many years, and, indeed, , we find much space devoted to them, and their whole clinical history is well described. One point strikes us as being pertinent, and as having been verified by personal clinical observation, and that is, that in some cases of parasitic skin disease there appears to be a peculiar favorable condition to its continuance, which can only be accounted for by some inherent defect in the nutrition of the skin which allows the parasite to luxuriate, from which Dr. Fox deduces an important therapeutical indi- cation, and that is, that in many instances a local treatment is wholly powerless in producing a cure, unless the state of the integument is so modified by internal medication that it ceases to afford pabulum to the development of the parasite. At the end of the book we find a copious formulary, which, as usual, contains many inefficacious and obsolete re- medies. We think that, in a future edition, Dr. Fox can economize space by abbreviating this section fully one-half, and not impair the value of his book. Finally, we would say that the various diseases are accurately and lucidly described, and their treatment tersely set forth, and that, all things considered, it is a useful and trustworthy work for the student and practitioner. The work of the American editor has consisted in inserting the notes, which in the English edition were in the appendix, in their proper places, in interpolating an instructive article by Hebra, and in arranging the formulary in a more convenient manner. We are glad to see that he has not followed the course so often pursued by American editors upon the works of English and Continental authors, in burdening the book with lengthy and irrelevant notes, which in the majority of 186 Proceedings of Societies. [N ov, cases is a great detriment. The American reprint forms a handsome octavo, much more convenient in size than the original. It is well printed upon fine paper, and the type, though not large, is very legible, and the binding is certainly in very good taste. #31:0 teti) in gº of $o tieties. PATHOLOGICAL SECTION OF KINGS COUNTY MEDICAL SOCIETY, BROOKLYN. September and October, 1871. DR. HUTCHISON exhibited an encephaloid cancer involving the left Superior maxillary and molar bones, both of which were removed with the malignant growth. - Also, an epithelioma which had destroyed the lower lip and anterior portions of inferior maxillary bone. The latter was sawed through on left side at angle, and on right about middle of body. The amount of soft tissues necessarily removed so shortened the flaps as to prevent complete closure of wound, even after a deep horizontal incision was made through each cheek. They were brought as nearly together as possible, secured by pins and twisted sutures (as for harelip), and left to granulate. There were two points specially important in this case : 1. There were alarming symptoms of suffocation, due, it was thought, to spasm of glottis. - 2. The remaining portion of body of bone on right side gave trouble from being drawn inwards over the tongue, and will have to be re- moved. He also exhibited a piece of slate-pencil, two and a half inches long removed by bilateral incision from the bladder of a married man. It had been used for titillating the urethra, and, accidentally slipping from his grasp, entered the bladder. After the operation, no urine escaped through the wound until the fifth day, and then only a few drops. Dr. Raymond exhibited the skull of a still-born hydrocephalic child. The total cerebral matter lay in the cella tunica, and weighed but 7 grs. Cerebellum weighed 7 dr. 23 grs. Eyes were well developed, but optic nerves could not be traced. He referred to a specimen in the Warren Museum Collection, Boston, history of which stated that no cerebral substance was present, yet child lived three years with sight and hearing good. He also presented a stomach and other organs from an obscure case. The walls of stomach unusually thickened; a rim of hard fibrous tissue constricting the pylorus; and the remains of an ulcer near each orifice The man suffered much from gastric distension, but morphine subcutan- eously would give instant relief. 187t. Proceedings of Societies. 187 Dr. Wunderlich said a quantity of liquid in stomach is sometimes a cause of gaseous distension, by dragging the organ downwards, constricting py- lorus and preventing efficient contractions. He stated that Kussmaul and Niemeyer had adopted the plan of removing this liquid by means of the stomach-pump, and afterwards washing out the organ by same method. These walls were unusually thick, yet had seen one thicker from chronic inflammation and tubercular deposit. Dr. Geo. K. Smith spoke favorably of the Faradic current for the re- lief of gaseous distension of the bowels and especially the colon. Dr. Mathewson thought the immediate benefit derived from the hypo- dermic injections of morphia indicated spasm of the stomach. Dr. Raymond attributed the pathological conditions to the excessive use of alcohol. . Dr. Thayer exhibited a two-cent piece which had lain four months in the stomach of a child two years old, causing persistent cough and dis- tressing dyspnoea. It finally passed per anum with entire relief of pul- monary symptoms. - Dr. Geo. K. Smith exhibited the lower half of the brain from a man who had been seven years paralyzed. It was thought to be abnormally firm. He took occasion in course of his remarks to propose a new method of securing the spinal cord without dorsal incision, by remov- ing bodies of vertebrae from within. Dr. Rushmore exhibited a cauliflower growth of cervix uteri, removed by the galvano-cautery; also the uterus and ovaries from same patient, widow aged 28 years. She died of tetanus on the fourteenth day; a hard plug of cotton, soaked in a solution of persulphate of iron, was found in the formix, and seemed projecting into the cul-de-sac of Douglas, yet very slight traces of inflammation were present. - Dr. Byrne believed the tetanus was induced by a cold sponge-bath taken on the eighth day, and was the cause of death. He was certain perforation could not have occurred at time of operation. The very limited amount of inflammation was not sufficient to produce death. He attributed the profuse haemorrhage to the rapidity with which the cervix was cut through. The hardness of the plug was due to the per- sulphate, which he did not use as a styptic, much preferring the actual Cautery, tannin and glycerine, or dilute acetic acid, Dr. F. N. Colton exhibited a collapsed lung, with three perforations in front of apex. Death from pneumo-hydro-thorax. During course of di- sease, no gurgling or tinkling sounds were present. He also showed the upper portion of abdominal aorta, the seat of aneu- rism projecting each side of the spinal column. In left projection, behind the peritonaeum, was a small opening through which blood had slowly passed, forming a large firm clot which extended into the pelvic cavity. Towards the last, patient had an attack of acute mania. Symptoms in- dicated a rupture of aneurismal sac four hours previous to death. Two hours before, was without pulse or speech, when morphine subcutaneously restored both for a time. - 488 Proceedings of Societies. [Nov., JUDGE BEDFORD’S AMENDMENT TO THE ABORTION LAW - IN THE ACADEMY OF MEDICINE. r At a meeting of the New York Academy of Medicine, held on the 21st of September, 1871, the following preamble and resolutions were ananimously adopted: - - “Whereas, In charging the Grand Jury on the occasion of opening the Court of General Sessions, September 6, 1871, Judge Gunning S. Bedford said: “Of late we have been living in an atmosphere of abor- tion. The very air is indeed heavy with the dark deeds of those heart- less and unscrupulous specimens of human depravity, professional abortionists. Let the warning word this day go forth, and may it be scattered broadcast through the land, that from this hour the authori- ties, one and all, are to put forth every effort and strain every nerve until these traffickers in human life be exterminated and driven from existence, by fully vindicating the majesty of the law in all of these cases of its fiendish violation. Let me express the earnest hope— shared in, as I feel confident it will be, by you and by all right-minded citizens—that the Legislature, at its next session, will amend the statute-book, so that, instead of reading, “Any person who shall administer to any woman with child, or prescribe for any such woman, or advise or procure her to take, any medicine, drug, substance, or thing whatever, or shall use or employ any instrument or other means what- ever, with intent thereby to procure the miscarriage of any such woman, tunless the same shall have been necessary to preserve her life, shall, in case of the death of such child, or of such woman, thereby produced, be deemed guilty of manslaughter in the second degree” (commonly known as the crime of abortion), it may read, “shall be deemed guilty of Amurder in the first degree,” then the punishment would be death. Now the crime is simply manslaughter in the second degree, punishable by imprisonment not exceeding seven years.” “Resolved, That in the opinion of the New York Academy of Medicine, the author of that language has, by so public a declaration of his sentiments, his intentions, and his hopes, given us reason for renewed expression of highest commendation, has vindicated the already widely-expressed support from the medical profession of the country of the course he has hitherto pursued, and has, we trust, greatly strength- ened the esteem and confidence in which he is held by the public. “Resolved, That this Academy, in the discharge of its professed duty to promote public health and public morals, pledges all its influence and all its efforts in support of any legislative or other measures which our law officers may propose as offering a reasonable promise of mitigating, if not removing, the pestilence of criminal abortion which is upon our country. “Resolved, That to remove all doubt from the public mind in regard to the position of the New York Academy of Medicine in this impor- tant matter, to secure the influence upon the State authorities desired 1871.] Miscellaneous. 189 tº: by this expression, and to stimulate the medical profession generally to similar acts, a copy of this preamble and these resolutions be forwarded to Judge Bedford, to District-Attorney Garvin, and to the President of the New York Bar Association; that the principal daily papers of this. city and the medical journals be furnished with the same; and that the secular and medical papers throughout the country be requested to copy.” MEDICO-LEGAL SOCIETY.—The fourth annual anniversary meeting of the Medico-Legal Society was held at the College of Physicians and Surgeons, Thursday evening, October 12, 1871. The annual reports of the various officials were read, and the society then balloted for officers to serve during the ensuing year, with the following result: President, Stephen Rogers, M.D. Cor. Sec., J. F. Chaveau, M.D. Vice-Pres., Jacob F. Miller, Esq. Librarian, Wm. Shrady, Esq. {{ Reuben A. Vance, M.D. Pathologist, S. J. Clark, M.D. Treasurer, F. S. Bahan, M.D. Chemist, A. Wohlfarth, M.D. Rec. Sec., James Ross, M.D. Asst.-Rec. Sec., Wm. M. Kemp, M.D. Trustees. J. C. Peters, M.D. J. J. O'Dea, M.D. Clark Bell, Esq. Jacob Shrady, M.D. T. C. Furnell, M.D. H. P. Farnham, M.D. The stated meetings of this society are held at the College of Phy- sicians and Surgeons, at 8 P.M., on the second Thursday of each month. iſłłisteſtantous. CHOLERA.—The amount of interest which is justly being felt in regard to the approach of cholera is the excuse we have to offer for devot- ing so much of our space to the following résumé of the recent contri- butions to our knowledge of this subject, which is copied from the Doctor of Sept. 1, 1871: “The British Medical Journal has published, from advance sheets, Sir Thomas Watson's ‘Lecture on Cholera,’ of which we proceed to give a full account : - “The learned lecturer is of opinion that very few of the original doubters remain unconverted to the doctrine which Sir Thomas held from the beginning, that epidemic cholera is catching—results from a material poison which is portable, capable of being conveyed from place to place, of being communicated from person to person, and from inani- mate substances to which it clings, food, furniture, clothing; that the morbific matter floats in the air and is wafted by its currents. He agrees with Dr. Baly that, when it travels over distances, it uses the vehicle of human intercourse, but that it may be diffused over shorter distances——as from either extremity of a town, or from a tainted port to a ship anchored to leeward—by the movements of the atmosphere. Long migrations of the disease are not made rapidly, and its rate of progress seldom exceeds the modern rate of human travelling. Its pri- 190 | Mºscellaneous. [Nov., mary appearance in an island or a kingdom is always at its outer boun- dary. In the statistical report of the Royal Navy, published in 1858, Dr. Bryson says, “The medical records of the Royal Navy have been searched in vain to discover one instance in which either cholera-morbus or yellow fever made its appearance amongst a ship's company, unless one or more of the men or officers had previously—within at most twen- ty-one days—been exposed in some house, ship, or locality where the infectious virus, which emanates from persons ill of the one or the other of these diseases, existed. The spontaneous origin of either mala- dy far away from an infected locality is unknown in the naval service.” “That the atmosphere forms one vehicle of infection seems proved by many incidents. At Constantinople it was observed, in 1865, that while the cholera raged there the sea-gulls, which used to flit over the waters of the Bosphorus, deserted it, nor did they reappear until the disease had departed and the atmosphere became pure. During the time of the first epidemic (1832), a Westport;correspondent of the Dublin Morning Register stated that, in the demesne of the Marquis of Sligo, near Westport House, there had been a large rookery. On the first or second day of the appearance of cholera there, all the rooks disappeared, and, during the three weeks that the epidemic raged in the district, did not return to their lofty habitations. Immense numbers of them were found lying dead on the shore, near Erris, about ten miles distant ; and, upon the decline of the malady, several of the old birds resumed their stations in the rookery, but some of them seemed unable, from exhaustion, to reach their nests. A proof that the air may be the vehicle of infection, and that the poison may enter the lungs with the breath, is furnished by the story of the two pilots who were stricken in consequence of having their open boats towed, by a ten-fathom rope, at a considerable distance astern of the steamship England, on board of which cholera raged, neither of these men had been on board the vessel; both took cholera, both transferred the disease to their families and to Halifax, where it had not appeared for many years previous. Still it seems doubtful whether the disorder can become epidemic except in certain conditions of the atmosphere “Mr. Glashier states that, in London, “the first three epidemics were attended with a particular state of the atmosphere, characterized by a prevalent mist, thin in high places, dense in low; during the height of the epidemic in all cases the reading of the barometer was remarkably high, and the atmosphere thick; in 1849 and 1854 the temperature was above the average, and a total absence of rain and a stillness of air accompanied the progress of the disease. In places near the river the night temperature was high, with small diurnal range, a deficiency of electricity, a total absence of Ozone, probably destroyed by the decom- position of the organic matter with which the air was charged.” There is no ground for ascribing cholera to the absence of ozone, except in the sense of there not being a sufficient quantity of it in the atmosphere to counteract all the poisonous miasm which actually produces that dis- ease. The total absence of ozone affords presumptive evidence of the presence of atmospheric impurities, but atmospheric impurities cannot generate cholera unless the specific exciting poison be present. In the autumn of 1859 the Thames stunk horribly, yet we had no cholera, and there is good reason to believe that this poison can never create a spread- ing pestilence unless it meet with a congenial atmosphere—the foul air lends force and diffusion to the poison, and aids or causes its increase. “The late Dr. Snow was the first to broach the notion that the poison may be swallowed with the food we eat, or the liquids we drink, and its multiplication take place within the system, whence by the alimentary canal a new and abundant stock of it is voided. The rice-water excre- 1871.] JMiscellaneous. 191 tions, colorless and nearly odorless as they are, may, without notice, adhere to our food during its preparation or its consumption, and the disgusting fact has been revealed to us by the microscope, that the water of some of our public companies habitually contains visible particles of human ordure. Mr. Simon reported to the Board of Health, as the re- sult of the enquiry founded on Dr. Snow’s theory, that “the population drinking dirty water appeared to have suffered three and a half times as much mortality as the population drinking other water.” The propaga- tion of the disease Mr. Simon considers due to excremental pollution; excrement-soiled earth ; excrement-reeking air; excrement-tainted water; and adds that the local conditions of safety are appropriate structural works, complete removal of fecal impurities, and pure untainted and uncontaminated water, Sir Thomas considers our knowledge of the morbid anatomy of cholera more complete during the last epidemic, drawing his conclusions from the post-mortem inspections made by Drs Parkes, Johnson, and Sutton. In cases of death from collapse, when an early examination is made, the lungs are shrunken, dry, pale, and light, in a word, unnaturally bloodless. The left ventricle of the heart is con- tracted and nearly empty. The right cavities, the trunk of the pulmon- ary artery, and the systemic veins are much distended with blood ; the mucous membrane of the intestines is pale and free from conges- tion. In some cases the lungs, though light in weight, may be dark in color, which gives them the appearance of congestion ; this color Dr. Johnson refers to a backward engorgement of the bronchial veins and capillaries, consequent upon the block in the pulmonary artery and its branches. When death occurs during incipient and imperfect reaction, the morbid conditions disclosed by dissection are the reverse of the foregoing, for the lungs are congested, sometimes inflamed, and the mu- cous membrane of the intestines is loaded with blood. These points bear upon the pathology of the disease, and upon its true pathology rests its rational treatment. “There are two conflicting theories as to the pathology of cholera, and there are two conflicting principles which accord with and flow from these theories, as to its proper treatment. Upon this momentous problem of treatment the final appeal must be made to experience. “It is acknowledged that the primary and special danger in cholera lies in the period of collapse, and it was a natural and plausible theory which attributed collapse to a drain upon the blood by profuse and re- peated fluxes from stomach and bowels, whereby the blood being robbed of its more liquid ingredients, and made thick like tar or treacle, be- came incapable of flowing freely, if at all, through its natural channels, and thus the circulation, coming ultimately to a stop, life stopped also : so the practice put in force was to arrest the destructive flux by astrin- gent drugs and by opium, to urge on the lingering circulation, and to restore the spent strength and the lost animal warmth, by alcoholic and other stimulants. Upon similar grounds was advocated the dilution of the thickened blood by water injected into the veins. On the other hand it is affirmed that collapse is not due to excessive discharges, but that these discharges.eliminate the cholera poison, or its products, from the body, and are to be encouraged rather than checked; consequently, that astringents and opiates are partially hurtful. Now, were the first theory the true one, there must exist a relation between the alleged cause and the effect of it; therefore, the greater the intestinal discharge, the more decided should be the resulting collapse. But no such proportion has been discovered; nay, the very reverse often obtains, and the most hopeless are those cases where collapse has followed absence of or very scanty discharges. Again, if collapse were owing to the drain on the blood, it would be prolonged, and become more perilous by the continu- 19 s Miscellaneous. [Nov., ance of those discharges; whereas it is a notorious fact that patients. emerge from collapse and recover, the evacuations continuing through- out. But in cases where evacuations stop during collapse, a fatal result generally follows. Dr. Parkes states that, ‘exclusive of the mildest form of the disease, a case with little vomiting or purging is more malignant and rapidly fatal than when these prominent symptoms are present.” “Tested, then, by the evidence of acknowledged facts, this theory must be pronounced a failure, and the treatment founded upon it a mistake “A fallacious analogy has been assumed between the collapse of ex- haustion arising from a drain upon the blood, and the collapse in cholera. Only in one point (the smallness, and weakness of the pulse) are they analogous; in every other point they differ widely. A person exhausted from loss of blood, or from a continued drain upon that fluid, may be in a state bordering on syncope; if he assumes the erect position, he may faint and become unconscious; but in the collapse of cholera, a patient with death stamped upon his features, with no pulse at the wrist, and a blue and icy-cold skin, may be able to walk his room and perform many of his usual functions, at the peril of his life, it is true, but the fact of his capability proves there is an essential difference between cholera col- lapse and ordinary syncope. The exhausted man, if he recovers, does so slowly, and with therepair of his impoverished blood. The cholera patient rallies at once, if at all, from his collapse. Again, the coldness and faintness of exhaustion are relieved by wine and brandy, but in the collapse of cholera alcoholic stimulants do not warm or invigorate, even for a moment, but seem to make matters worse. To draw blood from a person fainting from exhaustion may ensure death. ...Blood-letting in cases of collapse has sometimes afforded marvellous relief. “To Dr. George Johnson is justly due the great merit of having, by persevering efforts, established the worth and efficacy of the evacu- ant or cleansing practice in cholera. He holds, like many before his time, that the phenomena of cholera result from the entrance of poison into the blood, where it probably undergoes, like Small-pox, a process of self-multiplication, and destroys some of the blood constituents, which are ejected through the mucous membrane of the alimentary canal. The feeling of oppression and malaise sometimes experienced before the bowel symptoms are indicative of blood poisoning. The discharges are expressive of the efforts of nature to throw off noxious material, and consequently a necessary part of the process of recovery, and by check- ing the excretion, the risk of fatal collapse is increased. If ‘elimina- tion” be nature's method and condition of recovery, art may help it by the cleansing, and hinder it by the astringent treatment. “What is the explanation of the contrast between the anaemic condi- tion of the lungs, and the gorged condition of the trunk of the pul- monary artery and systemic veins, as observed after death, during collapse, and the sudden arrest of the stream of blood in the small arteries before it reaches the capillaries & Were the arrest of motion. due to gradual thickening of the liquid portion of the blood, it would be found stagnating in the capillaries as well as in the arteries. Bear in mind that one characteristic symptom of cholera which renders it a dis- ease truly to be dreaded—cramps in the large muscles of the body—pro- duced, we may assume, by the choleraic poison, just as they are produced by the poison of strychnine. Dr. Johnson supposes that a similar spasm, or cramped state of the muscular fibres which embrace the minute pulmon- ary arteries, is caused by the same choleraic poison, and bars these slender channels against the advancing blood. The thickening of the blood is a consequence, and not a cause, of arrested circulation and collapse. Precisely the same blood-thickening occurs as a result of the impeded 1871.] Miscellaneous. 193 circulation through the lungs, which is associated with long-continued, extreme, and fatal apnoea. The true explanation of the fact that diar- rhoea does not cause thickening of the blood, is probably—as Dr. John- son suggests—that water is rapidly absorbed from the soft tissues to take the place of that which escapes from the alimentary canal. Acting on this principle of physiological hydraulics, we remove a dropsical ac- cumulation by the action of hydragogue cathartics. Dr. Johnson does not propose to excite discharges from the mucous surface of the diges- tive organs, but to facilitate the removal of matters lodged there, by emetics, by draughts of tepid water, and other diluents, and by castor- oil, of which the action is both speedy and gentle. * “Sir Thomas continues’: ‘When I last spoke on this subject, I stated that the few recoveries that I had seen took place under large and re- peated doses of calomel, but that I could not affirm that the calomel cured them. At present I am much disposed to believe that by this cleansing action, the calomel may have helped recovery, and after all I have since seen, heard, read, and thought on the matter, I must confess that in the event of my having again to deal with the disorder, I should feel bound to adopt in its generality the evacuant theory and practice, and to avoid alcoholic stimulants and opiates.” MR. WILLIAM SEDGWICK's VIEWS. “Mr. William Sedgwick advocates, in the Lancet, the internal admin- istration of dilute phosphoric acid in half-drachm doses, combined with syrup of orange, and largely diluted with iced water. In cases of chole- raic diarrhoea and in the early stage of confirmed cholera, this remedy appears to him capable of checking the progress of the disease with greater certainty than sulphuric acid. It would be unreasonable to expect that in the stage of advanced collapse either phosphoric acid or any other pharmacopoeial remedy which has been proposed should exert any beneficial influence over the disease until reaction has set in. He says, that, a large proportion of the mortality in the last three epidemics of cholera has been due to excess of reaction, and that such excess has not only been very noticeable, but also very fatal, in those cases in which the so-called eliminative treatment has been pursued, showing that in- creased irritation of the gastro-intestinal mucous membrane has con- tributed to intensify the disease.” He directs attention to the unfavora- ble statistics of the castor-oil treatment of cholera at King's College Hospital in 1866; and says it is a suggestive fact that, up to the present time, no statistical evidence of any value has been published in favor of the administration of purgatives in cholera. When, for example, Dr. George Johnson advocated, at the Royal Medical and Chirurgical Society, “the necessity of a cathartic method of treatment, in the widest sense of that term, no reference was made to the results of the castor-oil treatment of the disease at King's College Hospital during the preceding epidemic ; but a supplementary paper on the treatment of the disease at the Liver- pool Parish Infirmary was brought forward. These papers are chiefly noticeable for the absence of any reference to the cases admitted into King's College Hospital under the exclusive care of Dr. George Johnson himself, and for the exceptional importance assigned to those treated at the Liverpool Parish Infirmary, which may, perhaps, be accounted for by what seems to have been a remarkable difference in the statistics of treatment at these two institutions; for whilst the mortality in the cases treated by castor-oil at Liverpool is said to have been only 30 per cent., the mortality at King's College Hospital at the same date, and under the same treatment, appears to have been 62 per cent. “On analyzing the Liverpool cases, it will be found that a large propor- tion of them, and especially of the cases which recovered, were not such VOL. I.-15 ,” : 194. Miscellaneous. [Nov., as are commonly described as cases of cholera. When, therefore, the method of treatment ‘by castor oil alone' is said to have been followed by a mortality of 30 per cent., it must be admitted that the statistics on which such a favorable report rests are practically of little or no value unless the relative proportion of cholera and of diarrhoea cases can be Satisfactorily ascertained. In the absence of this needful information, it can only be imperfectly inferred from the published report that, if the cases of cholera had been kept distinct from those of diarrhoea, the treatment by Castor oil alone” would not be found to have been more successful at Liverpool than it was in London, where, under the care of Dr. George Johnson, the average mortality was found to be about 62 per cent. ; a result which closely agrees with the mortality of 63 per cent. observed on board the Dreadnaught Hospital Ship in the preceding epi- demic of cholera, in 1854, under the same method of treatment. The purgative treatment of cholera, says Mr. Sedgwick, has failed, and is now very generally condemned in India, even by those who went from King's College Hospital prepared to carry it out to the fullest extent; and, he thinks, the entire absence of any satisfactory evidence in its favor is very remarkable in the newly-revised lecture on Cholera, by Sir Thomas Watson, in which the Liverpool statistics appear to be alone available for quotation, and which have accordingly been cited, to the exclusion of those referred to above, including even the statistical returns of cholera at King's College Hospital itself. PR. FAUVEL's VIEWS. : At the sitting of the Academy of Medicine of 1st of August, in Paris, Dr. Fauvel said that in reality, up to that date, true cholera did not exist either in England, Italy, or France. In a paper read to the Aca- demy, in December, 1869, it was shown that there was an epidemic of cholerain several parts of the centre and west of Russia, since its exporta- tion in 1865. In Moscow, on the 18th February, 1870, the disease existed. July, 1870, it appeared in Taganrog, and at Rostow, on the Don; Odessa was also visited. Fortunately, owing to careful quarantine, Turkey was exempt from the epidemic. From the 2d August to the 21st of Septem- ber no less than 700 ships, among which were several with cholera on board, was subject to quarantine at the entrance into the Bosphorus. It was thought at Constantinople that this epidemic came from Persia; it arose at Nijni-Novogorod, when the fair took place at that town. Dr. Fauvel thinks that the present epidemic is only a consequence of the im- portation of 1845, which has never been completely stamped out. On 5th September, 1870, the French Consul at St. Petersburg mentioned in several official documents the development in that town of several isolated attacks of cholera, but during the greater part of last winter the cholera seemed extinct throughout Russia. In February, however, it reappeared in St. Petersburg, and in March it became epidemic there. In March, April, and May, there were 1,294 cases, with 754 deaths. St. Petersburg is the town of all others in Europe, whence the disease once entering is with most difficulty expelled. In May there was cholera again in Moscow, and in August, 1871, it is epidemic in Tambow, a town south of Moscow. In June it showed itself in Wilna, and now it is at Königsberg, although it has not yet attacked many towns in Prussia. In July it was in Riga. The present invasion of cholerais distinguished by a greater benignity than it exhibited in former years. Cholera re- mains permanently as an epidemic in India, and at present is raging at Hyderabad. Persia, since the last year, has been the chief seat of the cholera. It appears during a pilgrimage, undertaken by the Shah to Kerbella, in Mesopotamia, in 1870. Cholera does not exist in Turkey at present, but it is found along the eastern coast of Africa as far as the 1871. Miscellaneous. 195 mouth of the Zambezi River, and at present it promises to attack Mauri- tius and Madagascar. Thanks to precautions adopted, the pilgrimage to Mecca has this year escaped from the attacks of cholera, and the pilgrims have been able to return home in the best condition possible. The Med- iterranean is still free, so that the danger comes to us now from the North.” CUNDURANGO.-In an exceedingly able and temperate article on “IIow to Treat Humbugs,” from the pen of Dr. E. W. Schauffler, the editor of the Kansas City Medical Journal (October, 1871), we quote the following, and give it our most hearty endorsement: “Physicians throughout the country are to-day being asked by the more intelligent reading portion of the community, ‘What of cunduran- go? Is it a cure for cancer? Merely and curtly to answer, ‘No, it's a humbug,’ will have the effect of making many a man doubt the sound- ness of our judgment or the extent of our information on the subject. Let us, then, from the start, meet this new fraud, for such we consider it to be, with facts and not merely with sneers. “Specimens of this drug were distributed in April last by the Do- partment of State to the Surgeon-General of the Army, the Chief Medical Officer of the Navy, the head of the Department of Agriculture, and some others, for the purpose of having its merits tested. It has been subjected to a chemical analysis by Prof. Antisell, of Washington, D. C., and Dr. E. R. Squibb, of Brooklyn, N. Y., both of them gentlemen of national reputation. They find it to contain no new active principle of any kind, rank it, therapeutically, among the aromatic bitters, and expect nothing more from it, as the result of analysis, than from any other vari- ety of the same class. “In practice, the drug has been tried by medical officers of the army and navy, residing in Washington, New York, and elsewhere, and hav- ing the best opportunity for selecting cases of cancer seated in various organs and at different stages of progress. In every case, cºndurango has entirely failed. We have seen the detailed report of four of these cases, two of which died, and the other two seemed in no degree benefited by the treatment. A number of reputable physicians, not in Government service, who were furnished with specimens of the bark, tried it with no better results. - “Now comes Dr. Bliss, of Washington, on to the stage, and, presto ' everything changes He tries it in some six cases. In every one it works like a charm ; all are immensely relieved, several are cured. The doctor hastens to herald to the world the glorious tidings that henceforth cancer shall be no more, for great is cundurango, and Bliss is its prophet. “We ask any reasonable person, Is it likely that all these other ob. servers were wrong and Dr. Bliss alone right—is it probable that they all reported falsely, and he only told the truth ? What object could they have in making out a case against cundurango 2 for, mind you, their ex- periments and reports were made before his, so that even jealousy of him could not have come in as a cause. Is there a reputable physician—may, is there a decent man living—who would not hail with joy the discovery of a cure for so dread a scourge of humanity as cancer? And yet some secular papers, amongst them even the New York Tribune, echo Dr. Bliss's doleful plaint that the regular profession are ‘persecuting him for his ‘discovery' of the virtues of this bark. Persecuting him because they report that they can find no efficacy in the drug, and because they have discovered that four of Dr. Bliss's sia, cancer patients, treated with cun- durango, have died // - “Was Dr. Bliss under any temptation to overestimate the value of the drug, to be misled himself, and thus to mislead others & Judge for 196 JMiscellaneous. [Nov., yourselves. Early in the history of this agitation, he despatched his partner (whose name, we believe, is Keen) to South America to buy bark. While he was gone, Dr. Bliss vigorously ‘puffed" the article by circulars, newspaper articles, etc. The cargo, which is to make his fortune, having arrived, the doctor has abandoned his practice in Washington and is to set up a “laboratory’ in New York. The New York Medical Record, of September 15, says: ‘A physician of this city, who recently applied for four ounces [of cundurangoj, was furnished with it, the bill being headed Bliss, Keen & Co., and the amount charged $50 !!” “Let those who ask us be informed of these facts, and when ‘Bliss's Cancer Cure,' put up in fancy bottles and covered with certificates of success, is ‘sold by all respectable druggists,’ some, at least, of the more intelligent in the community will know how to estimate its value.” CONDENSED FORM OF NITRous Ox1DE GAs.—At the late meeting of the American Dental Association, held at Greenbrier, White Sulphur Springs, a condensed form of nitrous oxide gas, with apparatus, was on exhibition, and the advantages it possesses over the more bulky appa- ratus, and troublesome way of preparing it by the common process, was apparent to all. The advantages which this condensed form possesses are described in an article we take from a correspondent of Middletown, Conn., which was published in the Hartford Post : “Anything that tends to relieve human suffering or to widen the ap- plication of the means for its relief is worth public attention; and in these days of quack nostrums, where money is only sought without ren- dering any just equivalent, every real improvement should be hailed with delight. From the time that Horace Wells applied the nitrous oxide gas to produce insensibility during surgical operations, to the pre- sent, various methods have been devised, and many substitutes for this gas have been introduced, all of which have more or less merit, but none which have been safe as the gas which was originally used for this pur- pose. But the objection to this was its bulk, and the difficulty of its manufacture, so that any one who used it to any extent must be pro- vided with the means, and must understand the method of its manufac- ture. In addition to this was the uncertainty as to its purity and free- dom from noxious and unpleasant odor, but when well prepared it was acknowledged to be by far the most pleasant and safe agent for produc- ing insensibility. In England, about two years ago, this gas was suc- cessfully reduced to a liquid, but in order to retain it in that state it had to be kept in iron bottles of enormous strength to prevent bursting. In this form it was palatable and was used to a considerable extent, and with great success, particularly in the late Franco-Prussian war. Va- rious attempts have been made in this country to learn the method of its manufacture, and sums as high as $5,000 have been offered for even a set of apparatus for this purpose. But our English cousins seem deter- mined to keep this good thing to themselves, and refused to part with the secret. It is, therefore, the more gratifying to learn that Johnston Brothers, 812 Broadway, New York, sons of Professor John Johnston, of Wesleyan University, and educated at this place, have succeeded in ac- complishing the same result, and can furnish one hundred gallons of this gas condensed into a liquid in a bottle twelve inches long by three inches in diameter, so that it can be carried with the surgeon or dentist, and used at the home of the patient as well as at the office; and we can assure our readers that the effects are truly wonderful. By this method, too, the absolute purity of the gas is ensured by the very nature of the 1871.] Miscellaneous. 197 operation. Its effects, too, are more rapid and pleasant than those of the gas prepared by the old method. - •, “We are informed that these bottles are subjected to a hydrostatic prèssure of 5,000 pounds to the square inch before being used for this purpose. From this fact alone some idea may be formed of the compli- cated and powerful character of the apparatus employed in the manu- facture of this new article.” THE OPHTHALMoscope AND THE SPHYGMOGRAPH IN THE STUDY OF THE PHYSIOLOGICAL ACTION OF MEDICINEs.-The following, in regard to the action of the bromide of potassium, is extracted from an article read before the Ohio State Medical Society, by Professor Roberts Bartholow, M.D., of Cincinnati, and subsequently published in the Clinic of Sept. 30, 1871: - “In the study of the physiological action of a remedy which, like bromide of potassium, does not produce marked phenomena when given in ordinary medicinal doses, it is necessary to employ the largest amount which may be tolerated by the stomach. In six hours, Mr. Drake received four drachms of the bromide, when the annexed tracing (No. 11) was taken : “As compared with the normal, we notice that the ascent of the wave is slightly oblique, the summit rounded, the descent gradual, and the dicrotism very slight—qualities indicating a much higher degree of arterial tension. With this obvious rise in tension, there occurs more or less slowing of the heart-beat—conditions of the circulation which should be indicated in the retina by ophthalmoscopy. Such I ascer- tained to be the fact. The vessels of the retina, both arteries and veins, were seen to contain less blood than normal, and the papilla was better defined. Dr. Vance's study of the retinal circulation in epilepsy, as a basis for rational therapy, seems to me, therefore, as regards the use of the bromide of potassium, an important step in the right direction. CONCLUSIONS. “Very important aid to exact knowledge of he physiological action of remedial agents may be obtained by an ophthalmoscopic examination of the retinal circulation. “To avoid erroneous conclusions from such examinations, the state of the arterial tension in general should be determined at the same time by the Sphygmograph. “Ophthalmoscopy will furnish us more precise indications for the treatment of cerebral disorders than has heretofore been attainable. “Ophthalmoscopy will enable us to use medicines that exert an influence over the circulation, with more definite aim, and with a nicer appreciation of their real therapeutical influence, than by the coarser emthods now employed.” DR. LEWIS A. SAYRE's TREATMENT OF HIP-JOINT DISEASE.-In a recent number of the British Medical Journal, its able editor, Dr. Ernst Hart speaks as follows in regard to our friend Dr. Sayre, who was, at that time, temporarily sojourning in Europe: - “The demonstrations and clinical remarks of Dr. Lewis Sayre, of New York, which we recently reported at University College Hospital, have excited a good deal of professional interest. The rapid and excellent results obtained by his light and effective extension-splint, the 198 Miscellaneous. [Nov., remarkable series of photographs which he has shown of patients hav- ing perfect motion at a newly-formed hip-joint after the subperiosteal exsection of the head of the femur and parts of the acetabulum, and the extremely ingenious application of his vertebrated probe for the dis- covery of dead bone at the bottom of sinuous sinuses, have arrested attention; and he has been afforded the opportunity of demonstrations at St. Bartholomew's, St. Thomas's, the Middlesex, and other hospitals. We furnish in another column a full report of one of these demonstra- tions, with illustrations which will make the text clear. While losing the warmth and earnestness of manner of the lecturer, and something of the peculiar raciness of diction, this lecture will still be found highly instructive and valuable. This is the second time that an American Surgeon visiting this country has brought to the cognizance of the profession here what claims to be a distinct improvement in surgical practice. We are happy to afford the hospitality of our columns to such contributions; and we hope that in the future they may be more . frequent. Everything which tends to give to scientific work a truly cosmopolitan character, must be hailed with satisfaction. The excellent work which is being done by our American brethren in medical and surgical practice is too little known in this country. The short visit of Dr. Sayre has, we believe, been gratifying to himself and welcome to the profession here. He has been warmly received by the most eminent Surgeons, and his vivid enthusiasm and natural force of character have produced a very favorable impression.” t ON THE TREATMENT OF SYPHILIS BY HYPODERMIC INJECTIONS OF CoRRosive, SUBLIMATE.—Dr. R. W. Taylor, Surgeon to the New York Dispensary, made a series of observations with this method of treatment during a period of eighteen months. He thus treated fifty adult males and females, and his conclusions are that, while there are some striking merits as to the method, it has certain disadvantages which are often inseparable, and materially limit the use of the treatment. He thinks that the early secondary and even late secondary rashes will disappear very quickly by the use of mercury in this form, and that the quickness with which it releases syphilitic neurosis is sometimes extraordinary. He thinks that pustular syphilides, or conditions of the system in which there is a tendency to produce pus, should be considered as contra-indicating circumstances, for the reason that perhaps the site of the injections might soften down and take on the ulcerative tendency. He confirms the results of other observers, who found that there were advantages in the treatment in the smallness of the dose, its rapidity of action, and the absence usually of systemic disturbance. In ordinary cases he injected one eighth of a grain of the corrosive sublimate dissolved in twelve drops of water every day under the integument of the back, and cured the case in from three weeks to two months. In infant cases he used sometimes two such injec- tions each day, and never produced any salivation, and very rarely slight stomatitis. The cases in which this active treatment was used were those in which the eruption appeared upon parts readily seen, or in which the rheumatoid pains were excessively severe. He does not think that the treatment is beneficial in syphilis of the nervous system or of bone, and that in cases of mucous patches, condylomata lata, and iritis a local treatment is absolutely necessary in combination with the internal. He thinks that relapses occur just as quickly and as severe and as fre- quent with this as with any other treatment. The objections to the treatment are pain at the punctures and upon the site of injection, indu- ration of the tissues, and abscesses. The symptoms of pain are sometimes so severe as to render a continuance of the treatment wholly inadmis- sible, whereas in others it is slight and only of short duration. The 1871.] Miscellaneous. 199 induration of the connective tissue generally rapidly disappears, but it may persist so long and render the integument so hard and brawny that another treatment is necessitated. Dr. Taylor had in all two abscesses, but he thinks that with a solution of the strength he has latterly em- ployed, and with care in its injection, they will rarely if ever occur. He thinks it is well to use the treatment only on intelligent patients who can understand the benefits held out to be derived from it, for among the ignorant it is often looked upon as experimentation, and that, as it involves some pain, the patient should be impressed with the gravity of his case in order that he may submit to the pain, however slight, which it produces. He also thinks that the frequency of the injections, which should be administered by "the physician, in many cases would render the treatment too expensive to continue it. Finally, that, while it has its advantages, it is necessarily limited in its sphere of application by the inconveniences which it produces, the patient's objections, and by the presence of contra-indicating lesions.—Medical Gazette, May 13, 1871. EPILEPSY FROM USE OF ABSINTHE.-M. Magnan concludes from ob- servation of about one hundred and fifty cases of acute alcoholism : 1. That the patients suffering under this disease, who have epileptic attacks, have almost always been in the habit of using “liqueur d'ab- sinthe.” 2. That those patients not epileptic, but having the “trembles,” whatever may be its degree, habitually drink wine and brandy. It may then be said in a general way, with reference to acute alcohol- ism, that alcohol produces delirium and trembling, and the “liqueur d'absinthe” (alcohol and absinthe) delirium, trembling, and epilepsy. Numerous physiological experiments with alcohol and the essence of absinthe have also furnished most complete demaonstration of absinthe- produced epilepsy.—Arch. Gener., Sept., 1871.-Clinic. DISINFECTION.—Experiments have been made by Prof. Hoppe-Seyler and Dr. N. Zapolsky, which are related in the Med. Chem. Unters., 1871, pp. 557–581. The action of carbolic acid on albuminous matters and on ferments being investigated, it was found that the acid precipitates albuminous liquids only when they are neutral, or nearly so, and the acid is in almost saturated aqueous solution. Neither the formation of hydrocyanic acid from the fermentation of bitter almonds, nor the gener- ation of oil of mustard, nor the conversion of starch into dextrine and sugar by diastase or saliva, is prevented by carbolic acid. . The solu- tion of fibrine by the gastric juice was prevented, but only in presence of a large quantity of acid. The ferments operated upon were such as are formed of chemical in- soluble substances. Pasteur's views are not admitted. The serum of pus, filtered and perfectly clear, and hydrocele fluid, were placed in tubes hermetically sealed ; others were loosely corked ; they were exposed to varying temperatures for various periods of time. They underwent putrefaction, whether living organisms were present or not ; the rapidity of the process was solely dependent on temperature. One fluid was corked at a temperature of 68° F., another put in an her- metically sealed tube at 108°. After a time the former swarmed with monads and vibriones, but had undergone much less putrefaction than the latter, in which no signs of life or organization could be detected. On adding carbolic acid to a putrefying albuminous solution, life ceases when 1% per cent. of acid has been added, while as much as 1 per cent. of acid putrefaction goes on. It seems that the acid acts much in the same way as heat, and that coagulation is necessary to arrest fer- mentation. 200 Jºecent Publications. [Nov., 1871. Cholesterine disappears in putrefying solutions, so that, instead of being a product of the splitting up of albumen by fermentative changes, it is more probably a product of oxidation. From these researches, it would seem that, in any attempt to disinfect, we should not only destroy the living organisms, but the ferment itself, which Hoppe-Seyler and Zapolsky think much more difficult. To re- move the offensive gases set free in putrefaction has no more effect than to get rid of carbolic acid in alcoholic fermentation. It is conjectured that disinfectants act by precipitating ferments. Sulphurous acid is re- commended as the most powerful disinfectant. Half a drachm or a drachm of sulphur, burned in every 100 cubic feet of space to be puri- fied, will set free 1 or 2 per cent. of the gas in a room, and none of the organisms can grow in such an atmosphere.—Med. Press and Circular. RECENT PUBLICATIONS. 1. HARTSHORNE–Essentials of the Principles and Practice of Medicine. Third Edition. Philadelphia: Henry C. Lea. 1871. 8vo, pp. 487. 2. WARING — Practical Therapeutics. Second American from Third London Edition. Philadelphia: Lindsay & Blakiston. 1871. 8vo, pp. 765. - 3. MEADows—A Manual of Midwifery, including the Signs and Symp- toms of Pregnancy, Obstetric Operations, Diseases of the Puerperal State, etc., etc. First American from the Second London Edition, revised and enlarged, with illustrations. Philadelphia: Lindsay & Blakiston. 1871. 8vo, pp. 487. 4. DILLNBERGER—Hand-Book of the Treatment of Women's and Chil- dren’s Diseases according to the Vienna Medical School. Trans- lated from the Second German Edition by Patrick Nicol, M.B. Philadelphia : Lindsay & Blakiston. 1871. 8vo, pp. 238. . PEREIRA—The Physician’s Prescription Book. Fifteenth Edition. Philadelphia: Lindsay & Blakiston. 1871. Pp. 286. 6. PULLING—The Pine Forests of Georgia as a Resort for Invalids. (From New York Medical Journal, Sept., 1871.) New York: D. Appleton & Co. Pp. 8. - 7. LEE–The late Dr. John Conolly, of Hanwell, England. (From the American Practitioner.) Louisville: John R. Morton & Co. 1871. Po. 14. 8. Nº-The Endoscope in Granular Urethritis in the Male. (From the American Practitioner.) Louisville: John R. Morton & Co. 1871. Pp. 16. 9. RUPPANER—Contributions to Practical Laryngoscopy. Second Series, with colored plate. New York: Bradstreet Press. 1871. 8vo, . 16. 4. 10. Fºr (T. A.)—Prolapsus Uteri: Its Chief Causes and Treatment. (From the Medical Record.) New York: Bradstreet Press. 1871. 8vo, pp. - 11. Biº-Medical Education in America. Cambridge : Welch, - Bigelow & Co. 1871. 8vo, pp. 83. 12. Minnesota State Medical Society Transactions. St. Paul. 1871. 8vo, pp. 63. 13. Transactions of the South Carolina Medical Association. Charles- ton. 1871. 8vo, pp. 126. - 14. Transactions of the Indiana State Medical Society. Indianapolis. 1871. 8vo, pp. 248. 15. WEST-Disorders of the Neryous System in Childhood. Lumleian Lectures, 1871. Philadelphia: Henry C. Lea. 1871. - ‘5 Medical & Scientific Books FOR SALE BY WILLIAM BALDVVIN & CO. 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Price $400 CONTENTS The Medical World for September 1871. —e—O—e- PAGE I. ORIGINAL COMMUNICATIONS. 1. Phenomena. Noted in a Case of Epilepsy, . e ge . 81 2. Hypodermic Injections, . . 89 .3. The Use of the Seton in Simple Suppurating Bubo, . . 91 4. Clinical Examination of Urine, 93 II. SELECTED ARTICT,ES. Extract from a Paper on the Philo- sophy of Intemperance, ... 102 III. REVIEWS. Wear and Tear; or, Hints for the Overworked, £º * * . 111 2 3 4 i 10. PAGF: IV. MISCELLANEOUS. . Winter Resorts for Consump- tives, g * > * . 114 . Fox on “Skin Diseases,” . . 117 . Changes in the University Med- ical College, . ... • . 117 . “The Physiology and Patho- logy of Scars,” . 118 . Diabetes Mellitus, . 118 Treatment of Psoriasis, . 118 . Infantile Diarrhoea, . . 118 . Correction, e e & . 119 . The Cause of Diabetes Melli- tus, e º * . 119 Hypodermic Injection of Mer- cury for Syphilis, . . 120 CONTENTS OF OCTOBER IN UMBER. PAGE I. ORIGINAL COMMUNICATIONS. 1. The Clinical Thermometer, . 121 2. Notes on the Treatment of Gun-Shot Wounds, as prac- tised in Berlin, . . 138 3. Lethargus, . 139 4. Bromide of Sodium, . 141 5. The Prevention of Abscesses in Hypodermic Medication, . 143 II. SELECTED ARTICLES. A New Ovariotomy Clamp, . . 149 III. REVIEWS. 1. A Medico-Legal Treatise on Malpractice and Medical Evidence, . . 153 2. 2 8. IPAGE Obstetric Operations, . 153 IV. MISCELLANEOUS. . Contagion of Scarlatina and Small-pox, t g . 154 . The Antiseptic Treatment of Wounds, . 155 . Phantom Tumor, . * . 156 . The Course of Epithelioma, . 157 . The Galvanic Current as a Means of Resorption, . 157 . The Radical Cure of Hernia, . 158 . Some Further Additions to . 159 Therapeutics, tº Liebig on Germany and France, 160 Cash Subscriptions for 1872 sent in directly to the Publishers up to December 1, entitle the senders to the numbers of THE WoRLD for November and December free. Address WILLIAM BALDWIN & CO., Publishers, P. O. Box 3472. 2ſ Park Row, New York. AD VERTISEMENTs. Manufactured by THE MONITOR SHIELD CoMPANY, is destined to supersede all other contrivances for the treatment of Sore Nipples. Its advantages are as follows:– 1. It protects the Nipple absolutely from contact with the patient’s clothing. - 2. It obviates the necessity of any dressings. 3. It allows the free access of air to the diseased surface. 4. It is in contact with the organ only around its base, where its action is beneficial by promoting the easy flow of the milk, 5. It is very light, cool, and keeps its place easily. A persevering use of this Shield, following the directions which accompany them, will, without other means, effect a cure in almost Every case of Sore Nipples. Full directions accompany each box. Boxes containing a pair of Shields sent by mail on receipt of $1.25. Address, “The Monitor Shield Company,” Box 3985, Post-Office, New York; or, HEGEMAN & CO., WHOLESALE AND RETAIL DRUGGISTS, NO. 203 BROADWAY, N. Y. (P O. Box 2228.) . . Ig Dr. Jerome Kidder's CELEBRATED ELECTRO-MEDICAL APPARATUS, #:#: s=== # E-ºr: - .#= &= E:::::::::: - *ºtºs, " - §: sºme --~~~~- i &ºº-ºº: . º *} | zºº ſ | | iſſ ſºft 4 º' § i ºft # * º ºliº#!/ i.# Improved forms now offered to Practitioners. Slip Varieties of Faradaic Elec- tricity. For the superiority of Dr. Kidder's apparatus over all others, reference is respectfully given to Dr. Reuben A.Vance, Editor of THE MEDICAL WORLD, Dr. Lewis A. Sayre, the distinguished surgeon, and many others. Prof. Silliman, of Yale College, New IIaven, says: “I have seen and examined experimentally, on several occasions, the Elec- tro-Magnetic Apparatus for medical use made as Patented by Jerome Kidder of New York. This apparatus is capable of producing modified and manifold cur- rents, differing from each other in respect of intensity and quality of Nervous and Muscular effect, as well as in magnetic and electro-chemical power.” The convenience and effectiveness of Dr. Kidder's Faradaic Electrical Appa- ratus, it is known, have advanced the cause of Electrical Medication during the last ten years, and he now adds the most effective arrangements to manipulate and control the currents of primary cell batteries by inventions recently patented. Office of sº Dr. KIDDER'S ELECTRICAL MANUFACTORY, 344 Broadway, New York. DETROIT MEDICAL COLLEGE, snºwn FACULTY. E. W. JENRs, M.D., President of Taculty, Professor of Medical and Sur- gical Diseases of Women and Clinical Gynaecology. SAMUEL P. DUFFIELD, Ph.D., M.D., Emeritus Professor of Chemistry. J. M. BIGELow, M.D., Emeritus Pro- fessor of Medical Botany and Ma- teria Medica. THEODoRE A. McGRAw, M.D., Pro- fessor of Principles and Practice of Surgery. Geo. P. ANDREws, M.D., Professor of Principles and Practice of Medicine. C. B. GILBERT, M.D., Professor of "Materia Medica and Therapeutics and Clinical Medicine. - J. F. Noyes, M.D., Professor of Ophthalmology and Aural Surgery. N. W. WEBBER, M.D., Professor of Descriptive and Surgical Anatomy. RICHARD INGLIS, M.D., Professor of Obstetrics. . - Hon. H. B. BRowN, Professor of Medical Jurisprudence. A. B. PALMER, M.D., Professor of Medical Diagnosis and Clinical Medi- cine. A. B. Lyons, M.D., Professor of Chemistry and Toxicology. W. H. LATHROP, M.D., Professor of Diseases of Mind and Brain. LEARTUs CoNNor, M.D., Professor of Physiology and Microscopical Anato- my. - H. O. WALKER, M.D., Demonstrator of Anatomy and Lecturer on Venereal Diseases. The regular annual session of the College will begin on the 20th of March, 1872, and continue four months. Especial attention is given to Clinical instruction, and drill in practical Diag- nosis of medical and Surgical diseases. The fees are as follows. Full course of lectures, Matriculation, Hospital fee, Graduation fee, $50 00 5 00 6 00 25 00 The lecture fees for graduates of other respectable Colleges, and for third course students, will be $35 00. Alumni will be admitted free. No student will be admitted into the graduating class whose first course of lectures has been completed within six months of the beginning of the term. This rule will be strictly enforced, and will remove the main objection that is urged against spring Schools. The laboratory will be open for chemical instruction, and daily clinics will be held during the entire year. For further information, address E. W. JENKS, M.D., 92 FORT STREET, WEST., 7 T. - º º - A Aſ ºz º. º ###| || #. | | t gº º º, ºh!, º fºul §§ fit #. º İğ | ||| |iº ||||| - | º #|| º º a ||"|*|†"i"; "|". º ####|Nº|| | Ełż. | Tilliºl | lillº |; ºf ºf .. | iſ: | | iſſiº - º lººtiº #. º - - - f ºi=# i : ſº º § --- - - §ºſſ ‘. . .” wº," " " ..." a § ºš º § t §§§ º § y |}}} % º º E!º º º -- % º % º º Żºłęsa s º §º gº The ria Hotel, Nassau, New Providence, Bahamas. Royal Victo The Royal Victoria Hotel will be opened for the Winter Season, November 1. The advantages of the climate are unequalled, and to persons suffering from pulmo- nary complaints this place offers unusual advantages. The thermometer averages 74°, with change rarely exceeding 6°. The almost entire absence of rain renders out- door exercise at all times agreeable—boating, fishing, driving, and bathing. In communication with New York by the steamers of the Atlantic Mail Steam- ship Co., sailing every second Thursday Fare by steamer, $45. Board, $3 per day, gold. A circular containing full description, together with meteorological reports, sent On application. w v. By special permission reference is made to the following-named gentlemen: DR. ALONZO CLARK, DR. For DYCE BARKER, “ JoHN J. CRANE, “ JoHN T. METCALFE, “ AUSTIN FLINT, “ T. G. THOMAs, “ JAMEs R. Wood, “ REUBEN A. WANCE. LEWIS F, CLEVELAND, Froprietor. JAMES LIDGER WooD, Agent, 758 BROADWAY, NEW YORK. GEORGE TIERMANN & CO., F. A. STOHLMANN. ESTABLISHED 1826. ED. PFA.R.R.E. 67 CHATHAM STREET, NEW YORK, MANUFACTURERS AND IMPORTERS OF Surgical Instruments, APPARATUS FOR FRACTURES, DISLOCATIONS, AND DEFORMITIES, Latest Instruments for Local Anaesthesia, and for Applications to the Larynx, Poste- rior Nares, Eustachian Tube, Uterus, Urethra, Bladder, etc., etc. Laryngo- scopes, Ophthalmoscopes, Endoscopes, Hypodermic Syringes, Fever Thermometers, etc. Surgical Instruments of all kinds made to order, and the Latest Improvements and Novelties prom: fly supplied. TWO SILVER MEDALS AWARDED BY THE PARIs ExPosLTION OF 1867, BEING THE ONLY SILVER MEDALS GRANTED TO AMERICAN EXHIBITOR'S OF SURGICAL INSTRUMENTS. Stohlmann, Ffarre & CO., F. A. STOHLMANN. ED. PFA.R.R.E. PHILIP SCHMIDT. 107 E, 28th Street, nr. Fourth Ave., ONLY BRANCH OF GEORGE TIEMANN & CO. FIRST PREMIUM AWARDED BY AMERICAN INSTITUTE, 1870. MICROSCOPES And Microscopic Accessories for Medical and Scientific Investigations. ALSO, MAGIC LANTERNS, With elegantly colored Illustrations of Anatomy for POPULAR LECTURES. Illustrated Price-list sent on application, to any address T. H. McALLISTER, 49 Nassau Street, New York. T0 Wholesale Druggists and Chemists, W E MANUFACTURE AN ASSORTMENT OF ENAMEL LED TINCTURE PRESSES, I: ETO RT STANDS, AND EVA PORATING DISHES, With many other Utensils used by Chemists, and solicit the patronage of the Trade, JAMES C. HAND & CO., BARROWS, SAVERY & C0. Factors, Iron Founders and Enamellers, PHILADELPHIA, PA. H. THOMPSON, Patent Chair Manufacturer, 70 EAST BROADWAY, NEW YORK, Will be happy to have his friends and the public in general call and examine. his IMPROVED RECLINING, RECUMBENT, and EXTENSION RECUMBENT CHAIRS, with PATENT RIGID alº IREGULATOR, which secures them at any angle. Also, IM- PROVFD WHEEL CH IR, SLEEPY HOLLC W, with extension Leg Rest, BARBER, COMMO DE, AND BED CHAIRS. CHAIRS for INVALIDS, the PARLOR, LIBRA it Y, OFFICE, etc., and SPECULUM CHAIRS of superior style and quality. HUNNEWELL’S Cathartic, Narcotic, Tomic, Sedative, Alterative, and Tolºw. A mody ave is a CD Cai Caº. The above so thoroughly defined, so highly approved, and the Formulas subjected to the fullest investigation, the Physician may rely on them with confidence. THEY COMPRISE THE tº Pill Aloin cum Ferro, tº Pill Podophyllum cum Ferro, tº Alterative Laocative Pill, tº Alterative Laacative Pill, £º Alterative Laacative Pill, tº Compound Quinine Pill, [3° Fluid Cannabis cum Tolw, º Páll Sedative, Known as Eclectic Pills. Dr. Jackson's Formula. Dr. Gilman Davies' Formula. Dr. P. S. Haskell's Formula. Dr. Edward Hall's Formula. Dr. N. I. Aiken's Formula. Known as Tolu Anodyne. Dr. N. I. Aiken's Formula. Five years have clearly proved their importance, and the future will be to keep that good. Formulas in detail, describing samples and plans of getting such, or in quantities, sent on demand. JOHN L. HUNNEVVELL, Laboratory Office, 97 Commercial St., Boston, Mass. (MEDICINAL) Prepared by the Rwmford Chemical Works, Provi- de??ce, R. I., wºoder the Direction of JProfessor E. N. Horsford, * LATE RUMFORD PROFEssGR AT HARWARD UNIVERSITY, GAMBRIDGE, MAss. The value of preparations of Acid Phosphates as therapeutic agents is in keeping with well-known chemical principles, and no article has ever been offered to the public which seems to so happily meet the general want as Horsford's Acid Phosphate. It is not nauseous, like most of the preparations of Phosphorus, but agreeable to the taste, and, with water and sugar, makes a cooling and pleas- ing drink. No danger can attend its use, as it is the same Acid that is found in wheat and other cereals. If we take more into the system than is needed, it is expelled with the secretions of the body. - - * It is especially recommended for Dyspepsia, Urinary Difficulties, Cerebral and Spinal Paralysis, Mental Exhaustion, Wakefulness, Hysteria, and Nervous Disorders in general. Most excellent results have attended its administration for the prostration and nervous symptoms following sunstroke. Dr. JUDSON B. ANDREws, Physician in the New York State Lunatic Asylum, in an article contributed to the Chicago Medical Journal on the use of Phosphoric Acid, says: “In cases where mental effort has been protracted till a sense of weariness renders its continuance difficult, a dose of the Acid, from its stimulant effect, relieves fatigue, and seems to invigorate the mental powers and prepare the mind for renewed exertion.” The foregoing remarks apply with increased force to that form of this invalu- able agent prepared by Prof. Horsford. This preparation is particularly adapted to professional men, especially those undergoing severe mental labor, and the general public will find it a remedy suited to all forms of Nervous Disorders. All persons interested will be furnished free, by mail, our Pamphlet upon this article, which contains the opinion of the following eminent gentlemen upon the value of Phosphoric Acid and the Phosphates: - Dr. M. H. HENRY, New York City, Edi- tor of the American Journal of Syph- Žlography and Dermatology. Professor ADoIPH OTT, New York City, Technical writer, and Editor of the department “Physics,Chemistry, and Technology” of the German-Ameri- can Cyclopædia. Dr. W.M. A. HAMMOND, New York City, Professor in Bellevue Hospital Medi- cal College. - - . Dr. For DYoF BARKER, New York City. Dr. R. Ogden DoREMUs, New York City, Professor of Chemistry in the College of Pharmacy. r, Dr. W.M. H. WAN BUREN, N. Y. City. Physicians wishing to examine and test this remedy are requested to apply, by letter or otherwise, to the undersigned, Wilson, Lockwood, Everett & Co., Gen. Agents, 31 Murray Street, New York City. John Ross & Co., PRINTERs, 27 Ross, STREET, NEw York. $1 50 a Year.] [15 Cents per Copy. *śāº s= a-mº VoI. I. §§§ º : A MONTIII, Y JOURNAL OF º AMERICAN AND FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL, - AND CHEMICAL LITERATURE, CRITICISM, AND NEWS. |. EDITED BY REUBEN A. VANCE, M.D. § # upon, Alcoholism, and Moral and Criminal Responsibility of Inebri- MISCELLANEuus, - gº -- - and Gastralgia, DR. F. E.'ANstie, - 230 FROC EEDINGS F SOCIETIES : # ates, DR. PALUEL DE MARMon, - 201 - 3| Pathological Section of Kings Coun. §: Art. II.-The Influence of { limate in ty Medical Society, Brooklyn, - 236 3i: the Treatment of Disease, DR. W. RECENT PUBLICATIONS. - - - A - 239 &#. KIRKWOOD, - - - - - 223 - 240 3; º ài e. & ||# & sº & # Y: § # ,” 3> sº Sº its *# 9.3 - * 3 # * - * ||% # DECEMBER, 1871. | § ! { % § ; : - § Jr. - | # ji CONTENTS. |; §s. - § º | - PAGE PAGE § *|| ORIGINAL CoMMUNICATIONs: Selected Articles: |# &# e & # It §: e g e Pathological and Therapeutical Rela- : # } i Art. I.-Medico-Legal Considerations tions ºf Asthma. . Pectoris, |8. *3; : # |% & 3. i | to º |* . | tº >:3; ; ; | § § |: # ~r- -* |. # NEW YORK : | º, § º | & } $º: 21 PARK ROW, |º 3: .. i; # - LONDO W. TIPUBNER & CO. | } \;"| #3 # |é * |: g===================== $go gº ºgº ºgº gº 33° gº ºgºg WILLIAM BALDWIN & CO., PUBLISHERS, CONTENTS. IPAGE. PAGE. I. origiNAL communications. III. PRocKEDINGs of sociFTIES. Pathological Section of Kings County Medical Society, Brooklyn, . e º . 236 1. Medico Legal Considerations upon Alcoholism and the Moral and Criminal Respon- sibility of Inebriates, . . 201 2. The Influence of Climate in - & IV. RECENT PUBLICATIONS. 239 the Treatment of Disease, . 223 II. SELECTED ARTICLES. On the Pathological and Thera- V. MISCELLANEOUS. peutical Relations of Asthma, Agoraphobia, . . * , 240 Angina Pectoris, and Gas- The Loss of Weight in the Newly tralgia, . e * & . 230 Born, . e te . . . 240 MOLLER'S Purest Norwegian Cod LIVER OTL. Was awarded a Silver Medal at Paris International Exhibition, 1867, heading twenty-seven competitors. - - * . Is prepared from selected Livers, and bottled at Lofoten Islands, Norway. Was awarded a Gold Medal at Bergen International Exhibition, 1865. Is the purest, and for limpidity, clearness, and delicacy of taste and smell is superior to any. Is highly recommended by the Medical Societies of Norway and England. Is more readily assimilated and more readily digested than any other Cod Liver ()il. Was awarded the First Prize and the only Medal at London International Exhi- bition, 1862. Is recommended by high medical authorities in Europe and America. Was awarded First Prize, the only one awarded, at Stockholm Great Exhibi- tion, 1868. r W. H. Schieffe/im & Co., AWew York. Sole Agents for United States and Canada. ſº- IN consequence of the unexpectedly large demand for Back numbers of Tm E WoRLD, the numbers for July are entirely exhausted. Those who have received already the July number, as a specimen copy, will much oblige the Publishers by returning the same, if they do not wish to subscribe, and they will get a copy of any future number in exchange. * THOSE WHO WISH to preserve complete files should make early application. Address - WILLIAM BALDWIN & CO., Publishers, P. O. Box 3472. - 2ſ Park Row, New York. COMMENTS OF THE PRESS ON THE AMERICAN JOURNAL OF OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN. N. Y. Medical Gazette, Jan. 28, 1871, “THIS is pre-eminently a journal for the family practitioner, whose services are so largely called into requisition by the frequent sickness of women and children. If viewed simply as a current epitome of all things bearing upon the branches of which it treats, it would be of infinite value to every physician engaged in general practice. But beyond this, the important original contributions which have been made to medical science through its columns entitle it to higher estimation. No other American periodical has attracted a more distinguished array of authors, foreign and domestic; few journals anywhere have maintained such uniform excellence in the character of their contents.” N. Y. Medical Record, Feb. 15, 1871, “This quarterly commenced its first issue in May, 1868, under the auspices of the leading obstetricians of this city, and many other equally eminent specialists abroad. The articles con- tained in the different numbers have been singularly good and of a thoroughly practical char- acter, a fact which the profession at large have not been slow to appreciate. The care and discrimination of the working editor, who is also the proprietor, Dr. B. F. D.Awson, has been one of the principal means to this end.” Boston Medical and Surgical Journal, Feb, 16, 1871. “We consider it one of our most valuable exchanges, including, as it does, articles bearing the names of Elliot, Emmet, Barker, Hammond, Skeene, Thomas, Eustace Smith, the Editors themselves, and other distinguished writers on the diseases of women and children. We com- mend the Journal most heartily to those of our patrons who need sound advice on the special subjects to which it is devoted—and who does not * * Baltimore Medical Journal, Feb., 1871, “We have no hesitation in declaring it the best journal devoted to this branch of medical literature. No further evidence of this fact is needed than a glance at the list of contributors, among whom will be found the well-known names of T. Gaillard Thomas and A. Jacobi, of New York; Storer, of Boston; Elliot, Hammond, Nott, Emmet, and Boziman, of New York, and many others, all of whom have contributed articles that would enrich the columns of any journal, and cannot fail to be read with pleasure and profit by all who desire to be informed on the subjects of which they severally treat.” -- Richmond and Louisville Medical Journal, Feb., 1871. “No journal in this country has achieved more rapidly a deserved and increasing reputa- tion. Its contents are always valuable and interesting, and the very best representatives of these departments of medicine contribute constantly to its pages. The work can be recommended with entire confidence, and all who desire the best and most recent information in connection with the specialties to whose cultivation the Journal is devoted cannot do better than, by sub- scribing, to have its pages always accessible.” Buffalo Medical and Surgical Journal, Feb., 1871. “The Journal is edited with consummate skill and ability, and receives contributions from many of the most eminent writers and teachers in the profession. The advance of knowledge in this department is so great that practitioners of medicine must give attention to present teach ing, or soon find that their profession is far in advance of them. This journal is a necessity in its department, since in it have appeared, and constantly are appearing, important practical papers, singly of great value, and combined, constituting the progress the art is making from month to month.” Pacific Medical and Surgical Journal, March, 1871. “The judgment and skill displayed in the choice of material have placed this journal in the foremost rank of medical periodicals, and given it a reputation of which the "itors may well be proud.” B. F. DAWSON, M. D., Editor and Proprietor, ADVERTISEMENTS. THE licago Medical Examiner, A IMIONTIEHILY JOTUIERN AT 4 DEVOTED TO THE flaiml \tientific and india º: OF THE micrºft, | MEDICAL PROFESSION. 1 ED ITED BY N. S. DAVIS, M.D., and F. H. DAVIS, M.D. PHRQSPECTUS FOR HS72. With a view of still further meriting the very liberal and constantly increasing patronage and support which the Profession throughout the country have extended to them during the past twelve years, the Publishers of THE EXAMINER have to announce that with the commencement of Vol. XIII., January, 1872, the Monthly issues of the “EXAMINER,” WILL BE ENLARGED, so as to include 72 Pages of Reading Matter, making it the Largest Medical Monthly in the Northwest. rººs C CPINTººHINTº sº; will be of such a character as will directly aid the Physician in the daily practi. cal duties of his profession. A large list of contributors, including many of the most eminent Physicians and Surgeons in the West, insures to the EXAMINER an abundant supply of Original Articles. Bill Numºr Will tiltill in allilill ſm 1% to 14 Piſº Uſ (limital REWrt, including Abstracts of all the principal Medical and Surgical Cliniques of the Mercy Hospital, the Cook County Hospital, and the Free Dispensaries. THE SELECT DEPARTMENT will contain a careful Digest of the Professional and Scientific News and Literature, both at home and abroad. Terms $3.00 per annum, payable invariably in advance No name will be entered on the books until the money has been received. {3}. LIBERAL COMMISSIONS offered to those who will interest themselves in obtaining new sub scribers for the EXAMINER. Tor every Club of Four new Subscribers, and $12, we will send an extra copy of the EXAMINER, gratis, for one year. SPECIAL IN OTHC E TO NEW SUPESCFR IBF R.S. To all new Subscribers who will send their subscription for 1872 to this office before Dec. 1st, we Will mail the October, November, and December numbers free. Lºld dress PUBLISHERS CHICAGO MEDICAL EXAMINER, 797, 7/26&s/ 212ſ., C/22 ago, ZZ2. N. B.-FIRE In consequence of the Great Fire in Chicago, the October number was burned in the Printing Office when it was ready for delivery It will be replaced immediately, however, and the Business of the Journal will go on as usual ADVERTISEMENTS. D.R. J.E ROME IRIDIDErºs ELECTRO-MEDICAL APPARATUS. The Portable Form can be obtained without spilling the fluid. Modified and mani- fold qualities of elec- tricity, patented in the United States, England, and France. The latest examina- tion and opinion of Professor Doremus : É'ſ “The only appara |* tus meeting the de # mand of advanced ºff science.” The only # one adapted to the H=H wants of Practition- = €7°S. --------> º - | || # | | § 5Rºß º º # º!* *-sº -—— opinion of PROF. DoREMUs. The following testimonial from R. O.GDEN DoREMUs, M.D., Professor Chemistry and Physics iſ: the N. Y. City College, and Professor Chemistry and Toxicology, Bellevue Hospital Medical College, refers to the Superior merits of Dr. Kidder's Apparatus:— “COLLEGE OF THE CITY OF NEw York, Cor. T.EXINGTON Ave., AND 23D STREET, “DR. J.EROME IS IDDER : New York, August 9th, 1871. “Dear Sir, Within the past few weeks I have carefully examined the construction of Several forms of your Electro-Magnetic Machines. “I find that they differ in philosophical principles from any I have before investigated, and that they possess, in addition, many mechanical improvements. “By your ingenious modifications and combinations of the primary current of the Galvanic Battery, accomplished by passing it through helices of wires of differing lengths and thicknesses, i. find that the electric effects are materially altered in a manner not accomplished by any other Inachines. “These variations I have tested by galvano-metric, electro-thermic, and other scientific instru- ments. “I have also experienced the varied effects produced upon the human system in my own person, and have witnessed the same in others, on applying the currents of electricity from the various Coils, and through Conductors of graded lengths and sizes. # “Thus the eye can be stimulated to appreciate various amounts of light without pain ; or slight pain may be experienced without so exciting the organ as to perceive iight. Iły changing the flow of the mysterious agent, its influence may be felt at the wrist, in the forearm, or higher up near the shoulder, in addition to all the variations of frequency, direction, and power usually provided for in electro-magnetic machines. “I confess I was surprised at the agreeable nature of the electric current. Most persons dislike the peculiar sensations experienced from the ordinary machines, and, after a first trial, decline a repetition of it. All Such would appreciate not only the bearable but the pleasant effects produced by your arrangement. “Thus you have placed in the hands of the skilled physician most valuable modifications of a power which is destined to Solve many of the mysteries of our organization. and to relieve many of the ills of life. “In conclusion, I would state that your method of varying the Primary as well as the Indºced Currents surpasses all other devices I have studied, as tested by scientific instruments and by physio- jogical effects. “I most heartily commend its use to my medical brethren as the instrument for research in: this attractive field of medical inquiry. “I have the honor to remain your obedient servant, R. O.GDEN DoREMUs, M.T).” Dr. KIDDER manufactures also the most approved Primary Cell Batteries, with improved facili- ties for manipulating the currents, and at reasonable prices. Primary Batteries, with an improved patented arrangement for throwing intensity into quantity, and wice versa. Varied and approved extra appliances for special cases. In order to get the genuine Apparatus, send for Illustrated Cir- §ular, with Price-List. Address, & * Dr. J.E.R.OMIE KIDDER, 544 Broadway, N. Y. ºft Will be sent by mail, (post-paid) on application, A P A M PHILET, Containing twe articles, by distinguished foreign authority, on “INHALATION OF ATOMIZED LIC WITH FORMULAE OF THOSE SUCCESSFULLY EMPLOYED, --~~~--— Also, an article by Dr. J. L. W. THUDICHUM, MI. R. C. P., on “A New Mode of Treating Diseases of the Nasal Cavity,” WITH HIS FORMULATE. f §: UIDS,” Also, an illustrated description of the best apparatuses for the above purposes, and for producing Zoca 2 24naesthesia, by Atomization with Ether, by the method of DR, RICHARDSON, of London; or with Rhigolene, as described by DR. HENRY J. BIGLow, in the Boston Medical azed Surgical journal of April 19, 1866. 24?? ozer 2420???zing Zaseruments are made with the utmost care, with a view to their complete efficiency, convience and durability, and every one is warranted. A Gold Medal has lately been awarded us by the Middlesex Mechanics’ Association, for Atomizing and Surgical Instruments, as will be seen from the following report, signed by a leading New England Surgeon and Physician: . ‘‘ Z503. Codmazz & Shºzrºzeff, Žosłozz, .7/ass. One Case Surgica? Zns?ree meezeźs azed 24lozzizers. . ... “The Committee have no hesitation in awarding for this superb exhibition the highest premium. : The various other instruments for Inhalation of Atomized Liquids, and for Local Anasthesia, were all apparently faultless, both in design and workmanship. The exhibitors are regarded as more especially deserving of the highest token of merit for having produced nothing except of their own manufacture.— Go?d .%eda?. - (Signedi - GILMAN KIMBALL, M. D., Chairman.” Also by the Mass. Charitable Mechanics’ Association.—Exhibition of 1869.--A Siła'e?' .7/eda?, the Highest Medal awarded for Surgical Instruments. :* * *k —- sººn. -º- A L S O TH'O ER, S A. L TEC : *Cammann's Stethoscopes: *French Rubber Urinals, with valves, male, Disarticulating. . . . . g e . $7 co for night or day, . tº * @ & OO *Knight's Modification, , , * e • Q 50 Male, day only, & wº e . . $2 50 to 4 oo Simple Throat Mirrors, Nickel-Plated. . • I OO *French Rubber Urinals, female, for day Ophthalmoscopes, Liebreich’s, . . $5 od to 7 oo Only, e tº e * e tº g OO Holt's Dilator, improved, . e • , , 2O OO *Ice and Hot-Water Bags, . . $2 20 to Io oo Barnes’ “ set of three, with Inflator and *Vaccinators, Whittemore’s Patent Auto- Stop-cocks, * º e e cº * OO matic, for Crust or Lymph fresh from Large Ear Mirrors, Troitsche's, . $3 50 to 5 od arm.—Instantaneous, certain, and al- Hypodermic Syringes, , . ſº * 3 OO to I4 oo most painless (post-paid), g g 3 oo *Miller's Intra-Uterine Scarificator, in case, *Powder Syringes, * & † gº & 2 OO (postpaid) g g * & º e 7 oo Laryngoscopes, complete, . . 16 oo to 25 od Lente's Intra-Uterine Caustic Instruments, *Dr. Oliver's Laryngoscopic Lantern, . 4 OO $1 25 to 3 50 The same, with Auto-Laryngoscopic Sponge Tents, plain and carbolized, each, 25 attachment, . e * wº sº g 5 OO Pinckham's improved Uterine Scarificator, The same, with ditto and three Laryn- in case, . gº º * o g * 8 oo goscopic Mirrors, in Case. . * 9 Oo *Dr. Cutter's Retroversion and other Pessaries 3 co *Dr. H. R. Storer's Combined Speculum, 6 oo Gaiffe's Electro-Medical Apparatus, e I5 Oo * Sezzd for Descriptive Circze/ar. Amputating, Trephining, Exsecting, Pocket, Dissecting, Throat, Ear, Eye, Uterine, Obstetric, and all other special and general sets of Instruments on hand and made up to order. Trusses, Spinal and abdominal Supporters, Shoulder Braces, Suspensory Bandages, Elastic Hose, Medicine Trunks and Pocket Medicine Cases, Otoscopes, Endoscopes, Dr. Sayre's Splints for Hip-Joint Disease, Fever. Ther- mometers, Respirators, Syringes, Crutches, Universal Syringes, Galvanic Batteries and Apparatus, French Conical and Olive-Tipped Bougies and Catheters. - Skeletons, Skulls and Anatomical Charts on hand; Manikins, Anatomical and Pathological. Models imported to order; prices on application. All Instruments, Implements and Materials used by Dentists, always on hand. Apparatus for Club Feet, Weak Ankles, Bow Legs, Spinal Curvature, and other deformities, made to order. Apparatus for Paracentesis Thoracis, approved by Dr. Bowditch and accompanied with directions kindly furnished by him. Having our Manufactory with steam power, and a corps of experienced workmen connected with our store, we are able promptly to make to order new Instruments and Apparatus, and to supply new inventions on favorable terms. INSTRUMENTS SHARPENED, POLISHED AND REPAIRED. CODMAN & SHURTLEFF, Makers and Importers of Surgical and Dental Instruments, 13 & 15 TEREMONT STEREET, BOSTON. I 2 CODMAN & SEIUERTLEFT"S Amaim of Himi for 1mhalation, Łal Amien &t. By the Atomizer, any medicated liquid may be converted into the finest spray. In this state it may be inhaled into the smallest air-cells, thus opening a new era in the treatment of all diseases of the throat and lungs. THE COMPLETE STEAM ATOMIZER FOR IN HALATION, &c. (See Fig. 15.) It consists of the sphere-shaped brass boiler A, steam-outlet tube B, with packing box C formed to receive rubber packing through which the atomizing tube D passes, steam-tight, and by means of which tubes of various sizes may be tightly held against any force of steam, by screwing down its cover while the packing is warm; the safety-valve E, capable of graduation for high or low pressure by the spring or screw in its top, the non-conducting handle F, by which the boiler may be lifted while hot, the medicament-cup and cupholder G, the support H, iron base I I, the glass face-shield J, with oval mouth- piece connected by the elastic band K with the cradle L, whose slot- ted staff passes into a slot in the shield-stand M. M., where it may be fixed at any height or angle required by the milled-screw N. . The waste-cup, medicament-cup and lamp are held in their places in such a manner that they cannot fall out when the apparatus is car- ried or used over a bed or otherwise. All its joints are hard soldered. It cannot be injured by exhaustion of water, or any attainable pres- suſ: º: Steam. h h ld t g- º e t does not throw spirts of hot water, to frighten or Scald the Fig. 15, The Complete Steam Atomizer, patient. 1. 3. e * * * * r Acz ſiz/kalation, &c. ls compact and portable, occupies space of one-sixth cubic foot only, can be carried from place to place without removing the atomiz. Patented March 24, 1868, and Mar. 16, 1869. ing tubes or the water, can be unpacked or packed without loss of time. Will render the best of service for many years, and is cheap in the best sense of the word. Price $6 oo. Neatly made, strong, Black Walnut-i}ox, with convenient handie, additional, $2 5o. Brass Parts Nickel-Plated, additional, $2 50. SHURTLEFF'S ATOMIZING APPARATUS (See Fig. 5), ſor Inhalation, and with suitable tubes, for Local Anaesthesia, and for making direct local applications of atomized liquids for a great variety of purposes. [See our Pamphlet.] The most desirable hand Apparatus. Rubbers warranted of very best gua/ity. Valves imperishable, every one carefully fitted to CCDMA N & SH U R T LEFF, BOS TO N s its seat, and work perfectly in all positions. Šsºlº The Bulbs are adapted to all the Tubes made by us Fig. 5, * { §hurtleff's Atomizing Appar for Local Anaesthesia in Surgical Operations, Teeth Patented March 24, 1868. Extraction, and for Inhalation. Price $4 oo. Each of the above Apparatuses is supplied with two carefully made annealed glass Atomizing Tubes, and accompanied with directions for use. Every Steam Apparatus is tested with steam, at a very high pressure. Each Apparatus is carefully packed for transportation, and warranted perfect. Also, HAND BALL ATOMIZER, No. 5, without face-shield, e e g © * g & & . . $3 THE BOSTON ATOMIZER, with two glass Atomizing Tubes, . . tº g & & tº • 2 50 THE TREMONT ATOMIZER, with two glass Atomizing Tubes, g © º * 2 GLASS ATOMIZING TUBES to fit any of our Apparatus, warranted perfect, each, sº g g NICKEL-PLATED TUBES, for Local Anaesthesia and for Inhalation, each, . * & * 75C. to 2 oo RHIGOLENE, for Local Anaesthesia, best quality, packed, . & tº e § e tº & NASAL DOUCHE, for Treating Diseases of the Nasal Cavity, eight different varieties, each with two Nozzles, packed & º gº e sº tº wº $r 20, I 5o, I 75, 2 oo, and 3 5o I OO N.B.—To save collection expenses, funds should be sent with the order, either in form of draft, post- office order, or registered letter. (For complete illustrated price-list of Apparatus, Tubes, etc., see Pamphlet.) Wm. Baldwin & Co., £iates of 3dvertising PUBLISHERS, 21 Park Row, New York, Receive subscriptions for every medical journal in the world. Very liberal reductions made on all home journals when several are taken together. N THE MEDICAL WORLD. One page, one time, - - - - - - $25 if it” ”, “ . . . . . . *f; Quarter { % sº ſº sº sº º ºs 8 Card, * wº as as * * *gº º 5 3 months less 20 per cent., 6 months less 30 per cent., 12 months less 50 per cent. Fifty per cent. in addition to above rates will be charged for insertions on the cover pages of Joºrnal, or facing reading matter, No quack advertisements will be received at any price. Application in every instance should be made to the Publishers direct, Wm. Baldwin & Co., 21 Park Row, N.Y. JAMES LIDGEFWOOD, 758 Broadway, New York, I offer to the medical profession the following enumerated articles for use in the sick-room, guaranteeing them to be of the very finest quality: Clarets, Hock JWines, Burgundy, Port Wine, Sherry, Madeira, Bitters, Braavolies, Whiskey, Ratam, Gin, Cordials Porter, Arrack. J E L L E.S. CRACKERS. CURRANT, RED. bºts ºft. { % BLACK. $ $ §§ STRAWBERRY, ... $923; BLACKBERRY. ... ºrsia. RASPBERRY. Fox oxêiºTBP. GRAPE. wº * * CRAB APPLE. Pºnsas & CO., in QUINCE. #º *"PALMER TAMARIND. 'S PEACH. LONDON SUGAR WAFERS DAMSON. gº." B RAN DIED FRUITS. LIME. #; ES PEAR. GAGES. ' CANTON GINGER. PEARS. GUMQUOT ORANGE. FIGS. (Liquetta’s), Champagnes, Ale and DUNDEE MARMALADE. APRICOT tº $. SOUPS–all Varieties. COCOA. B ROMA. BAY RUM. ORANGE WATER. CONDENSED MILK. L[EBIG'S EXTRACT MEAT. LEMON SUGAR. MALAGA GRAPES. PRUNES. MUSTARD. CHOCOLATE–VANILL A. { % COMMERCIAL RAISINS. Collection on Orders by mail carefully packed and promptly shipped. delivery. Notes of enquiry attended to by return mail. JAMES LIDGER WOOD. Patent Plate GRAND, SQUARE,&UPRIGHTPIANOS VVareroons, 33 Union Sq., Eroadway. FACTORY, 322, 324, 326, 328 & 330 W. 35th ST, EXTENDING TO 313, 315, 317, 319 & 321 W. 34th ST. “One of the simplest and most truly valuable improvements yet made in the pianoforte is that invented and patented by Decker Bros.”—From the New York Tribune. - CoNTENTs The Medical World for September, 1871. •–), (), 4– PAGE PAGE I. ORIGINAL COMMUNICATIONS. IV. MISCELIANEOUS. 1. Phenomena. Noted in a Case of 1. Winter Resorts for Consump- Epilepsy, e e g ... 81 tives, . º º e . 119 2. Hypodermic Injections, . . 89 2. Fox on “ Skin Diseases,” . . 117 3. The Use of the Seton in Simple 3. Changes in the University Med- Suppurating Bubo, . . 91 ical College, . & e . 117 4. Clinical Examination of Urine, 93 4. “The Physiology and Patho- logy of Scars,” . & . 118 II. SELECTED ARTICLES. 5. Diabetes Mellitus, . e . 118 Extract from a Paper on the Philo- º hº º g * i. sophy of Inte 3 * ... 102 . In Iantlle LJ1arrhoea, . e gº Sopny Intermperance 8. Correction, e º º . 119 8. The Cause of Diabetes Melli- III. REVIEWS. tus, • & . 119 Wear and Tear; or, Hints for the 10. Hypodermic Injection of Mer- Overworked, º © & . 111 cury for Syphilis, . t . 120 PAGE PAGE I. ORIGINAL COMMUNICATIONS. | 2. Obstetric Operations, . . 153 1. The Clinical Thermometer, . 121 IV. MISCELLANEOUS. 2. Notes on the Treatment of Gun-Shot Wounds, as prac- 1. Contagion of Scarlatina and tised in Berlin, . te . 138 Small-pox, te . . . 154 3. Lethargus, º º © . 139 2. The Antiseptic Treatment of 4. Bromide of Sodium, º . 141 Wounds, . tº ſº . 155 5. The Prevention of Abscesses in 3. Phantom Tumor, . * . 156 Hypodermic Medication, . 143 4. The Course of Epithelioma, . 157 II. SELECTED ARTICLES. 5. The Galvanic Current as a A New Ovariotomy Clamp, . . 149 Means of Resorption, . 157 III. REVIEWS. 6. The Radical Cure Of Hernia, o 158 1. A. Medico-Legal Treatise OIl 7. Some Further Additions to Malpractice and Medical Therapeutics, . . . 159 Evidence, . g * . 153 8. Liebig on Germany and France, 160 Cash Subscriptions for 1872 sent in directly to the Publishers up to December 1, entitle the senders to the numbers of TIIE WorlD for November and December free. Address WILLIAM BALDWIN & CO., Publishers, P. O. Box 3472. 21 Park Row, New York. UNIVERSITY OF NEW YORK. MEDICAL DEPARTMENT, 426 East 26th St., opp. Bellevue Hospital, New York City. T H II: T Y- FIR S T S E S S I O N , 1 & 7 1 – 18 º' 2. FA C U L T Y O F M E D M C I N E . REV. HOWARD CROSBY, D.D., tº Chancellor of the University. MARTYN PAINE, M.D., LL.D., tº Emeritus Professor of Materia Medica and Therapeutics. JOHN W. DRAPER, M.D., LL.D., Ameritus Professor of Chemistry and Physiology. President of the Faculty. ALFRED C. POST, M.D., - Professor of Surgery. WILLIAM DARLING, A.M., M.D., F.R.C.S., Professor of Descriptive and Surgical Anatomy. IIENRY DRAPER, M.D., Professor of Physiology. Itegistrar of the Faculty. WILLIAM H. THOMSON., M.D., Professor of Materia Medica and Therapeutics. FREDERICK D. LENTE. M.D., ºfessor of fiseases of Women and Children. EDWARD G. JANEWAY, M.D., º Professor of Physiological and Pathological And tomy. D. B. ST. JOHN ROOSA, M.D., Câmical Professor of Diseases of the Eye CHARIES A. BUDD, M.D., Professor of Obstetrics and Clinical liidwifery. JOHN C. DIRAPER, M.D., | Professor of Chemistry. ALFRED L. LOOMIS, M D .. and Ear. Professor of Institutes and Practice ERSEINE MASON, M.D., of Medicine. Adjunct Professor of Surgery. The Collegiate Year is divided into two sessions—a regular Winter Session and a Spring, Summer, and Autumn Session... The latter is auxiliary to the former, and the design Of the Faculty is to furnish instruction to medical students throughout the year. _Attendance on the regular Winter Session is all that is demanded of the candidates for graduation. Those who attend the Other session receive a Certificate of Honor, as having pursued voluntarily a fuller course than usual. The Spring and Sunnmer Session is principally of a practical and clinical charac- ter, and affords particular facilities to students who have already taken one course in schools where such practical advantages exist to a less extent. The course consists also partly of lectures and ex- aminations on the subjects necessary for graduating in medicine, conducted by the Professors of the regular Faculty and their assistants. The examinations will be addressed to both first and Second course students. For the purpose of making the visits to the wards of the hospitals as available as possible, the class is divided into sections. One, division at a time is instructed in practical diagnosis, prescrip- tion, and treatment of patients. The course begins in the middle of March, and continues till, the beginning of June, when the Summer Commencement is held. During the Summer the College Clinics are kept Open. * The Auturmn or Preliminary Session commences in the middle of September, and continues till the opening of the regular session. It is conducted on the same plan as the Spring and Summer Session. The Regular Winter Session occupies four and a half months, commencing on the second of October, and continuing till the middle of February. The system of instruction embraces a thorough Didactic and Clinical Course, the lectures being illustrated by two clinics each day. One of these daily clinics will be held either in Bellevue or the Charity, Hospital, The location of the pollege building affords the greatest facilities for Hospital Clinics. It is opposite the gate of Bellevue Hospital, on Twenty-sixth Street, and in close proximity to the ferry to Charity Hospital, on Black- well’s Island, while the Department of Out-door Medical Charity and the Hospital Post-mortem Rooms are across the street. The students of the University Medical College will be furnished with admis- sion tickets to these establishments free of charge. The Professors of the practical chairs are connect. ed with one or both of these Hospitals, and students are also entitled to attend all the clinics held by other physicians in them.... Besides the Hospital Clinics, there are eight clinics each week in the College building. The Faculty desire to call attention particularly to the opportunities for dissection. Subjects are abundant, and are furnished free of charge, and the Professor of Anatomy spends several hours each day in demonstration in the dissecting room. Fees for the Winter Course. Full Course of Lectures................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $140 00 Matriculation... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e g; e s e s s e s e e s = * * * * * * * * * * * * * 5 00 Demonstrator’s fee, including material for dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 00 Graduation fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 00 Fees for the Spring, Summer, and Autumn Course. Students who have attended the Winter Course will be admitted free of charge. Those who have not attended the Winter Course will be required to pay the matriculation fee and $30; and should they decide to become pupils for the winter, the $35 thus paid will be deducted from the price of the Winter Tickets. For the purpose of assisting meritorious individuals, the Faculty will receive a few beneficiaries, each of whom will be required to pay $43 per annum and the matriculation fee. For further particulars and circulars, address the Registrar, PROF. HENRY DRAPER, M.D., UNIVERSITY MEDICAL COLLEGE 426 East 26th St., New York City. ‘THE MEDICAL WORLD. A MONTHLY RECORD OF AMERICAN AND FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL, AND CHEMICAL - LITERATURE, CRITICISM, AND NEWS. VOL. I. NEw York, DECEMBER, 1871. No. 6. @ t iſ itſ a [. ART. I.- MEDICO-LEGAL CONSIDERATIONS UPON ALCOHOLISM AND THE MORAT, AND CRIMI- NAL RESPONSIBILITY OF INEBRIATES.* BY PALUEL DE MARMON, M.D., Of Kingsbridge, W. Y. IN order to well understand the real value of the Subject, it is necessary to see first what are the physiological properties of alcohol, and the different degrees of alcoholic intoxications. According to the recent researches of Maurice Perrin, it has been ascertained that “alcohol acts as a regular dynamic agent in the system; that it remains in the blood; that it exerts a direct and primitive action upon the nerve-centres, of which it modifies, perverts, or abolishes the functions; that it does not become transformed or destroyed in the blood or respiration; that it accumulates in the nerve-centres and the blood; and that, finally, it is expelled in nature from the economy by all the ways of elimination.” This author found also, by ex- periments made upon himself, that the use of alcohol di- minishes the quantity of carbonic acid exhaled, and lessens in the same proportion the intra-vascular oxidation, and conse- # A paper read before the Medico-Legal Society of the City of New York March 31, 1871. Entered, according to Act of Congress, in the year 1871, by WILLIAM BALPWIN & Co., in the Office of the Librarian of Congress, at Washington, D. C. 202 Medico-Legal Considerations upon Alcoholism. [Dec., quently the production of animal heat; also, that it increases the secretion of urea. It is not an aliment proper, but, equally with opium, it pre- vents to a certain degree denutrition. Like all substances pro- ducing stupefaction when given in a large dose, it is an excitant when given in a small one. - It causes the temperature of the body to decrease, and that of the brain to increase, thus explaining the effect of congestion of this organ. In acute alcoholism or accidental drunkenness we have three periods: first, excitation; second, perturba- tion; and, third, stupefaction. In the first period, which, in accidental drinkers, is produced after the injection of a few glasses, the subject becomes com- municative, justifying then the old adage, In vino veritas; he is jolly, good-natured, witty; his natural timidity has been chan- ged into boldness; he is kind, generous, friendly, as one who feels happy and has nothing to trouble his mind; he is sociable and obliging; the words flow out of his mouth like a stream. It is this period of happiness so well painted by Macnish * in the following terms: “The consequences of drunkenness,” says he, “are dreadful, but the pleasures of getting drunk are cer- tainly ecstatic. While the illusion lasts, happiness is complete; care and melancholy are thrown to the wind; and Elysium with all its glories descends upon the dazzled imagination of the drinker. Some authors have spoken of the pleasure of being completely drunk; this, however, is not the most exquisite period. The time is when a person is neither drunk nor sober, but neighbor to both, as Bishop Andrews says in his ‘Ex-ale- tation of Ale.” The moment is when the ethereal emanations begin to float around the brain; when the soul is commencing to expand its wings and rise from earth; when the tongue feels itself somewhat loosened in the mouth, and breaks the previous taciturnity if any such existed.” In this period, the individual is very seldom dangerous, and is fully responsible for his acts. If he continues to drink, his ideas become obtuse; his tongue gets thick; he speaks louder, for on account of the buzzing sensation in his ears his auditive power is blunted So he does not hear himself speak, and judges of others by himself; the * “Anatomy of Drunkenness.” 1871.] Medico-Legal Considerations upon Alcoholism. 203 merry feeling of the first period has been replaced by an excess of susceptibility and irritation; he does not take a joke, and is ready for fight; if you don’t listen to him, he gets mad. Mus- cular strength is in that degree at its maximum ; at that time the drunkard becomes a bore to all those surrounding him; he is not conscious of what he says or of what he does, and it is generally then that he is more apt to commit a crime. In the second period of drunkenness, says Hoffbauer: “A man has still the use of his senses, although they are notably af. fected; but he is out of his wits; memory and intellect have left him ; he acts as if living only for the present ; for he does not think of the result of the actions he may commit, and he has forgotten the past. The least occasion is sufficient to awaken in him the greatest passion, although his mind may be changed very easily. In this condition, he is so much the more danger- ous for himself and for others, that he is subjected to an irre- sistible impulse, and that he knows rarely what he is doing: for, in order to be conscious of what is done at the time, it is necessary to know what was done an instant before. He is, then, assimilable to a maniac, and cannot be made responsible for his actions, although he is responsible for his drunkenness.” This question of responsibility has been advocated and argued for and against as all questions of law, when the right, seen separately, seemed to be on both sides. We may ask questions, and add another argument still: Insanity is a legal excuse for crime. Trunkenness, although not an excuse, is assimilable to, and in its second and third degree is really in- Sanity. Then, would an insane man committing a crime while under a fit of alcoholic intoxication be less insane for it, and liable to a different punishment? An insane man or a drunkard cannot be responsible for a deed committed against his will, and, where there is no reason- ing, there is no will, for reasoning cannot exist without will. In a state of drunkenness, man is deprived of reason. Thus, he is not willing. In this case, the body—the animal, if I may so speak—acts without consent of the mind, and any actions committed with absence of mind, consequently in a state of in- sanity, whether it be temporary or permanent, cannot make its author responsible. (I wish it to be well understood that I do not mean to ex- 204 Medico-Legal Considerations upon Alcoholism. [Dec., cuse drunkenness, my views being, on the contrary, diametri- cally opposed to it. I only emit an argument, and hope it will be combated. We will see very soon the different opinions upon this subject.) The second stage, however, does not last long, but changes into a third one—brutishness and somnolence. Relaxation of the whole muscular system has taken place; the subject is not able to walk; he is vomiting; his mind is stolid as well as all his faculties; he cannot find his house, nor does he know his friends. He has in that period reached a degree below the Swine, for this last can find its own pen and knows its own young ones.” In that third period, man cannot commit a crime, or, if he does, it must be involuntarily and by accident; but it is at that period that a crime may be committed upon him, as he is unable to defend himself; and as in this period, also, there is a great degree of anaesthesia, the most severe wounds, the most painful operations, are not felt; and we know that, before anaes- thetics were used in surgical operations, barber-surgeons used to intoxicate patients until complete relaxation of the muscular system was produced, before making an operation or reducing a fracture. Drunkenness may be produced upon a child, a woman, with the guilty intention of committing a rape. In this case, if intoxication has been pushed to a high degree, the victim is totally unaware of the deed committed upon her. It may in such instance create difficulties as to the evidence in the case. No traces of resistance are shown, above all, if the deed has been committed upon a married woman. If it has been committed upon a virgin, it is different. Traces common to this crime may be easily detected. A man will get intoxicated sometimes with the intention of committing a crime and prepare an excuse under the plea of drunkenness. The laws of the State of New York do not accept the excuse as long as drunkenness is a voluntary action. * Casper says moral liberty varies according to the degrees of drunkenness; the shades are difficult to discern, the stages are transformed rapidly. At what moment are conscience and will lost 2 The first glasses, says an Italian proverb, give lamb's blood, which causes one to be good-natured; the second ones give tiger's blood, which makes one furious; the last ones, hog's blood, which causes one to roll in the mud. These are the three i. ºitatiºn, perturbation, and stupefaction—as I aWe already described them. 1871.] Medico-Legal Considerations upon Alcoholism. 205 We will see farther that, however, where drunkenness has de- generated into a mental disease, jurists think differently. Medico-Legal Diagnosis.-In a medico-legal examination of a case of alcoholism, “the first point to establish,” says Tourdes (“Dict. Encycl.”), “is the fact of alcoholism. This Question is asked in most of criminal cases. Sudden death, accidents, as well as suicide and homicide, require this investi- gation.” Medical evidence is furnished by the symptoms, the post- mortem and chemical examinations. We will not enter into these details, which would lead us too far and cause our remarks to extend beyond our limited time. Intoxication does not present the same character when caused by different drinks. Spirituous liquors are obtained, some by fermentation and others by fermentation and distil- lation. They all have the same active principle, viz., alcohol, in a more or less large quantity. Such are, wine, cider beer, brandy, rum, whiskey, arrack (made with fermented rice and catechu), absinthe, gin, etc. Absinthe is the most hurtful, and lately the name of absinthism has been given to the disease caused by its abuse. - All these beverages do not contribute in an equal proportion to the production of the disease, but generally it is possible to ascertain their degree of nocuousness by the state of concen- tration of the alcohol. It would, however, little conform to observations to attribute to them identical effects. Professor Trousseau (Dict. en 30 vol.) finds special properties in cham- pagne, Rhine wine, spirits of grain and of potatoes. “Drunk- enness caused by wine,” says M. Bouchardat, “exerts some less marked and slower modifications upon innervation and diges- tion than intoxication by brandy; death is also less rapid than by the abuse of strong liquors.” Cider acts somewhat like sparkling wines, and brings its action upon the nervous system, and, besides, causes some affection of the digestive organs, such as indigestion, diarrhoea, gastralgia, and sometimes leads into glycosuria. Beer strongly alcoholized may produce the same effects as wine, but intoxica- tion produced by it is generally more dangerous. This bever- 206 Medico-Legal Considerations upon Alcoholism. [Dec., age leads into obesity, and into the decrease of the active forces of the economy. Hogarth has perfectly understood it in his caricatures called “Gin Lane and Ale Alley,” the difference existing between the beer and the spirit drinkers. The beer drunkard is fat and bloated, whilst the spirit drinker is thin and emaciated. The expert shall have to make the differential diagnosis between alcoholic and other intoxications. A poison may have been given to an individual, and to conceal the homicide a dose of alcoholic liquor or wine be injected in the mouth and stomach to give rise to the suspicion that the subject died of drunkenness. In this case, the liquor injected would be nearly all found in the stomach; some might be found also in the tra- chea, but none would be found in the brain, where it is always found in subjects poisoned by alcohol. This absence of alcohol in the brain, after having been found in the stomach, should of itself lead the expert into the suspicion that the subject died from some other cause, and lead him to look for that cause. The medical expert must also detect simulated drunkenness, as well as intoxication caused by other substances, such as opium, belladonna, datura stramonium, ether, chloroform, tur- pentine, naphtha, benzine, or carbolic acid; which, especially the two last, produce regular drunkenness. : . The effects of intoxication by alcohol are sometimes very Sudden, so much so that in some cases instantaneous death has been produced in individuals swallowing one quart or more of brandy at one time. Of all intoxicating liquors, potato whiskey is the one which produces the most disgusting drunkenness. Alcoholism may be mistaken for the symptoms of a disease; for example, for the first delirium of typhoid fever, congestion of the brain, apoplexy, the sequelae of a wound upon the head. Very often a man attacked with concussion of the brain after a wound, or one having been exposed to an intense cold or heat, has been taken for a drunkard, and vice versa.” The diagnosis must then be based upon the presence of alcohol and the comparative signs of the intoxication and the wound. The difficulty, however, is greater if a consecutive disease, as apoplexy, for example, is added to the effects of drunkenness, or * “Dict, Encyclopèdique.” 1871.] Medico-Legal Considerations upon Alcoholism. 207 if it is complicated from the effects of a wound. In this case, then, both conditions must be examined and diagnosticated separately. According to Ware and Calmeil, delirium tremens is seldom a cause of death, being 1 to 20; but Grisolle” thinks the pro- portion to be much higher, as it is demonstrated by statistics published in 1842, at Brussels, by Dr. Bougard: out of 447 cases of delirium tremens observed at Copenhagen, Paris, and Brussels, there were 85 deaths, being one-fifth of mortality. Death, says Grisolle, is the consequence of some cerebral complication, exhibited by convulsions in some, whilst in others it is caused by diseases independent of the brain. Finally, most of them die in consequence of the perturbation experi- enced by the nervous system ; they fall suddenly into collapsus, and succumb abruptly after an agony of only a few minutes. |Wounds.-In regard to traumatism, we all know what in- fluence is exerted upon wounds by alcoholism, although they often differ very much, and depend upon whether the subject is laboring under acute or chronic alcoholism, for the con- sequences and the treatment are very different in both cases. Drunkenness acts upon the traumatism as traumatism acts upon drunkenness.” In the first case, drunkenness plays an im- portant part in a hygienie and medico-legal point of view as a cause of the traumatism. It complicates the diagnosis, and gives rise to important questions of intervention, such as an indica- tion of delay in the operation, and a contraindication to the administration of chloroform. In the second case, the traumatic action seems to act upon the drunkenness. It may increase it, and necessitate an active treatment, of which a striking example is the observation of Simpson, who performed tracheotomy in a case of drunkenness, and saved his patient. “The most slight traumatic lesions,” says M. Peronne, “especially the wounds upon the head, may have the most serious consequences when the subject is under the influence of alcohol; but accidental drunkenness does not seem to have any marked influence upon the future consequence of the wounds. “Traumatism is often the occasional cause of acute alcoholic * “Traité de Pathologie interne.” + Peronne, “De l'Alcoolisme dans ses Rapports avec le Traumatisme.” 208 Medico-Legal Considerations upon Alcoholism. [Dec., accidents in individuals laboring under chronic alcoholism, the most frequent of which is delirium tremens. “The gravity and frequency of alcoholic delirium seem to have more effect upon traumatisms exposing to alteration of the blood, and delirium is declared so much the sooner as trau- matism exposes more to these alterations. The nervous de- lirium as described by Dupuytren must certainly have been alcoholic delirium. . “Finally, alcoholism contraindicates all operations not neces- sarily urgent; but, if immediate intervention is indispensable, it will be advantageous to act promptly before traumatic fever sets in.” These questions are of the highest importance in a medico- legal point of view; and both wounds and subject in cases of assaults or murders must be carefully and separately examined, as the wound inflicted may become mortal in an alcoholic sub- ject, which otherwise would have been of no consequence in a sober one. The wound or contusion is then only the occasional, the secondary cause ; drunkenness is the essential, the real, the predisposing one, since, according to the judicious remark of Tardieu, in death supervening so suddenly in drunken subjects, pulmonary and cerebral apoplexy are, if not constant, at least very frequent and almost characteristic leisons. Spontaneous Combustion.—Since the medico-legal examina- tion of the Countess of Goerlitz's murder, there has been a great doubt as to the veracity of the cases reported as cases of spontaneous combustion, and the fact is that modern authors do not speak of it; it seems to have been buried in oblivion. I shall here revive the subject, and report a few cases; for, not- withstanding the conclusion in the report of MM. Siebold and Tardieu in the case above cited, and which says that, of the pretended facts of human spontaneous combustion re- ported, not one has been attested by competent witnesses, the question still remains unsettled. Among the many cases reported by Lair” is one reported by Joseph Bataglia, surgeon at Ponte-Bosio. Don G. Maria Ber- tholi, a priest of Mount Valerius, went to the fair of Filetto, and afterwards visited a relation in Fenilo, where he intended to * Lair, P. A. : “Essai sur les Combustions Humaines produites par un ong Abus des Liqueurs spiritueuses.” In-8. & Paris. 1800. 1871.] Medico-Legal Considerations upon Alcoholism. 209 pass the night. Before retiring to rest, he was left reading his breviary, when, shortly afterwards, the family were alarmed by his loud cries and a strange noise in his room. On opening the door, he was lying prostrate on the floor, and surrounded by flickering flames. Bataglia was immediately sent for, and on his arrival the unfortunate man was found in a most deplorable state. The integuments of the arms and back were either consumed or detached in hanging flaps. He said that he felt all of a sudden as if his arm had received a violent blow from a club, and at the same time he saw a blue flame rising from his shirt-sleeves, which were consumed with- out having burnt the wrists. A handkerchief which he had tied round his shoulders, between the shirt and the skin, was intact. His drawers were also sound; but, strange to say, his silk skull-cap was burnt, while his hair bore no marks of com- bustion. He died the fourth day; his body exhaled an intoler- ably putrid smell, and was full of maggots. CASE II.-An old woman, very devoted to ardent liquors, and who never went to bed without being drunk, was found reduced to ashes; both femurs and several other portions of bones were not entirely consumed. The case is reported in the Commentaries of Zeipsie. CASE III.-Another fact of the same nature is reported by Jacobaeus in the Annals of Copenhagen. In 1692, a woman who was making a great abuse of spirituous liquors, and took very little food, having fallen asleep upon a chair, was found entirely burned, except the cranium and the last articulations of the fingers. CASE IV.-In 1765, Countess Cornelia Bandi, of Cesena, who was in the habit of using frictions of camphorated spirits, was found consumed close to her bedside. No traces of fire could be observed in the room; the very lights had been burned down to their sockets; but the furniture, closets, and linen were covered with grayish, damp, and clammy soot. (Bian- chini.) - There are on record about fifty cases of human combustion, of which forty-five are reported by Lair (loc. cit.) It is possible that these accidents may be attributed to the escape of hydrogen gas. The presence of this inflammable body in animals is evident. Morton saw flames issuing from 210 Medico-Legal Considerations upon Alcoholism. [Dec., the body of a pig. Bonami and Buysch, with a lighted candle, set fire to the vapor arising from the stomach of a woman whom they were opening. In the Memoirs of the Academy of Sciences of Paris, of 1751, we find the case of a butcher who, on opening the body of an ox that had died after a malady which had caused him to swell considerably, was severely burned, as well as a little girl who was alongside of him, by an explosion and a flame which rose to the height of about five feet, lasted several minutes, and emitted a very dis- agreeable odor. Sturm, Nieremberg, Bartholin, Gaubius, Gmelin, speak of fiery eructations when, after copious libations, drinkers expose themselves to a cold atmosphere. Liebig remarks that the forty-five or fifty cases reported since 1725 present all this in common : that, first, they all took place in winter. Second, in alcohol drinkers in a state of drunkenness. Third, in countries where apartments are heated with open fireplaces. But such facts are so rarely observed in our days that it is difficult to confirm the theories and reports of old authors by new and well-identified observations. A paper upon the subject of spontaneous combustion has been lately written by Prof. Alexander Ogston, of Aberdeen, and published in The British and Foreign Medico-Chirurgical Review, No. 89, January, 1870, in which he classifies the cases in two classes. The spurious cases belong to the first class, which comprises those based on the most unreliable data; they, how- ever, make a small percentage. The second class comprises cases whose deductions are based upon conditions which cannot be denied as being true and doubtful, and are admitted indis- criminately as evidence. This author counts fifty-seven cases as an exact number of those on record; and he himself reports one case he has observed, with his father, on the 14th of March, 1869. - They were requested to examine the remains of Mrs. War- rack, of Ross, aged 66, who resided alone in a house near the Bridge of Dee, Aberdeen. She was said to have been stout, of intemperate habits, and her son stated that he had left her at 10 A.M. on the 14th in her usual health. She was found at 11 A.M. on the same day, lying burnt on the lower steps of 1871.] Medico-Legal Considerations upon Alcoholism. 211 the stair of her house, on her left side. The condition of the body showed that the fire had caused the greatest alterations in it. The hair was burnt off; the soft parts of the face and front of the head burnt off, the bones exposed, blackened and calcined; the back of the head, the neck, and the trunk everywhere converted into greasy charcoal to the depth of about an inch; the skin totally removed, and the bones of the trunk lying bare, blackened and calcined; the front wall of the abdomen totally destroyed; all the internal organs were burnt to ashes, black and greasy; the right foot totally de- tached from the leg, and converted into a soft, black, greasy, and shapeless cinder, through which the finger could be pushed with ease, etc. Not a vestige of clothing remained anywhere. Dr. Beveridge, in a number of experiments as to the com- bustibility of human tissues, concludes, first, that, while simple heat or exposure to a red flameless heat is slow in charring and destruction, the exposition of tissues to a flame gives rise to a much more rapid process of destruction; second, that in por- tions of flesh removed from the human body, if without fat, the charring is slow and very gradual, while, if fat and placed next to the flame, the cutis is speedily destroyed and charred, and, cracking, permits the liquefaction and flowing out of the subcutaneous fat, which, taking fire, envelops the whole mass in a flame so strong as to speedily reduce it to the condition of a black, greasy cinder. Illusions and Hallucinations.—These two conditions, al- though not identical in their effects, are connected together, produced by the same cause, and one is often the consequence of the other. They are intimately connected with the ques- tion now occupying us, as being frequently the cause of murder or suicide. By illusion, we understand a mental condition in which the subject takes one thing for another, or one person for another, or for an animal or a devil. Briene de Boismont (“Des Hallu- cination”) relates a number of those cases, a few of which we shall repeat. In one case, a woman killed her husband with an iron bar, having taken him for the devil, and, although she afterwards recognized her mistake, she always persisted in say- ing that she took him for this evil spirit. Once before, mis- 212 Medico-Legal Considerations upon Alcoholism. [Dec., taking her sister for a cadaver, she took her by the neck, and was going to throw her out of the window. Ring Theodoricus, blinded by jealousy, and yielding to the perfidious suggestions of his courtiers, ordered the Senator Symmachus, one of the most virtuous men of his time, to be put to death. This order is hardly executed before the king is overwhelmed with remorse; he incessantly reproaches himself with that crime. One day a new kind of fish is served upon his table; he gets filled with terror, for in the head of the fish he has recognized that of Symmachus. M. C. (“Obs.” 23), after a mental affection of which he is now completely cured, returns to his family. The next day he goes down in the cellar, followed by his wife. His sister, not seeing them return, goes down also. The absence of these persons is so prolonged that the servant becomes anxious, and goes to see what may be the cause of the delay, when she suddenly reappears, and runs out of the house screaming terribly. From the expression of fright painted on her face, something frightful is expected; the police arrive; two women are seen swimming in their blood, and a man sitting on a barrel, with a razor lying at his feet. Being questioned, all he can answer is that he has seen the devil, and has defended himself against him. This man, whose mental disease had been ascertained, was sent to Charenton, and afterward transferred to a private asylum, where Briene de Boismont saw him for nearly a year. He spoke rather reasonably, and his conduct presented nothing peculiar. The doctor was struck by only one thing: every time the washerwoman came, he saw the woman’s clothes spotted with blood, and his eye took a sin- istral expression. C., tired of living in an asylum, claimed his liberty, and obtained it, notwithstanding the protestations of Esquirol and Marc. A few years after, he assaulted the woman who lived with him, taking her for a demon who was reproaching him for his crimes; she only escaped an imminent death by jumping out of a window. Twelve days after he expired in an asylum in the midst of raving madness, thinking himself surrounded by phantoms and devils.” * Briene de Boismont : “Observations Medico-legales sur la Monomanie Homicide.” Paris. 1827. - 1871.] Medico-Legal Considerations upon Alcoholism. 213 Mare relates a case where, two friends being intoxicated, the one killed the other under an illusion that he was an evil spirit. The drunkenness of the accused was held to have been voluntary, and he was condemned to ten years' impris- onment with hard labor. A case of this description (Taylor) was tried at the Norfolk Lent Assizes, 1840 (Reg. v. Patteson). A man while intoxicated killed his friend, who was also intox- icated, under the illusion that he was some other person who had come to attack him. The judge made the guilt of the prisoner to rest upon whether, had he been sober, he would have perpetrated the act under a similar illusion. As he had voluntarily brought himself into a state of intoxication, this was no justification. He was found guilty of manslaughter, and sentenced to two months' imprisonment. “The proof of drunkenness may fail,” says Taylor,” “but still, if the party charged with the death acted under an illu- sion, he will be acquitted. In Reg. v. Price (Maidstone Sum- mer Ass., 1846), it was proved that prisoner, who had been on friendly terms with deceased, was going home at night, having previously been in company with deceased at a public-house, when, according to his statement, a man sprang upon him from the hedge by the road-side, and demanded his money and his watch, or else he said he would take his life. The prisoner closed with and beat him severely, inflicting such injuries that he died shortly afterwards. The supposed robber turned out to be the friend, and it was believed that he had made an attempt to rob the prisoner jokingly, which, however, had ended in this fatal manner. The prisoner throughout told the same story, and there did not appear to be the slightest ground for believing that it was untrue. Coltman, J., after hearing the evidence of the witnesses, said it appeared to be quite clear that the prisoner had acted under an impres- sion that he was protecting his own life from the attack of a robber, and under such circumstances he could not be held to be criminally responsible. The jury accordingly returned a verdict of not guilty, and the prisoner was discharged.” 1 //allucination is a mental condition in which the pertur- bation of the senses is such that the hallucinated sees, feels, --> * “Medical Jurisprudence.” 214 Medico-Legal Considerations upon Alcoholism. [Dec., hears, or smells things existing only in his imagination. The pretended sensations of the hallucinated, says Esquirol, are images, or ideas reproduced by memory, associated by imagi- nation and personified by habit. - Hallucinations caused by alcoholism have generally the same character. In some cases, the subject is persecuted by men forc- ing him to endorse a forged check, as I have witnessed one a short time ago; another one is terrified by the presence of thieves, thinks he is tied up and is going to be thrown in a river; in other cases, the prominent idea is the presence of devils or animals. Morel remarks that, in the principal of this wretched passion, it is not infrequent to see phosphorescent lights presenting the most fantastic forms. The patients have frightful dreams, they see hideous objects, threatening faces, unclean animals of all sorts, which they try to keep away in extending the arms or covering their faces. In the period when the alcoholist experiences some formications in the legs, they may be illusioned in the same way as hypochondriacs. An insane man of this category followed, with a sensation of stupid uneasiness, the motions of a cat, which, climbing on his legs, stuck its claws in his flesh. When arrived at the par- oxysm of pain, the illusion was becoming so complete that this patient would catch hold of and evidently squeeze his scrotum, thinking he had caught the animal. Hallucinations are more generally a cause of suicide, either voluntary or involuntary; and is it astonishing that it should be so 2 A man thinks he is pursued by something who wants to kill him; he runs out through a window, taking it for a door, and kills himself in the fall. Another one is so oppressed and persecuted by the sensation of animals running on him to devour him that he hangs himself. Briene de Boismont (“Du Suicide et de la Folie Suicide”) relates the following case: X., a day-laborer had been, through drinking excesses, subjected to a superexcitation, revealing to him the thousand small miseries of life. The idea of work appeared to him as a horrid malediction ; he resolved to get rid of it without delay. Providing himself with a rope, he climbed on a tree, and, after fastening it and passing round his neck, he threw himself into eternity. Fortunately for him the same was broken by the shock, and his body deposited upon the ground, where it 1871.] Medico-Legal Considerations upon Alcoholism. 215 was found by a charitable passer-by, who cut the rope, and, as- sisted by the police, took him to the station-house, where he could say nothing, except that drinking made him crazy. However, when completely sober, he thanked his star for having escaped so miraculously from death, and preserved care- fully the rope, probably as a future warning from getting drunk again. Drunkenness may also lead to kleptomania, this new excuse for fashionable people who are in the habit of supplying themselves with other people's property. - A man whose honesty was unspotted was no sooner drunk that he was stealing everything that came under his hands. As soon as the paroxysm was terminated, he felt ashamed of himself and restored the stolen goods. He was led to commit sui- cide from the fact that he could not cure himself of this bad habit.” Moral and Criminal Responsibility of Drunkards.--This is a question which has been the subject of the greatest contest- ations and variety of opinions. Aristotle and after him Quin- tilianus did not admit that drunkenness, even when so complete that liberty of action was abolished, was an excuse or even a cause of extenuation. Drunkenness, they said, was a state of voluntary degradation, and one cannot find a means of jus- tification in his own degradation. Drunkenness aggravates the crime instead of excusing it; and there is, then, a reason for applying two punishments, one for the offence and the other for the drunkenness. This opinion was accepted by jurists of the middle ages, when a citation was an argument, and was defended by Bartholes. In the statutes of Francis I., the offences committed in that condition were more severely pun- ished. In England as well as in this country drunkenness is no excuse for crime, and Blackstone declares that it is rather a cause of aggravation. In Prussia and Bavaria, on the contrary, drunkenness is a cause of excuse (Briaud and Chaudé). How- ever, we see in the Prussian code that any one who, through gambling, drunkenness, or otherwise, is unable to support his family is sent to prison.* The French Penal Code is silent on this point, and the dis- cussion rolls upon the interpretation to be given to Art. 64, * Briene de Boismont, loc. cit. - # The criminal code of Maria Theresa admitted that the indiv dual in a 216 Medico-Legal Considerations upon Alcoholism. [Dec., which declares, first, that there is neither crime nor offence where the accused was in a state of dementia at the time the deed was committed, and, after, that no crime or offence can be excused or the punishment mitigated except in cases or circumstances where the law declares the fact excusable, and allows an extenuation of the pain. In regard to civil responsibility, authors are unanimous and agree that drunkenness pushed to a certain degree engenders an incapacity; depriving temporarily the individual laboring under its influence from the faculty of making a contract, and that the nullity of an agreement passed in this condition must be granted. (Pothier, cited by Briaud and Chaudé.) Taylor says: “When the mind of a man is completely weakened by habitual drunkenness, then the law infers irrespon- sibility, unless it plainly appears that the person was at the time of the act, whether of a civil or of a criminal nature, en- dowed with full consciousness of what he was doing; and a court of equity will not interfere in other cases unless the drunk- enness was the result of collusion by others for the purpose of fraud. When the drunkenness has occasioned a temporary loss of the reasoning powers, the party is incapable of giving a valid consent, and therefore cannot enter into a contract or agreement, for this implies aggregatio menţium, i.e. a mutual assent of the parties. Partial drunkenness, therefore, provided the person knew what he was about, does not vitiate a contract or agreement into which he may have entered. Thus the law appears to create two states in drunkenness: one, in which it has proceeded to but a slight extent, and it is considered that there is still a power of rational consent; another, in which it has proceeded so far that the person has no consciousness of the transaction, and, therefore, can give no rational consent The proof of the existence of this last state would vitiate all the civil acts of a party.” Upon the criminal question of respon- sibility, the same author remarks: “When homicide is com- mitted by a man in a state of drunkenness, this is held to be no excuse for the crime. If voluntarily induced, whatever may state of drunkenness was incapable of offence. The Austrian code says that involuntary drunkenness leading to criminal action destroys the judgment, and, of course, responsibility. It declares that drunkenness must be punished as transgression when one has committed an action which in another time should be considered as a crime. 1871.] Medico-Legal Considerations upon Alcoholism. 217 be its degree, it is not admitted as a ground of irresponsibility, even although the party might not have contemplated the crime when sober. Thus it appears that, when the state of drunkenness is such that any civil act of the person would be void, he may still be held responsible for a crime like murder.” & In the State of New York, we have a statute which places the property of habitual drunkards under the care of the chan- cellor, in the same manner as that of lunatics. The overseers of the poor in each town may, when they discover any person to be a habitual drunkard, apply to the chancellor for the exercise of his power and jurisdiction. And certain cases, when the person considers himself aggrieved, may be investigated by six freeholders, as to whether or not he is actually what he is de- scribed to be, and their declaration is prima facie evidence of the fact. (Beck’s “Med. Jur.”) Now, we must decline to accept the validity of such a law, that the testimony given by six freeholders is prima facie evidence of the fact in a medico-legal question. We have always opposed medical eaſpertise given by laymen, and we do it now more than ever. So many blunders and illegal acts are caused daily by such experts that it is time they should be stopped. No question involving a medical question should be judged and its validity become incontestable except when given not only by a physician, but by a medical expert. And members of a jury, especially of a country jury, are, as a common thing, very incompetent in everything regarding medical matters, and no man is able to discuss or judge of a question he is totally ignorant of. Far from being a pretext to extenuate the offence, drunken- ness must, on the contrary, aggravate the circumstances. In fact, the perpetration of a crime is in most cases encouraged by it. Drunkenness has been the first offence which has led to a second one more criminal still, and the second offence is very often the consequence of the first. The man who gets drunk has often the idea of satisfying a passion, and only uses drunk- * The English laws do not excuse. Whoever gets drunk voluntarily is responsible for the action committed in that condition, if even, when sober, he could not have premeditated the crime. Drunkenness has no legal action ; it neither extenuates nor increases the penalty attached to the transgression. (Guy.) VOL. I.-17 218 Medico-Legal Considerations upon Alcoholism. [Dec., enness as a cloak to conceal his premeditation. The records of criminal cases show that often murderers, incendiaries, and seducers get intoxicated before committing their crimes; and, as Taylor says, “it is obvious that, if drunkenness were to be readi- ly admitted as a plea of irresponsibility, three-fourths of the whole of the crimes in this country would go unpunished.” Sir E. Coke declares that, “as for a drunkard who is volum- torius demon, he hath no privilege thereby; but what hurt or ill soever he doeth, his drunkenness doth aggravate it.” In our own day, Judge Parke, a very authoritative Crown judge, said to a jury: “I must also tell you, if a man makes himself voluntarily drunk, it is no excuse for any crime he may commit while he is so. IIe takes the consequences of his own voluntary act, or most crimes would go unpunished.” (John Bellónport.) Such opinions, of course, must vary a great deal according to whether the judge is a temperate man or the contrary. The French laws do not make any mention of drunkenness. it is not admitted as a legal excuse, “There is neither crime nor offence where the accused was in a state of dementia at the time of the action.” (Code Pénal, 64.) Attempts have been made to apply to drunkenness this disposition of the penal code. Dementia is a general expression designing all conditions in which consciousness, judgment, will, are suspended; it is men- £al alienation, permanent or temporary, primitive or secondary, a delirium as well as a mania. Should we hesitate, says Tourdes (“Dict. Encycl. des Sc. Med.”), to excuse the acts committed under the influence of typhoid fever, of poisoning by belladonna, by datura! Why, then, judge differently when it is a question of alcohol, which has identical effects upon conscience and will ? Jurisprudence has always rejected this doctrine. Drunken- ness is a voluntary action, a wicked one, disapproved by morals, and cannot constitute a legal excuse. “If the will of the legis- lator had been to place drunkenness upon the same level as dementia, and classify it among the excuses, he would have mentioned it as he mentioned dementia and provocation. His silence reveals his formal will to refuse that character to it.” (Briaud and Chaudé.) The question of drunkenness cannot be submitted to the jury. In 1808, the Court of Assizes of Cher, having put a question relative to drunkenness presented by the accused, the Court of Cassation disapproved, specifying that 1871.] Medico-Legal Considerations upon Alcoholism. 219 drunkenness, being a voluntary and reprovable action, can never constitute an excuse acceptable by law and morals. Such is French jurisprudence, which makes man responsible for crimes committed during drunkenness. We will now ex- amine this doctrine in its medical aspect. Drunkenness is a temporary dementia, destroying conscience and free-will. Tesponsibility and absence of moral liberty are contradictory ideas. Such is the absolute principle. “Drunk- onness,” says Rossi, “when complete, destroys completely the conscience of good or evil, the faculty of reasoning; it is a sort of temporary dementia. The man who became intoxicated may be guilty of a great imprudence, but it is impossible to say with justice, ‘This crime you understood at the time it was committed by you.’” The man who gets drunk must only be responsible for the imprudence he committed in getting drunk. To impute to him the actions he committed when he had lost his power of reasoning is punishing as a crime a purely material action, abstraction being made of the guilty will of the agent. (Chev- reau and F. Helis.) If the individual has lost all faculties of knowledge, judgment, and will, he becomes unable to dispose. and contract. His actions can no more be imputed to him. If in a general view this principle is not contestable, let us, however, confine it between some narrow limits, and indicate the circumstances ruling its application. It would be danger- ous to give the character of a legal excuse to a fact reprovable in itself—to legitimate, to so speak, an immoral habit and pre- pare an excuse to all crimes. Drunkenness alters more or less. our moral faculties; but the insane himself, in a certain measure, may be considered as responsible for his actions when they are committed during a lucid moment, and when the mental lesion. is not very deep or specialized. The same appreciation, with still more right, is applied to the effects of alcoholism. We must not in such a matter admit any absolute doctrine. There are regarding drunkenness Some cases of excuse or of extenua- tion, as well as there are cases where responsibility remains en- tire or is even aggravated. This opinion is not contrary to law. Some authors go still further. Dr. Steph. Rogers, in a paper read before this Society, says: * “The finding of a man drunk * Quarterly Journal of Psychological Med., April, 1869. - 220 Medico-Legal Considerations upon Alcoholism. [Dec., and absent from business that he knows to be important, I should at once regard as evidence of the existence of metho- mania in his case”; and as “methomania,” according to the same author, “is a manifestation of brain disease,” and that brain disease involves generally impairment of mental faculties, and consequently a form of insanity, any man drunk and absent from business that he knows to be important, committing a crime in that condition, should be treated not as a criminal, but as a maniac. Dr. Tyler, quoted by the same author, says: “An inebriate has a diseased brain. No will or agency of his can bring forth therefrom other than diseased mental and moral products. A person who is governed by an uncontrollable influence is not a responsible being, and should be so treated.” Now, as we have seen above; the drunkard is in some cases responsible and in others he is not ; and, in fact, how can we condemn a man committing a crime against his will? In a criminal case, the question must be carefully examined; for, if the guilty party has had attacks of delirium tremens, if it is ascertained that he is a dipsomaniac, he ought to be confined in an asylum as any other insane, and, no matter how well he may appear to be while confined, it is not till after a long time, probably ten years, before he can renounce spirits, or that he may be set at liberty without danger for himself and society. No matter how much he might promise, swear, that he will not “touch another glass,” the inclination before that time is stronger than he. He cannot resist it as long as he can procure it. The habit of getting drunk is as old as the world. It is a chronic evil, and a chronic evil as well as a chronic disease can- not be cured by quick-acting remedies. The symptoms may be amended, but before a cure can be effected we must first combat the diathesis, and use slow-acting remedies as well as all the resources of hygiene. When we want to treat a disease, we always try to find its cause. When this last is found, it is often an indication for the treatment. - - Now, in ninety cases out of a hundred, drunkenness is first contracted by imitation and politeness; for it is considered very impolite by some individuals to refuse to drink when in- 1871] Medico-Legal Considerations upon Alcoholism. 221 vited to join in. It soon becomes a habit, and then constitutes One of the most incurable diseases. Every additional glass is one more stitch in that other Nessus' tunic, called chronic alco- holism, and from which, when once entangled in its folds, it is impossible to come out, and Hercules, like the drunkard, dies in the most wretched agony. - The disease is not even ended by his death, but its influence extends from generation to generation until extinction of his race. Morel” reports many examples of this fact. According to him, the sequence is as follows: First generation: immorality, depravity, except in the use of alcoholic liquors, moral debasement. - Second generation : hereditary drunkenness, paroxysms of mania, general paralysis. Third generation: sobriety, hypochondria, melancholy, sys- tematic ideas of being persecuted, homicidal tendency. Fourth generation ; intelligence slightly developed, first accession of mania at sixteen years of age, stupidity, sub- sequent idiocy, and probably extinction of the family. Another cause rests principally in this country upon the bar- room system. There were in New York, on the 1st of last Feb- ruary (1871), 7,000 dram-shops or hotels paying license, under the Excise Law ; and I was told by one of the officers of the de- partment that there was at least an equal number of people selling liquor without license, which would make for the city of New York alone the enormous number of 14,000 drinking places, one for every 65 inhabitants. The amount of revenue tax collected last year upon spirits and fermented liquors was nearly fifty-six millions of dollars, at a rate of fifty cents per gallon, making 23,000,000 gallons of native spirits only, whilst in 1868, when the tax was two dollars per gallon, it amounted only to nearly nineteen millions, making 9,500,000 gallons. We may thus judge of the increase in the use of spirits since the decrease of the tax; for, if in 1870 the tax had been at the same rate as in 1868, the amount would have been one hundred and sixty-eight millions instead of nineteen Vice-President Colfax, in a recent lecture at Washington, said that the money spent by the people of the United States in * “Traité des Dégénérescences physiques et morales de l'Espice humaine.” 222 Medico-Legal Considerations upon Alcoholism. [Dec., drinking amounted to the fabulous sum of one thousand mil- lions a year. Messrs. Otis Clapp, John E. Tyler, and William B. Spooner, who were appointed commissioners to consider the expediency of establishing an asylum for inebriates in Massachusetts, have submitted a very interesting report to the Governor and Coun- cil of that State, which has been communicated to the Legisla- ture. They estimate that there are 600,000 persons in the United States who have lost their power of self-control in the use of intoxicating liquors, and that in Massachusetts there are 23,000, of which number two per cent. die each year a drunk- ard’s death. According to the report of the Board of Health of the City of New York for 1870, there were 307 deaths, direct from intemperance; but, as I said in my last paper, those who die of some other disease caused by intemperance are credited to the disease and not to the cause. We must however, be thankful to Dr. Charles P. Rºsel, Registrar of Re- cords of Vital Statistics, who has begun for the year 1871 to take an accurate account of the deaths which are caused directly or indirectly by intemperance. We do not wish to extend our remarks any longer upon the subject of statistics, which we have sufficiently developed in our last paper.” Nor can we suggest a means of arresting the progress of in- temperance in this country. We leave this task to legislators. The evil is known, and has been advocated by thousands better tlian I can do myself, only I must repeat with Magnus Huss: “Things have arrived to such a point that, if energetic means are not taken against such a fatal habit, the nation is threat- ened with incalculable evil. . . . The danger to which is exposed the intellectual and physical health of Scandinavian [we might as well say American] populations is not one of those more or less probable eventualities. It is a present evil, whose ravages may be observed upon the present generation. It is no more time to back out before the means to be taken, should they even injure many interested parties. It is better to steal away from danger at any price than to be obliged to say it is too late.” * “Report of Three Cases of Poisoning by Whiskey, with Remarks upon Alcoholism,” New York Med. Journal, Dec., 1870. Reprinted in pamphlet form. D. Appleton & Co., New York, - 1871.] The Influence of Climate. 223 As we have said above, one of the greatest causes of drunk- enness is imitation; but what we must add is that imitation is in most part inherent to minors. It is most generally between the ages of seventeen and twenty-one that the habit is con- tracted. I asked, a short time ago, a youth of nineteen, who was in the habit of getting intoxicated, if he liked the taste of the liquor. .He answered that he disliked it ; and finally confessed that he was drinking to do like the others, and that among his friends he who drank the most was considered the Smartest and most manly Now, the best means to cut short this human plague is to do away with the bar-room system, when, if bar-rooms are not met with in every block, the occasion of drinking will be less frequent, and the habit will be made less easily contracted; or, if this measure be found too rigid to begin with, let the num- ber of drinking-places be limited, a heavier tax imposed upon them, and a sufficient bond furnished by the keepers of those establishments, who should be liable to a heavy fine for sell- ing liquors to minors or to people already intoxicated. By these means, we should arrive soon to a decrease of this plague, which, if not soon stopped, will be the ruin of the coun- try and a cause of degeneration of the human race. ART. II. THE INFLUENCE OF CHLIMATE IN THE TREATMENT OF DISEASE. BY W. KIRKWOOD, M.D., NASSAU, N. P. THE influence of climate in the treatment of disease has been recognized from the earliest days of medical Science. One of the most famous treatises of Hippocrates was devoted to illustrate and extol its great remedial power. Asclepiades, Celsus, Pliny, and nearly all the most eminent physicians of every age have united in recommending it in various ailments, but especially those of a pulmonary character. Of its unques- tionable utility, medical men of the present day have no doubt. The profession acknowledging and proclaiming the great benefit pulmonary invalids may derive from a judicious choice of climate, it might be supposed that a thorough knowledge of the subject would be expected from every well-educated physi- cian. But do the majority possess any really accurate ideas 224 The Influence of Climate in [Dec., on the subject 4 I am afraid not. A patient is recommended to go South, and his medical attendant, in too many instances, has merely a vague conception that this place or that place being situated in the same latitude must necessarily have the same climate, and be equally eligible for his patient’s sojourn an error, however, of the most serious nature, to which the patient too often pays a fatal penalty. In this matter, ought we not to consider ignorance in the physician unpardonable, in fact criminal in as great a degree as if he neglected to acquire a proper knowledge of the drugs which he prescribes in his practice? In the present age of facile communication, when the best climates are so easily accessible, and the univer- sality of meteorological observations renders our means of acquiring a correct knowledge of the position and compara- tive climatic conditions of winter resorts of invalids, both in this country and abroad, so easy, no mistakes should be made by the medical man in so important a matter, on which so great an issue as the life or death of his patient may depend, and who acts in the full confidence that his adviser has made himself fully competent to fulfil his professional duties. It may be conceded, however, that the profession has few reliable guides, as a good work on climatology remains to be written ; and of course the number of medical men who have acquired information on the subject by travel and personal experience must necessarily be few. There is nothing more delusive than taking the mean tem- perature of any place to form a judgment on its climate; we must note the minimum and maximum daily and nightly, from week to week and month to month, to enable us to form a just idea of its climatic conditions, and, above all, the impor- tant one of equability. One of the first conditions, therefore, to consider is equality of temperature, and the next its degrees, whether too high or too low—not sufficiently high to induce great relaxation and debility, or to prevent constant daily carriage or other exercise in the open air, or so low as to prevent free action of the cu- taneous exhalants, which contribute so materially to the relief of the mucous membrane in bronchial affections. A tempera- ture of 70° to 75°, we consider, secures the above-named desiderata. Combined with an equable and warm temperature, 1871.] the Treatment of Disease. 225 freedom from malarious exhalations, excessive moisture in the atmosphere, and all such depressing agencies, are important considerations in the selection of residences for pulmonaries. It must strike every one who investigates the influence of cli- mate on pulmonic affections, that sudden and extreme varia- tions of temperature cannot fail to counteract to a great extent any beneficial effects which might result from a resi- dence in a climate such as we find in our Southern States, and our personal experience has led us to the conviction that the climate of Florida is too variable to secure all the advantages which might be obtained in a less variable climate. It is ob- vious that the conditions we consider essential cannot be obtained in any of the famous European sanitariums; Pau, Nice, Scrantona, Malaga, are all objectionable from their great variability of climate and low degree to which the thermome- ter descends during the winter season, frequently falling to the freezing point. There is one resort much visited by the Euro- pean pulmonary invalid which deserves its high reputation, and possesses to a great extent all the conditions which we have enumerated. We mean Madeira, which, from its insular position, warm and equable temperature, and pure air, has placed it in the foremost rank as a sanitarium for consump- tives in the opinion of the profession at large, both European and American. But, acknowledged and undoubted as its claims are, its distance and the circuitous route required to be taken to reach it debar the mass of American invalids from visiting it. We have, however, at our own doors, as it were, a place which in all climatic conditions compares most favorably with Madeira. We refer to New Providence, one of the islands of the Bahama group, in north latitude 25°, about two hundred miles southeast of Florida, from which it is divided by the warm waters of the Gulf Stream, which spreads into still more breadth to the south of the archipelago, a circumstance which will be referred to hereafter as a principal cause of the greater equality of climate of New Providence compared with localities west of it. The island is small, not exceeding twenty-two miles in length by seven broad; no portion of it is elevated over two hundred feet, several salt-water lakes occupy a portion of its area, and extensive ranges of pine for- w $226 The Influence of Climate in [Dec., ests, termed “barrens,” spread over the southern and western surface. The whole island is formed of a porous limestone, composed of comminuted shells and coral, which permits rain to percolate through it with great rapidity. The following table will exhibit the day temperature during the six winter months, being compiled from daily observations at the military hospital in Nassau, the hour for observation being 9 A.M.: Variation Maximum. Minimum. during month. November, 79° 709 99 December, 77 (39 8 January, 7 66 9 February, 76 66 10 March, 78 66 12 April, 83. 68 13 It must be noted that the variations above are those which occur during the whole month, simply indicating the coldest and warmest days during that period, the variation during any particular day of twenty-four hours seldom exceeding eight degrees. Although the coldest day noted in the above table was only 66°, it must be understood that in some winters, during the prevalence of a “northwester,” the thermometer at midnight has descended as low as 54°. This point, however, is seldom reached—only in exceptionally severe “northers,” and not every winter. To enable the reader to compare the winter climate of Madeira with that of Nassau, we give the result of five years' observations by Dr. White at Funchal, 8 o’clock A.M. being the hour of observation: Maximum. Minimum. Warfatton. November, 68-59 619 7.59 December, 65 56 9 January, 64 54 10 February, 66 55 11 March, 67 59 8 April, 69 57 42 From this it will appear that the variations do not differ much relatively, the temperature of Funchal averaging lower than that of Nassau. We will take the extremes during the winter of the temperature of Nassau and Madeira as a fair mode of comparison, the tables indicating the highest point of the mercury during the day and the lowest at night. The calculations for Madeira are those of Dr. F. A. Bañal: wº 1871.] the Treatment of Disease. 22? NASSAU. Maximum. Minimum. Variation. November, 819 700 119 December, 79 54 25% January, 79 64 - 15 February, 81 64 17 March, 84 70 14 April, 83 71 12 MADEIRA. * * Maximum. Minimum. Variation. t”, November, 769 529 249 December, - 73 53 20 January, 70 50 20 February, 73 - 51 22 March, 75 51 24 April, 76.5 53 23.5 In comparing the amount of variation in the above tables, we can justly claim for Nassau the advantage. There is, however, an advantage beyond this in the higher range of temperature in favor of Nassau, which no person can overlook who has resided in tropical or semi-tropical climates, as the sensations of chilliness and discomfort are extreme when the thermometer indicates a degree of cold as low even as 60°: and so forcibly has this fact struck us that we are convinced that in most cases of pulmonary disease a temperature ranging between 68° and 80° is the most desirable for consumptive invalids. One important effect of such a temperature is the activity of the cutaneous exhalants, which undoubtedly acts beneficially as a derivative in bronchial and other affections of the mucous membranes. We have observed from this cause very marked benefit in many renal disorders. It will be im- portant to remark, in the first meteorological table, the fact that in no case does it appear that the thermometer indi- cated a temperature below 66°, even as early as 9 A.M. With such convictions as to the utility of a higher degree of tem- perature than exists at Madeira, we are persuaded that the climate of Nassau is better adapted for the cure or alleviation of affections of the lungs. * We adverted in the beginning of this article to the geo- graphical position of the island of New Providence—or, as it is more commonly called, Nassau, from the name of the city—in respect to the Gulf Stream, which forms its watery boundary to the east and north, forming an expanse of warm * This was during an nnusually severe “northwester.” 228 The Influence of Climate in [Dec., water of from two to four hundred miles in breadth, mollify- ing to a great extent the rigor of the severe northwest winds which reduce the temperature of Florida to the freezing point, and even in Key West lowers it some fifteen degrees compared with Nassau; and during their prevalence the climate of Ha- vana is much colder, although at other times the thermometer ranges higher than in Nassau. The prevailing winds are from the southeast and east, blowing from these points nearly two hundred days in the year, in steady and strong breezes from the broad expanse of the Atlantic Ocean, refreshing and cool- ing the atmosphere even when the heat is at its maximum. In the absence of mountains, no land breeze reduces the tem- perature after Sundown, which makes the climate of Jamaica on the seaboard so variable, a difference of fifteen or twenty degrees often occurring between day and night, to the injury and discomfort of the invalids sojourning there. The humidity of the atmosphere does not vary much from that of Madeira, the average for the winter season being by Mason's hydrometer 3:58, and for the same season in Madeira 3:29. If we take the difference in temperature into account, the result will be almost identical. The rain fall during the whole year is great, being on an average 56 inches; but this occurs principally during the summer or wet season, as it is termed, only 17 inches falling during the winter or dry season, and in showers principally at night. A continuous rainy day is not known during the six months of winter, even cloudy days are rare, so that parties making engagements for pleasure excursions have little fear of their enjoyment being marred by the weather; on the contrary, the clearest and most cloud- less of skies, the most pellucid and transparent of ocean waters, and the balmiest of ocean breezes may be calculated upon with a certainty unknown in northern climes. A cli- mate so uniform and beautiful in all that nature can contribute to woo the invalid to spend his time in the open air is not to be overlooked if he be able to use so potent a means of restor- ing him to health ; it acts better than genial Sunbeams and warm air on a sickly plant long secluded in the shade. - In considering the climate of Nassau as a resort for pulmo- nary invalids, we do not by any means wish to convey the idea that it is perfect, as there are some days when a south 1871.] the Treatment of Disease. . 229 wind prevails that are debilitating and oppressive; and during the continuance of a “norther,” many invalids are sensitive most painfully to its influence; but all these drawbacks are much less felt in Nassau than in any other available winter resort of North America, as any one acquainted with the ex- treme variability of Florida would not dream of instituting a comparison with Nassau. We have already alluded to the lower temperature incidental to a “norther ” in Havana and Key West, and the higher temperature at other times in those places. To the student of climatology the European winter resorts—Nice, Menton, Tome, etc.—would not be compared for a moment to that of Nassau. Even Cairo, in Egypt, is much more variable, and it is only when we reach Upper Egypt, as high as Thebes, that an equable climate equal to Nassau can be found. As such a distant region is destitute of the Society, home comforts, and ready access of Nassau, we may leave it out of the question, and recommend Nassau as the best sanitarium for Americans, where they will find the manners, language, and religion of the population similar to their own, good roads for driving, a magnificent harbor for boating, and have attentions and hospitality from the best families. Invalids, however, are not to expect that climate alone is all-sufficient for their cure, as all the measures neces- sary at home, whether medical, precautionary, or of regimen, must be as strictly adhered to as if they were exposed to the rigors of a northern winter. 230 Pathological and Therapeutical /ēelations of [Dec., §tletted 3rticles, ON THE PATHOLOGICAL AND THERAPEUTICAL RELATIONS OF ASTHMA, ANGINA PEC- TORIS, AND GASTRALGIA. *=º BY F. E. ANSTIE, M.D., F.R.C.P., Senior Assistant-Physician to Westminster Hospital; Lecturer on Medicine in Westminster Hospital School; Physician to the Belgrave Hospital for Children, etc. DURING the last three or four years my attention has been drawn to an interesting pathological and therapeutical connec- tion between three nervous affections which are individually reckoned among the anomalies and the difficulties of practical medicine, and which, so far as I know, have not usually been directly associated with each other in the classifications of wri- ters on nervous diseases. I refer to spasmodic asthma, angina pectoris, and gastralgia. It is true that Kneeland some years since indicated the fact that there was some connection be- tween asthma and angina pectoris; but, so far as I know, no author has distinctly classified these diseases as depending essentially on neurosis of the vagus; and certainly no one has yet advanced the theory that both of them, and also gastralgia (or neuralgia of the gastric nerves), are essentially dependent on neurosis of the vagus, which is of central origin, and in a large majority of cases is mainly or entirely due to inherited peculiarities of the central nervous system. Such is the pro- position which I now submit to you. In so short a communication as can alone be received by this Association, it would be impossible to bring forward suffi- ciently detailed evidence to establish positive proof of this doctrine; nor do I pretend myself to possess such positive proof. It will be sufficient to indicate to the members the chief of those facts which, to my judgment, make the hypo- thesis exceedingly probable, and certainly worth following up. The evidence arranges itself under five sections: 1. Inferences from the known physiological functions of the vagus. 2. Evidence of the interchangeability of asthma, angina, and gastralgia in the same individual. 1871.j Asthma, Angima Pectoris, and Gastralgia. 931 3. Evidence of the pathological connection of these neuroses with neuralgia of the fifth nerve. 4. Evidence of the common dependence of asthma, angina, gastralgia, and neuralgia of the fifth, on peculiar inherited neurotic tendencies. 5. Evidence from the similarity of effects produced by cer- tain remedies on all these maladies. 1. As regards the physiology of the vagus, there is no need to deliver a class-room lecture to the present audience. It will be enough to remind you that, besides its other offices, the pneumogastric acts as the great afferent of sensory impressions from the stomach and from the mucous surfaces of the lungs and trachea, and as the main, if not the sole, organ of cardiac sensibility; that its ramifications form an integral part of each of the various nervous plexuses in the cardiac, gastric, and respiratory territories; and that its deep origin is placed with- in the medulla oblongata, and united by the most intimate connections with the sensory nucleus of the fifth nerve. There are thus prima facie reasons for presuming that the three neuroses, asthma, angina, and gastralgia, would all depend upon irritation of the vagus. As regards asthma, there is, I suppose, a pretty general adhesion among the best recent au- thorities to the theory of irritation of the pneumogastric, which is well expressed by M. Sée, of Paris, in an article on the treatment of asthma in the Practitioner for July, 1869. As regards the pain of angina—and, indeed, as regards the Sources of cardiac sensibility in general—there has been much dispute; but the facts seem to me to point very clearly to the belief that branches of the vagus, reinforced in the cardiac plexus by other spinal branches which come from the cervical and the uppermost dorsal cord-centres, through the medium of the sympathetic ganglia of the neck, fully account not only for heart-sensibility, but also for the curious transmission of pain in angina to the arm, the chest-wall, and the neck. The chief objection to this view has rested upon the belief that the sympathetic branches must also have a share in the production of the pain; but the idea that the sympathetic is capable of expressing sensations of pain seems to me to rest on an ex- ceedingly doubtful basis, and to be supported chiefly by the apparent analogies of the pain of colic, gall-stone, etc., for 232 Pathological and Therapeutical Relations of [Dec. which pains there is really a much more probable source in branches of spinal nerves. Everything in recent physiological observation seems to suggest that all the apparent cases of sen- sation in the sympathetic fibres are really due to branches of spinal nerves that are bound up with them. As regards an- gina, the only question" as to which I feel much doubt is, whether the vagus centre or the cervical and upper dorsal cord-centres just referred to are most prominently concerned in the origination of the disease; but, at any rate it seems clear that, from the moment that serious symptoms of angina are set up, the vagus centre must be involved, since this must be the intermediate instrument of the reflex disturbances of respiration which occur during the paroxysms. On the whole, I lean strongly to the idea, which will be found expressed in the pathology chapter of my work on “Neuralgia,” that the irritative process in angina commences in the spinal centres, which send branches to the cardiac plexus, and then involves the vagus secondarily, but at a very early period. 2. The second branch of the evidence that connects asthma, angina, and gastralgia all with the same great nerve is derived from the singular interchangeability of the three maladies. Kneeland long ago remarked that spasmodic asthma and angina were thus apt to pass the one into the other. For my own part, I can refer to several instances of the connection between all three diseases, and would sum up the general results of what I have seen in the following terms: 1. Severe and protracted asthma nearly always becomes complicated, after a time, with symptoms which may not amount to what would commonly be called angina, but assuredly belong to the same category; and in not a few instances (I have myself seen three) asthma leads directly into declared and unmistak- able angina. 2. Asthma is nearly always associated with gas- tralgia. It is true that the neuralgic character of the pain is very often overlooked, and it is attributed incorrectly to dys- pepsia; but I have frequently had occasion to prove the fallacy of this idea, the only ground for which is that asthmatic pa- tients will not bear putting a large amount of food in the stomach at once. Asthmatic patients are not commonly dys- peptic, in the proper sense of the word; and the epigastrie pain, from which they almost all suffer more or less, requires 1871.] Asthma, Amgina Pectoris, and Gastralgia. 233 to be dealt with as a part of the general nervous affection. 3. The chronic form of angina is, so far as I am aware, almost invariably associated with more or less gastralgia, which, as in the case of asthma, is continually being mistaken for dyspeptic pain, and treated, with very unfortunate consequences, from a gastric instead of a nervous point of view. Ilike asthmatics, these patients require to be fed in small meals; but nothing save harm can come of keeping them on a small total supply of nutriment. 3. The next branch of evidence for the essential intercon- nection of the three neuroses of which we are speaking is derived from the way in which they are mixed up and compli- cated with neuralgia of the fifth nerve—a complication which, if it can be shown to occur with a certain special frequency in these diseases, would go far to trace home the fons et origo mali to that portion of the medulla oblongata in which the nuclei of the vagus and the fifth are found in intimate connec- tion with each other. Upon this point the evidence is, in my experience, exceedingly strong, and may be shortly stated thus: That, whereas neuralgia of the trigeminus is a more or less occasional complication or attendant of other neuralgias generally, it is an almost invariable complication of nervous asthma, nervous angina, and gastralgia. Of course it varies greatly in severity. It may amount, and indeed generally does, to nothing but an attack of migraine every month or six weeks; but there it is, nearly always. And, as regards gas- tralgia, I have seen numerous instances of its interchange- ability with facial neuralgia, of which the following is perhaps the most striking: A watchmaker's assistant, aged 42, applied to me at Westminster Hospital, suffering from intermittent attacks of epigastric pain, which came on especially at times when he was exhausted from want of food, and were uncom- monly severe and prostrating. After he had been under my care for ten or twelve days, these pains were abruptly super- seded by violent neuralgia in the globe of the right eye and in the branches of the ophthalmic division of the right fifth nerve generally. This neuralgia was not merely severe in itself, but it ran on into secondary iritis, with destruction of the eye for visual purposes. This is the most severe case of trigeminal neuralgia complicating gastralgia that I have seen, VOL. I.-18 - - 234. Pathological and Therapeutical Relations of [])ec., but I have witnessed plenty of slighter ones; and, on the whole, I believe that true gastralgia, as distinguished from mere dyspeptic stomach-pain, is nearly always attended with a tendency to facial neuralgia in some form and degree. 4. In the next place, the close interconnection of asthma, angina, and gastralgia, and their common dependence on an affection of the central nervous system, are rendered more pro- bable by the remarkable history of inherited neuroses which the sufferers from them will always be found, upon careful en- quiry, to present. This is a branch of investigation which has greatly engaged my attention; and in my work on “Neu- ralgia,” the results of a good many such enquiries as to the pedigree of neuralgic patients will be found. But I have not had space for everything in that work, and must probably re- serve for a separate publication the remarkable facts which come out respecting the hereditary connection of asthma and angina pectoris. Respecting gastralgia, it has been for obvious reasons impossible to procure evidence of a precise and reliable character; but, as respects asthma and angina pectoris, I will go so far as to say that I believe there hardly ever existed a Sufferer from one of these diseases in whose blood-relations, either of the same or previous generations, one or more exam- ples of the other could not be found by proper enquiry; and occasionally one comes across families which seem to have been quite plague-stricken, as it were, alternately with these two maladies. And it is a singular fact that I have twice known these diseases to be the only nervous maladies that could be traced in a large family of two or three generations. I may here properly introduce the reply to an expression of surprise which some of my audience may have on their lips, at the frequency which I ascribe to angina pectoris, which, on the contrary, has usually been considered a very rare disease. But I have already had the honor to tell this Association (at the meeting in 1868) that observation had convinced me of the error of that opinion, which arose from neglect or misun- derstanding of all but the severest and suddenly fatal cases of angina ; whereas there are, in fact, a multitude of cases in which the nervous affection—the cardiac neuralgia—which is the only essential portion of the disease, exists in all shades of severity, down to an exceedingly mild and trivial complaint. 1871.] Asthma, Angina Pectoris, and Gastralgia. 235 And my subsequent experience has strongly confirmed me in this belief, which is also expressed by some of the most careful recent writers. 5. The last, and to me personally the most interesting, link in the chain of evidence which connects together the three neuroses, asthma, angina, and gastralgia, is formed by the results of therapeutical experience. There is one remedy which is supremely effective, where it can be tolerated, in all these three maladies, namely, arsenic. As regards angina, I may say that, since my attention was drawn to arsenic by a remarkable case published by Philipp, in 1865, I have had a rather large number of severe cases to treat; but it is within the last twelve months that I have received the most conclu- sive proof of the power of this drug over the nervous symp- toms of angina. Two examples especially illustrate this, the subjects being respectively aged 65 and 75. Each of these gentlemen was free from recognizable organic heart-disease, but there was much probability in both cases that there may have been a certain amount of ossification of the coronary arteries. Be that as it may, in both these cases arsenic, in five-minim doses of Fowler’s solution three times a day, re- lieved the attacks very rapidly, and completely removed them in the course of about a fortnight. There had previously been daily paroxysms in each of these cases, and the elder of the two gentlemen was the more struck with the rapidity and completeness of the relief obtained, inasmuch as he was a medical man, and was of course thoroughly well aware of the intractability and the formidable nature of the disease. As regards gastralgia, the efficacy of arsenic was some years ago pointed out by Dr. Leared, and I have had several opportuni- ties of proving the correctness of his statement. But more especially is it an effective remedy in that form of gastralgia which accompanies asthma. I have for many years been ac- customed to the use of arsenic in asthma, and had seen great benefits produced by its tonic effect. I had also noticed, with- out thinking much about it, that the tendency to gastralgia, and also to facial neuralgia, was at the same time remarkably diminished ; but at present I cannot regard the coincidence as accidental. In regard to the effects of arsenic upon asthma and angina, it seems proper to refer to the facts, long disputed, 236 Proceedings of Societies. [Dec., but now established as true, respecting arsenic-eating in Styria. It has been ascertained beyond doubt that many natives of that country eat arsenic, with very remarkable ben- efit to their power of ascending steep mountains. It enables them to do this comparatively without distress to breathing and circulation. There are, however, a considerable number of persons who cannot take arsenic in the doses and for the prolonged period which are necessary to make any permanent impression upon either of the three neuroses of which we have been speaking. These patients suffer such irritation of the stomach or bowels from it that they cannot continue it. For the relief of such persons, I beg leave again to suggest a remedy that I mentioned in my paper on “Visceral Neural- gias,” in 1868, and which I have since found very useful in spasmodic asthma, as well as in gastralgia and angina: I mean the subcutaneous injection of Strychnia in very small doses, from the 1-120th to the 1-80th or the 1-60th of a grain. I would always try the subcutaneous administration before giv- ing the remedy by the stomach, wherever it is possible to do so ; but, if this cannot be done, strychnia should be given by the mouth in doses of 1-40th to 1-24th of a grain three times a day. I think there is little doubt that strychnia also has a physiological affinity for the tract of the vagus and the trige- minal nerves; also, this is much feebler than that of arsenic; hence I should always recommend that the latter be tried first.— British Medical Journal. 13 to teti) in g3 of $o tittit 8. PATHOLOGICAL SECTION OF KINGS COUNTY MEDICAL SOCIETY, BROOKLYN. DR. A. J. C. SKENE presented several well-developed joints of taenia solium from a child only five days old. It being a unique case, its clinical history is given somewhat at length as follows: Kate Quinn, ast. 24, an Irish domestic, was admitted to the Long Island College Hospital, Sept. 3, 1871. Less than an hour previous to entering the hospital, she gave birth to a well-developed male child, in the street. Sept. 4.—Mother doing well. Child nurses vigorously, and is appar- ently well. 1871.] Proceedings of Societies. 237 Sept. 7.-Child for the last fourteen hours has refused to nurse. An examination reveals trismus preventing; introduction of little finger into mouth, and touching extremities, induce slight tetanic spasms. A mild anodyne was given, but without relief. Sept. 8.—Supposing child to be suffering some intestinal irritation, three one-sixth grain doses calomel, followed by ol. ricini, were ordered. Ten hours after taking the first dose of calomel, the infant passed per anum two segments of what was at once recognized, from obvious ap- pearance, as tape-worm. They were flat, peculiarly cornuted, and pos- sessed of slight motion of a moment's duration. Different members of hospital staff examined specimens, and pronounced them unmistakable joints of well-matured taenia solium. Sept. 9.—Trismus continues. Small amount of mother's milk fed by spoon. At five o'clock P.M., three more segments of worm came away. Ordered ol. terebinth., 15 drops in mucilage. * Sept. 10.—One more segment voided. Trismus continues; spasmo- dic action of extremities less; takes milk from spoon eagerly, but has no power to grasp the nipple. Turpentine repeated. Sept. 11.-Another segment came away. Still makes fruitless at- tempts to grasp the nipple. Ordered oil of male fern, 15 drops in mucilage. Sept. 12.-Repeated the oil of fern, to be followed by small dose of castor-oil. Sept. 13.—One more segment passed. Medicine suspended. Sept. 18.—Five half-grain doses of calomel at intervals of two hours. Soon after last dose four segments passed. Trismus entirely gone. Child nurses well, the mother having an abundant supply of milk. Treatment discontinued. Oct. 18.-Mother and child still in hospital, and both doing well. The infant has passed segments since last record, but none having the appearance of head. The child has never taken other nourishment than the mother's milk. Dr. B. A. Segur examined several of the segments passed, and reported “that the specimens presented to him had the obvious appearance of taenia solium, and under the microscope, with half-inch objective, he could see the eggs, having the same size as those belonging to joints passed by adults.” Up to the time when this history ends, no evidence had been obtained to indicate that the child's mother had tapeworm. She was apparently in perfect health, yet it was advised to subject her to treatment. A preparation of pumpkin seeds was accordingly given, with the effect of bringing away large joints of taenia solium, some of which were exhib- ited to the Section. Dr. B. A. Segur presented an encephaloid cancer from popliteus of a man aged thirty-five years. Both parents were subjects of malignant disease. Three years before death he was sensible of a strain behind 338 s Proceedings of Societies. [Dec., the knee, followed by slight pain and tumefaction, which never com- pletely disappeared. But no positive inconvenience resulted until a few months before death, when, after unusual anxiety and fatigue, it en- larged rapidly with severe pain. A short time before cancerous deposit of same form occurred in lungs, and the post mortem showed both nearly solid. The doctor said this was the second case which had re- cently fallen under his observation, where medullary cancer had been developed after slight injuries. He believed the original swellings were due to simple inflammatory effusions forming nuclei, about which the cancerous deposits took place. Asked if it had ever occurred to any one present to see tumors originally benign becoming malignant. Dr. Burge thought it a difficult point to decide, as the previous be- nignity of any malignant growth would always be a matter of doubt. Dr. Stiles did not think it at all probable. He also believed to be erroneous the idea of Virchow and some other pathologists, that cancer." is primarily a local disease, becoming general from absorption of the morbific material. Dr. Segur considered the beginning of its rapid development due to the great mental distress under which the man was laboring. Dr. Arthur Mathewson exhibited a sarcomatous tumor which had its growth from the choroid coat of eye of a young woman. The organ, being useless, was extirpated. Previous to removal, it was impossible to determine the exact character of growth. Dr. R. C. Stiles exhibited an intra-cranial tumor, also sarcomatous, from a man aged fifty-four years, who died with symptoms of compres- sion of the brain. It was about the size of an orange, and found em- bedded in right hemisphere. The inner table of parietal bone, at a point over tumor, had been absorbed. The doctor believed it had its origin in the dura mater. Dr. C. H. Giberson exhibited heart and kidneys from an old man who was the subject of Bright's disease. One kidney was healthy, and considerably larger than the opposite, which was contracted and useless. The man had used alcohol rather freely. The heart was greatly hypertrophied and the subject of valvular disease. Liver, small and firm, without cirrhosis. Spleen unusually Small, and as firm as liver or kidney tissue. Dr. Stiles said this was a typical case. Not uncommon to have one healthy and one diseased kidney, with normal urine. He had notes of four hundred autopsies made whilst in charge of Kings County Hospi- tal, and stated that a greater proportion of them presented two distinct pathological types: one in which there were tubercular deposits causing death ; the other, with conditions illustrated by the case before us; oc- curring especially in foreigners who had been intemperate for a number of years. He generally found a hypertrophied heart, granular con- tracted kidneys, small spleen and liver, with atheromatous aorta. Was 1871.] Jºecent Publications. 239 of opinion that cardiac hypertrophy might be produced by long-con- timed overaction excited by alcoholic stimulation; could not perceive why the heart might not enlarge as do other muscles when overworked. Dr. Colton did not think the cases analogous, and particularly so where there is hypertrophy without obstruction. Dr. Wunderlich said hypertrophy often occurred without valvular disease, but believed atheroma or other deposit would be found, as a rule, in aorta or other large vessels, and, by depriving their coats of normal elasticity, become a source of obstruction to the circulation. Dr. Thayer believed it might be induced by increased and long-con- tinued bodily activity alone, as in cases of rowers, mountain climbers, and the like. - Some members expressed the opinion, and cited instances from per- sonal observation, to prove that there might be decided hypertrophy of the heart in certain cases, without giving rise to any symptoms recog- nizable by the patient, or exciting suspicion that such a condition existed. Dr. Wunderlich believed, and quoted Wiemeyer to confirm the same, that very considerable organic disease even might be present with hyper- trophy, and yet no difficulty be experienced so long as the disease and compensating enlargement were equivalents. When the balance is de- stroyed, dyspnoea and other symptoms result. Dr. Stiles remarked that when hypertrophy follows obstructive dis- ease, the pulse is slow. Compensation is obtained by force, not fre- quency, of the heart's action. Dr. Segur thought the case of interest, as illustrating the tendency to fibrous degeneration in old persons. He suggested such degeneration of valves and lining membranes of the heart, often coming on insidiously, as a cause of hypertrophy, and particularly so in the aged. He found an opium plaster most beneficial for the relief of pain and tenderness over apex, which, in many cases, are distressing symptoms. h. A 4 y w RECENT PUBLICATIONS. 1.—EMMETT–Prolapsus Uteri, its Causes and Treatment. New York: Bradstreet Press. 1871. P. 34. 2. --BRADSTREET-On Wertigo or Dizziness, London : Macmillan & Co. 1870. P. 40. 3.—WANDERPOEL–Pathological Anatomy. The Necessity for its Study, and its Influence upon Medicine as a Positive Science. Utica : Roberts. 1871. P. 36. 4.—BURR–Medico-Legal Notes on the Case of Edward H. Ruloff. Re- print of a paper read before the Medico-Legal Society of New York City, Sept. 14, 1871. 5.–CONKLIN–The Relations of Epilepsy to Insanity and Jurisprudence. Reprint of a paper read before the Ohio State Medical Society, April 6, 1871. 6.--Lori Ng—Some Remarks on Cataract. Reprint of a paper read be- fore the American Ophthalmological Society, July, 1871. 240 Miscellaneous. [Dec., 1871 iſłłigtt iſ a n tott 3. AGORAPHOBIA.—With this name Westphal denotes a neuropathic in- fection which he has recently occasionally encountered. Its most essen- tial symptom is a most acute anxiety or fear, experienced in open places, long passages, theatres, concert-saloons, etc., with no other cerebral dis- turbance. This feeling of dread is lost if a wagon or an individual stands in close vicinity, as also in the neighborhood of a well-known house. This sensation is totally distinct from vertigo; it is simply a feeling of anxiety, not all occasioned by anything on the part of the patient. In the three typical cases which the author describes, all intelligent men, there presented a suspicion of epilepsy; one of the patients, indeed, suf- fered from well-marked epileptic attacks, the others from symptoms which stand in close connection to epilepsy (loss of consciousness, etc.)—symptoms, however, so common to other conditions than epilepsy as to be without evidence of characteristic nature. In etiology, it was ascertained that there was a hereditary taint in but one ; in the others, the first attack was sudden. The prognosis is favorable, as a further or more extended development to grave disease does not occur. The therapy employed—stimulation of the power of the will, frequent visits to the dreaded place—was without effect. There still remains to men- tion, too, that the insufficience of the musculus recti interni of the eye by which Benedict claimed to be able to recognize this affection was not a symptom of the cases here detailed.—Archiv. f. Psychiatrie, III. —Clinic. THE LOSS OF WEIGHT IN THE NEWLY BORN.—The observations made by Chaussier, and later and more accurately by others, to the effect that the newly born child loses in weight during the first few days after birth, and then gradually regains it and increases, incited Gregory to a renewed investigation of the subject, more particularly because of the numerous contradictions among other observers. His conclusions are that all children lose weight from the first moment of extra-uterine life, that this loss in healthy, full-timed, breast-nourished infants is of slow duration—on the average, two days—in sickly, premature and artificially nourished children, on the contrary, it is longer, 2 to 5 days. Mature and immature infants, nourished at the breast, gradually, then, increase in weight, and in such degree that the former have regained their orig- inal weight by the seventh day, while the latter have at this period regained but half of the original weight. Males begin this increase sooner than females. Artificially nourished children show no increase at all for the first eight days. This stands in no connection, as maintained by Winckel, with the fall of the cord, which is hastened by the nourish- ment of the nurse. The cause of the loss of weight is the evaporation of water by the skin and lungs, and the discharges of urine and meconium. —Archiv. f. Gymakologie. Advertisements. Shepard & Dudley, MANUFACTURERS OF Ford's Surgical Instruments, INSTRUMENT_MAIKERS TO THE U. S. Navy; Bellevue, New York City, and New York State Woman’s Hospitals, and Hospitals in charge of the Commissioners of Public Charities and Correction. IMPORTERS AND MANUFACTURERS OF EVERY DESCRIP- TION OF R U E E E R G O O DS. 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Collated from the best authorities, with the addition of New Words not introduced into a Lexicon. With an Appendix. Second Edition, enlarged. 64mo. Roan, 75 cents; or tucks, $1 C0. Code of Medical Ethics adopted by THE AMERICAN MEDICAL Associ ATION. (Re- *ised to date.) . A yery neat little book, in flexible muslim binding. Price 40 cents. John Brocklesby, A.M. The Amateur Microscopist; or, Views of the Microscopic World. One 12mo volume, pro- fusely illustrated with plates and engravings. Price $1 75. Henry R. Prescott. Strong Drink and Tobacco Smoke. Plates. In one 8vo volume. Price $3 00. Richard A. Proctor. Other Words than Ours. Many colored plates. Second Edition. 12mo. Price $2 50. J. Matthew Duncan, M.D, Oxn the Mortality of Childhood and Materni- ty Hospitals. 8vo. Price $2 50. [ESTABLISHED 1867.] WILLIAM BALDWIN 2 ... No. 21 Fark Row, Nº. York, PUBLISHERS. v ºf Advertising, Subscription, and general COMMISSION AGENTS/ Offer their services to the Medical Profession throughout the Country. They make a specialty of filling orders for Physicians, at Manufac- turers’ prices, for any and every article they may require, such as Books, Medicines, Chemicals, Chemical Apparatus, Surgical Instru- ments, Electro-Magnetic Machines, Galvanic Batteries, Microscopes, and Microscopic Accessories. All orders will receive PROMPT ATTENTION, and be sent securely to any part of the United States, C. O. D. ON ALL BILLs under $10 the expense of collection must be borne by the purchaser. - BTUTLER'S Half-Yearly Compendium of Medical Science. Published January and July. Over Three Hundred pages in each number. Good paper—good type. The most complete abstract of the medical journalism of the world published in the |Bnglish language. None other does justice to American medical literature. Its fourth year began January, 1871, and it is the most successful medical enterprise thus far ever started in this country. Subscrip- tion price, Three Dollars per annum, including postage. - The Physician's Daily Pocket Record. - Admitted to be the best Physician's Visiting List and Pocket Manual published. It contains many new features, among which are: A list of New Remedies; Doses of Medicines by Inhalation, Hypodermic Injection, Suppositories, etc.; Classified List of Medicines, with doses and prices Tables for Examination of Urine, etc.; Fee Bills, etc., etc, tº Itäs:perpetual, being good for a year from date of purchase. Tº A Patent Self-closin Clasp, or the Ordinary Tuck, at the option of the purchaser. Tº This work is growin in popularity —its Salé increasing rapidly. PRICE:-35 patients a week, $1 50; 70 patients, $2 00; including postage. COMMUTATION FATES. The Medical World and Compendium, * - . $4 00 “sºft's “…a, “ Pocket Record, . . . . . 2 50 § { “T Compendium, and Pocket Record, 5 00 $6 ** and Journal of Obstetrics, . . . 6 00 Address Williarn Baldwin & Go., 21 Park Row, New York. CONTENTS. The Medical World for NOWember, 1871. PAGE, PAGE I. ORIGINAL COMMUNICATIONS. 3. Medico-Legal Society, . . 189 1. On Chronic Hypertrophy of the Lips, . © e . 161 V. MISCELLANEOUS. 2. Subacute Meningitis Remit- 1. American Journal of Obstetrics, 173 tent, . * > e . . 168 2. Ice in Rectum in Retention of 3. Medical Thermometers, . . 172 Urine, . . gº tº . 173 4. A Modification of the AEsthe- 3. Cholera, . & e º . 189 siometer, e g & . 174 4. Cundurango, . e & . 195 - - 5. Condensed Form of Nitrous II. SELECTED ARTICLES. g A Contribution to the Surgery of - Oxide Gas, . tº * . 196 Bleeding Wessels. . . . 178 6. The Ophthalmoscope and the c. } wº Sphygmograph in the Study III. REVIEWS. of the Physiological Action Skin Diseases: Their Description, of Medicines, e sº . 197 Pathology, Diagnosis, and 7. Dr. Lewis A. Sayre's Treat- Treatment, . . . . 183 ment of Hip-Joint Disease, . 197 IV. PROCEEDINGS OF SOCIETIES. 8. On the Treatment of Syphilis 1. Pathological Section of Kings by Hypodermic Injections of County Medical Society, Corrosive Sublimate, . . 198 Brooklyn, . gº e . 186 9. Epilepsy from Use of Absinthe, 199 2. Judge Bedford's Amendment 10. Disinfection, . * g . 199 to the Abortion Ilaw in the Academy of Medicine, . , 188 - VI. RECENT PUBLICATIONS. ºs. 0IT MEDICAI, (;0LLEGE Detroit, Mich. SPRING SESSION, 1872. FACULTY. E. W. J.ENKs, M.D., President of Faculty, Professor of Medical and Sur- gical Diseases of Women and Clinical Gynaecology. SAMUEL P. DUFFIELD, PH.D., M.D., Emeritus Professor of Chemistry. J. M. BIGELow, M.D., Emeritus Pro- fessor of Medical Botany and Ma- teria Medica. - THEODoRE A. McGraw, M.D., Pro- fessor of Principles and Practice of Surgery. Geo. P. ANDREws, M.D., Professor of Principles and Practice of Medicine. C. B. GILBERT, M.D., Professor of Materia Medica and Therapeutics and Clinical Medicine. . J. F. Noyes, M.D., Professor of Ophthalmology and Aural Surgery. N. W. WEBBER, M.D., Professor of Descriptive and Surgical Anatomy. RICHARD INGLIS, M.D., Professor of Obstetrics. - . . Hon. H. B. BRowN, Professor of Medical Jurisprudence. A. B. PALMER, M.D., Professor of Medical Diagnosis and Clinical Medi- cine. A. B. Lyons, M.D., Professor of Chemistry and Toxicology. - W. H. LATHROP, M.D., Professor of Diseases of Mind and Brain. LEARTUs CoNNor, M.D., Professor o Physiology and Microscopical Anato- my. H. O. WALKER, M.D., Demonstrator of Anatomy and Lecturer on Venereal Diseases. The regular annual session of the College will begin on the 20th of March, 1872, and continue four months. * Especial attention is given to Clinical instruction, and drill in practical Diag- nosis of medical and surgical diseases. The fees are as follows. Full course of lectures, Matriculation, ſº e º Hospital fee, e º º Graduation fee, $50 00 5 00 e tº © 6 00 º tº . 25 00 The lecture fees for graduates of other respectable Colleges, and for third course students, will be $35 00. Alumni will be admitted free. No student will be admitted into the graduating class whose first course of lectures has been completed within six months of the beginning of the term. This rule will be strictly enforced, and will remove the main objection that is urged against spring schools. The laboratory will be open for chemical instruction, and daily clinics will be held during the entire year. For further information, address E. W. JENKS, M.D., 92 FORT STREET, VVEST. ºft #ji ###". | |ll lill Tilſillºrºi § ſº =t §§ T. #. jºšić. -- Bºº- º § º - Rºss --- sº: º #º yºğ. ºf; #º lº §§ º sº § g § º #º § §§§ '. §§ º ſº º :=º §§§ º º : Mºſ º . #º. §§ º Zºº ſº º:##ſº § § º wº º tº º' º ſ §§ º | º :::: º º § flº §§º } - § º, º - - ɺ: §§§ §§ §§ ~ º - sº ºn tº - ? ... ºº º & #. §§§ º: =ss&# ÉÉ §§ § \, =s =#E º & §§§ - N:Sºs º:=: ºf 'º, º żº ſº º SºV. \\ flºº ºº::---- §§ § §§ § &##sºs - sº “SEAE; *###Stºß The Roy. Nassau, New Providence, Bahamas. The Royal Victoria Hotel will be opened for the Winter Season, November 1. The advantages of the climate are unequalled, and to persons suffering from pulmo- nary complaints this place offers unusual advantages. The thermometer averages 74°, with change rarely exceeding 6°. The almost entire absence of rain renders out- door exercise at all times agreeable—boating, fishing, driving, and bathing. In communication with New York by the steamers of the Atlantic Mail Steam- ship Co., Sailing every second Thursday Fare by steamer, $45. Board, $3 per day, gold. A circular containing full description, together with meteorological reports, sent On application. . By special permission reference is made to the following-named gentlemen: DR. ALONZO CLARK, DR. For DYCE BARKER, “ JoHN J. CRANE, “ JoHN T. METCALFE, “ AUSTIN FLINT, “ T. G. THOMAs, “ JAMEs R. Wood, “ REUBEN A. WANCE. LEWIS F. CLEVELAND, Proprietor. JAMES LIDGER WOOD, Agent, 758 BROADWAY, NEW YORK. GEORGE TIEIMANN & CO., F. A. STOHLMANN. ESTABLISHED 1826. ED. PFARRE. 67 CHATHAM STREET, NEW YORK, MANUFACTURERS AND IMPORTERS OF Surgical Instruments, APPARATUS FOR FRACTURES, DISLOCATIONS, AND DEFORMITIES, Latest Instruments for Local Anaesthesia, and for Applications to the Larynx, Poste. rior Nares, Eustachian Tube, Uterus, Urethra, Bladder, etc., etc. Laryngo. scopes, Ophthalmoscopes, Endoscopes, Hypodermic Syringes, Fever Thermometers, etc. Surgical Instruments of all kinds made to order, and the Latest Improvements and Novelties promptly supplied. EY THE PARIS EXPOSITION OF 1867, BEING THE ONLY SILVER MEDALS GRANTED TO AMEIRICAN EXHIBITOR'S OF SURGICAL INSTIR UMENTS, Stohlmann, Pfarre & Co., F. A. STOHLMANN. FD. PFARRE. PIHILIP SCHMIDT. 107 E, 28th Street, nr. Fourth Ave., ONLY BRANCH OF GEORGE TIEMIANN & CO. FIRST PREMIUM AWARDED BY AMERICAN INSTITUTE, 1870. MICROSCOPES And Microscopic Accessories for Medical and Scientific Investigations. - ALSO, MAGIC LANTERNS, With elegantly colored Illustrations of Anatomy for POPULAR LECTURES. Illustrated Price-list sent on application, to any address T. H. McALLISTER, 49 Nassau Street, New York. T0 Wholesale Druggists and Chemists, WE MANUFACTURE AN ASSORTMENT OF JENAMELLE D TINCTURE PRESSES, I: ETO RT STANDS, AND EVA PORATING DISHES, With many other Utensils used by Chemists, and solicit the patronage of the Trade, JAMES C. HAND & CO., |BARROWS, SAVERY & C0. Factors. Iron Founders and Enamellers, PHILADELPHIA, PA. H. THOMPSON, Patent Chair Manufacturer, 70 EAST BROADWAY, NEW YORK, §§ ºkſ) Will be happy to have his friends and the public in general call É= § ſ N -- § { 3. fºr and examine his IMPRO VED RECLINING. RECUMBENT, and = }; ===N. - *i; EXTENSION RECUMBENT CHAIRS, with PATENT RIGID 㺠REGULATOR, which secures them at any angle. Also, IM- PROVF D WHEEL CH VI R, SLEEPY HOLLOW, with extension Leg Rest, BARBER, COMMODE, AND BED CHAIRS. CHAIRS for INVALIDS, the PARLOR, LIBRARY, OFFICE, etc., and SPECULUM CHAIRS of superior style and quality. EHUNNEWELL’S Cathartic, Narcotic, Tomic, Sedative, Alterative P L L S AND TOLU ANODYNE. The above so thoroughly defined, so highly approved, and the Formulas subjected to the fullest investigation, the Physician may rely on them with confidence. THEY COMPRISE THE ſº Pill Aloin catan, Ferro, 3 Pill Podophyllum cum Ferro, |# Alterative Laacottive Pill, º Alterative Laacative Pill, ſº Alterative Laacative Pill, [* Compound Quinime Pill, [3° Flatio. Camanabis cum Tolat, ſº Pill Sedative, Known as Eclectic Pills. Dr. Jackson's Formula. Dr. Gilman Davies' Formula. Dr. P. S. Haskell's Formula. Dr. Edward Hall's Formula. Dr. N. I. Aiken's Formula. Known as Tolu Amodyne. Dr. N. I. Aiken's Formula. Five years have clearly proved their importance, and the future will be to keep that good. Formulas in detail, describing samples and plans of getting such, or in quantities, sent on demand. JOHN L. HUNNEVVELL, Laboratory Office, 97 Commercial St., Bostor, Mass. ADVERTISEMENTs. HORSFORD'S AG|D PHOSPHATE - (MEDIO/WAL). . - Prepared by the Rumford Chemical Works, Providence, R.I., Late Rumford Professor at Harvard University, Cambridge, Mass. THE value of Preparations of Acid Phosphates as therapeutic agents is in keeping with well-known themical principles, and no article has ever been offered to the public which seems to so happily meet the feneral want as Horsforty's ACID PHOSPHATE. It is not nauseous, like most of the preparations of Phos- phorus, but agreeable to the taste, and with water and sugar makes a cooling and pleasing drink. No danger can attend its use, as it is the same Acid that is found in wheat and other cereals. If we take more into the system than is needed, it is expelled with the secretions of the body. - It is especially recommended for Dyspepsia, Urinary ...ifficulties, Cerebral and Spinal Paralysis, Men. tal Exhaustion, Wakefulness, Hysteria, and Nervous Disorders in General. Most excellent results have attended its administration for the prostration and nervous symptoms following Sunstroke. . . We ask the careful attention of all thinking persons to the high character of the following testi. monials : - . . : RM. H. Henry, Rſ. D., - Editor of the American Journal of Syphilography and Deronatology, New York City, says: “I have, for more than two years, prescribed the Acid Phosphate, rather extensively, in a variety of gases where the use Of phosphorus was indicated, and I assure you with the most Satisfactory results. In llervous dis eases I kaow of no preparation to equal it.” r Adolph Cºtt, - Technical Writer and Editor of the Department of “Physics. Chemistry, and Technology "of the Ger. frvan-American Cyclopædia, says: “I have tried several phosphites, and even phosphorus in substance, but none of them with such marked success as your “Horsford’s Acid Phosphate.” The statements made by others as to its effects on the nervous system and the brain, I fully confirm.,,. Some months have been enabled to dev te myself to hard mental labor, from shortly after breakfast till a late hºur in the evening Without experiencing the Slightest relaxation, and I would now at no rate dispense With it.” John P. Wheeler, M.D., Hudson, N. Y., says: “I have given it, with present decided benefit, in a case of innutrition of the brain from abuse of alcohol.” Dr. Wrm. A. Harm rm ond, - now of New York, formerly Professor of Physiology in the University of Maryland, says: “I make use habitually of phosphoric acid and the phosphates, in the treatment of nervous diseases. I presgribe it €onstantly every day of my life. It is very well known that, in certain cases of ſº (paralysis of the lower extremitiès), and which are dug to paralysis of the spinal cord-–to a degeneration of the Sub. º: § the cord—the disease cannot be so effectually cured by any other means as by the administration of phosphorus." - - Dr. Fordyce Barker, New York City, says: “There are very often cases where the human system needs, for its restoration, the administr ti in of the phosphates. The cases that require a phosphatic treatment are those where the waste of the phosph tes is greater than the Supply. The class is very numerous. First, in all those cases of derangement of the digestive and assimilative organs, where, ill consequence of this derathgennent, the waste is greater that the supply. The next most frequent is where there is an excessive demand for nerve-power, as in men engaged in professions, and in bus ness excil ements : next, in ex cessive demands resulting from prolonged lactation ; and a lother class still, the excessive tax on phys. ical power and muscular effort, without the necessary supply. - - - R. Ogden Dorem us, - . . . . . Professor of Chemistry in the College of Pharmacy of this city, and in the Medical College of the City of e w York (formerly called the Free Academy), and in the 13ellevue Medical Hospital, sāys : " I have had, for many years, professional employment, in the matter of examining human urine. The amoung of the phosphätts will be increased in the urine, as the result of abnormal exercise of the bodyº where the brain and nervous system are overexcited . This result of the discovery of a greater pro portion of the phosphates in urine, after excessive, mental labor, has been verified by experiments within. my experience, and is in accordance with an ordin ry knowledge from examinations of urine, insomuch that we teach these facts in our lectures to medical students.” William H. Van Buren, fºi. D., * * , - of New York, says: “I have been employed professionally to make examinations of the human urine and have generally found the phosphates in excess in cases where the nerve Centres (the brain and spinai’ Cortl) had been overworked or Subjected to undue labor. The Öpillion which obtains in the profession and which has been confirmed by my own personal experience, is that there is a regeived relation be tween an excess of phosphates in the urine and intellectual exercise.” • - • Physicians wishing to examine and test this remedy are requested to apply, by letter or otherwise, to . the undersigned. • - - ,- - * , WILSON, LOCKWOOD, EVEREIT & Co., GT Agis, 51 Murray Street, New York City. II Jon N Ross & Co., PRINTERs, 27 Rosie ST, NEw York. § -..- -* .-...: -s'-. - *- -. -- -...'•º i•§-ſ§s:§igº* ;ài|**ſ ~ d-|- d-+% y+||.: • ,' '• ,!r! : } # } ~. i ; | ORIGINAL CoMMUNICATIONs: : REvrews: : : SELECTED ARTICLES: 2 | | Subscriptions inva a. | Subscription riably in advance 㺠No. 7. .* “y -- ºr-. --~~~~ * * > * -- * * ~~- - - - - - - -, -ºs--------- THE cal World. A MONTH LY JOURNAL OF AMERICAN AND FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL, AND CHEMICAL LITERATURE, CRITICISM, AND NEWS. EDITED BY REUBEN A. VANCE, M.D. & tº:§ <§ s JANUARY, 1872. CONTENTS. PAGE . . PAGE ART I.—Homicide by Poisoning, DR. WARING—“Practical Therapeutics,” 271 BEACH, - - - - - - 241 Taylor—“Dactylitis syphiitica.”- aid ART. II.-Four Cases of Fracture of * *—” pacty yp 5 * the Skull, DR. CRUSE, - - - 255 MISCELLANEOUS : Prof. Körner's Contributions to a On Hysteria and its Interpreters, Dr. 260 Knowledge of Tuberculosis, - - 276 TILT, - º * sº NEW YORK : WILLIAM BALDWIN & CO., PUBLISHERS, [15 Cents per Uopy.º. & -ºi º§ § y : . § : M ſº Ko : £ # Jº { *; & f } § * f { | t; i 21 PARK Row. LoNDON TRüBNER & Co. #| Q - - * #| ºs —º $) #2.jj . . . . . . . . ºS&NA? w F: º ºs º ºr ºf ºf x -º-; ; ; ; º * - ; : --- *, * * ºr º.º.º. - *4. --~~~~ ------------> ------------------- *-*----- -- frºzzº; § t. Xs CONTENTS. FAGE. ** PAGE. I. ORIGINAL COMMUNICATIONS. III, REVIEWS, - 1. Homicide by Poisoning, . 241 Practical Therapeutics, . . .271 2. Four Cases of Fracture of the On Dactylitis Syphilitica, . . 274 Skull, Operated on at Belle- vue Hospital, - e . 255 IV. MISCELLANEOUS. Professor Körner's Contributions II. SELECTED ARTICLES. to a Knowledge of Tubercu- On Hysteria and its Interpreters, 260 losis, * e t º . 276 J MOLLER'S Purest Norwegian COD LIVE R O |L. Was awarded a Silver Medal at Paris International Exhibition, 1867, heading twenty-seven competitors. Is prepared from selected Livers, and bottled at Lofoten Islands, Norway. Was awarded a Gold Medal at Bergen International Exhibition, 1865. Is the purest, and for limpidity, clearness, and delicacy of taste and smell is superior to any. Is highly recommended by the Medical Societies of Norway and England. Is more readily assimilated and more readily digested than any other Cod Liver Oil. Was awarded the First Prize and the only Medal at London International Exhi- bition, 1862. Is recommended by high medical authorities in Europe and America. Was awarded First Prize, the only one awarded, at Stockholm Great Exhibi— tion, 1868. W. H. Schieffelin & Co., New York. Sole Agents for United States and Canada. IN consequence of the unexpectedly large demand for Back numbers of THE WoRLD, the numbers for July are entirely exhausted. Those who have received already the July number, as a specimen copy, will much oblige the Publishers by returning the same, if they do not wish to subscribe, and they will get a copy of any future number in exchange. THose wiro wrSH to preserve complete files should make early application. Address WILLIAM BALDWIN & CO. Publishers, P. O. Box 3472. 2ſ Park Row, New York. ADVERTISEMENTS. IDIER. J.E J & O MIEC EXIOIDEER,”S ELECTRO-MEDICAL APPARATUS, The Portable Form can be obtained without spilling the fluid. Modified and mani- fold qualities of elec- tricity, patented in the United States, Ingland, and France. The latest examina- tion and opinion of Professor Doremus : “The only appara tus meeting the de ºff mand of advanced # = science.” The only º: # one adapted to the º # wants of Practition- É= €7°S. The following testimonial from R. O.GDEN DoREMUs, M.D., Professor Chemistry and Physics in the N. Y. City College, and Professor Chemistry and Toxicology, Bellevue Hospital Medical College, refers to the superior merits of Dr. Kidder's Apparatus:— “COLLEGE OF THE CITY OF NEW YORK, CoR. LEXINGTON Ave. AND 23D STREET, “T)R. J.EROME KIDDER : New York, August 9th, 1871. “Dear Sir, Within the past few weeks I have carefully examined the construction of several forms of your Electro-Magnetic Machines. “I find that they differ in philosophical principles from any I have before investigated, and that they possess, in addition, many mechanical improvements. “By your ingenious modifications and combinations of the primary current of the Galvanic Battery, accomplished by passing it through helices of wires of differing lengths and thicknesses, I find that the electric effects are materially altered in a manner not accomplished by any other machines. “These variations I have tested by galvano-metric, electro-thermic, and other scientific instru- ments. “I have also experienced the varied effects produced upon the human system in my own person, and have witnessed the same in others, on applying the currents of electricity from the various coils, and through conductors of graded lengths and sizes. - “Thus the eye can be stimulated to appreciate various amounts of light without pain; or slight palm may be experienced without so exciting the organ as to perceive light. By changing the flow of the mysterious agent, its influence may be felt at the wrist, in the forearm, or higher up near the shoulder, in addition to all the variations of frequency, direction, and power usually provided for in electro-magnetic machines. “I confess I was surprised at the agreeable nature of the electric current. Most persons dislike the peculiar sensations experienced from the ordinary machines, and, after a first trial, decline a repetition of it. All such would appreciate not only the bearable but the pleasant effects produced by your arrangement. * Thus you have placed in the hands of the skilled physician most valuable modifications of a power which is destined to solve many of the mysteries of our organization, and to relieve many of the ills of life. “In conclusion, I would state that your method of varying the Primary as well as the Induced currents surpasses all other devices I have studied, as tested by scientific instruments and by physio- logical effects. “I most heartily commend its use to my medical brethren as the instrument for research in this attractive field of medical inquiry. “I have the honor to remain your obedient servant, R. O.GDEN DOREMUs, M.D.” Dr. KIDDER manufactures also the most approved Primary Cell Batteries, with improved facili- ties for manipulating the currents, and at reasonable prices. Primary Batteries, with an improved patented arrangement for throwing intensity into quantity, and vice versa. Varied and approved extra appliances for special cases. In order to get the genuine Apparatus, send for Illustrated Cir- gular, with Price-List. Address, * Dr. J.E.F.OMIE KIDDER, 544 Broadway, N. Y. ſº Will be sent by mail, (post-paid) on application, A EP A M E H L TE T. Containing two articles, by distinguished foreign authority, on “INHALATION OF ATOMIZED LIQUIDS,” WITH FORMUL.A.; OF THOSE SUCCESSFULLY EMPLOYED. Also, an article by Dr. J. L. W. THUDICHUM, M. R. C. P., on “A New Mode of Treating Diseases of the Nasal Cavity," WITH HIS FORMUL.E. Also, an illustrated description of the best apparatuses for the above purposes, and for producing Zocal 2 24reatsthesia, by Atomization with Ether, by the method of DR, Richarpson, of London; or with Rhigolene, as described by DR. HENRY J. BIGLow, in the Bosfort Medical and Szergical %urnal of April 19, 1866, 2422 ozer 24?oznāeing Z72&ārzements are made with the utmost care, with a view to their coºplete efficiency, convience and durability, and every one is warranted. A Gold Medal has lately been awarded us by the Middlesex Mechanics’ Association, for Atomizing and Surgical Instruments, as will be seen from the following report, signed by a leading New England Surgeon and Physician : ‘‘ £503. Codman & Shurrie/, Zºoseon, .7zass. One Case Surgica/ Ares frzzzzzezzi's cezzº 24?onzèzers. “The Committee have no hesitation in awarding for this superb exhibition the highest premium. The various other instruments for Inhalation of Atomized Liquids, and for Local Anaesthesia, were all apparently faultless, both in design and workmanship. The exhibitors are regarded as more especially deserving of the highest token of merit for having produced nothing except of their own manufacture.— Go?d .%ada?. (Signed, GILMAN KIMBAL.I., M. D., Chairmaazz.” Also by the Mass. Charitable Mechanics' Association.—Exhibition of 1869.-A Siºve,' .7/edozè, the Highest Jºſedal awarded for Surgical Instruments. : A: * * —a-ºº-º- *E* _A. I., SO TH"O R. S. A. L THE : *Cammann's Stethoscopes: *French Rubber Urinals, with valves, male, Disarticulating, . . tº 9 º . $7 co for night or day, . . tº º QQ *Knight's Modification, , . - & - 9 5o Male, day only, - e - e $2 50 to 4 oo Simple Throat Mirrors, Nickel-Plated. . ... I OO *French Rubber Urinals, female, for day Ophthalmoscopes, Liebreich's, . . $5 oc to 7 oo only, * - © e º & “ 4 OO Holt's Dilator, improved 2O OC) *Ice and Hot-Water Bags, . . . $2 20 to Io oo *Vaccinators, Whittemore’s Patent Auto- Barnes’ ‘‘ set of three, with Inflator and OO matic, for Crust or Lymph fresh from Stop-cocks, e - e - - • 5 Large Ear Mirrors, Troitsche's, . $3 50 to 5 oc arm.—Instantaneous, certain, and al- Hypodermic Syringes, . - . $3 oo to 14 oo most painless (post-paid), - e 3 OO *Miller's Intra-Uterine Scarificator, in case, *Powder Syringes, g - º - e 2 CO (postpaid) e * º g º e QC Laryngoscopes, complete, . . 16 oo to 25 Oc Lente's Intra-Uterine Caustic Instruments, *Dr. Oliver’s Laryngoscopic Lantern, . . 4 Oo $1 25 to 3 5o The same, with Auto-Laryngoscopic Sponge Tents, plain and carbolized, each, . 2 attachment, . - 4. e * -r 5 Oo Pinckham's improved Uterine Scarificator, The same, with ditto and three Laryn- in case, * - & e * • - 8 oo goscopic Mirrors, in case, . & • 9 *Dr. Cutter's Retroversion and other Pessaries 3 co *Dr. H. R. Storer’s Combined Speculum, . 6 oo Gaiffe's Electro-Medical Apparatus, º 15 OO * Sendº ſo.” Descriptize Circular. Amputating, Trephining, Exsecting, Pocket, Dissecting, Throat, Ear, Eye, Uterine, Obstetric, and all other special and general sets of Instruments on hand and made up to order. Trusses, Spinal and abdominal Supporters, Shoulder Braces, Suspensory Bandages, Elastic Hose, Medicine Trunks and Pocket Medicine Cases, Otoscopes, Endoscopes, Dr. Sayre's Splints for Hip-Joint Disease, Fever. Ther- mometers, Respirators, Syringes, Crutches, Universal Syringes, Galvanic Batteries and Apparatus, French Conical and Olive-Tipped Bougies and Catheters. \ - Skeletons, Skulls and Anatomical Charts on hand; Manikins, Anatomical and Pathological Models imported to order; prices on application, All Instruments, Implements and Materials used by Dentists, always on hand, Apparatus for Club Feet, Weak Ankles, Bow Legs, Spinal Curvature, and other deformities, made to order. Apparatus for Pºtracentesis Thoracis, approved by Dr. Bowditch and accompanied with directions kindly furnished by him. *-* Having our Manufactory with steam power, and a corps of experienced workmen connected with our store, we are able promptly to make to order new Instruments and Apparatus, and to supply new inventions on favorable terms. INSTRUMENTS SHARPENED, POLISHED AND REPAIRED. -*T*. ---, —--— --->~~~~ CODMAN & SHURTLEFF, Makers and Importers of Surgical and Dental Instruments, 13 & L5 TEEMONT STREET, BOSTON. CODMAN & SHURTLEFF's Amaim of Himi for lithalation, ja Amish. &4, By the Atomizer, any medicated liquid may be converted into the finest spray. In this state it may be inhaled into the smallest air-cells, thus opening a new i era in the treatment of all diseases of the throat' and lungs. THE COMPLETE STEAM ATOMIZER FOR INHALATION, &c. t (See Fig. 15.) It consists of the sphere-shaped brass boiler A, steam-outlet tube B, with. packing box C formed to receive rubber packing through which the atomizing tube D passes, steam-tight, and by means of which tubes of various sizes may be tightly held against any force of steam, by screwing down its cover while the packing is warm; the safety-valve E, capable of graduation for high or low pressure by the spring or screw in its top, the non-conducting handle F, by which the boiler may be lifted while hot, the medicament-cup and cupholder G, the support H, iron base I I, the glass face-shield J, with oval mouth- piece connected by the elastic band K with the cradle L, whose slot- ted staff passes into a slot in the shield-stand M M, where it may be fixed at any height or angle required by the milled-screw N. . The waste-cup, medicament-cup and lamp are held in their places in such a manner that they cannot fall out when the apparatus is car- . ried or used over a bed or otherwise, - All itsjoints are hard soldered. - It cannot be injured by exhaustion of water, or any attainable pres- *: º Stearn. h . . . h - ld th t - s t does not throw spirts of hot water, to frighten or scald the Fig. 15. The Complete Steam Atomizer, patient. p ~~ s Aſozº Izzhalatzozz, & c. Is compact and portable, occupies space of one-sixth cubic foot 2 only, can be carried from place to place without removing the atomiz- Patented March 24, 1868, and Mar. 16, 1869. ing tubes or the water, can be unpacked or packed without loss of time. Will render the best of service for many years, and is cheap in the best sense of the word. Price $6 oo. Neatly made, strong, Black Walnut-Box, with convenient handie, additional, $2 50. f Brass Parts Nickel-Plated, additional, $2 so. SHURTLEFF's ATOMIZING APPARATUS (See Fig. 5), for Inhalation, and with suitable tubes, for Local Anaesthesia, and for making direct local applications, of atomized liquids for a great variety of * * B purposes. [See our Pamphlet.] The most desirable hand Apparatus. Rubbers warranted of very best quality. Valves imperishable, every one carefully fitted to Co DMAN & SH U R T L EFF, BOST ON . its seat, and work perfectly in all positions. #######swääß # The Bulbs are adapted to all the Tubes made by us Fig. 5, Shurtleff's Atomizing Apparatus, Patented March 24, 1868. Extraction, and for Inhalation. Price $4 oo. Each of the above Apparatuses is supplied with two carefully made annealed glass Atomizing Tubes, and accompanied with directions for use. Every Steam Apparatus is tested with steam, at a very high pressure. Each Apparatus is carefully packed for transportation, and warranted perfect. Also, HAND BALL ATOMIZER, No. 5, without face-shield, * * * * * * * * * $3 5o THE BOSTON ATOMIZER, with two glass Atomizing Tubes, . . . . . . . . 2 so “HE TREMONT ATOM12ER, with two glass Atomizing Tubes, • * * * * g e 2 OO , LASS ATOMIZING TUBES to fit any of our Apparatus, warranted perfect, each, & gº $ • 25 *ICKEL-PLATED TUBES, for Local Anaesthesia and for Inhalation, each, . . . . 75c. to a co RHIGOLENE, for Local Anaesthesia, best quality, packed, . . . • * . . I OO NASAL DOUCHE, for Treating Diseases of the Nasal Cavity, eight different varieties, each with two Nozzles, packed . * sº & & te * e $r 20, 1 50, 1 75, 2 oo, and 3 5o N. B.--To save collection expenses, funds should be sent with the order, either in form of draft, post- office order, or registered letter. g (For complete illustrated price-list of Apparatus, Tubes, etc., see Pamphlet.) for Local Anaesthesia in Surgical Operations, Teeth TNIVERSITY OF NEW YORK. MEDICAL DEF AFTMENT, 426 East 26th St., opp. Bellevue Hospital, New York City. TH II: Ty-FII: S T S Ess I O W, 1871-1872. FA C U L T Y O F M E D i C N E . REV. HOWARD CROSBY, D.D.,. . . . WILLIAM DARLING, A.M., M.D., F.R.C.S., Chancellor of the University. Professor of Descriptive and Surgical MARTYN PAINE, M.D., LL.D., - Anatomy. - Emeritus Professor of Materia Medica HENRY I) RAPER, M.D., and Therapeutics. Professor of Physiology. Registrar of JOHN W. DRAPER, M.D., LL.D., the Faculty. Emeritus Professor of Chemistry , and WILLIAM II. THOMSON., M.D., ... . Physiology. President of the Faculty. Prºg #geria Aſedica and ALFRED C. POST, M.D., - terºpelates. - Professor of Surgery. FREDERICK D. LENTE, M.D., * CHARLES A. BUDD, M. Professor of Diseases of Women and Children. Professor of obstetrics and Clinical EDWARD G. JANEWAY, M.D., • Midwifery. Pºlº, of Physiological and Pathological JOHN C. DRAPER, M.D. 72&top?y. * Professor of Chemistry. D. B. St. JOHN ROOSA, M.D., ... Clinical Professor of Diseases of the Eye ALFRED L. LOOMIS, M. D.. &nd Jºa”. Professor of Institutes and Practice ERSKINE MASON, M.D., of Medicine. Adjunct Professor of Surgery. The Collegiate Year is divided into two sessions—a regular Winter Session and a Spring, Summer, and Autumn Session. The latter is auxiliary to the former, and the design of the Faculty is to furnish instruction to medical students throughout the year. Attendance on the regular Winter Session is all that is demanded of the candidates for graduation, Those who attend the other session receive a Certificate of Honor, as having pursued voluntarily a fuller course than usual. The Spring and Surn mer Session is principally of a practical and clinical charac- ter, and affords particular facilities fo students who have already taken one course in schools where such practical advantages exist to a less extent. The course consists also partly of lectures and ex- aminations on the subjects necessary for graduating in medicine, conducted by the Professors of the regular Faculty and their assistants. The examinations will be addressed to both first and Second course students. For the purpose of making the visits to the wards of the hospitals as available as possible, the class is divided into sections. One division at a time is instructed in practical diagnosis, prescrip- tion, and treatment of patients. The course begins in the middle of March, and continues till the beginning of June, when the Summer Commencement is held. During the Summer the College Clinics are kept open. The Autumn or Pre; inninary Session commences in the middle of September, and continues till the opening of the regular session. It is conducted on the same plan as the Spring and Summer session. The Regular Winter Session occupies four and a half months, commencing on the second of October, and continuing till the middle of February. The system of instruction embraces a thorough Didactic and Clinical Course, the lectures being illustrated by two clinics each day. One of these daiiy clinics will be held either in Bellevue or the Charity Hospital. The location of the £ollege building affords the greatest facilities for Hospital Clinics. It is opposite the gate of Bellevue FIospital, on Twenty-sixth Street, and in close proximity to the ferry to Charity Hospital, on Black- well’s Island, while the Department of Out-door Medical Charity and the Hospital Post-mortem Rooms are across the street. The students of the University Medical College will be furnished with admis- sion tickets to these establishments free of charge. The Professors of the practical chairs are connect- ed with one or both of these Hospitals, and students are also entitled to attend all the clinics held by other physicians in them. Besides the Hospital Clinics, there are eight clinics each week in the College building. The Faculty desire to call attention particularly to the opportunities for dissection. Subjects are abundant, and are furnished free of charge, and the Professor of Anatomy spends several hours each day in demonstration in the dissecting room. - Fees for the Winter Course. Full Course of Lectures... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $140 00 Matriculation... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 00 Demonstrator's fee, including material for dissection................................. 10 00 Graduation fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 00 Fees for the Spring, Surnrner, and Autumn Course. Students who have attended the Winter Course will be admitted free of charge. Those who have not attended the Winter Course will be required to pay the matriculation fee and $30; and should they decide to become pupils for the winter, the $35 thus paid will be deducted from the price of the Winter Tickets. - e For the purpose of assisting meritorious individuals, the Faculty will receive a few beneficiaries, each of whom will be required to pay $43 per annum and the matriculation fee. For further particulars and circulars, address the Registrar, PROF. HENRY DRAPER, M.D., UNIVERSITY MEDICAL COLLEGE 426 East 26th St, New York City. THE EDICAL WORLD. A MONTHLY RECORD OF AMERICAN AND FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL, AND CHEMICAL LITERATURE, CRITICISM, AND NEWS. VoI. I. New York, JANUARY, 1872. No. 7. © tº i gi tì iſ , * ART. I.—HO.M.IOIDE EY POTSONING. BY WOOSTER BEACH, M.D. IN all civilized communities, the most important object of legislation is the protection of human life. The highest crime known in our law is homicide, and it is the only one punishable by death. The growth of civilization appears to go hand in hand with efforts taken to prevent the shedding of human blood. The savage finds his aged parent is unable conveniently to take part in the rovings of his tribe, and he knocks him on the head without compunction of conscience or calling forth a protest from his associates. A little higher up in the scale, the murderer is, perhaps, punished, but life is valued so low that the death penalty is inflicted for comparatively trivial crimes. We reach at last the enlightened nations, where the taking of human life is ranked by law as the greatest of crimes. The history of our own land embraces a time when the death penalty was in use for lower grades of offences than at present. As increased progress in intelligence and morality in society advance the value and importance of life, it seems not Entered, according to Act of Congress, in the year 1871, by WILLIAM BALDw1N & Co., in the Office of the Librarian of Congress, at Washington, D. C. 242 IIomicide by Poison. [Jan., unlikely that we may, in time, safely look for the entire abolition of capital punishment. With the increased appreciation of the value of life has come a desire for its prolongation and protection, and for the fulfilment of both these objects society looks to the lawyer and to the physician : the latter, to point out the various dangers tending to shorten or destroy life, and suggest means, to avert them ; and the former, to enact and administer laws that shall carry such means into effect. Administration of poison as a means of murder has been common as far back as history extends, and that it is still fre- quently practised our newspapers almost daily attest. We are all familiar with the Borgias of the sixteenth century; With the Aqua Tofana, a poison used to a fearful extent in Italy, with which the female whose name it bears confessed to having, by its use, caused the death of six hundred persons. Christison says: “The crime of poisoning, from its nature, must be a secret one. But little apprehension need be enter- tained of the art of secret poisoning as understood by Tofana or Brinvilliers, or as it might be improved by a modern imi- tator. It seems to have escaped the attention of those who have written on the subject that the practice of such an art requires not only the knowledge of a dextrous toxicologist, but also of a skilful physician; for success must depend on the exact imitation of some natural disease.” Notwithstanding this assertion, we have reported every few months a repetition of the Borgia horror, although not on so large a scale as the original. In the year 1828, Margaretha Gottfried, a woman in affluent circumstances, residing in North Germany, was ar- rested for murder by poisoning. For over fifteen years she had been practising her fatal art undetected. The death of fourteen persons had been traced to her, and some twenty others were known to have taken her deadly draughts, but Without losing their lives. Arsenic was the poison employed. At about the same period a servant named Zwanziger, a resi- dent of Bavaria, gave arsenic to some fifteen individuals without exciting suspicion. These cases occurred at the beginning of the present century, when the study of toxicology was not by any means neglected, the authors then treating of that subject still ranking high as 1872.] JIomicide by Poison. 243 authority, and in a country where the police system is the most perfect in the world, and where all the advantages which science lends to the detection of crime are most faithfully applied. Within a few months a woman in Baltimore was accused of crimes precisely similar to those of Zwanziger and Gottfried, and in Massachusetts at present a woman is about to be tried for causing a number of deaths under like circum- stances. As a matter of course,"or almost as a matter of course, it is only the last crime committed by the individual that is detected—that murder being brought to light by some acci- dent, or the want of care in the poisoner, the natural effect of his previous success. It is to the consideration of the chances of homicidal poison- ing remaining undetected that this paper is given. It will be its purpose to show that there is a strong probability—it may safely be said a certainty—that undetected murder by poison- ing is of frequent occurrence. From an examination of a large number of homicides of this class, I find that, as a rule, suspicion against those commit- ting them has been aroused by some accident, and not through the instrumentality of police regulations, or other means usually employed to discover crime. To illustrate this, as well as some other points further on, I beg leave to call attention to a few cases, the outlines of which are probably familiar to most of my hearers. - In 1857, the wife of James L. Stephens died after a short illness. She was attended by two physicians, one succeeding the other in the treatment. They treated her during the attack till the time of her death, when the one in attendance last gave a burial certificate, which followed the usual course prescribed by law, being presented to the City Inspector for a permit, on which Mrs. Stephens was interred, as some others. are, without any one being the wiser as to the cause of her death. To be sure, there were some suspicions of foul play in the minds of one or two of the relatives of the deceased; but the apparent wisdom of the attending physicians, who saw nothing unnatural in the woman’s death, allayed them. Subsequent events transpired, however, the effect of which counterbalanced the profound learning of the physicians, and pointed to Stephens as the murderer of his wife. A year 244 J/omicide by Poison. [Jan., after her death, the body was disinterred, arsenic was dis- covered in it, and with this and other evidence he was con- victed and executed. FIere is a case where the most common of all poisons was given, its effects clearly seen by two physicians, and yet no suspicion of the true cause of her demise was entertained by them. The burial certificate stated that inflammation of the stomach was the cause of her death. - George C. Hersey was executed in Massachusetts for the murder of Betsey Frances Tirrel by administering strychnine to her. She had become pregnant by him, and the conceal- ment of the fact was the apparent motive of the crime. I quote an extract from the opening sketch of the District Attorney, giving a lucid history of the case. After saying that Hersey had been on an errand for the family, he proceeds as follows: “On their arrival at the house, at about eight o'clock in the evening, the defendant, after disposing of the horse and carriage, came into the room in which the family were sitting, and immediately prepared to retire to his room for the night, which was so unusual a thing at that early hour that Mrs. Tirrel asked him if he was going to bed so soon. He replied, ‘Yes’; giving as a reason that he had a violent headache, and immediately went up to his room. The family then for the first time heard him speak of his headache. Did he then in truth seek his couch for rest and as a cure for bodily ills 2 Or did there remain some needed preparation for the work that night to be accomplished ? Was there a fatal dose to be poured out and made ready for his unsuspect- ing victim, so that she might receive it as she passed his door & “I fear that his malady was one for which the couch had no cure, and which drives sleep from the pillow. “It will conclusively appear in evidence that at this time Betsey Frances was advanced three or four months in a state of pregnancy, and we expect to satisfy you that the defendant was the father of the child. “It is the theory of the government, authorized and fully sustained, we think, by the facts in the case, that, having sur- rendered her virtue and her honor to George C. Hersey, the 1872.] Iſomicide by Poison. 245 defendant, and having found that the consequences of her in- discretion were about to bring ruin on herself and shame and disgrace upon her family, she came readily to desire that she might be relieved from her situation by the use of some drug. “To the defendant, the author of her misery, she looked for the help; and to whom else could she turn for help in such an hour ! She knew that he was to prepare for her that night a potion which she, in her confident simplicity, believed would save her from shame and restore her peace of mind, which her own folly had served more to distract than even that dispensation which had bereft her of her sister Mary. Confident in this belief, she was more cheerful and happy that night than she had been weeks before. “Before Betsey Frances lay down upon her bed, upon which also slept the young sister Louisa, she left the room for a moment; but whither she went or upon what errand, the young, drowsy sister took no note. After some delay in pre- paration, she finally got into bed beside Louisa, who instantly fell into the gentle sleep of childhood. “We know no more until, after a short space of time, not exceeding half an hour, the young sister awoke in alarm, and found Betsey Frances, apparently speechless, trembling and twitching in every limb. The little girl called, ‘Mother, Frances is in a fit !” The mother heard the cry, and was listening to hear it repeated. In a moment Hersey, who was quick to detect the sound of distress from that room, rushed into the room of Mr. and Mrs. Tirrel, and summoned them, saying, “Frances is in a fit or something.” After calling Mr. and Mrs. Tirrel, the defendant led the way into Frances' room, he entering first, the father next, the mother following. In answer to the earnest enquiry of the mother, “What is the matter?” Frances answered only, ‘I shall die; I shall die;’ and once said, ‘Give me some physic;' and this is all which the spasmodic action of the muscular system allowed her lips to utter. A few mute spasms of a singular character, the peculiarities of which were carefully noticed and will be minutely described, ended her earthly existence.” I extract from the evidence on the trial the testimony of the physician who had attended the family, and who made the autopsy in the case : 24.6 JIomicide by Poison. [Jan., “Appleton Howe, sworn : I was first called to deceased by Hersey, and, when I arrived where she was, I found her dead. After consultation with her father, I decided to make a post- mortem examination. Mr. Hersey requested to be present, and was allowed to do so.” After describing the manner of making the examination, and the appearance of the heart, lungs, and so forth, he pro- ceeded to testify : “The next step was to examine the abdomen. The question came up whether we should commence the examination at the stomach or at the pelvis, and it being determined that it would be more convenient for the indivi- dual holding the knife to begin at the lower part of the abdomen, the small intestines were raised at the pelvis, and in doing so pregnancy was brought to notice at once. Dr. Tower said, ‘Look here,' pointing to the womb. I saw enough to convince me that pregnancy existed. I then turned to Mr. Hersey, who stood a little to my right and to the back of me, and told him we should be glad to have him leave the room, as we should like to be alone. He immediately left the room, and I did not see him again. “It was decided to communicate the condition of things to the friends, and it was first communicated to Mr. Tirrel’s sister. “I then determined to call a coroner, and let him investi- gate the case. Mr. Tirrel directed me to take such measures as I thought best, and I immediately called Coroner Birney.” The autopsy was concluded after the coroner arrived. There had been two sudden deaths in Mr. Tirrel’s family, otherwise it is not probable that the post-mortem examination would have been made. Although the moral evidence against Hersey was strong, and the symptoms indicating death by strychnine now seem plain, it is evident that the physician who examined the body was not by any means certain that death had resulted from poison. It was not until he discovered that the deceased was preg- nant that his suspicions were sufficiently awakened to call the coroner. Had he not have discovered pregnancy, it is likely that congestion of the lungs or of the brain, or something else as indefinite that may be found in any dead body, would have satisfied him as to the cause of death. The mistakes of the doctors in these cases will by many be 1872.] Homicide by Poison. 24.7 ascribed to stupidity, but I believe that similar errors may be made by the majority of physicians. As a rule, very little is known by the profession of toxicology, and death by poison will most naturally be ascribed by the doctor to the disease most resembling the action of the poison. It is a grave affair to assert to a family that one of their members may have been taken off by poisoning, and a medical attendant might well hesitate before making such a charge. Christison says: “It is now laid down by every esteemed author in medical jurisprudence that the symptoms, however exquisitely developed, can never justify an opinion in favor of more than high probability”; and, again, when treating of arsenic: “The present doctrine of toxicologists and medical jurists seems universally to be that symptoms alone can never supply decisive proof of the administration of arsenic. This opinion is certainly quite correct when applied to what may be called a common case of poisoning with arsenic, the symp- toms of which are little else than a burning pain in the stomach and bowels, vomiting and purging, feeble circulation, excessive debility, and speedy death. All these symptoms may be caused by natural disease, more particularly by cholera, and conscquently every sound medical jurist will join in condemning unreservedly the practice which prevailed last century, of deciding questions of poisoning in such circum- stances from symptoms alone.” Cholera morbus, peritonitis, the violent invasion of the exanthemata or of fevers generally, may produce rapid death resembling the action of poison by arsenic. Another disorder that, so far as I can learn, has not been mentioned as resembling irritant poisoning, is a violent emesis that frequently proves fatal in a very short time, and occurs in those addicted to the immoderate use of liquor. In my experience in the coroner’s department, I meet such cases almost daily. I will not take time to give a full description of the ailment, but merely state that it is marked by persist- ent and obstinate vomiting, excessive thirst, considerable prostration, and usually terminated by a sudden and generally unexpected sinking of the vital powers, followed very soon by death. I have known the cramps and pain attending haemorrhage 24.8 JZomicide by Poison. [Jan., from a ruptured aneurism to have caused suspicion of death by irritant poison, and the like symptoms caused by rupture of the sac in an extra uterine foetation have produced a similar impression. The effects of the narcotic poisons closely resemble those from natural disease. Epilepsy, meningitis, compression of the brain, apoplexy, or fatal syncope may cause death in a way not easily distinguishable from that resulting from nar- cotism. A case illustrating this point came under my notice a short time ago. A negro, aged 45, porter by occupation, was reported to the coroner to have died suddenly. On investigation it was found that he had attended to his business faithfully for a week before his death, apparently in good health, only com- plaining of some headache. At five in the afternoon he left his store on account of his headache becoming more severe. He went home at once, and shortly after arriving there he became slightly, then fully unconscious, fell off in a profound sleep, from which he could not be aroused, and continued in this state till he died at five the next morning. With the exception of the headache, which, if it had not been so speed- ily followed by death, might have been unnoticed, the case could have easily passed for one of narcotic poisoning. I confess to some surprise when, on opening the brain, I discovered unmistakable signs of acute meningitis. No physician had attended the deceased, and I was obliged to rely upon the statement of friends for a description of his symptoms. I will describe another case of interest where two physicians were in attendance. A young girl of about ten had been treated for what appeared to be a slight ailment by an irregu- lar doctor, but, her case becoming more alarming, two physi- cians, both intelligent men in good standing, were called in, and she died very soon after they saw her. She had received a mixture from the first medical attendant, to which her death was attributed by the friends, and their convictions appeared to be shared by the physicians. A druggist who had seen the mixture declared that it contained aconite, and the symptoms preceding death were thought by the physicians to have been the effect of that poison. Autopsy revealed, in this case, acute 1872.] IIomicide by Poison. 249 meningitis; and a little more care in a subsequent examina- tion of the suspected mixture indicated that it contained lobelia instead of aconite. Now, in this case, suppose the order of things to have been reversed, and death from aconite had actually taken place. Could a physician be accused of special ignorance if he attri- buted the fatal result to meningitis? . Poisoning by strychnine may be mistaken for tetanus, hydrophobia, or almost any form of disease in which convul- sions occur. To be sure, the violence and character of the convulsions from the poison, together with the rapid fatal termination, ought to distinguish its effects from those of disease; but it must be remembered with this, as with other kinds of poisoning rapidly fatal, that their actions are rarely seen by the physician, and frequently not by any one, but, when noticed by non-medical persons, it is during a time of great confusion and excitement naturally connected with a violent illness and a death-bed scene. A history gathered from the statements of such observers would make it very difficult for ever so intelligent a physician to definitely deter- mine the exact mode of death. A young man of about 21, while in the West, lost the sight of both eyes by the accidental discharge of a gun, the ball passing in close contiguity to the brain. He was brought to this city almost immediately afterwards, where efforts were made to recover the use of his eyes, but were abandoned in a few months as hopeless. From the time of the accident he was much depressed in spirits, and seemed to evince a suicidal tendency, causing him to be closely watched by his parents. He died suddenly about six months after reaching the city. His mother was with him during the time just preceding death, and she described his symptoms and conduct as follows: The first that she noticed unusual about him was that he complained of slight nausea when he lay down upon a lounge in the room. He remarked that he would die, but did not appear particularly ill. Soon after he was seized with con- vulsions, which were described as slight. Their character could not be well made out from her description, but from what could be learned they did not appear those of strychnine poisoning. A well-known physician of high standing was 250 JIomicide by Poison. [Jan., called in after death, and, on closely questioning the mother, he decided that some brain trouble produced by the musket- ball had caused death. - Suicide by strychnine had been considered, but there seemed to be no possible way in which the deceased could have procured that poison, and the manner of death was thought to argue against it. The case was referred to the coroner. On post-mortem examination, the brain was found normal, as, in fact, were all the other organs. Near the pyloric end of the stomach was discovered a small amount of white crystallized matter, the appearance of which, in spite of evi- dence against death by Strychnine, we were compelled to ascribe to that drug. It yet remains a mystery how a totally blind person, carefully watched with the object of preventing suicide, should have procured that poison. I should say that I subsequently proved, by testing, the article to be what we had suspected. . The effects of cyanide of potassium, although exerting its deadly power almost instantaneously, have sometimes been mistaken for disease of the heart, apoplexy, and other natural diseases causing death. These allusions to the similarity between the action of cer- tain poisons and disease are made with the object of showing that it would not be at all difficult for an individual to die of poisoning, and his death to be ascribed by the physician attend- ing him, or one called immediately after his death, to natural C3, UISéS. It is almost unnecessary to say that, where a motive for murder is strong, and an opportunity occurs for its commission without detection, the crime has been and will be common an.) Ong llS. It is not with the low and ignorant only the offence is to be looked for. History, as well as daily observation, teaches us that the most deeply laid and atrocious murders have been traced to individuals of great intellectual attainments, and oc- cupying high places in Society. Most of us know of the killing of Parkman by Professor Webster, the many murders of Wainwright, as described by Dickens, and of the man Palmer, an English case. Within 1872.] Jłomicide by Poison. 251 the last few days, the murder of his wife by John Selby Watson has attracted considerable attention, and I take the liberty of quoting entire the leading article of a daily paper in reference to it: “The perpetration of wife murder is not so unusual an occurrence as to excite any very considerable attention on the part of the public, unless the circumstances of the crime are of an extraordinary character. When, however, an educated Episcopalian clergyman, over sixty years of age, murders his wife, who is almost his equal in years, on his own hearth- stone, and then endeavors to conceal the deed by attempting to remove her body in a chest, the case is decidedly interesting. Such are the principal facts in the Stockwell tragedy, the account of which we have already published. “The Rev. John Selby Watson graduated with high honors at Trinity College, Dublin, thirty-three years ago. One year after taking his degree he was ordained, and became a minister of the Church of England. He did not long officiate as a parochial clergyman, for he was soon elected headmaster of the Stockwell Grammar School in Surrey. This position he had retained for upwards of twenty-five years previous to the 6th of October, 1871, living, with his wife and a female servant, in the neigh- borhood of the school. He was in comfortable circumstances, and was, to all appearances, happy in his family relations. After the custom of many teachers, he became an author. Several volumes of translations in Bohn's Classical Library—a series of works with which college students, to whom they are known as ‘ponies,’ are quite familiar—were written by him. He edited Pope's Homer, and a number of Latin and Greek au- thors, besides writing a book on ‘The Reasoning Power in Animals.” It seemed as if he had more than most men to make his old age content. He could look back upon a career both creditable and satisfactory. He was not exposed to the suffering of extreme poverty. He enjoyed the companionship of his books, and the affectionate regard of his pupils, who, we are told, were wont to seek his assistance and advice when in trouble. “If there seemed a person in the world unlikely to do murder, this was the man. Yet, on the second Sunday of last month, in the evening, while the servant was absent, he killed his wife by crushing her skull with the butt of a pistol. On the servant's return, he informed her that his wife had gone to the country, to remain five or six days. He retired as usual, spent the two following days in arranging his books and papers, and on the succeeding Wednesday took poison, but was not killed by it. On the arrival of the physician summoned by the servant, he handed him a paper, on which were written these words: “‘In a fit of fury I have killed my wife. Often and often have I en- deavored to restrain myself, but my rage overcame me, and I struck her down. Her body will be found in the little room off the library. I 252 Homicide by Poison. [Jan., hope that she will be buried as becomes a lady of birth and position. She is an Irish lady, and her name is Anne. The key is in a letter on the table.” “It has often been doubted whether intellectual education tends in any wise to repress crimes against honesty. The life of Bacon is fre- quently cited as evidence that it does not. Froude, the English historian, maintains that our modern education has only increased the relative pro- portion of rogues in the community. “I doubt very much indeed,” he says, “whether the homesty of the country has been improved by the Substitution so generally of mental education for industrial.” As to deeper and darker crimes, however, the question is still more important, and far less easy to answer. It is difficult to believe that intellectual culture exerts no influence to prevent the commission of murder and kindred offences. To say that moral education alone can do this, even if the truth of the proposition be admitted, explains nothing; for the mere fact of intellectual culture must affect the moral faculty, and must affect it in some proportion to the extent and thoroughness of such cul- ture. This murder in England is the act of a man of superior mental acquirements. His familiarity with the moral law is of no moment, be- cause the instances of its violation by its most attentive students are sadly numerous in the history of crime. The noteworthy fact is that the most liberal education, followed by years of literary toil, and conse- quent increase in intellectual culture, will not suffice to restrain a man from the commission of the highest crimes.” In this case, although the note of Watson says that he killed his wife in a fit of fury, it is improbable, from his conduct after- wards in hiding the body, and other circumstances. The mur- der was, without doubt, premeditated. Criminal records of all countries show deliberate murders almost without number by stabbing, shooting, drowning, beat- ing, and many other methods, but homicide by poison is com- paratively rarely observed. In this city, for example, we have some fifty homicides a year, but there has been no conviction for murder by poison in several years. - Is it probable that none have occurred ? In view of the ease with which murder of this kind can be accomplished, of the chances against its detection, of the strong motive in many wicked persons to commit the crime, I do not think I can be accused of a distorted imagination or of great exaggeration when I assert that, for one homicide by poison that comes to light, there are ten that are never known except to the perpe- trator and to Him who knoweth all things. The annual number of Suicides in this city averages about 1872.] - Homicide by Poison. 253 One hundred. The means employed for self-destruction are various, but quite uniformly one-third of those ending their Own existence do so by poison. Is it not a fair inference that, if poison would be thought of by a certain number of individuals as a means of taking their Own life, it would enter the minds of an equal number of other individuals as a means of taking the lives of others? Mur- derers and suicides, though perhaps not to be compared with one another as far as guilt is concerned, would probably be equally well acquainted with poisons and their mode of action, and the one would be as likely as the other to make use of them in carrying out their purpose. ſ The machinery for the administration of justice is not to be depended upon to make the first discovery of a homicide of this class. Accident almost invariably takes the initial step in pointing out the crime; but, when suspicion is once aroused, the expert detective, the acute lawyer, and the skilful chemist combine to unearth it, and mete out justice to the guilty one. Undoubtedly modern science has given valuable aid, and continues every day to add strength to the law in accomplish- ing this object. The wholesome fear to the criminal exerted by the adroitness of the chemist in bringing secret murder to light certainly exerts a strong influence in preventing crime, but we need something more for the protection of the commu- nity. We want to know with certainty the precise cause of death or of an attack of illness afflicting any one of its mem- bers, and it is only in this way that we can positively know that the poisoner is not at work among us. That this object is not now attained, even in cases where suspicion should have been excited, I think I have shown. Can it be done? I believe it may, at least to answer the pur- pose indicated, and it is on the medical profession that the duty of accomplishing it falls. In the first place, physicians in general practice should be better versed in medical jurisprudence, and more especially in toxicology. - Our colleges now only touch on these subjects, and that mostly with the object of not leaving the student entirely un- acquainted with the duties of a medical witness. Were forensic medicine more thoroughly and universally 254 Homicide by Poison. [Jan., taught, even in its present rather neglected state, we would have in the physician a guardian of the lives of our citizens in every household, and it would be almost an impossibility for homicide by secret poisoning to occur. With increased attention to the subject, our acquaintance with it would extend, and more careful study would so perfect the science that much that is now vague and uncertain in it would be replaced by positive and substantial knowledge. Symptoms, especially, upon which the medical attendant must mostly rely for his discovery of illness by poison, would, with greater care in observation and classification, be adequate to reduce to a certainty what now can only be considered a probability. There are many changes in the mode of adminis- tering the law that would add to the certainty of detection of secret poisoning, but their consideration would furnish abun- dant material for another paper. I will here merely allude to these changes, without now attempting to show how they could be carried out : - First. All dead bodies should be viewed by a proper medical officer before burial. * * Second. Post-mortem examinations should be more fre- quently and more thoroughly made. Third. A chemist appointed by government should always stand ready to make analyses when required. Fourth. The bureau that inspects certificates of death and grants permits for burial should use greater circumspection in its operation. Fifth. No body should be interred on a burial certificate granted by an uneducated physician. 1872.] Fracture of the Skull. 255 ART. II.-FOUR CASES OF FRACTURE OF THE SKULL, OPERATED ON AT BELLEVUE HOS- PITAL. REPORTED BY THIOS. R. CRUSE, M.D., House Surgeon. FIRST CASE : OPERATION BY DR. CRUSE. JoſiN McNAMARA, aged 50; married ; Ireland; laborer; ad- mitted March 11, 1871. About two hours before admission, while in liquor, this patient received a blow on the head with a hatchet. He was brought to the hospital by the ambulance. The patient was found smelling strongly of whiskey, and resisted every attempt at an examination. Pulse eighty, strong and full, and there was no paralysis or other symptoms of compression. Near the posterior superior angle of the right parietal bone, there was an incised wound, one incli in length, extending in a direction downwards and forwards. On thrusting my finger into the wound, I discovered a perforation of the bone, corresponding to the size, shape, and situation of the external wound. The pa- tient being put under chloroform, on enlarging the external wound by a crucial incision, in addition to the perforation of the parietal bone, there was found extensive splintering of the external table for a distance of one inch in all directions from the line of the original wound. The splintered portion was conically depressed to a depth of three-quarters of an inch. As I could pass neither bone elevator nor other suitable instru- ment through the perforation, the smallest sized trephine was applied, half of the circumference of its crown resting on unde- pressed bone. Through the circular opening, made by the instrument, a periosteum knife was passed, and the depressed bone raised and removed. The internal table was more dis- organized than the external. Through the opening the dura mater pressed upwards, and that membrane was found intact. The large external incision was then carefully syringed with a strong solution of carbolic acid, and Lister's antiseptic dress- ing applied. A “protective ’’ was extemporized from oil-silk dipped in a solution of gum-arabic, carbolic acid, and water, 256 Fracture of the Skull. [Jan., over which lac-plaster was applied, oakum forming the exter- nal dressing. March 12.—Passed a restless night. Pulse eighty. Took some milk and gruel. March 13.—Pulse and temperature normal. Feels well. A corner of the lac-plaster is raised, and the wound inspected under a stream of a weak solution of carbolic acid. That part of the edges which were accidentally in contact has united. There is not a drop of pus visible, and but slight discharge of liquor sanguinis has occurred, not enough to invade the external Oakum dressing. After this date, the patient passed a week full of dangers. Erysipelas attacked the scalp, and venous thrombosis was felt starting from the wound and extending forwards; little sub- integumentary abscesses developed on each side of the plug- ged veins; the patient’s fever curve was that of septicæmia, and for two days his condition was almost typhoid. Ten days after their inception, these symptoms had yielded entirely to a treatment the principal factors of which were milk-punch, quinine, and open bowels. During all this time, the wound unaccountably continued to present, at the portion that had not united by first intention, small, red, healthy granulations. In this case, it is most natural to charge the thrombosis to the account of the confinement of the secretions of the wound by the lac-plaster; nevertheless, I am satisfied that the anti- septic dressing was in no wise to blame for the accident, for the daily inspection of the wound under a stream of carbolic acid at no time revealed a single drop of pus, or watery effu- sion more than sufficient to moisten the surface. On the seventh of April the original dressings, which had not been changed since their application, were removed, and, the wound being healed, the patient was discharged cured. SECOND CASE : OPERATION BY DR. GOULEY. John Fitz, aged 40; married; Ireland; laborer; admitted March 1, 1871. On day of admission this man fell from a height of forty feet to the pavement, but whether he struck on his head cannot be learned. When admitted—three hours after the accident—he 1872.] Fracture of the Skull. 257 was recovering from stupor, and soon became very delirious. Pulse eighty, full and soft. There is no paralysis nor loss of sensation. A few unimportant bruises on various parts of his person. On the right side of the head there is a lacerated wound, which, commencing near the occiput, extends trans- versely forwards a distance of five inches across the middle of the parietal bone. Corresponding to the wound, there is a depression of the parietal bone near its posterior border, the size and shape of the outline of a hen's egg. The crown of a trephine was then applied so as to include a portion of unde- pressed bone. Through the perforation made by the instru- ment in the depressed portion, the external table was found Separated from the internal. The tables were removed sepa- rately, and the sharp edges of bone trimmed. The dura mater, raised by the pulsations of the brain beneath, was found un- injured. The wound was left open. - On recovering from the anaesthetic, the patient talked rationally, ate his supper, and said he felt well. For four days. after the operation this man’s condition was favorable in all respects, demanding no other treatment than a milk diet and an occasional mercurial purgative; but, at the end of that time, the left leg, which had been bruised by the fall, became erysi- pelatous, and the edges of the scalp wound, hitherto granulat- ing well, assumed a diphtheritic appearance. These complica- tions were ushered in by several chills, and symptoms of cere- bral irritation; delirium, flushed face, contracted pupils, and great restlessness followed. On the ninth day free incisions were made into the leg, and a quantity of ill-conditioned pus with shreds of decomposed tissue escaped. After this he continued to sink, and though no metastasis was discovered, yet, from the frequently repeated chills, the extremely irregular fever curve, and the delirium, the cause of death, which occurred on the fifteenth day, was. plain. No autopsy was allowed. THIRD CASE : OPERATION BY DR. BRY ANT. Charles Leonard, aged 4; New York; admitted January 20, 1871. - This little fellow, while walking past a building, was knocked senseless by a blow on the head from a beam of wood. VOL. I.-20 258 Jºacture of the Skull. [Jan., which had fallen from a height of several stories. When brought to the hospital, one hour and a half after the accident, he was found unconscious to external impressions, breathing quietly, with regular pulse, normal pupils, with no pain and no paralysis, but occasionally vomiting. On the left side, one incli from the middle of the Sagittal suture, there was a puffy tumor the size of an English walnut. This swelling being incised, the corresponding portion of the parietal bone was found depressed to the depth of seven-eighths of an inch. The depression was greatest anteriorly, where there was a solution of continuity in the bone. The thin and pliable bone readily admitted an elevator through the opening, but on removing the depressed portion—an irregularly shaped piece the size of a quarter-dollar—a slight laceration was seen in the dura mater, through which issued a few drops of arachnoid fluid. A few stitches are put in the laceration in the dura mater, an ice-bag applied to the wound as a prophylactic, and the patient ordered 3 SS. of the confection of senna. With the exception of two convulsions the day after the operation, and a slight grade of traumatic fever, this patient presented no unfavorable symptoms, and was discharged, with the wound completely healed, on the fifth day of February following. The treatment consisted of a milk diet, and daily syringing the wound with the weak solution of carbolic acid. FOURTH CASE : OPERATION BY DIR. C. O'CLEY. Adolph Allminck, aged 35, single; Germany; laborer; ad. mitted March 11, 1871. This man, while at work, was struck on the head by a brick falling from a scaffolding. He was brought to the hospital immediately after the accident. On admission, his pulse was strong and full; the breathing superficial; he vomits occasion- ally ; is somnolent, but moves his arms and legs about. A slightly-lacerated wound, situated one inch above the upper border of the temporal fossa of the left side, extends trans- versely a distance of three inches, as far forwards as the coronal suture. At the posterior limit of the wound, there is a circular depression of the parietal bone one inch in depth and one and one-half inches in diameter; a number of foreign bodies— pieces of brick—are felt in the wound. Immediately under a 1872.] Fracture of the Skull. 259 sharp ledge of bone there is an opening of sufficient size to admit a periosteum elevator beneath the calavarium. The de- pressed portion is readily raised, and on removal is found not only extensively splintered, but to have little particles of brick forced between its numerous fragments. At this step of the operation a very troublesome venous hæmorrhage occurred, from a vein on the under surface of the bone at the seat of frac. ture; the bleeding was stopped by the pressure of a small piece of sponge left in situ. The dura mater is found much lacerated, pia mater and brain substance protruding. The pro- truding viscus being shaved off, the wound is carefully sy- ringed with the strong solution of carbolic acid, and Lister’s antiseptic dressing applied. Later in the day, the patient took some milk, and afterwards fell into a quiet sleep, but the next day coma became com- plete, and towards evening he died with symptoms of general paralysis. No autopsy could be obtained. At Bellevue, the experience with operations for fracture of the skull has been as unpleasant as that of the old New York and Paris hospitals; hence it is a subject for congratulation that of four cases operated upon at about the same period of time, a cure was effected in two, and a third died from causes in no wise connected with the fracture of the skull. Although the boy presented the most unfavorable feature of laceration of the dura mater, he recovered with scarcely an unfavorable symptom. Meningitis developed itself in none of fhe cases. The absence of the latter circumstance can well be attributed to the neglect of active antiphlogistic treatment : and though for several days after the operation it is well to apply ice-bags to the head and to give an occasional dose of calomel, yet let it be remembered that plenty of milk and the regular administration of quinine will reduce pulse and tem- perature much more surely than the most frequently repeated bleedings. I was induced to use the antiseptic dressing from the success I had had with it in the treatment of wounds and of stumps after amputations. Its action in the first case more than answered my expectations. 260 On Ilysſerial and its /nterpreters. [Jan., #ttitleg. scietted ON IIYSTERIA AND ITS INTERPRETERS. By Eßw ARD JOHN TELT, M.D., M.R.C.P. (Read before the Midwifery Section at the annual meeting of the British Medical Associa- tion in Plymouth, Algust, 1871.): TIE multitudinous writers on hysteria may be divided into two groups: a comparatively small number of authors consider the acord hysteria to be the miserable misnomer of a nervous affection that has no more to do with the womb than with the liver. This group is chiefly composed of more or less eminent men who have never been in the habit of examining women, and therefore know little about the diseases to which they are subject; who, indeed, freely say so, when we meet them in consultation or elsewhere, and who, nevertheless, with singular want of logic, deny that hysteria often depends on diseases of which they profess to be ignorant. On the other side, an im- posing majority of writers do not think the old IIippocratic denomination so bad a name, provided it be well understood that the womb only acts by the power which it derives from the ovaries. These writers admit that bysteria is a nervous, affection, but they also hold it to be generally caused by some kind of sexual stimulus, either physiological or morbid. This imposing majority comprises almost all those who have made diseases of women the study of their lives—the obstetric authorities of all countries and of all doctrines; and I think it is a very strong presumption in favor of a doctrine when it is held by two men so utterly opposed to each other on many points of uterine pathology as Dr. Itobert Lee and myself. The same view is entertained by a host of men accepted as authori- ties on diseases of women, and who do not practise midwifery. It is worth while examining what medical students are now taught by men who own they know nothing about diseases of women; and I will give a few samples from the writings of three writers in deservedly high repute. For Dr. King Chambers (“Lectures,” 3d edition), hysteria is another word for “defective volition”; he tells his pupils that hysteria has no more to do with the organ of reproduction than with any other part of the human body; and that it is no 1872.] On 17/storic and its Interpreters. 261 truer to say that women are hysterical because they have wombs, than that men are goûty because they have beards. Dr. Tºussell ſteynolds, quoting from the best work on hys- teria, owns that its author, Tandouzy, found marked disease of the generative apparatus in fifty-eight out of sixty-seven cases of hysteria, and that in nineteen cases hysteria subsided so soon as the uterine disease was cured ; and Dr. Reynolds adds: “But, so far as my experience extends, it is the exception, and not the rule, to find any definite malady, or, indeed, definite complaint in that direction; while in a vast number of cases, £here has been absolute health in all particulars relating to the reproductive organs.” (Article Hysteria, “System of Medicine.”) He admits, of course, that a disease of the womb may coincide with hysteria, just as disease of the liver may ; but he believes it to be more commonly the effect of hysteria than its cause. I am at a loss to understand what this means, unless it be that the womb can be enlarged and ulcerated by hysteria—a position Tequiring explanation. . * Dr. Tiandfield Jones (“On Functional Nervous Disorders”) teaches that hysteria is characterized by two factors—(1) mo- bility and excitability of the nervous system ; (2) temper; but, in his chapter on hysteria, and in many parts of his valuable look, the complaint is evidently looked upon as the surrender of the patient’s will to temper and deception; and he probably gives us his true opinion in a note at page 669, when he says: “A patient. I call hysterieal who magnifies her ailments; courts sympathy unduly; is selfish, absorbed in her own fancies and troubles; is unreliable or actually deceitful; and Blas undergone no serious bodily or mental shock or suffering that might occasion nerve disorder.” It seems to me this definition applies more to insanity than to hysteria, whereas the diseases are distinct, though the two may combine. It is surely wrong to teach medical students that hysteria is usually a more or less elaborate process of deception, to be cured when the patient likes by an effort of volition. If I rightly understand Mr. De Berdt Hovell, who has paid great attention to the subject, he also considers hysteria to be a form of insanity, independent of ovario-uterine causation. My experience has taught me differently ; but I quite agree with him when he says that we must not “mistake the help- 262 On IIysteria and its /nterpreters. [Jan., lessness of nervous disease for moral guiltiness, and inflict suf- ferings on patients we were asked to cure.” (Journal of Men- tal Science, vol. xiv., 1869.) It is due to Dr. Russell IReynolds to state that no one has more forcibly insisted than he has recently done, in the columns of Our Journal, on the present injudicious tendency to depre- ciate the value of the symptoms that can only be learnt from the record of a patient's inner consciousness, and to only attach importance to objective symptoms. It is, indeed, obvious that to found diagnosis exclusively on objective symptoms, is to treat Human beings as if they were dumb animals, and to degrade medicine to the level of veterinary surgery. Could the advance of medicine require this, we should have no right to do so; for the art of healing must ever be partly built on faith, as are all arts that are founded on the relation of human beings one with: the other. We must still continue to believe hysterical patients, unless we have strong proof that they are deceiving us or themselves; and when this is not the case, to let the relatives know that we do not believe an hysterical patient is to sour her temper, damage her character, and perhaps irretrievably blight her future. Such is the teaching of three of our foremost pathologists; and as a first fruit of their little acquaintance with diseases of women, I beg to remark that they seem ignorant of what is admitted by all gynaecologists, that menstrual disorders have a most potent influence to bring on hysteria. They neither deny nor admit this influence; they simply ignore it, as well as own. belief in it. The state of menstruation is scarcely ever men- tioned in the numerous cases they give, and they do not even seem aware that, by being able to note it as healthy, they would strongly substantiate their own hypothesis. Neither do these pathologists notice the physiological basis on which rests our belief that diseases of the sexual organs will cause hysteria in women predisposed to it. I allude to the fact that some young women remain healthy until first menstrua- tion ; and that although this function be well performed, it brings on an attack of hysteria, because the nervous system is so badly tempered that it is, as it were, poisoned by the healthy stimulus of ovarian influence. They forget that connection has been repeatedly known to cause hysteria, in women who 1872.] On Hysteria and its Interpreters. 263 had not previously suffered from it; nor do they notice the occurrence of hysteria in young and healthy widows, in whom matrimonial habits have been suddenly suspended, and in prostitutes on their first entering penitentiaries; nor that symp- toms similar to the minor forms of hysteria have been noted in men who have given themselves up to masturbation ; and also in others who, after having been accustomed to sexual inter- course, have successfully restrained strong desire by a sense of duty during a protracted courtship. They ignore these facts, and seem not aware that, in healthy subjects, the ovaries, like all other viscera, must be fed by their appropriate stimulus, under penalty of disease, sometimes assuming the hysteric type; and as it is thus correct to hold that perfectly healthy ovarian action will evolve hysteria in those predisposed to it, it will be easily conceded that the morbid condition of these organs may likewise do so. You will ask how it is that some of the best men in the pro- fession should teach such extraordinary pathology; but you will understand it by referring to two long and elaborate clini- cal lectures on “Hysterical Vomiting,” by another most able pathologist, Dr. Hyde Salter, whose death we have now to de- plore. In these lectures there was no intimation of the indis- soluble connection of vomiting with the physiology and the pathology of the womb, and that vomiting cannot be called hysterical or nervous when it is explained by structural disease of the womb—facts to us so patent, that to attempt to discuss exhaustively hysterical vomiting, and not to mention them, is like omitting the part of IIamlet from the tragedy that bears his name. Nor was it stated that any examination had been made, although the subject of the lectures had many uterine symptoms; and when I wrote to say that this kind of pathology could not bear examination, Dr. Salter admitted; to a certain extent, the correctness of my strictures, and said he had for- gotten to mention that he had asked the Physician-Accoucheur of Charing Cross Iſospital to examine the patient, omitting to state what kind of examination had been made, for in such a case a digital examination could not be held sufficient. Here we have a first-rate pathologist seriously at fault, be- cause he lectures on hysteria without knowing anything of uterine pathology; and one of the reasons why he knows 264. On Hysteria and its Interpreters. [Jan., nothing of uterine pathology is that, in conformity with the established custom, he asks the obstetric officer of his hospital to examine the patient, instead of examining her himself. It is obvious that, until this form of etiquette is set aside, the men composing the staff of our hospitals have no opportunity of be- coming acquainted with diseases of women; and I hope to con- vince you that this ignorance is a very serious disadvantage to themselves, to their patients, and to the profession. In the first place, this ignorance of uterine pathology on the part of hospital men in good repute, tends not unfrequently to their misunderstanding the cases they meet with ; and I confi- dently appeal to those who are engaged in consulting practice, whether they do not far too often meet with cases, in which serious uterine disease has been overlooked by men in high po- sition, the symptoms being ascribed to hysteria ; drugs being given when surgery was wanted; walking recommended when rest was required ; and exertion enforced, instead of placid en- durance of the inevitable. I shall merely mention a bad case of chronic inflammation of the body of the womb, with spongy softening of the cervix, frequent menorrhagic or purulent dis- charges, and a host of hysterical symptoms. This case had been attended for three years by several hospital men, who called it hysteria—spinal irritation; and for a well-known orthopaedist, now dead, it was a case of hysterical back; he had repeatedly blistered it, but no examination had ever been made. It is obviously desirable that lectures in public schools should be well-grounded in knowledge of diseases of women, or they will not be able to interpret rightly the cases they meet with. For instance, Dr. King Chambers, in the work from which I have quoted, thinks he has triumphantly answered those who admit the womb to have part in the induction of hysteria, by stating that he had met with the disease in a woman who had no womb. He does not seem to know what we all admit : that the womb derives its power from the ovaries; that, the womb missing, the ovaries may be present ; and that the presence of one of them is quite enough, in our hypothesis, to account for hysteria in any one predisposed to it. To be good leaders of our profession, men should certainly be well acquainted with uterine pathology, or they will be un- 1872.] On Hysteria and its Interpreters. 265 able to correctly estimate the contending views held by gynae- cologists. While, in France, a Trousseau, a Chomel, and a Nélaton could give as good an opinion on a uterine case as Paul Dubois, I doubt whether any of our leading men would undertake to do so: indeed, with most commendable modesty, they always own to us their ignorance of uterine pathology, when we meet with them in consultation and in friendly inter- course. The public will not, however, believe in their ignor- ance, and insists on being guided by them. Their patients in- sist on their deciding respecting the relative merits, in their particular case, of applying leeches, caustics, and pessaries to the womb, or of leaving it without any surgical treatment whatever. Thus our leading men have to direct their patients as to where they can get most of one or the other of these modes of treatment, without sufficiently understanding their value in uterine disease, and without any knowledge of their. adaptability to the case in point. Nothing would contribute more to the advance of all that relates to our branch of the pro- fession than a good acquaintance with its pathology by Our leading men; standing on neutral ground as umpires between us, they would exert a healthy control over extreme views, and put an early extinguisher on crotchets that menace to become too rapidly offensive. - Another great evil of hospital men observing the etiquette to which I have alluded, is that, by their example, they teach medical students that it is not possible or proper that the same man should know uterine affections as well as other diseases; and thus it happens that the men who sometimes preach most eloquently against specialism, teach the innocent students con- fided to their care that it will be impossible for them to em- brance the whole range of medical science. - Without in the least undervaluing the part that we accouch- eurs have taken in raising that already imposing structure that We now call gynaecology for want of a better name, we must remember that it was founded some fifty years ago by Paris hospital men unconnected with midwifery, of which Gendrin is now the only surviving link between the illustrious dead and a new generation of hospital men, who, like Huguier, Richet, Nonat, Bernutz, and many others, have never confined a wo– man since they were medical students. Such being the case 266 6 On Hysteria and its Interpreters. [Jan., in a neighboring country, we may well look forward to the time when, in our own, hospital men will have a thorough Knowledge of diseases of women, although they may not prac- tise midwifery. Is it not absurd that Mr. Jonathan Hutchinson, writing on “Surgical Diseases of Women” in Holmes’s “System of Sur- gery,” should feel bound by etiquette to omit all that relates to cervical stricture, uterine ulceration, and a host of purely surgi- cal diseases, upon which the judgment of a neutral and an accomplished surgeon, viewing them in the full light of com- parative surgery, would have been invaluable? He might have imitated the late Dr. Addison, who wrote an excellent paper on “Uterine Irritation,” and who was led, by the study of uterine disease, to recognize it as the cause of hysteria. In a late number of our valuable Journal will be found a striking instance of the advantage it is to an alienist to be well up in uterine pathology; for, in a lecture on “Hysterical Mania,” Dr. Crichton Browne does not hesitate to say, “As the result of large experience, I am satisfied that it is, without exception, preceded or accompanied by some derangement of the repro- ductive system, the existence of which is most frequently indi- cated by alteration and obstruction of the menses.” (British Medical Journal, July 29, 1871.) Whatever may be the outcome of these suggestions, I trust, at all events, it will be admitted that, no matter how deservedly eminent pathologists may be in other ways, if they claim ignor- ance of diseases of women, they are thereby placed out of court in all that relates to hysteria; and when they tell us that the disease does not more frequently coincide with uterine affec- tions than with diseases of any other part of the body, the assertion has not the value of the paper on which it was written. Turning now from pathologists who write of hysteria in ig- norance of diseases of women, to those who are acknowledged to know them well and likewise diseases of the nervous system, I find certain interpretations of hysterical phenomena from which I decidedly dissent. For instance, there are men for whom hysteria is equivalent to lust. They lose sight of the twofold action of the sexual organs on the system. One mode of action, that begins at puberty to end with the ménopause, 1872.] On Hysteria and its Interpreters. 26'ſ is incessantly progressing, although it may be modified by dis- ease, as in chlorosis; whereas the mode of ovarian action pro- ductive of erotic desire is intermittent, and depends on many incidental influences. I have already admitted that the denial of their legitimate satisfaction to organs ripe for action in healthy women is a well-known cause of hysteria for those who understand the nature of woman. Still hysteria is often ob- served when sexual desires are moderate ; and I have met with it in women who loathe connection, and in girls before sexual instinct had awoke. Again, I have met in consultation men who call hysterical the actual symptoms of ovario-uterine affections, whereas every form and degree of these affections may be made apparent by their own specific symptoms, without ever bringing on hysteria, and can never do so without a special predisposition on the part of the nervous system. - Lastly, there are others who go on the principle of omne àg- notum pro hysterico, and who call hysterical all symptoms and pain met with in women, when they cannot be accounted for by some definite local lesion. I think the term should be re- stricted to cases in which neuralgia or unaccountable pheno- mena coexist with, or intermit with, evident signs of hysteria, such as extreme nervous excitability, rapid or motiveless pas- Sage from tears to laughter, and globus hystericus—the best single sign of the hysterical state. After doling out criticism, right and left, pretty freely, it is fair that I should allow my friends like opportunity; so I will mention in a few words my views of hysteria. I think it re- quires two factors for its production—1. A predisposing ner- vous state; 2. The stimulus of some determining cause. Of the predisposing cause, we may safely say that it must depend on that modification of the nervous system which makes the nervous system of woman more prone to emotion than her mate; otherwise, how is it that the disease is in the main feminine, and only met with in men whose nervous sys- tems are built on the feminine type 3 We moreover know that, although a disease of every climate and social condition, hysteria is most frequent in women of the upper classes of the civilized races, in whom emotionalism is intensified, at the expense of reason and self-control, by injudicious training in 26S On //ysterta and its Interpreters. |Jan., childhood, and the subsequent pampering that ill fits them for the trials of life. We can go no further than say that this undue action of the brain is the predisposing cause of hysteria. It may be that, in severe cases, this predisposition may be so strong as to be of itself sufficient to bring on the disease. At all events, we know that there are various degrees of intensity in this predisposition, and that the slightest determining cause will make some women hysterical. In a family with which I am intimate there are ten healthy children, whose parents are not in the least nervous; but a paternal uncle is insane; two maternal uncles died of delirium tremens; one brother has been epileptic from childhood ; and a sister died of meningitis. Out of these ten children, two little girls—one seven, the other eight years old—burst into tears if they are looked at, if they are not placed as they like at table, and are not helped in their Tight turn. They pass rapidly from laughter to tears, which will flow for hours and very abundantly. They have some- times globus hystericus. These symptoms have been repeatedly guelled by preparations of iron ; but they occasionally return, and must be taken as evidences of the hysterical state, very likely to be followed by the worst manifestations of the disease on slight provocation. With regard to the determining causes of hysteria, I must first mention those that intensify all nervous affections— debilitating influences like loss of blood, diseases, physical shocks, mental and emotional shocks, prolonged worry, and want of sleep. Neither should I omit the contagion of one hysterical nervous system on another predisposed to become SO. }oming to the most important causes of hysteria—those originating in the viscera—I will first remark that, as with our mental acts, so with our emotions, they are conceived in the brain ; and that old physiology and the poetry of all times have erred in placing the actual origin of our passions in our ab- dominal organs. Still, universal consent shows how strongly they are acted on by emotion—that, in fact, in the viscera are the reflex centres of emotion that stimulate the nervous system to emotional acts. If I have, therefore, been correct in ascribing hysteria to un- die action of the brain as an organ of emotion, a potent cause HS72.] On IIysteria and its Interpreters. 269 of hysteria must be found in undue action of one or other of our viscera. It is, no doubt, wonderful that bodies shared by us with the lower animals should not only support the bodily structure, but, by their healthy action on the brain, give lucidity to the mind and warmth to the feelings, making genius more admirable and charity more godlike. This sounds like poetry, but becomes plain matter of fact when we remember how often anger has caused jaundice, and how frequently a host of dis- fressing mental and emotional sensations are due to that state of liver and stomach derangement that we call biliousness, and which doubtless acts by deranging the functions of the neigh- boring great ganglia. I have likewise seen repeated attacks of hysteria brought on by biliousness, and their recurrence pre- vented by such measures as are best calculated to prevent biliary derangement. Such cases are, however, very rare, when compared with those in which the determining cause of hysteria is an ovarian or uterine ailment. The statistics of Landouzy, Brierre de Boismont, and Dubois d’Amiens, as well as the recent assertions of Dr. Crichton Browne, show this to be the case; and those who deny it must bring forward similar masses of equally well-digested facts. What, then, are the diseases of the sexual system that cause hysteria? Not those in which the structure of the ovary and womb are almost destroyed—acutely, as in abscess of the ovary, slowly, as in ovarian tumors and uterine cancer—but, as a rule, the mildest forms of anaemic ovarian uterine disease ; showing that it is not the intensity of the disease that causes hysteria, but the fact of its coincidence with a nervous system prone to become hysterical. Thus, hysteria is most frequently caused by those limited ovarian lesions that I have described as sub-acute ovaritis, lesions depending on morbid ovulation, and that fre- quently pass unrecognized under the disguise of diseases of lmenstruation. Of uterine affections, it is chiefly the milder sort—that are mucous membrane deep—which cause hysteria; and sometimes, by applying nitrate of silver to an ulcerated cervix, we most unwittingly bring on an attack of hysteria, in patients who presented no signs of its being likely to come on, and thus experimentally prove that the two complaints may stand in relation as cause and effect. On one occasion, I thus brought on an attack in a lady who had never before had 4)Il G. 270 On Hysteria and its Interpreters. [Jan., How is the brain, laden with emotion, to be brought into contact with the viscera, the reflex centres of our emotions? The late Dr. Todd thought that hysterical delirium and other hysterical phenomena might be explained by toxaemia resulting from retained menstrual blood; but hysterical phenomena fre- quently arise before there is any menstrual blood to be retained; and Dr. Handfield Jones agrees with me, that with hysteria, as with other neuroses, there is no blood-poisoning. The distance between the brain and the viscera, between mind and appetite, is bridged by the ganglionic nervous system, which unites the viscera by a federal bond of union, and places this federation in intimate connection with the cerebro-spinal system. When the ganglionic nerves transmit healthy impressions to the brain, they pass unnoticed; but a hysterical fit shows how differently nerves and ganglia act when visceral action is more or less dis- eased. In many hysterical fits, after a period of incubation, in which the system seems to become more and more charged with ex- citement, the attack begins with pain in the womb and ovaries. Soon the hysterical aura passes to the epigastric ganglia, and, concentrating there, gives rise to the suffocation and distress characteristic of the disease. Ascending still higher, the hysterical aura reaches the cervical ganglia, producing the sense of strangulation ; it then attacks the brain, deranging its functions in ways too numerous to be mentioned, and, at the same time, deranging more or less the functions of the spinal cord, according to the degree of tension of the hysterical aura. For a time pain will thus concentrate—sometimes in the brain, Sometimes in the visceral ganglia—and the patient collapses into prostration when the system has been sufficiently relieved by convulsions and by critical discharges. It has been possible, in cases published by Romberg and Schulzenberger, to produce the succession of phenomena just described by simply pressing on the ovaries; and I have repeatedly brought on unconscious- ness in a nervous patient of mine by pressing the left ovary. It seems to me I have shown the following points in this paper: 1. To be efficient leaders of the profession and lecturers in our public Schools, our hospital men should be thoroughly acquainted with diseases of women. 2. Whenever a patient is hysterical, the state of menstruation should be carefully ascertained, and the sexual organs should be accurately ex- 1872.] Reviews. 271 amined if they present signs of disease. 3. The best way for neurologists to disperse the clouds that still overhang Our knowledge of hysteria and its allies, catalepsy and epilepsy, is for them to study the diseases of the ganglionic nervous sys- tem.—Brit. Med. Jour. ift tº it? §. sºm-º-º-º-º: PRACTICAL THERAPEUTICs. By Edward John Waring, M.D., F.L.S. Second American, from the Third London Edition. Philadelphia : Lindsay & Blakiston, 1871. It would seem that this work of Dr. Waring has met with a success in this country fully equal to, if not greater, than that it gained in his own, for we have here a second American edition within five years, and in England there have been three editions within ten years. Con- sidering that the author was not prominently before the medical public as a writer or teacher, we can only explain the unusual success of the work by the fact of its inherent merit. Indeed, upon careful perusal, the reader is struck with the practical features of the work, and it re- quires scarcely more than a glance to observe that it is a book needed by every practitioner. Being devoid of all pharmaceutical and chemical details, it answers much better the wants of the busy practitioner than the works of Pereira, Neligan, Ganod, Coyle, Headland, Biddle, and Christianson; being more succinct than the treatise of Stillé, it possesses advantages over that work; and being more comprehensive in scope, it is better than the little book of Ringer. In fact, the work is expressed in its title, “Practical Therapeutics,” and is a very complete and admir- able compendium of that very necessary branch to which the general practitioner can always turn and obtain the views of nearly every ob- server upon the merits and cures of the various therapeutic agents. Such a work is very necessary in this country where materia medica is, in the main, so badly taught; for, with few exceptions, the men who lecture upon this branch waste fully half of their time in describing the botani- cal relations and the physical properties of each bark, root, or herb, and then pass over with a meagre consideration the mode of their action and indication for their use. The result of this unwise and slip shod method of instruction is apparent every day, and those who have any acquaintance with medical students, or with recent graduates, can attest the truth of the statement, that they are more deficient in this branch of medicine than in any other, and that, while they are fully taught diagnosis and pathology, they in most cases would be wholly unable to prescribe for a given disease if the outlines of treatment had not been 272 . ; Zeeviews. - [Jan., sketched out for them by the professor of medicine. Indeed, consider- ing the profuse doses of irrelevant and useless facts which lecturers upon materia medica are wont to force upon their hearers, it is wonderful how little they retain, and these delinquencies now stand as a stigma upon medical education generally. In fact, we know of no course of instruc- tion which is in need of so thorough a reconstruction as this one; for, on all sides we hear students complain and lament of the superficial character of the instruction in materia medica, and as practitioners we see every day instances of the bad results of this ignorance. It would seem that the various faculties feel indifferent and apathetic about the chair of materia medica, and are necessitated to entrust, in many in- stances, young and inexperienced men, who, having no practical ideas upon therapeutics, have to supply the want by borrowing the ideas of others, or in spinning out their course with the barren and dry details which we have alluded to. These thoughts suggested themselves to us as we looked over the pages of Dr. Waring's work, and knowing the want of this kind of instruction, we were struck with the fact that in this book was to be found the means of compensating this truly deplor- able want. - The work is divided into two parts, the first treating of therapeutics, and the second of non-medicinal agents. The introductory chapter to the book gives a clear idea of the importance and nature of therapeutics, and of the methods of prescription, and the indications, and the condi- tions which should modify their use. And then follows in alphabetical order the description of each article of the materia medica; and we are pleasantly struck with the fact that articles which are unimportant are treated of only in the briefest terms. We think that the author's method of dealing with each article is particularly happy. He first gives the name of the article and its synonym, then in less than a line the genus of the plant, or the chemical definition, then its source of origin, all of which rarely occupy more than four lines. Then we have the medical properties and action succinctly but carefully described; this is followed by a carefully regulated scale of doses, and then follow, arranged under the head of the various diseases, the therapeutic uses of each article. The arrangement is certainly very considerable, and, when we state that in almost every instance the views given are fully up to the present time, it will be seen that very little is left undone. The limits of this review preclude a very extensive consideration of the many new remedies which have lately been proposed, and also of the new uses of many of the old ones; so we shall confine ourselves to some of the most important. We are pleased to see that the very important therapeutic uses of muriate of ammonia are fully treated of, and that the multifarious indications for the use of arsenic are carefully and fully presented, and we may say the same of the article upon belladonna. Chloral is treated of in less than four pages, and we certainly can add that in no volume accessible to the American physician is there to be found so admirable and com- plete an account of the drug in all its phases. The article upon chloro- 1872.] - Reviews. 273 form is equally as full, and very much enhances the practical value of the book. The account of the rules and the modes of its administration, of the symptoms indicating danger, and contra-indicating its use, as well as the methods of resuscitation in dangerous cases, are all fully treated of, and we certainly know of no book to which we can refer the reader where he will get such a good account of the whole subject as to this one. The very important and practical point as to the uses of chloro- form in midwifery receive full consideration. Though the article upon digitalis is very good indeed, it can be much improved in a future edi- tion by interpolating the views lately promulgated by Fothergill. We are glad to see that the author has availed himself of the results of Reith’s investigations upon this subject. We should like to have seen the subject of the action of ergot upon special congestions more thor- oughly treated of, and also the same action of bromide of potassium upon the cerebral circulation. The uses of the muriated tincture of iron are fully given, and we are pleased to see that the observations of Rey- molds upon the treatment of acute rhematism by it are alluded to. The various preparations of mercury receive due attention, and, on the whole, the subject of their uses may be said to be quite fully dealt with. The sections on morphine, opium, and cod-liver oil are deserving of great praise. We may say the same of that upon quinine, but we see no allu- sion to the experiments of Beinz with this agent. The remarks upon the administration of quinine are in an aphoristic form, and are very valuable. We meet these aphorisms very frequently in the work, and they strike us as being a very excellent plan for a work of this kind. We are somewhat surprised that the unequivocal recommendation of Albutis of sarsaparilla in old syphilis is not mentioned by Dr. Waring. We think also that the various opinions as to the merits of sandal-wood oil might have been with advantage more fully treated of Such new agents as iodide of methyl, bichloride of methylene, protoxide of nitrogen, and apomorphia, which were not treated of in former editions, receive full attention in this. The second point of the work treats of the various classes of medicine, with full consideration of their mode of action and the indications for their use, and the non-medicinal agents are also treated of in a very ad- mirable manner. We see by reference to the authorities cited that the author has availed himself mostly of English and French observations, and though we might regret that the observations of the Germans were : not fully given, when we consider how little they have practically con- ...tributed to therapeutics and how much theoretically, we are not dis- posed to look upon the omission as a cardinal fault. We find a very copious index of diseases at the end. We have thus entered quite mi- nutely into the contents of this work, from the fact that it struck us as being one of exceptional merit, and one which every practitioner should possess. It is well printed, and forms a very convenient and handsome octavo, and reflects great credit upon its publishers. vol. I.-21 274 Reviews. [Jan., ON DACTYLITIs SyPHILITICA : With Observations on Syphilitic Lesions of the Joints. By R. W. Taylor, M.D., Surgeon to the New York Dis- pensary, Department of Venereal and Skin Diseases. Reprinted from the American Journal of Syphilography and Dermatology. Pp. 30. New York : F. W. Christern. 1871. Very rarely do we find compressed within thirty pages of print, such a complete and admirable study in pathology and clinical history as that with which Dr. Taylor has here presented us. Heretofore systematic writers on syphilis have either altogether ig- mored the rare and very interesting lesions of the fingers and toes de- scribed by Dr. Taylor, or have contented themselves with a bare refer- ence to a case published by Nélaton in 1860. Besides this case, Tüche has reported two cases, with a reference to three others observed by Erlack; another has been recorded by Berg ; one by Volkmann, and one by Archambault. Dr. Taylor's attention was specially directed to this manifestation of syphilis by a case which occurred in his service at the New York Dispensary during the past year, which, together with those above mentioned, and another communicated to the author by Dr. B. W. McCready, is detailed in his article. These cases are related in all the fulness of detail which their importance requires, and with the clearness and aptness of expression characteristic of the author's contributions to the literature of Venereal and cutaneous diseases. They are well illustrated with wood-cuts, three of which are The excellent and thorough analysis to which Dr. Taylor has subject- ed these cases leads him to divide them into two classes: “First, that in which the subcutaneous connective tissue as well as the fibrous struc- tures of the articulations and the phalanges are involved ; second, that in which the morbid processes begin in the periosteum and bones, and secondarily implicate the joints, and may or may not be accompanied by deposit in the subcutaneous connective tissue. But it must be re- membered that this division is wholly arbitrary, and only adopted for simplicity in description, as they are in fact stages of progress of the le- sion and not different varieties of it. But it can be observed upon peru- sal of the history of the cases that those in which the gummy deposit was developed in the connective tissue, with only slight deposit in the deeper structures, have a different clinical history from those in which the deposit is chiefly in the bones and fibrous structures. & © e. It will thus be seen that in the varying phases of the affection all the deeper tissues are involved, and that to complete the history it will be necessary to study the course of the lesion in all of these structures. It would be foreign to the purpose of this article to enter into very minute histological details of the neoplasm which is thus deposited ; and I will briefly say that in each instance it is that immature form of connec- tive tissue which is called gummy material.” The changes which occur in the configuration of the fingers and toes are, as a rule, not attended with pain, their chief inconvenience being 1872.] Reviews. 275 from their interference with prehension and locomotion. They are decidedly chronic, and do not show the usual necrotic tendency of gummy tumor. The integument and its modifications, the nails, gener- ally escape any primary implication. When the deposit is deep-seated, in the fibrous tissue of the joints and in the bones, although the final result is not very serious, during its progressive stage it produces a decided impairment of motion of these members, rendering them sometimes immobile : in others preternatural- ly mobile, so much so that the joint-structures are flaccid, and though the fingers or toes will, by slight force, bend in any direction, they are not at all responsive to volition. In the second class of cases, those in which the disease begins in the periosteum and bones, the involution of the gummy enlargements of bone is accomplished, says Dr. Taylor, either by an interstitial absorp- tion, in which there is no lesion of continuity of the overlying soft parts, or by a softening of the deposit and its discharge through a sinus which it forms. Even when softening occurs, it is not usually accompanied by a formation of pus. The final results are, that certain portions of the shaft may be wholly absorbed, or the whole shaft may be slightly at- tenuated. The shafts of the bones may also be rendered light and frag- ile, or local or general eburnation may take place in them. When the phalanges are divided into two portions, or when the approximate ends of two bones are absorbed, a ligamentous band of connective tissue is formed, which unites them, and in the future serves as a joint. A fin- ger with one of these false joints loses its power of grasp, and its func- tion, though not wholly abolished, is much impaired. When very ex- tensive shortening has taken place in a finger, it is remarkable how the integument contracts and adapts itself to the altered condition; it seems that nearly all of the redundant tissue disappears, and that the superfi- cial tissues finally adapt themselves to the decrease. This is very bene- ficial in giving steadiness and solidity to the false joint. Dr. Taylor attaches great importance to the diagnosis of these lesions, for the reason that, when their syphilitic origin is recognized, an ap- propriate treatment may prevent serious destruction, and at least mate- rially lessen the ultimate deformities. The disease is to be distinguish- ed from paronychia, whitlow, gout, rheumatoid arthritis, enchondroma, exostosis, periostitis, and the so-called strumous disease of bone. The rules for establishing the differential diagnosis of syphilitic dactyl- itis from these several affections are briefly, but very completely, set forth by the author. “The prognosis of this affection of the fingers and toes depends" says Dr. Taylor, “entirely upon the accuracy of the diagnosis, and to a cer- tain extent upon the period at which it is recognized, and in the event of its being correct, and as a consequence an appropriate treatment being instituted, it may be stated to be good, for the final impairment of the members is generally not so great as to cause utter uselessness. But if the origin of the lesion is not recognized, the chronic enlargement 276 Miscellaneous. [Jan., of the bone, the chronic hydrarthrosis with crepitation, or the latter symptom combined with chronic capsular thickening, might lead the unwary surgeon to pronounce an unfavorable prognosis, and perhaps to institute unnecessary operative procedure. The treatment is that of late syphilis, the use of iodide of potassium, either alone or combined with a mercurial. The combination always answers best in cases where there is a coexistence of tegumentary lesions, but, when these are strictly os- Seous and ligamentous, our chief reliance is upon the iodide, and we can, if that is inefficient, add the mercury. When the parts are very much distended, a minute incision may be necessary.” In this short notice of Dr. Taylor's essay, we have to a very great ex- tent made use of his own language, and nothing but lack of space pre- vents us from yielding to the temptation to produce the entire article. It is a solid addition to the literature of syphilis, and of a kind which should be oftener exemplified in the writings of American physicians. 1.—JEFFRIES-Diseases of the Skin ; the Recent Advances in their Pathology and Treatment. Boylston Prize Essay. 1871. Boston: Alexander Moore. 1871. 8vo, pp. 79, 2.—Statement of the Sayre-Ruppaner Case, and Opinion of the Supreme Court. 3.—OTIs—Circular No. 3, Surgeon-General's Office, 1871. Report of Surgical Cases in the Army. - 4.—HAMMOND—Diseases of the Nervous System. 2d Edition. New York: D. Appleton & Co. 1871. Pp. 754. 5.—ALLBUTT–The Use of the Ophthalmoscope in Diseases of the Ner- vous System, etc. London and New York: Macmillan & Co. 1871. 6.—BRowNE—The Medical Jurisprudence of Insanity. London : J. & A. Churchill. 1871. iſłſigttiſantottº, º-º-º-º-º: PROFEssoR KöRNER's Contrºl BUTIONS TO A KNOWLEDGE OF TUBER- CULOSIs.--In the Allge. Wien. Med. Zeit., Dr. Körner has been recently giving some interesting observations upon the pathology of tuberculosis, from which we extract some passages: “I have,” says the professor, “found young patients with the clavicles but little bent backwards, and this I have noticed to be a very unfavorable symptom. When the clavi- cles stand out strongly in a forward direction, their distance from the sternum walls (especially when these are flattened and sunken in) is very small, a circumference which is likely to impede the motion of both lungs with respect to their contraction. Nutrition is usually, in the commencement of tuberculosis, as a rule, not injured. The appearance of the patients is on the whole good, but variable, so that by times they are blooming, and at other times, again, of suffering aspect. Certainly there are many individuals with great loss of the fatty tissues, but there are also many, especially among the female sex, whose subcutaneous cellu- lar tissue is full of fat, although unmistakably lax. The skin is, as a rule, soft and white, and the superficial veins are easily seen through it. The suspicion of latent chlorosis often is felt in such cases, especially 1872.] Miscellaneous. 277 when some disturbance of the menstruation exists. In all other respects such persons may feel themselves in good health. But when we examine the muscles we find an inequality in their development, so that the mus- cles of the upper half of the body exhibit signs of more or less exten- sive weakness, whilst those of the pelvis and lower extremities are pret- ty healthy, or almost entirely so. Amongst the earliest, the anomaly of the muscles of the neck and nape of the neck is evident. The sterno-mas- toid and trapezius, first of all, are effected, whence arise quickly flatten- ning of the side of the neck, and next follows a strong projection of the clavicle; last of all comes the deformity of the thorax. I do not say that every individual with this form of chest is unavoidably the victim of tuberculosis; many may remain free from it for a long time, and for all their lives, but I add that, when an individual with such bodily formation is examined as to the condition of the lungs, it may happen that, at first at any rate, when we do not take all circumstances into con- sideration, nothing actually may be discovered. Especially are the ap- pearances of catarrhal inflammation or secretion from the mucous mem- brane wanting, when the patients do not suffer from other causes from catarrh of the organs of respiration, in which case the local appearances are not different from what they are in other diseases. When, then, there does not exist an extraordinary disease of the bronchial mucous mem- brane, the patients do not cough. They themselves, and sometimes only their relatives, remark, when they take rapid exercise, at most a shortness of breath, which is merely passing, and which is sometimes accompanied by palpitation of the heart. Sometimes, too, they confess to a weakness in the chest, especially during walking and speaking. They are easily tired, and it is only after this that an irritation is noticed in the larynx, which they speak of for the most part as tickling. At this period of the disease we hear mostly only of weakness of the chest in general, of nervousness, and the like ; most frequently our atten- tion is called to the lively pulsations of the heart, the patients consider- ing themselves suffering from disease of the heart, and are thought by others to be so affected. I have often been consulted on such occasions in order to decide concerning a supposed disease of the heart. This opinion is the more plausible, since sometimes the flattening of the chest- wall, particularly when the clavicles project strongly, permits a contact between it and the heart, whereby the motions of that viscus are not only felt by the patient, but become more easily seen and felt by the hand. Long before the commencement of the first appearances of a commenc- ing catarrh of the bronchi at the summit of the lungs, I have noticed in most cases these appearances, together with insufficient development, or commencing wasting of the muscles of inspiration. Among the earliest observed symptoms, we notice over the apices of the lungs an inequali- ty in the pitch and clearness of the percussion note; and, truly, a height- ened pitch, with unusual clearness of percussion, denotes the commencing injury to the parenchyma of the lungs. At the same time, we notice the disproportion of the intensity of the inspiratory murmur in this point as compared with the same in other parts of the lungs, especially in the lower lobes in calm respiration. There is heard in the diseased apex, in regular easy respiration, either no respiratory murmur at all, or a hardly audible murmur or humming, which on deeper respiratory efforts passes through different modifications; very frequently it is only relatively later on that signs of catarrhal inflammation of the mucuous membrane become clearly marked; and beyond this, again, there is this peculiarity notice- able, that the catarrh of the pharynx and larynx frequently becomes earlier developed, and already gives the patient no slight annoyance, before any disease of the lungs be dreamt of, by causing catarrh of the bronchi. These patients busy themselves in preference with their throat disease, 278 JMºscellaneous. [Jan., and willingly deceive themselves as to their real position when this has become hopeless. - With or without catarrh of the pharnyx or larnyx, we notice in patients, before the advent of symptoms of bronchial catarrh, a slight cough, which at first is easily overlooked, and apparently is without expectoration Gradually the slight cough is more frequent; it also periodically rises to short exacerbations, and if the patients are told to watch carefully, we lastly notice true sputa, although these may be at first so rare that days may pass without clearly seeing any. These sputa often are nothing more than little lumps the size of linseeds, soft, round- ed, and greyish-white. With careful attention in such cases, we see from time to time single sputa, which are already characteristic of disturbed nutrition of the parts. These are single knots of saffron-colored sputa, not slimy and striated with blood-streaks, but such as cannot be at all distinguished from pneumonic sputa. I have often found that often these single yellow or rusty-colored sputa are not expelled with attacks of coughing, but that they come mostly in the morning after forced ex- piration. When, during a week of observation, only single sputa of this kind are expelled, these are important enough to indicate the com- mencement of a neighboring severe change in the parenchyma of the lungs. They doubtless arise from circumscribed lobular infiltrations, which arising in the relaxed parenchyma of the lung, in consequence of disturbed circulation in the nutrient vessels, are far too slight to alter unfavorably the vibrations of the relaxed lung parenchyma aroused by percussion. Perhaps it requires such accidental circumstances, in the physical condition of the lung substance, for these sputa to appear; but they appear pretty frequently, for I have remarked them in cases with- out any catarrh too often, to make me hesitate in considering them as very important. - If these lobular infiltrations (a circumstance unavoidable in such cases) fall into destruction, or become tubercular, and in the end become tubercular sputa, they yield, even when of the smallest dimensions, enough deleterious matter to prepare the greatest danger by entry into the venous passages of the organism. From the explanation that has preceded this, it is evident that such-like little infiltrations in relaxed parenchyma of the lungs, even when not recognizable by marked percus- sion or auscultation sounds, are to be recognized, if they are incapable of rising to the height of vital products, as doubly dangerous, be- cause the condition of the surrounding tissues, and especially of the ves- sels of the same, tends to favor instead of preventing the entry of injuri- ous matter into the blood. Experience teaches us that the form of tuberculosis of the lungs, which commences with the least thickening of the parenchyma, often most rapidly gives rise to obstinate feverish symp- toms, whilst commencing infiltrations may often remain a long time without causing fever; of these forms, one prefers the acute, the other a chronic progress. In a series of years I have noticed many cases in which nothing was to be discovered for a long time except the degener- ation of the muscles of respiration, and the above-mentioned marked diminution of the contractility of the lungs when the patients were already attacked with fever, became rapidly anaemic and thin, or attacked by hamoptysis. The first certain sign of beginning tuberculosis after these, was the saffron-colored sputum, coming on after simple catarrhal expectorations, which last at first was only expectorated in very small masses, often only in the morning, with slight hawking or slight cough- Ing. These discussions may, perhaps, suffice to prove, that the commence- ment of tuberculosis of the lungs immediately and chiefly is dependent on the imperfection of the thoracic muscles of inspiration, and next on the les- 1872.] Miscellaneous. 279 sening of the power of contractility of the apices of the lungs. . I could bring forward a number of cases to prove this to be true, were it not for the fear of trespassing on the space allowed to me. I will only give the facts of one case, because it especially tends, and through the absence of any obscuring surroundings, through the simplicity of the appearances observed, to throw light on the matter. In the year 1867, I visited almost every day an elderly gentlemen on account of a long-continued, severe disease, for some months, and thereby had an opportunity to observe his blooming daughter, a girl of nineteen years old, under various circum- stances. She had never been sick before this period, had often danced for a lengthened time without feeling unwell from this exercise, and had never experienced any peculiar sensation in the chest. During the long- continued sickness of her father, she was much occupied by nursing him, and had also passed nights at the bedside of the patient. On the re- mark of the mother that since a short time a certain nervousness had been apparent in her daughter, probably on account of her emotions being excited by the hopeless condition of the patient, her father. I expressed my opinion as to the marked alteration in the appearance of the young lady for some time past, which was caused by the fatigues she had undergone, and which might not be unimportant for her health. At once an examination was proposed, which revealed the following condi- tion : The body was well grown, slender, and pretty well nourished, with a slight flush on the cheeks. The patient was upright in her gait, with long neck, thin in the upper part, and slightly bent forwards; the Scapula stood out from the chest, the shoulders sloping, the clavicles very little bent backwards; between the inner edge of the scapula and the clavicles little deep pits, which caused some trouble in the complete examination of the neck. The trapezius muscle was clearly soft In its upper part. The sterno-mastoid muscles on both sides was thin, and clearly apparent in every position and movement of the head. Between these muscles and the trapezius of the neck 'on both sides, that is, out- wards, there was flattening, the skin sunk in between these muscles, and the muscles in the hollow soft. Both shoulders were rather bent for- wards; the upper ribs slopingly directed towards the sternum, and marked by leaning against the clavicles. The distance of the manu- brium sterni from the clavicle, as also the diameter of the thorax between both axillae, was small, in comparison with the considerable compass of the thorax in its lower half. The muscles of the neck, of the nape, and of the front of the chest were slender, lax, and little developed. On the other hand, those in the loins, the pelvis, and the lower extremities were still rather powerful and well-developed. The right shoulder was higher than the left. The liver, especially the left lobe, stood forward rather from the edge of the ribs. The stomach was rather expanded by gases, and its walls markedly tense. The percussion note over the left clavicle and left fossa supra spinata gave a note which was unmistakably higher and clearer than that on like position of the right side; also under the left clavicle, as far as the under side of the thorax, was this difference remarked, but in a lesser degree. In all other points of the thorax the note was not of tympanitic clearness; it was full, and everywhere of like pitch. When the patient breathed gently, there was heard on both lower lobes of the lungsa normal vesicular inspiratory murmur, which accorded with the inspiratory movements of the heart, and which was followed in the second half of the motion by a weak and blowing expiratory mur- mur. Of like quality were also the murmurs in the upper lobes of the lungs, especially in front of the thorax: behind, these were only a little less loud and clear beneath the spines of the scapulac. In the fossa supra spinata, as also above the clavicles, was heard during quiet breathing, on the right side, a weak, not well-marked in and eaſpiration; and, on the 280 Miscellaneous. [Jan., 1872. left side hardly to be heard, and on the right side a scarcely noticeable humming, in quickened and deep inspiration ; the inspiration on the right side was vesicular and regular in its intervals. On the other hand, on the left side the murmur remained unequal in inspiration and expira- tion, and the expiratory murmur was never completely vesicular. With the gradual quickening of the respiration, the first inspirations were accompanied by single bubbles of fine and vesicular rustling. As the inspiration increased in depth and duration, the expiratory murmur became still more marked, more intense, sharper, and gradually length- ened. The peculiar characters of the inspiration and expiration murmurs showed also several modifications and degrees. In loud speaking, and also in quiet whispering, the apex of the lung was set vibrating, and every inspiration taken in during speaking was accompanied by a mur- mur which was heard neither in the left apex nor in any other part of the lungs. The patient confessed that for some time she had experienced a certain tenseness in the epigastrium, with occasionally occurring eructa- tion (which had no peculiar smell or taste), and that it felt as if her clothes round the lower ribs were rather uncomfortable. With this exception, all other symptoms of disease were absent. The patient felt neither tired nor weak, her appetite was normal, she had no cough, com- plained neither of dyspnoea nor oppression in the chest; some palpitation of the heart, and rapid breathing when she went up-stairs, and rather disturbed sleep, were alone remarked. It is, from the above remarks, not difficult to perceive that the left apex had lost its normal contractile power. The vibratory power of the apex, which was very full of air, was raised, whilst the contractility of the muscles in the walls of the bronchi and arterial and venous twigs had suffered a notable diminution. Hence the abnormal height and clearness of the percussion note. I made the mother, a most able and thoughtful lady, aware that up to this date there was no clear disease of the lungs, but that the apex of the left lung was in a weak condition, which in unfavorable circumstances made it to be feared lest great evils might arise. I described as its most imminent. danger that of haemoptysis, and then such circumstances as these, which, at first coming on unmarked, might later bring on, in spite of all reme- dies, fever and tuberculosis of the lungs. I warned against all emotions of the mind or fatigue of the body, regulated the diet with attention to the catarrh of the stomach, for which I prescribed, and recommended frequent moving about in the garden, with, above all, great care for the bowels, and added to this a carefully-regulated use of all the neck, nape, and chest muscles. All work in sitting posture—at the writing-desk as well as the work-table—was to be given up. The patient was also to go to Gleichenberg, and in September of the same year, on being again examined, the patient looked better, felt stronger, and had lost the stomach catarrh. She had no trace of cough, but there was no difference perceptible in the condition of the left apex. The same orders were given, and care recommended at this raw season of the year against the occurrence of the bronchial catarrh. In the first week of October, after having felt nothing peculiar up to this time, the patient wrote some let- ters—not without excitement, walked for about the distance of two miles to a carriage, rather hastily skipped over two steep steps, and spoke with some animation immediately on reaching home. Suddenly there arose a fit of coughing, which was followed immediately by profuse haemoptysis. After this, deposit of tubercle followed, and the patient died in the month of March.--Doctor, Oct., 1871. Advertise?//ents. () F Ford's Surgical Instruments. INSTRUMENT-MAKERS TO THE U. S. Navy; Bellevue, New York City, and New York State Woman’s Hospitals, and Hospitals in charge of the Commissioners of Public Charities and Correction. IMPORTERS AND MANU FACTURERS OF EVERY DESCRIP- TION OF R U B B E R G O ODs. 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Full course of lectures, Matriculation, & * •. Hospital fee, * * e Graduation fee, º * e. * $50 00 sº e * tº 5 00 * g * º 6 00 25 00 The lecture fees for graduates of other respectable Colleges, and for third course students, will be $35 00. Alumni will be admitted free. No student will be admitted into the graduating class whose first course of lectures has been completed within six months of the beginning of the term. This rule will be strictly enforced, and will remove the main objection that is urged against spring schools. The laboratory will be open for chemical instruction, and daily clinics will be held during the entire year. For further information, address 5 GEORGE TIEMANN & Co., F. A. STOHLMANN. ESTABLISHED 1826. ED. 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Physicians wishing to examine and test this remedy are requested to apply, by letter or otherwise, to the undersigned, Wilson, Lockwood, Everett & Co., Gen. Agents, 31 Murray Street, New York City. JOHN ROSS & CO., PRINTERS, 27 ROSE STTREET, NEW YORK. * - - - - * *, . . . .'”, Jºº 3. #º , , , º' ' , , , i l . . . . . •. ...’, i. ) º: §§ & ". º: ", , 3. w h ºf AC { *g “A /V13 - 34 p THE Vy * MEDICAL WORLD. A Monthly Journal of AMERICAN & FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL AND CHEMICAL LITERATURE, CRITICISM & NEWS. ~ *~ * Vol. I. FEBRUARY, isº. No. 8. Subscription Price, $1,50 a Year. Single Copies, 15 cents C O N T ENTs. PRACTICAL MEDICINE : Clinical Lecture on Diseases of the The Pathology, and Treatment of Skin, D.R. DAVIs, & * . 299 Cholera, DR. JOHNSON, ſº 281 On the Treatment of Asthma, DR. The Use of Baths in Small-pox, THoRowgood, º * & . 303 DR. 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William BMW 3 CD, FBISEs, Siſsman, NY. fºr Will be sent by mail, (post-paid) on application, A P A M P HILET, Containing two articles, by distinguished foreign authority, on “INHALATION OF ATOMIZED LIQUIDS,” WITH FORMULAG OF THOSE SUCCESSFULLY EMPLOYED. ——º-C- Also, an article by Dr. J. L. W. THUDICHUM, M. R. C. P., on “A New Mode of Treating Diseases of the Nasal Cavity,” WITH HIS FORMULAF. Also, an illustrated description of the best apparatuses for the above purposes, and for producing, Zoca/ 24naesthesia by Atomization with Ether, by the method of DR, RICHARDSON, of London; or with Rhigolene, as described by DR. HENRY J. BIGLow, in the Bostoſz Medical area. Surgicat! }overnal of April 19, 1866. 2422 our 24tomizing Znstrumezzi's are made with the utmost care, with a view to their complete efficiency, convience and durability, and every one is warranted. 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All its joints are hard soldered. It cannot be injured by exhaustion of water, or any attainable pres- sº º: Stearm. p g t does not throw spirts of hot water, to frighten or scaid the Fig, 15, The Complete Steam Atomizer, patient. p 3. § For /t/alation, & c. Is compact and portable, occupies space of one-sixth cubie fºot only, can be carried from place to place without removin; the atoliyiz. Patented March 24, 1868, and Mar. 16, 1869, ing tubes or the water, can be unpacked or packed without loss of time. Will render the best of service for many years, and is cheap in the best sense of the word. Price $6 cy, Neatly made, strong, Black Walnut-Box, with convenient handle, additional, $2 5o. Brass Parts Nickel-Plated, additional, $2 50. SHURTLEFF'S ATOMIZING APPARATUS (See Fig. 5), for Inhalation, and with suitable tubes, for Local Anaesthesia, and for making direct local applications of atomized liquids for a great variety of purposes. 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Our SUBSCRIBERs AND PATRONs will please excuse the delay in the regular appearance of this Journal. Circumstances entirely beyond our control were the imme- diate cause of the same. In future, we will have the Journal promptly with our subscribers. In strict accord with the name and description of the Journal on our title-page, we propose to make THE MEDICAL World in future numbers a faithful résumé of everything that is of value to the busy practitioner, carefully selected from the home and foreign medical press. We want a circulation of 10,000 copies per month, and will endeavor to secure and merit such a patronage. Out of nearly 75,000 physicians in the United States of all classes, there is no medical journal having anything like the above circulation. Any of our present subscribers in the country who will send us the names of physicians practising in their vicinity will much oblige the publishers. Address all communications in future to William Baldwin & Co., PUBLISHERS AND PROPRIETORS, 8 II Broadway, N. Y. THE EDICAL WORLD. A MONTHLY RECORD OF AMERICAN AND FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL, AND CHEMICAL LITERATURE, CRITICISM, AND NEWS. VoI. I. NEw York, FEBRUARY, 1872. No. 8. ipractical jºſeiºſitine, THE PATHOLOGY AND TREATMENT OF - - CHOLERA. BY GEORGE JOHNSON, M.D., F.R.C.P., Physician to King's College Hospital, Professor of Medicine in King's College, London. My experience of cholera began during the epidemic of 1849. I had been taught, and I firmly believed, that the main object of treatment in the earlier stages of the disease is to arrest the discharges by opiates and other astringents, in order to prevent that drain of liquid from the blood which was assumed to be the cause of choleraic collapse. Acting upon this theory of the disease, I soon found reason to question its truth. The first case which painfully excited my doubt was that of a woman about forty years of age, who had what ap- peared to be a mild attack of choleraic diarrhoea. She had vomiting, purging, and cramps, but she had a warm skin, a good pulse, and no symptoms of collapse. I prescribed five grains of Dover's powder to be taken every hour; and when I saw her again, after three doses had been taken, I found that the vomiting, purging, and cramps had all been abruptly Entered, according to Act of Congress, in the year 1871, by WILLIAM BALDWIN & Co., in the Office of the Librarian of Congress, at Washington, D. C. 282 Pathology and Treatment of Cholera. [Feb., checked by the opium, but, to my dismay, she was in full col- lapse, and in a few hours she died. These facts appeared to me to be inconsistent with the theory which I had accepted and acted upon. If collapse results from the drain of liquid, it was difficult to understand the occurrence of extreme collapse immediately after the sudden arrest of the discharges. It was years before I obtained the clue to the mystery; but this case greatly excited my interest, and made me watchful and observant of the phenomena of the disease, and, in particular, of the influence of various and opposite modes of treatment. During the course of that epidemic, I had the opportunity of witnessing the effects of two very different modes of treatment in King's College Hospital. At one period all the cases were treated by liberal doses of brandy and opium, and about two- thirds of the cases thus treated died. The treatment was then entirely changed; brandy and opium were discontinued, and unlimited quantities of salt and water were given. The effect of this treatment was to excite frequent vomiting, and certainly not to check, but rather to increase, the purging; yet, under this rough and apparently unscientific treatment, the recoveries were as numerous as the deaths had been under the brandy and opium treatment—about two-thirds of the cases treated by salt and water recovered. The larger proportion of re- coveries under this method of treatment was not accounted for by the milder character of the disease—the cases were of equal severity. In the year 1854, as the Junior Assistant-Physician, I was left in sole charge of the hospital during nearly the whole period of the epidemic, and I entered upon the work with feel- ings of anxiety bordering upon dismay. Bearing in mind the results of my experience during the previous epidemic of 1849, I also learnt what I could of the effect of what is called the saline treatment of the late Dr. Stevens, and of the treatment by repeated small doses of calomel with cold water, as recom- mended and practised by the late Dr. Ayre, of Hull. It is very difficult to make an exact comparison between different modes of treatment, at various times and places, by different practitioners, but it appeared to me that the results of the saline and the calomel and cold water treatment were decidedly more favorable than the opiate and stimulant treatment. The 1872.] Pathology and Treatment of Cholera. 283 effect of the Salines and the calomel would be rather to en- courage than to check the discharges. It might be, so I argued, that the discharges were the means by which a morbid poison is eliminated, and, if so, they may be as much an element in the natural process of cure as the cutaneous eruption of the acute exanthemata. . . By this train of reasoning I was led to make trial of the treatment by castor oil and cold water, and the results were Such as to convince me that, at any rate, we were on the right track. The experience of a very few cases sufficed to show, with unmistakable clearness, that the drain of fluid from the blood, by the discharges from the stomach and bowels, is certainly not the main or essential cause of choleraic collapse. . This was proved by the fact that patients who were admitted in collapse recovered from that condition while pro- fuse discharges by vomiting and purging still continued, and that no recovery from collapse occurred without a continuance of the discharges; while, on the other hand, it was found that a complete arrest of the discharges during a collapse is a sign of fatal import. - At that time I knew nothing of the pathology of cholera, and I made some serious practical mistakes, one of the greatest being that of giving a needless amount of medicine. On the whole, however, the results were so satisfactory that I deter- mined to publish the cases in detail. Meanwhile, stimulated to unusual exertion by the unreasoning outcry which had been raised against my practice, I determined to do my utmost to solve the problem of the pathology of cholera. I began to read, and carefully to analyze and annotate, the works of those men who had seen most of the disease, especially in India. , I found in the works and reports of the earlier Indian writers on cholera—Scot, Bell, Orton, Twining, Annesley, Christie, Kennedy, etc.—a rich storehouse of facts, and it soon be- came apparent that these facts were quite irreconcilable with the theory which had gained almost universal acceptance; I mean the theory which explains the collapse of cholera by the discharges from the alimentary canal. By degrees and by dint of hard work during the winter of 1854–55, I arrived at what I believed to be the true physiological explanation of the phenomena of choleraic collapse, and in the spring of 1855 284. Pathology and Treatment of Cholera. [Feb., I published in a volume (on “Epidemic Diarrhoea and Chol- era”) the results of my labors, with a detailed report of all the cases treated by me during the epidemic of the year preced- ing. From that time to this I have seen no reason materially to alter my views, either as to the nature of the disease or the principles of treatment. If I had foreseen to what an extent the publication of my doctrines on the nature and treatment of cholera would involve me in painful, profitless, and time-consuming controversy, I am not sure that I should have had the courage to undertake the duty. I have always been thankful to receive candid and unprejudiced criticism, but it is not pleasant to have to defend one's self against such a weapon as deliberate, unscrupulous mis- representation. This, unfortunately, I have had to do quite recently, as on more than one occasion before. Having once, however, committed myself to this work, I have never felt the slightest inclination to withdraw from it. Moreover, the labor has not been without its reward. The investigation which it has involved has led me to the interesting discovery of hyper- trophy of the muscular walls of the minute arteries in many tissues throughout the body; and in this fact to find the explanation of the hypertrophied left ventricle in cases of chronic Bright's disease. * In prosecuting these researches, I have had the satisfaction of knowing that I have been work- ing to promote the interests of mankind as well as the credit of my own profession, which is deeply concerned in the solu- tion of the problem as to the nature and the correct treatment of cholera. While the opposition which I have met with has certainly not been free from prejudice, and has, for the most part, been more noisy than rational or argumentative, I have obtained the public support of men of great eminence, distin- guished alike for the extent of their knowledge and the soundness of their judgment. And last, but not least, you, Mr. President and gentlemen, have done me the honor to invite me here to-night to discuss with you the pathology and treatment of cholera. In the brief history which I have given of the manner in which I was led to take up this question, and to prosecute the * See British Medical Journal, April 16, 1870. 1872.] Pathology and Treament of Cholera. 285 enquiry, my main object has been to show that I did not begin by theorizing on the subject of cholera; on the contrary, I loyally accepted the current theory, and proceeded to give it a practical application. It was not until I discovered that, when thus applied, it was misleading and mischievous, that I felt bound to examine the grounds upon which the theory was based. I now propose to bring distinctly before you, in the fewest possible words, the main points relating to the pathology and treatment of cholera which I believe to be probably true, and upon each of these points to invite comment and criti- CISIOl. -- - Cholera is the result of a material and portable morbid poison, which is capable of being conveyed from place to place and communicated from person to person. The poison may enter the system either with the air through the lungs, or with the food and drink through the alimentary canal. It is probable that the rapid spread of the disease over a limited district is mainly due to atmospheric agency during an epidemic season; it is still more probable—nay, it is certain—that sudden local outbreaks have been caused by the drinking of impure water, and especially of water contaminated by choleraic discharges. Mr. Charles Macnamara, of Calcutta, records the fact that nineteen healthy men, upon one occasion only, drank water with which cholera stools had been mixed. In the course of the next three days five of these men were seized with cholera. At the time of this remarkable occurrence there was no cholera in the neighborhood, nor had there been for years. The poisonous discharges employed in the performance of this experiment were brought from a distance. It is probable that, during an epidemic season, water contain- ing feculent matter, even though not contaminated with the specific choleraic discharges, may communicate the disease directly; or it may act as a predisposing cause, concurring with some unknown specific atmospheric agency. In connection with the subject of impure water as the vehicle of the cholera poison, the name of the late Dr. Snow deserves most honorable mention. It is to his persevering efforts, in spite of ridicule and opposition, that we are mainly indebted for our knowledge of this important agency in the causation of cholera. . 286 Pathology and Treatment of Cholera. [Feb , In whatever way the poison enters the system—whether with the air through the lungs, or with water through the alimentary canal, it is absorbed, and enters the circulation before it gives rise to its characteristic symptoms. The chief facts and arguments upon which is based the doctrine of a blood infection in cholera are these:– It is a general law of physiology that the absorption of a poison into the circulation precedes the occurrence of the con- stitutional symptoms to which it gives rise. The cholera poison, if it were not absorbed, would form an exception—and, I believe, the only known exception—to this general law. When the poison enters the system by the lungs, the blood is obviously the only channel by which it can reach the alimen- tary canal. In like manner, when the foetus in utero (as has frequently happened) is found to have been infected by cholera, its intestines containing the characteristic rice-water fluid, it is obvious that the morbific poison must have traversed the blood of both the mother and the foetus before it could reach the alimentary canal of the latter. There is usually an interval, varying from one to three or four days, between the absorption of the poison and the onset of the characteristic symptoms. During this period of incubation there is, in some cases, a general feeling of malaise and depression—the result, probably, of blood-poisoning and a consequent disturbing influence upon the nervous system. It would be a very interesting point to determine whether, as is highly probable, there is febrile eleva- tion of temperature during this initiatory stage of the disease. In a large proportion of cases, not only of collapse, but of choleraic diarrhoea, the urine which is first passed after the height of the disease is over is found to be albuminous. This affords the same kind of evidence of blood poisoning as is afforded by the same symptom in cases of diphtheria, Scarla- tina, and other diseases which are unquestionably associated with a specific blood poison. Lastly, the most probable explanation of the formidable symptoms which have often followed the abrupt arrest of the choleraic discharges by Opium is that the poison, being thus retained within the circulation, had caused the collapse or the fever, as the case may be. The discharges from the alimentary canal are the means by 1872.] Pathology and Treatment of Cholera. 287 which the poison and its products are expelled from the system. In this respect they are analogous to the eruption of small- pox and intestinal discharges of enteric fever. That , the discharges in a certain stage of decomposition do contain a Specific poison, is conclusively proved by such experiments as that of Mr. Macnamara, before referred to ; and the doctrine is implied in the practice of disinfecting the cholera stools, the importance of which is almost universally acknowledged. The discharges, when abundant, are obviously a source of great exhaustion, and they may be so copious as to kill; but that they are neither the sole nor the chief cause of choleraic collapse, is evident from the following consideration: They bear no direct relation to the degree of collapse; in the worst class of cases an inverse relation appears to prevail. Collapse and death may occur without discharges, and with but a scanty secretion into the alimentary canal; while, on the other hand, recovery from collapse is always associated with a continuance of the discharges, which gradually cease as reaction occurs. The state of collapse is evidently different from that of mere exhaustion by profuse discharges; it has often been relieved by venesection, which would certainly aggravate a state of mere exhaustion; on the other hand, it is not beneficially in- fluenced by the remedies for exhaustion—such as alcoholic stimulants, for instance. The onset of collapse has often been too sudden to be satisfactorily explained by exhausting dis- charges; and recovery from extreme collapse is sometimes so rapid as to form a striking contrast with the necessarily slow recovery from the exhausting effects of profuse discharges. Neither the amount of the discharges nor the rapidity with which they are poured out affords a satisfactory explanation of the state of collapse, which, as I have said, gradually dimin- ishes and passes away, while the liquid flux continues until re- action has been established. Dr. Edward Goodeve admits that symptoms similar to those of collapse may result from poisons without purging. He says: “I have seen people under the influence of the malarious poison, in Calcutta, lie for hours as cold and pulseless, and as embarrassed in the breathing, as in cholera.” (Reynolds's “System of Medicine,” vol. i. p. 712, second edition.) There is reason to believe that the main and essential cause 288 Pathology and Treatment of Cholera. [Feb., of choleraic collapse is an impeded flow of blood through the lungs, and a consequent defective circulation throughout the whole system. The proofs of this impediment during life are—1st. The comparative emptiness of the systemic arteries; the pulse being small and feeble, or even imperceptible, at the wrist. 2d. The fulness of the systemic veins and the consequent lividity of the surface. After death.-Anatomical evidence of impeded circulation is found in the condition of the heart and lungs. The left side of the heart is empty, or nearly so, while the right cavities of the heart, the pulmonary artery, and the large systemic veins are distended; the lungs are anaemic, light in weight, and either dark or light colored, according to the pre- sence or absence of a retrograde passive engorgement of the bronchial veins and capillaries. When collapse has been very prolonged, the lungs may be oedematous, a result of serous exudation from the passively engorged bronchial capillaries. The haemorrhagic spots commonly seen beneath the peri- cardium and the pleura are analogous results of engorged systemic veins and capillaries. Similar haemorrhagic spots are often found in cases of valvular disease of the heart; and these, again, are similar to the ecchymoses beneath the skin and conjunctiva which. Sometimes occur during an epileptic fit. & The most complete and accurate record of the post-mortem appearances is that contained in the fourth volume of the “London Hospital Reports.” The only probable explanation of the arrest of the circula- tion during collapse is that which refers it to contraction of the minute pulmonary arteries excited by the poisoned blood. A similar arrest of the circulation occurs in cases of acute apnoea. The anatomical condition of the heart and lungs after death from sudden suffocation is identical with that which is found in cases of choleraic collapse. So, during a severe fit of spasmodic asthma, a state of collapse occurs very similar to the collapse of cholera. The main difference between choleraic and asthmatic collapse consists in this—that in asthma there is a primary apnoea, the result of bronchial spasm, and a second- ary asphyxia or pulselessness, consequent on contraction of 1872.] Pathology and Treatment of Cholera. 289 the minute pulmonary arteries; on the other hand, in cholera collapse there is a primary asphyxia and a secondary apnoea, consequent on the arrest of the circulation. - The rapidity and the duration of arterial contraction in different diseases vary exceedingly, from the sudden spasm of the cerebral arteries, which is now generally believed to be the immediate cause of an epileptic fit, to the persistent contrac- tion of the minute systemic arteries, which results in hyper- trophy of their walls, and causes the hypertrophy of the left ventricle in cases of chronic Bright's disease. - It is evident that an impeded flow of blood through the lungs does explain the phenomena of collapse. I have references to several cases of embolism of the pul- monary artery, the symptoms of which have borne a striking resemblance to those of the collapse stage of cholera. The most completely recorded case of this kind is one published by Dr. Alfred Carpenter (Lancet, September 23, 1871). In that case, as Dr. Carpenter remarks, “the only symptoms wanting to make it apparently one of cholera were alvine discharges and cramps in the limbs.” The symptoms actually noted were blueness of the surface, icy coldness of the uncovered parts of the body, cold, clammy perspiration, coldness of the breath, sinking of the eyes, feebleness of the voice, a feeble, thready pulse, with quick breathing, excessive thirst, and almost com- plete suppression of urine (two ounces of urine only being passed one day, and on another day less than two ounces).- Medical Times and Gaześće, Jan. 13, 1872. THE USE OF BATHS IN SMALL-POX. BY CHRISTIAN BAEUMLER, M.D., Assistant-Physician to the German Hospital. LookING upon hospitals as our guides in therapeutical mat- ters, I am sure that other members of Our profession besides myself must have felt some disappointment at the uncertainty of opinion regarding the above subject, which the medical 290 The Use of Baths in Small-Pow. [Feb., evidence in the Hampstead Hospital enquiry has brought to light. The statements which were made were not character- ized by that confidence which is founded on an exact know- ledge whether and when a remedy is suitable or even neces- sary, or when it is contraindicated. At the present day, no more doubt or uncertainty ought to exist on so important a point as this; and if it would be un- reasonable to expect from any hospital accurate clinical obser- vations on such a question at a time when an epidemic is rapidly spreading or at its height, and when necessarily all the sources of the hospital are strained to the utmost, yet the opportunity to settle this question ought not to be allowed to pass while the epidemic is declining and the hospital staffs are less overworked ; for I am afraid we are still very far from the much-desired end of stamping out smail-pox altogether, nor is the mortality from it so reduced as to let us lay down our hands in complacency, and as to make unnecessary any further endeavors to find out means for reducing it still I\}OI’62. The beneficial results which follow the use of cooling baths in other fevers can only encourage an attempt in the same direction with small-pox. Any one who has seen how the restlessness of a patient suffering from the initiatory fever of scarlatina or in any other fever is quieted by, and how sleep follows upon, a cool bath, cannot help thinking that the same effect would be produced in small-pox whenever the restless- ness and delirium are accompanied by high pyrexia, and that, consequently, mechanical restraint would much more rarely become necessary. That the pyrexia had something to do with the delirium of those patients that had to be restrained at Hampstead, I conclude from the fact that this restraint has, in most all the cases, only been found necessary during the night, when naturally the fever would be at its highest. I have very little experience of delirium in small-pox, but I should think that in the majority of cases the delirium will chiefly occur during the initiatory fever, and then be accompa- nied by high pyrexia. It is very probable, however, that in a certain number of cases, and especially with drinkers, delirium of a violent character may also come on at the stage of the crisis, and then have the significance of what Dr. Hermann . 1872.] The Use of Baths in Small-Poa. 29.1 Weber has called the “delirium of collapse.” The treatment in the two cases will, of course, be essentially different—the one requiring cooling, the other, stimulating measures. In cases of the first category, I have seen baths with cold affusion used in the hospitals of Paris, and this seemed to be the recognized treatment for great restiessness and delirium. Currie, who is too much forgotten in England, used them in Small-pox in the last century, and says (Med. Ideports, ii. p. 58): “This, however, I can declare, that, in all the cases in which I have used the affusion of cold water during the eruptive fever, however severe the symptoms may have been, these symptons instantly abated, and the disease assumed a benignant form.” And, in conclusion, he remarks that the Chinese are said to have long followed the practice with extraordinary success. Evidence similar to this last remark is given by a Dr. Fischer in the beginning of the last century, of some parts of Hungary and Silesia, where tepid bathing of small-pox patients had long been a popular treatment; this certainly is remarkable, as, upon the whole, those classes which generally suffer most from small-pox are not distinguish- ed by any particular predilection for water. Cases of haemorrhagic small-pox, which generally are not accompanied by very high pyrexia and delirium, do, according to two cases related by Currie, not seem to be benefited by the use of cold or tepid affusion. But sufficient has been said to show the more important bearings of the question ; and I venture to express a hope that the profession will soon be in possession of conclusive evidence upon the following points: 1. What influence has a syste- matic reduction of the temperature of the body in small-pox on the delirium accompanying the eruptive stage, and on the further course of the disease? 2. What is the effect of such a treatment, more especially on the eruption ? 3. What effect has tepid, or, with high fever, cool bathing in the later stages of the disease on the eruption and on the general state of the patient —British Medical Journal, Jan. 13, 1872. 292 Treatment of Sick Headache. [Feb., ON THE TREATMENT OF SICK-HEADACHE. From Reports of Medical and Surgical Practice in the Hospitals of Great Britain. DR. LAWSON, of St. Mary’s Hospital, says that, so far as he knows, there is no better defined or less understood malady than sick-headache. It is not common at the hospital—that is, in the outdoor department. He is disposed to think it is most frequent in private practice, and is sorry to say from what he knows of it that it is incurable; that is, not that it cannot be relieved, but that it recurs. In fact, he knows of at least five persons who have it regularly about eight or ten times a year. He does not think it is more frequent in one sex than in the other, and he is not aware that menstruation affects it in the slightest manner. Its symptoms are well known. They are, a violent pain across the front and upper part of the head, with disinclination for food, sickness, and occasionally vomiting. It extends over various periods, ex- tending from twenty-four hours to three or even four days. When the vomiting is severe, the pain comes to an end sooner than when there is no vomiting. Frequently it will be found that the bowels are costive, but this is by no means always the case. People of a bilious temperament are most subject to “sick-headache.” As to treatment, he simply recommends the patient to avoid food, and to rest in bed. He allows a certain amount (varying, of course, according to the age and habits of the patient) of alcohol, either brandy or whiskey, and administers a good purgative at onc. If the case be severe, he promotes vomiting as soon as possible, but gene- rally a good purge is sufficient to carry off the bile and restore the patient to health. As to the causes of sick-headache, Dr. Lawson does not like to hazard an opinion ; he thinks it is due not to any overaction of the liver, but to a reflection of the bile toward the stomach. In fact, he is disposed to think that, owing to the condition of the intestine, the bile does not flow downwards; hence it is propelled toward and into the stomach, and that it is its action on the pneumogastric nerve which promotes the headache. But to what the obstruction 1872.] Treatment of Sick Headache. 293 is due, he is ignorant. One thing to be avoided is any promise that the patient will not probably have the same com- plaint again before very long. Dr. Cheadle thinks that headache accompanied by bilious vomiting appears to depend upon a morbid irritation of the nervous centres which govern the act of vomiting, accompa- nied probably by a depression of the vaso-motor centres, which gives rise to increased fulness and pulsation of the ves- sels of the head. The pain is probably due to increased vas- cular pressure upon sensory nerve-fibres, rendered hyper- aesthetic by the reflex action of the primary cause of irritation. The primary irritation may be in action at the nervous centre itself, or may be applied to the peripheral expansion of an afferent nerve, and thence reflected. In sick-headache of cen- tral origin, the phenomena are closely analogous to those met with in meningitis and concussion, with the exception that in the latter case the exciting cause is a serious organic lesion— in the sick-headache a transitory derangement only. There is another analogous form in sea-sickness, although in this the headache is often little marked or absent altogether. Simple sick-headache due to central irritation is, in Dr. Cheadle's experience, extremely rare, but he has met with one very striking instance of it recently. It occurred in the case of an Indian officer who had suffered severe concussion of the brain. He was thrown from his horse, his head struck against a tent- peg in the fall, and he lay many days insensible and in a cri- tical condition. Since that time he has been subject to frequent attacks of violent throbbing headache, accompanied by pulsation of the temporal arteries and bilious vomiting. These attacks are almost invariably brought on by one of two causes—a railway journey or a ball. He was at one time in the habit of visiting Brighton for a day once a fortnight, and never escaped the penalty of this journey, although he con- tinued the practice for several months, during which he was under Dr. Cheadle's care. The central disturbance produced by dancing was equally as certain as the shaking of the rail- way train to produce this unpleasant result. Under ordinary circumstances his health was perfect. With regard to the treatment of central sick-headache, it may be said that drugs exert but little special influence upon the disorder. The 2.94. Treatment of Sick Headache. [Feb., various sedatives (with the doubtful exception of bromide of potassium in large doses) fail to give relief. Two or three minims of hydrocyanic acid with four or five grains of carbon- ate of soda given in two teaspoonfuls of water only (the small quantity of fluid being less liable to rejection by the stomach) may be prescribed with advantage when the retching is ex- cessive. The bowels should be cleared out by a mild purga- tive. But the best remedies are absolute rest and quiet, and the application of refrigerant lotions to the head. The latter give relief to the symptoms, and with rest and quiet the cen- tral equilibrium quickly returns. In an enormous majority of cases, however, headache is due to reflected irritation—to morbid stimulation of the peripheral expansions of afferent nerves distributed to different organs. Thus the seat of irri- tation may be in the stomach, the intestines, and the uterus. The first is a constant source of the disorder, the presence of undigested or unwholesome food, or of food in excessive quantity, being a cause of sick-headache, from which most persons have suffered occasionally. In the same way irrita. tion of the intestines will produce corresponding reflex phe- nomena. One case which may be quoted in illustration is that of a patient who infallibly suffers from nausea and violent throbbing headache whenever by an yuntoward accident the daily action of the bowels is prevented. The accumulation of faeces in the large intestine appears to be the immediate cause, for rapid subsidence of the symptoms follows the evacuation of the bowel, even by a simple enema. The obvious treat- ment in such cases is to clear out the alimentary canal by a free purge, and soothe the firritated mucous surface by ant- acids, with small doses of hydrocyanic acid, and a light, un- stimulating diet. The form of disorder which depends upon uterine irritation is less easily remedied. When dependent upon, and coincident with, menstruation, it constantly persists until that period is over. In such cases everything must be done to ease the process, and favor the proper discharge if it be deficient. Warm formentations to the abdomen, rest in bed, with the hypodermic injection of morphia, or forty grains of bromide of potassium every six hours, have proved the most effectual remedies in Dr. Cheadle's hands. In one or two in- stances, when all other means had failed, the reflex symptoms 1872.] Treatment of Sick Headache. 295 have rapidly ceased upon the administration of eight or ten minim doses of tincture of Indian hemp. This must be carefully mixed with mucilage to prevent precipitation by the water subsequently added. The neglect of this precau- tion probably accounts for the reputed uncertainty of action of the drug. According to Dr. Cheadle's experience, the spe- cific effects can always be obtained by proper doses. Dr. Nunneley says that, considering that the headache precedes the vomiting, that the special senses, the heart, the conjunctival vessels, and the nerves of the scalp are all more or less implicated, it would appear probable that sick-head- ache is a nervous disease, having its origin in the brain itself; but with the exact notion of the cerebral change we are unac- quainted, just as we are with the alterations in the centres of the cardiac nerves which give rise to palpitation. In treat- ing this affection, the vomiting will tend to remove undigested food when this is the cause, and may be encouraged by warm water. A mild aperient is also desirable. In other cases, when the bowels are regular, a purgative is unnecessary, and has usually been resorted to already by the patient. The main object is to restore the morbid condition of the brain to a healthy state. Sometimes taking food will accomplish this, as has been already said, or rest and quiet will bring sleep, from which the patient will awake well. Of medicinal agents there are two : he has found ammonia and nux vomica very useful when administered in the following manner: Drachm doses of the aromatic spirit of ammonia, with ten-grain doses of the chloride of ammonium, should be given as soon as the attack begins, and repeated every twenty minutes or half-hour for two, three, or four doses, and then at longer intervals. Nux vomica is best given in the form of the tincture in small doses frequently repeated, as two minims every quarter of an hour for two or three hours, the intervals between the doses being then increased. A few doses of one or other of these medicines may cut short a commencing sick-headache. Hy- drate of chloral will also be found a most useful remedy in ten to fifteen grain doses given at bed-time. It allays ner- vous irritability and fatigue, and promotes sleep, and will thus often ward off a sick-headache, or terminate one which has begun. Bathing the head with hot or cold water some- 296 -- Treatment of Sick Headache. [Feb., times gives relief. If the scalp become tender, tincture of opium or the liquor opii sedativus rubbed on or applied under oiled silk or compresses soothes the pain, and is more valuable than belladonna. A mild, nutritious diet is the best for the patient; but the details of this and the question of stimulants must be decided after a careful study of each case by itself. When the attacks are frequently repeated, change of scene— if possible, of Society—and a dry and bracing air, with walk- ing or other exercise, are the most valuable aids to special treatment, though iron in any of its less irritating forms is always useful. Dr. McCall Anderson, of Glasgow Royal Infirmary, says that the term sick-headache is variously used, but is most applicable to that form of headache which is associated with nausea and vomiting, and dependent upon constipation, or upon functional derangement of the stomach or liver. If the stomach be loaded, an emetic of mustard or ipecacuanha is indicated, followed by a sharp purge containing calomel or podophylline. The former is preferable, as a rule, if nausea be complained of, as it is more likely to be retained, and to relieve this symptom. Perfect quiet and rest, bodily and mental, is indispensable; indeed, if the symptoms be not at all severe, the patient of his own accord carries this indication into effect. In many cases relief is afforded by the warm bath, or by plunging the feet in hot water to which mustard has been added. The use of cloths wrung out of iced water laid upon the forehead is often grateful, or the application to the temple of the mouth of a “spill-box,” the bottom of which is stuffed with cotton soaked with a teaspoonful of chloroform or bisulphide of carbon. This may be kept in position for about five minutes, and it may be reapplied from time to time if it give relief. During the attack, if it be not prolonged, the patient should not be forced to take food; and at all events the lightest nourishment, such as milk, milk and lime-water, or weak soup, is all that should be given. After the bowels have been moved, a full dose of chloral may pro- cure sound and refreshing sleep, out of which the patient may awake free from headache and nausea, and ready for food. If the first dose be vomited, a second may be administered, which is more likely to be retained. In the intervals between 1872.] Treatment of Sick-Headache. - 297 the attacks, regular exercise short of fatigue should be taken, the diet carefully regulated, and constipation avoided. The mineral waters of Marienbad are very useful in the case of those whose liver and bowels are sluggish ; and in gouty sub- jects, colchicum is sometimes serviceable. Dr. Clifford Allbutt, of Leeds General Infirmary, believes it to be of the highest importance that sick-headache, properly so-called, should be recognized as a neuralgia, but he also believes that among physicians there is no longer much ignorance on this point. These headaches may, and often do, occur in persons who present every other indication of good health and vigor ; but in them or their family there is generally found a history of some other neurosis, such as asth- ma, neuralgia of the stomach, trunk, or limbs, insanity, bed- wetting, eczema, psoriasis, and the like.” If this be absent, there is generally some history of great mental strain during the earlier life of the sufferer. The only well-marked excep- tion to this rule which Dr. Allbutt has noted is the occurrence of sick-headache in connection with uterine or ovarian disease, and in these cases bromide of potassium is especially valuable. Generally speaking, however, sick-headaches are not due to peripheral causes, though these may intensify them as epilepsy may thus be intensified. A coated tongue and a bad taste in the mouth are often complained of by the patients, and by these symptoms both patient and physician are often tempted to a purgative treatment and to a lowering of diet, which is very injurious. In the intervals of the attacks a very liberal diet is required, together with mental rest and wholesome conditions of routine and of variety; and the disordered tongue and taste are, no doubt, to be regarded as of nervous origin. In hemicrania, for example, both the bad taste and the coat are often confined to the side on which the pain occurs. If the attack set in violently and without warning, little can be done, even by the hypodermic use of morphia, to cut it short. If a stimulant, such as black coffee, be given, it must be at the very commencement; afterwards it will do * There is no doubt a curious connection between sick-headache and gout ; but Dr. Allbutt thinks that this is not due to any common ground in abdominal congestion or dyspepsia, but rather in the curious neurotic element which enters into the true conception of gout itself. 298 Treatment of Sick-Headache. [Feb., harm. The patient must be placed in a darkened and abso- lutely quiet room, and must abstain from all but the very lightest food till about 5 P.M., when the attack generally relaxes, and a mutton-chop may be taken with advantage. Dr. Allbutt thinks that sick-headache is substantially the same affection as hemicrania, for every transition may be traced between the two, hemicrania in the majority of cases Wandering beyond its proper limits. Hemierania he believes, with Anstie, to be a neuralgia of the fifth nerve ; hence the injunction to avoid food during an attack is borne out by the well-known experience of asthmatics, who find that food in the stomach, probably by setting up irritation in the vagus- root, intensifies the paroxysm; in the same way, the presence of food in the stolnach during a paroxysm of sick-headache seems by the intermediation of the vagus to disturb the mor- bidly irritable root of the fifth nerve, which lies near its own. In the same way, Dr. Allbutt regards the vascular changes as secondary, and due to a propagation of the irrita- tion in the medulla to the vaso-motor centre contained in that part ; he believes that the vasal paresis described by other writers on the subject is but partially true, and that this paresis is preceded by a period of irritation shown by pallor, coldness, small temporal pulse, and dilated pupil. This stage is seldom observed, as it usually occurs between 5 and 8 o'clock A.M., and is succeeded by the paresis of exhaustion, with its evidences in the flushing, full and soft temporal pulse, and contracted pupil. The tight handkerchief and the cool applications comfort, he thinks, by their sedative influence upon the terminal expansion of the fifth nerve, and not by affecting the vascularity of the head. Many persons have more or less warning of an approaching attack, such as a feeling of dulness in the head, odd tinglings in limited regions, and the like. Such persons may avert an attack by the use of five to ten cells of a continuous galvanic battery, or by means of twenty to sixty grains of nitrate of ammonia. In the in- tervals he relies, in addition to the measures already mentioned, upon tonics, of which arsenic is the first in value and strych- nine the second, and upon the daily or tri-weekly use of the continuous current. In uterine cases, of course, attention will be given to the peripheral disorder. 1872.] Diseases of the Skin. 299 Dr. S. W. D. Williams, of Sussex Lunatic Asylum, Hayward's Heath, writes that the treatment adopted in this institution has in many cases been very successful. It is the administration of the tincture, or extract, of Indian hemp daily between the attacks. His colleague, Dr. Greene, first introduced its use here ; but neither can remember who first recommended it, nor can they explain the mode in which the medicine acts. It is certain, bowever, that in several cases marked benefit has been derived from its use, and in One case an almost total cessation of the attacks. Dr. Wil- liams thinks it worthy of a more extended trial.-British Medical Journal, Jan. 13, 1872. CLINICAL LECTURE ON DISEASES OF THE SRIN —CASE OF PSORIASIS MEDICAL WARDS OF MERCY HOSPITAL. B Y N . S. D A W I S., M. D. , Professor of Clinical Medicine. GENTLEMEN : Before subjecting to your examination the case before us, your attention will be occupied a few moments with some comments on the general subject of cutaneous dis- eases. To most practitioners this is an uninviting topic, and students rarely give it that attention which its importance de- mands. - This class of diseases, although seldom dangerous to life, are nevertheless of frequent occurrence, many of them protracted in duration, some of them contagious or communicable, and all of them more or less annoying to the patient. Hence it is very important for every student to give them such attention, that he may be able to promptly distinguish one class from an- other, and to give such as may apply to him for relief the most efficient treatment. Modern writers on dermatology, or cutaneous diseases, appear not to agree on any common prin- ciple of classifying the diseases in question ; but some are grouped together from a supposed analogy in causation, as when they arise from parasitic influence; others from a com- 300 Diseases of the Skån. [Feb., mon property of communicability or contagiousness; and still others from something common in the form of the eruptions. As an aid in the work of diagnosis, we think no better princi- ple of classification has been discovered than that which was adopted many years since by Willan and Bateman, and was founded on the anatomical structure of the different varieties of cutaneous eruptions. If we omit the modifications dependent on constitutional syphilis, and the morbid growths, such as tubercle and molus- cum, we may arrange all the ordinary cutaneous eruptions into five classes. The first will embrace all those in which the inflammation is so superficial as to produce only a red spot of greater or less size, without any appreciable exudation either into the cutis vera or between it and the cuticle, conse- quently there is neither elevation, induration, nor vesication in this class, but simple red spots. These spots may be small and generally diffused over the surface, as in scarlatina, or they may be small and grouped in clusters, as in measles, or they may be larger and more isolated, as in roseola and erythema. These form the Æſcanthematous class. The second will em- brace all those eruptions in which the inflammation is suffi- cient to cause a serous exudation between the cutis vera and the cuticle, simply elevating the latter into the form of a vesi- cle filled with lymph or serum, but without any plastic exuda- tion sufficient to give hardness or thickening of the cutis vera. The vesicles may be very small, as in scabies and eczema, or larger, as in varicella, herpes, and pemphigus. These are called vesiculae, or the vesicular class. - The third will embrace those in which the inflammation is sufficiently intense not only to cause an exudation of lymph or serum between the cutis vera and cuticle, forming a vesicle, but, in addition, sufficient plastic exudation into the true skin and the subjacent tissue to furnish a more or less elevated and indurated base on which the vesicle will rest. Suppuration or the formation of pus in the vesicle during some stage of its progress is also a constant occurrence in all the varieties in- cluded in this group. Hence they are called pustulae, or the pustular class. The more important examples of this class are Ecthynia, Impetigo, Mentagra, Porrigo, and the pustules of Variola and Vaccinia. 1872.] Diseases of the Skim. 301 The fourth embraces those eruptions in which the inflamma- tion causes a minute amount of plastic exudation into the cutis vera, causing a slight induration and elevation, but with- out either vesication or suppuration. The small indurated and elevated spots thus formed are called papules; hence the group are called papulae, or the papular class. The chief varieties of disease included in this class are Lichen, Strophulus, and Porrigo. The fifth and last class embraces those affections of the skin characterized by such a chronic grade of inflammation as causes spots of variable size, in which the cutis vera is more or less thickened, and from which the cuticle is constantly being ex- foliated in the form of laminae or dry scales. This latter cir- cumstance has caused this group to be called squamae, or the squamous class. ' The varieties of disease properly belonging to this class are Pityriasis, Lepra, Psoriasis, and perhaps the leprosy of the ancients. Ichthyosis, or fish-skin, which has sometimes been included in this class, is generally a congenital defect rather than a cutaneous inflammation. . With these general remarks, you will be prepared to proceed with the examination of the case before you. The patient is a young man of foreign birth, a sailor by occupation, and ap- parently in fair general health, but presents spots of cutaneous disease on his legs, thighs, arms, and a few on the trunk of the body. The first step in the matter of diagnosis is to deter- mine to which of the classes we have named the case belongs. As you individually proceed to examine carefully those spots on the uncovered parts of the patient’s legs, you will readily see that they are not made up of minute red points like the rash of measles or scarlet fever, and cannot therefore belong to the exanthematous class. Neither can you find any vesicles either filled with lymph or broken and weeping a serous fluid, as in the vesiculae; nor any pustules filled with pus and standing on a hard base, as in the pustular class. You look equally in vain for the small hard elevations or papules which characterize the fourth or papular class. What, then, have you in this case? Simply scattered spots, varying in size from the circumference of a pea to that of a silver half-dollar, of irregular outline, deep-red color, slightly elevated and rough, and on the surface of which appear dry, 302 Diseases of the Skin. [Feb., white, thin laminae of exfoliating cuticle. These character- istics place it directly in the class of squamae, or scaly diseases. Having designated the class to which it belongs, the next step is to ascertain which variety of that class it represents. There being but three varieties of this class met with in this coun- try, the identification is easy. The Pityriasis seldom if ever exists on any part of the skin except that covered with hair, as the scalp, arm-pits, and pubes. It is accompanied by only slight redness, and the exfoliating euticle is in the form of very small scales, like dandruff. None of these circumstances apply to the case before you. Lepra may come on any part of the surface in red, dry, rough spots, at first the size of a half-dime. They spread regularly on the circumference and heal in the centre, and thereby soon assume a circular or ring form ; hence the popular name of “ring worm.” The spots before you have no such regular ring form, although some of them have existed and been slowly increasing for many months. The only remaining variety of the squamous class is Psoriasis, of which the spots on the legs before you are perfect examples. You see them variable in size, irregular in outline, dry, rough, deep red, with large thin white laminae of cuticle on the surface. The disease is chronic, the spots gen- erally increasing in size slowly, and continuing for months and years, unless interfered with by remedies. Sometimes the spots come in the palms of the hands, and present a very hard, rough, and sometimes fissured appearance. It is then called Psoriasis Palmaris, or “baker's itch.” The disease does not appear to be dependent on any particular constitutional de- 'angement, though often connected with constitutional syphilis. In the latter case, the spots have a more livid or cop- pery color. Except in the latter class of cases, the most im- portant part of the treatment consists in proper local appli- cations. If there is any manifest derangement of the digestive or other important functions, it should be corrected. In the absence of any special indications, it may be advantageous to give small doses of some one of the arsenical preparations. We shall give this man eight drops of Donovan's Solution, three times a day for the first ten days, and have the spots rubbed thoroughly night and morning with an ointment of iodide of sulphur, 20 grains to the ounce of cerate. After the 1872.] The Treatment of Asthma. 303 first ten days we will substitute an ointment of ammoniated mercury, 20 grains; pulverized gum camphor, 8 grains; tincture bloodroot, fl. 3 ss., rubbed together and mixed with simple cerate, 3 j. Let this be applied every night, and the surface wet with glycerine in the morning. A full alkaline bath should be used twice a week; the diet plain, exercise in fle open air moderate, and all stimu- lants avoided.— Medical Epaminer, Jan., 1872. ON THE TREATMENT OF ASTH MA. BY JOHN Q. THOROWGOOD, M.D. Loso, Assistant Physician to the Hospital for Diseases of the Chest, Victoria Park. ExPERIMENTs made by Paul Bert, Tranbe, and others, have shown that one result of irritation of the pneumogastric nerve is to cause contraction of the lungs and arrest of respira- tion ; this arrest being more easily produced during expiration than during inspiration. The lungs themselves contract just as does a sponge when Squeezed in the hand, and so long as this contraction continues so long does the paroxysm of asthma and difficult breathing exist. Prolonged expiratory efforts, as by a violent burst of cough- ing or a fit of laughter, are very apt to determine a fit of spasmodic asthma in one predisposed thereto, illustrating the fact shown by the experiments above alluded to, that arrest of respiration from closure of the lungs is more easily produced during expiration than during inspiration. This will be enough of the pathology of asthma for my pre- sent purpose, since I have shown what a fit of asthma is in itself, and that it may be caused by irritation of the pneumo- gastric nerve. Now, this pneumogastric nerve, as its name implies, supplies nervous filaments not only to the lungs, but also to the upper part of the alimentary canal—viz., the pharynx, oesophagus, and stomach, and hence any irritation of these parts may show 304 The Treatment of Asthma. [Feb., its effects in the form of contracted lungs and asthmatic par- Oxysms. - - These are matters tolerably well known and understood, and yet, in the practical treatment of such a complaint as spas- modic asthma, we seem hardly to get that help from this phy- siological and anatomical knowledge to which we are fairly entitled. Efficiently to treat spasmodic asthma in its various forms, we must recollect that we are dealing with a pulmonary neurosis, and endeavor to allay any irritation of the pneumo- gastric nerve as much as lies in our power. . Commonly we find in a paroxysm of pure spasmodic asthma that medication of those filaments of the pneumogastric that go direct to the air-tubes and lungs by means of certain fumes and vapors, as, for example, burning nitre paper, or the smoke of stramonium or tobacco, is sufficient to relieve the spasm and cause relaxation of the air-tubes; but these are at best but temporary expedients, and naturally patients and physicians seek after some means of cure likely to be more radical and permanent in its effects. So far as the experience of the present writer goes, this may be found often in treatment carefully directed to the stomach and liver—in the first instance; and, secondly, in the use of certain tonics that have in some way or other a perma- nently curative power over neuroses of the lungs and heart. In observing patients with various chronic maladies of the lungs, we often have brought before us the sympathy that exists between the pulmonary and gastric organs. For ex- ample, E. J., a man among my out-patients at Victoria Park Hospital, has been almost from childhood liable to cough and difficult breathing, and he remarks that he has always noticed any overloading of his stomach with food to be invariably and at once followed by increase of frothy expectoration. Again, Mr. B. has had asthma for twenty years, and has taken all the most approved remedies for this complaint, under most able advice, with very little real benefit. He has, however, no trace of structural disease about the heart or lungs, while symptoms point very decidedly to irregular action of the liver and stomach. The occasional use of the Cigarettes de Joy and a mild dosing with Carlsbad salt brought this 1872.] The Treatment of Asthma. 305 gentleman to a degree of freedom from asthma that he had not enjoyed for full twenty years. Much stress is very properly laid in books on asthma on the patient's diet. He must not dine late, and certainly must never indulge in supper. Sound and sensible as this rule is, yet I believe the practice of eating nothing after midday is carrying things a little too far in most cases. A state of ex- haustion may be induced which always increases any kind of nervous irritability, and, further than this, the long-continued innutrition may later in life lead to actual structural change of a degenerative kind in the lung tissue. I find in practice that a small sandwich of bread and meat, or sometimes a cup of bread and milk, is very grateful to a hungry asthmatic in the evening, and in no way injurious. The medicines that have more or less credit in the cure of asthma are almost “legion,” the reason being that some fit, as it were, one end of the pneumogastric, some another. Thus, bismuth and hydrocyanic acid are of great value when the neurosis is of gastric origin. Carlsbad salt, nitric acid, and at times small doses of mercury, are all unmistakably curative when the hepatic system requires relief. - Other remedies, such as ipecac, belladonna, nux vomica, will cover a wider range of symptoms dependent on pneu- mogastric disturbance, while if we have reason to suspect a gouty or rheumatic diathesis as the root of the trouble, alka- lies with iodide of potassium, sulphur, and arsenic will be the remedies indicated. While, then, we certainly have no “specific * for the cure of asthma, we may, by considering the complaint in its wide range as a neurosis of the pneumo- gastric, get some very satisfactory results from treatment. DR. STOREs, in the Dublin Journal of Medical Science for January, in his notes on the treatment of small-poa, recommends the employment of local means, such as poultices for the exclusion of air; the maintenance. of a moist state of surface, and the lessening of local irritation, as a means of preventing pitting; the influence of local depletion, in some cases, in modifying or even aborting the pustular eruption; and the beneficial effect of the warm bath, as recommended by Hebra. Dr. Stokes states that no danger attends the employment of the bath, and in asthenic cases stimulants can be freely used. In the Vienna Hospital patients have been kept continuously in the bath for 100 hours with good effect. 306 Miscellaneous. [Feb., ſłłigt tº it n to tig. BROMIDE OF POTAssi UM IN EPILEPsy.—So many scattered observa- tions have been published upon the alleviation of epilepsy by this bro- mide, that it is time to come to a conclusion; and give a few general laws. We can only do it incompletely, but we must at least know what has been learned, and what remains to learn upon the subject. The dis- cussion of the views of the Medico-Psychological Society; the memoirs of Talbot and Voisin; and the one by M. Arthaud—such are the sources where we are going to search the teaching of experience. We are going to study the bromide in its action, its administration, and its effects. Mode of Action of Bromide of Potassium.—This question has not been raised, and the field remains open to the various interpretations. Two opinions are in presence: some pretend that the bromide acts upon the bulb only by the medium of circulation; it shrinks, it galvanizes the arterioli, and, under the influence of this artificial ischia, the nervous system loses its irritability. . The others pretend that the bromide comes in intimate contact with the nervous cells, which it brings back to their normal tension, and that its anaemiating properties are only the result of the rest of the bulbar centres. Without intending to decide the ques- tion, we may say that the second hypothesis is the most likely, as it is the only one showing the special mode of action of the bromide. Bella- donna and nicotine anaemizes the marrow and the bulb ; the same effect is produced with ether and chloroform ; with digitalis and sulphate of quinine. However, none of these agents has the identical action of its congener, and can be substituted for it as an absolute equivalent; none of them can replace the bromide. What I have said about anaemiating substances is applied equally to those producing hyperaemia. Wine, alcohol, and opium, all three congest the brain; but under the influence of this same congestion the brain reacts in three different ways: lucid and impulsive with alcohol, obscured and drowsy with wine, and at once agitated and depressed with opium. Also, we think ourselves au- thorized to conclude that what makes the electric power of nervous remedies is not the influence upon the circulation, but that it is before all their direct action upon the nervous element; their special mode of combination with the tubes and cells. Administration of Bromide.—This question is one of the most impor- tant, for it explains more than insuccess. One of the first conditions is to have the salt chemically pure. It is often adulterated by a certain quantity of iodide of potassium, of which it has not been entirely rid. From this cause, come catarrhal hyperamia, an acneform eruption, and a sequel of iodic symptoms, wrongfully credited to bromism. - Bromide of potassium is given diluted in a gummy mixture, and its sapid taste is masked with syrup of bitter orange peel. The Doge must be Slightly Progressive.—This is a capital point, and all the alienists have been unanimous in rejecting the method of rapid doses inaugurated by Vulpian. The rapid doses produce bromism, etc., and consequently intolerance. The degrees of the therapeutic scale must be raised only by degrees. Begin with one gramme, and increase of that much every two or four weeks. When arrived at four grammes, it is time to stop; it is the dose where physiological effects are produced; then increase progressively and arrive at eight grammes, representing a second time of arrest when therapeutic effects are manifested. An in- 1872.] Miscellaneous. 307 crease of one-third, 8-12 grammes, must be given to certain refractory organizations. Woman is more sensitive, and with ber the two stopping times are often limited to three and six grammes. Finally, and it is a singular thing, children are more difficult to be impressed and can bear easily the high doses of the adult, undoubtedly because the activity of his functions eliminates rapidly the bromide absorbed. When is it time to stop giving this medicine & Never, or pretty near so. Once the paroxysms suppressed, the epileptic must decrease the doses to one or two grammes, but never stop for any length of time the use of the bromide. “For him, it is not a medicine,” says A. Voisin, “it is an aliment.” “It is his daily bread,” as termed by Legrand du Saulle. Physiological Action.—We have said that, as a general rule, it was at a dose of four grammes that physiological effects were manifested. They are as follows:–Frequency and feebleness of the pulse ; pallor of the face. (The two cases of cyanosis reported by M. Arthaud must be considered as an exception). Intellectual hebetude. It is a torpor, a laziness of the mind with anaemia. Suppression of Refiev Sensibility.—Laborde and Voisin have established, contrary to Gubler's assertion, that the bromide is in no way anaesthetic, that it leaves intact the three sorts of insensibility, and only suppresses the reflex phenomena. This special action is manifested upon the whole body, but before all to the throat. Coughs, weeping, sneezing, and re- flex nausea can no more be produced. The suppression of reflex nausea is a constant fact (37 times out of 40) indicating the time when the medicine begins to act. Amaphrodisia.-General Catarrh.—The elimination of the bromide by the respiratory and digestive ways, with or without serous hypersecre- tion, produces a catarrh, as its elimination through the skin produces acne. This acneiform eruption, regarded by Tabret as a criterion of action, has not the importance nor the frequency attributed to it by him. It is noticed in two-thirds of the patients, and has no prognostical meaning. It may come so far as to be boils or an anthrax. Other eruptions, like urticaria, knotty erythema, or eczema, have been ob served. Tonic Action.—Bromide of potassium is the type of medicines which do not accumulate, but which always act in proportion to the dose given. However, in certain circumstances badly defined, an acute or slow intoxication may be observed, and is manifested by the following symptoms: Pallor of the face, stupor and coma, rarely obvious delirium, titillation, bronchitis, diarrhoea, wasting away, a dynamy. Therapeutic Action. — The therapeutic effects are classed in three groups: insuccess, improvements, and cures. By cure is understood the suspension of paroxysms, ascertained for one year at least. One may resume in a few propositions the results acquired, such as they are pre- sented by comparing a considerable number of facts. In putting together all the cures cited by authors, we come to a total of 267 epileptics treated with bromide of potassium ; out of this number we find 46 cures, 116 improved, and 104 failures, which gives a propor- tion of: failures, one-third of the cases; improvements, one-half; and cures, one-fifth. We must remark, however, that certain statistics, even large ones, have only one-seventh of cures. The several phenomena of epilepsy do not present the same parity before the bromide. The grande crise, the paroxysm, is the easiest cur- able accident; irritability and mania are notably amended; as to verti- go, what contributes larved epilepsy, they are the most frequently in- curable, and if by chance they disappear, they are always the last. 308 - - Mºscellaneous. - [Feb., Finally, the different forms of epilepsy must be carefully distinguished in regard to their chances of cure. We must class by order of curabil- ity, or at least by improvement; simple epilepsy without vertigo; sim- ple epilepsy with vertigo; epilepsy with insanity, and epilepsy with organic lesion. This distinction is capital, but does not, unfortunately, exist in statistics. Most of the facts reported have been collected in insane asylums, and statistics should be much more valuable if it was brought to bear only on private practice. Let us say that the pre-ex- istence of epilepsy is an element to be taken in consideration. The cure of epilepsy in children is very difficult. Such is the limit to which science has arrived ; it is to the school of Bicêtre, it is to Legrand du Saulle and Tabret, and, above all, to A. Voisin, that we are indebted for these important data, and for the vul- garization of bromide in the treatment of epilepsy. This example has been followed in the hospitals of Lyons, and the epileptic wards bear astonishing testimonials of what bromide can do in this disease. It is the only remedy which will delay the paroxysms without increasing their character, whilst other agents, according to the expression of a physi- cian, an epileptic himself. “delay the time of payment to charge you double.”—A. Chanzy, JAyon. Médical. THE RATIONAL TREATMENT OF THE ACUTE EXANTHEMATA, AND ESPECIALLY MEASI, Es AND SCARLET FEVER.—The following is a résumé of an article by Dr. Ottmar Hofmann, of Marksteft, near Würzburg, contained in the Second Part of the third volume of Hallier’s “Zeit- schrift für Parasitenkunde.” The first and most important require- ment, he says, “of a rational treatment of any disease consists in the removal of its causes. Unfortunately, in the case of many diseases this is impracticable, either from our not being acquainted with the nature of the cause, or that the cause is due to certain conditions of the life of the patient from which it is impossible to withdraw him. In such cases we must rest contented with an expectant line of treatment, or treat symptoms as they arise. The advance of science, however, is continu- ally enabling us, by improving our knowledge of the causes of disease, to treat it in a truly rational manner. Thus the carefully made and important researches of Professor Hallier, into the nature of the con- tagions of infectious diseases, so long obscure, have clearly shown that they are of a vegetable nature, and indeed are true fungi, which, by their introduction into the body and subsequent multiplication. gener- ate the diseases in question.” Dr. Hofmann forbears to enter into a consideration of the prophylaxis of measles and scarlet fever, consider- ing this to be a matter of medical policy, and to consist essentially in the purification of dwelling-houses and the removal of all excremen- titious matters, which form the fruitful soil for the generation of these fungi. In all cases he supposes the disease to be present, and the prac- titioner has to deal with the parasitic organisms after they have gained entrance into the body. Now, in such case it is necessary either to render these parasites harmless by the administration of certain remedies which are capable of killing them, or we must seek to elimi- nate them from the body as soon as possible. The treatment of these affections by means of the most varied remedies has demonstrated satisfactorily enough that we know of no remedies capable of neutral- izing the poison of measles or of scarlet fever, that is to say, of killing the cells of the fungi; and even if, as the beautiful researches of Binz appear to show, we possess in quinine a substance capable of exerting a favorable influence on the acute exanthemata similar to that which it has been demonstrated to have in typhus, still it can scarcely be administered in doses sufficiently large, especially in children, to destroy 1872.] Miscellaneous, . 309 the life of the fungi, as Binz himself admits, whilst the somnolence of the patients in the severer cases, which most resemble typhus, renders the introduction of the medicine quite impossible. On these grounds it seems desirable to adopt the other plan, and to promote the dis- charge of the fungi from the system as rapidly as possible. With this object in view, the plan of the late Dr. J. Steinbacher, of lowering the temperature of the body—that, namely, of rolling the patient up in sheets wrung out of cold water, and surrounded by a woollen cover or dry sheet—in which condition he is allowed to remain for some time. The first effect of this proceeding is to powerfully excite the whole nervous system ; heat is withdrawn from the body in proportion as the temperature of the skin and that of the wet cloth approximate, and this again leads to a steady flow of the internal temperature towards the skin. If the body remain enveloped for a still longer period, so that the temperatures of the body and of the cloth have become equalized, a more or less abundant excretion of sweat occurs as a result of the cutaneous hyperaemia. On this increased excretion of sweat, Stein- bacher lays special stress, contending that by its means the special poison of the disease is eliminated from the body. In order to deter- mine whether this supposition be correct, M. Hofmann treated a child of four years of age, suffering from a severe attack of the measles, in the hydropathic fashion, but placed upon its chest a fine piece of linen, and after the child had lain for two hours in the wet cloth and had perspired freely, the piece of linen was removed, and the sweat expressed from it received into small tubules. These were transmitted to M. Hallier at Jena with a request that he would examine them and report On the presence of micrococcus. The reply was that the micrococcus was abundant in the fluid ; and Professor Hallier at once instituted experiments, the results of which are not yet published, to determine whether this micrococcus will propagate the disease of measles. If this be found to be the fact, it will tend to show that the hydropathic plan of treatment is well adapted for the rapid removal from the body of the parasitic organisms. M Hofmann states that he has adopted this method of treatment with good results in many severe cases of measles and Scarlet fever, even when the patients were in the first instance comatose, and has observed not only that the febrile symptoms are rapidly subdued, but that the convalescence of the patients is much Quicker than under other plans of treatment. The particular mode in which M. Hofmann applies the wet cloths is perhaps worthy of being here inserted. In those slighter cases, he says, in which the tempera- ture of the body measured in amo does not exceed 40° C. and the brain is clear, he envelops the patient only from the axilla to the hips in the wet cloth, which is thus applied : The patient is made to sit up, and a folded towel is spread across the bed behind the back; an equally broad and long soft linen cloth, folded six or eight times and wrung out of cold water, is placed on this, and is again covered by a fine piece of cambric or muslin. The patient is then told to lie back, and the cloth is folded as close round the patient as possible, and secured by a band- age. The dry cambric next the skin is only to prevent the disagreeable impression of cold, and children make no complaint. The patient is retained in the wraps for one or two hours, according to the tempera- ture, and they are then reapplied, freshly dipped in cold water; and this is continued till the temperature of the body falls to 38° or 38-59 C., which usually happens in from two to four days. He then directs the patient to use a warm bath daily to promote desquamation, and con- siders him well in about eight days. In more severe cases, where the temperature of the body rises above 40° C. and comatose Symptoms are present, he envelops the patient in from two to four wet cloths, and 310 Miscellaneous. [Feb., covers these with wool. In the early period they are only allowed to remain on for fifteen or thirty minutes, and are then renewed after the lapse of one or two hours. Subsequently, in order to promote per- spiration, they are allowed to remain longer in the cloths, that is to say from one or two hours, and they are applied less frequently, as from two to three times daily. As often as the patient is removed from his envelopes, in order to maintain the cooling effect the whole body is sponged freely with cold water, or, if the comatose symptoms are well marked, he is placed in a bath of lukewarm water, and cold water poured over him till slight shivering is induced. He is then quickly removed to bed, and as soon as the temperature has again risen the whole procedure is repeated. As the febrile symptoms diminish, the method of partial investment above described is adopted. A good deal in respect to the temperature of the water in which the cloths are dipped, the length of time, and the frequency with which they are applied, must necessarily depend upon the age and strength of the patient, the degree of the fever, and the discrimination of the medical attendant; whilst judicious medicamentation (though but little of this is required in slight and uncomplicated attacks of measles and scarlet fever) is in some cases a very necessary adjunct to the hydropathic plan of treatment.—Zeitschrift für Parasitenkunde, Band iii., Heft 2. ON THE PHYSIOLOGICAL ACTION OF CRYSTALLIZED ACONITINE (a Note of MM. Greliant and Duquesnel presented to the Académie des Sciences by M. Claude Bernard).--In order to study the physiological action of crystallized aconitime, we have first prepared a solution in water holding one milligramme of liquid solution to the thousandth part per cubic centimetre of water. Then we have made, on a frog, the following series of experiments:— 1st experiment —Under the skin of the back of a frog was injected, by means of a syringe of Pravas, 1-20th of a milligramme of aconitine. At first the animal was agitated, the head bent down on the thorax: thirty minutes after the injection of this feeble dose of poison, the sciatic nerve, being uncovered, had completely lost its motor power, whilst the muscles of the leg contracted as soon as they were excited by inducted currents. The thorax, on being opened, showed that the heart continued to beat regularly. - 2d experiment.——On a frog the gastrocnemius muscles were detached, together with the sciatic nerves left adhering to the muscles. In a watch-glass the muscle is plunged in a solution of aconitine holding only 1-5th of a milligramme per cubic centimetre, the nerve is suspended without. In a second watch glass the Sciatic nerve is immersed in the same solution, leaving the muscle without. The two preparations were covered with a damp cover. At the end of a certain time, the nerve of the first preparation had completely lost its excitability, whilst the nerve of the second made the muscle contract immediately it was excited. Thus, aconitine destroyed the motor faculty of the nerve by acting on its peripheric terminations. 3d experiment.—Before poisoning the animal, the circul tion was stopped in one of the posterior members: all the motor nerves which re- ceived poisoned blood lost their physiological property, whilst the nerves of the preserved limb remained perfectly excitable. It was proved that the animal remained sensible, whilst the motor nerves per- mitted the production of reflexive movements. These experiments, made according to the method instituted by M. Slaude Bernard in the study of curare, seemed to establish that, in small doses, the physiological properties of aconitine are analogous to those 1872.] Miscellaneous. 311 of curarine. It is thus that acolitime des; roys at first the motor power of the nerves. In fine, we have made another experiment which at first embarrassed us. We injected in a frog a dose of one milligramme, that is to say, a dose twenty times stronger than that which served for our first experi- ment. Our astonishment was great at seeing that the animal preserved a very long time the excitability of its motor nerves, and that it exe- cuted always spontaneous or convulsive movements. But in examining the thorax, then in opening it, we recognized that the ventricle of the heart had completely stopped, and the auricles alone feebly contracted. The idea then struck us that the poison administered thus in a strong dose could perhaps primitively arrest the heart, which would also result in the arrest of the absorption. The experiment completely justified this hypothesis. A frog was dis- posed under the microscope for the examination of the circulation of the interdigital membrane; an injection was made under the skin of one milligramme of aconitine; a minute and a half after, the circu- lation showed itself considerably slackened in the arteries; after three minutes it had quite stopped. The thorax was opened, the ventricle of the heart was immovable. The nerves of the brachial plexus were found excitable, but a little less than the lumbary nerves, which had almost preserved their normal motor power. The heart being stopped, the poisoning could no longer take place except by imbibition, as in the second experiment. In mammals, the toxic phenomena produced by aconitine show them- selves very rapidly, and are much less easy to analyze ; nevertheless, we have injected in a rabbit one milligramme of aconite, then we have maintained artificial respiration, and at the end of half an hour the sciatic nerve no longer determined contractions in the muscles, which had nevertheless preserved their contractility. The physiological experiments that we have just exhibited have been performed in the physiological laboratory of the Museum of Natural History, placed under the direction of M. Claude Bernard.—Medical Press and Circular, Jan., 1872. TREATMENT OF FIFTY CASEs of TYPHOLD FEVER AT THE GREAT BEND TUNNEL, C. & O. R. R., WEST VIRGINIA. By Drs. G. McDon ALD and B. G. MCPHAIL. [Reported by Dr. McPHAIL, December, 1871.]— During the past summer there were at this place a large number of cases of dysentery, which was mostly of a mild type, and generally relieved by a saline aperient (usually sulph. magnesia was given), fol- lowed immediately after its action by a full dose of Dover's powder, which was repeated if necessary. As the autumn approached, typhoid fever made its appearance, and during August and the fall months it continued to prevail. This tunnel is through a mountain range, lying north and south, rising precipitously from the margin of the Greenbrier River, on the east, to nearly five hundred feet in height, and descends with a gradual slope towards the west. Along this western slope, and around the base, the cabins are constructed, plain railroad shanties, about 16 by 18 feet, built of logs, and chinks filled with clay. Each of these buildings is occupied by from ten to fifteen hands. In some of these cabins there existed several cases simultaneously, while in others within a few yards there were none. From the great difficulty of obtaining suitable nourishment and re- liable nurses, most of the cases were poorly nursed and nourished. As far as possible, they were fed on sweet milk and beef, or chicken soup. 312 Miscellaneous. [Feb., Milk seemed to be the most acceptable, and was given freely, in some cases as much as two or three pints in the twenty-four hours. In the commencement of the disease, if constipation existed, an enema or mild laxative was prescribed. If a tendency to nausea existed, an emetic of ipecacuanha was administered with apparent good results. If the pulse was accelerated and strong, small doses of tincture of aconite were given two or three times a day. But the remedy relied on with most satisfaction was the hydrochloric acid, which was administered generally from the commencement of the fever till it subsided, the usual dose being thirty drops of the dilute acid every three or four hours during the day and night, given in half a glass of sweetened water. In a large number of cases the acid alone was given. Astringents if the bowels moved oftener than once or twice in the twenty-four hours, and if insomnia, coma-vigil, or delirium existed to any extent, an opiate was administered, Dover's powder being preferred. The want of true sleep doubtless tends to exhaustion, de- lirium, and death, and the importance of securing sound sleep can hardly be overestimated. If symptoms of prostration manifested themselves, quinine, in doses of one or two grains, were administered every few hours, and a half ounce of whiskey every one, two, or three hours, according to the amount of exhaustion. If the tongue was dry, and abdominal symptoms marked, the oleum-terebinthinae was administered as recommended by Dr. Wood. During convalescence, the tr. ferri chlor., elixir vitriol, quinia, and other tonics were given. | The results of the above treatment were as follows: Of thirty-two cases of whites, none were fatal, Another, however, who did not come under treatment till the third week, and who was badly nursed and nourished, died. Of the remaining eighteen (negroes), three died during the progress of the disease, and one nearly two months after the fever had subsided, from a complication of causes—prostration, bed- sores, continued diarrhoea, and neglect "on the part of his nurse. An- other who left when convalescent, and travelled several hundred miles, had a relapse which terminated fatally. The cases exhibited the leading characteristic symptoms, gradual de- velopment, absence of marked remissions, abdominal symptoms, ochre- colored dejections, epistaxis, and the characteristic eruption in most of the cases. The usual evidence of propagaton by contagion was demonstrated, the nurses and those most in contact being the sufferers. Of the fifty cases, forty-eight were youths and young men, mostly under the age of twenty-five, and the remaining two cases were girls. The average duration of the fever was about three weeks, some con- valescent earlier, others later. There was less trouble from diarrhoea than usual, and in Some cases constipation existed with considerable sweating, sometimes profuse, which seemed to be favorable symptoms, all of these cases recovering. Epistaxis was not troublesome. Only one case of haemorrhage from the bowels. No perforation, and few relapses, the patients rapidly gaining strength and appetite after the termination of the fever. The difference in the mortality between the whites and blacks was probably due to want of cleanliness and good nursing, for the medical treatment was precisely the same. In the majority of these cases there was less amorevia than usual, the appetite remaining good throughout the attack. (May this not have been due to the hydrochloric acid administered, it being an important constituent of the gastric juice 3) Sweet milk tends to constipate, and, as it is both food and drink, we deem it the very best article of nourish- 1872.] Miscellaneous. 313 ment, where it is acceptable to the stomach. (We found only one out of the fifty patients who did not relish it.) With proper nursing and hy- gienic conditions, it is fair to presume the results of the foregoing treat- ment would have been more favorable. It is worthy of note that along the eastern slope and base of this mountain, not a single case occurred among the nearly two hundred residents located there.— Virginia Clinical Record, Jan., 1872. INDICATIONS FOR THE EMPLOYMENT OF THE CATHETER IN OLD PEOPLE.-M. Guyon, in one of his clinical conferences at the Hôpital Necker, lately remarked that retention of the urine is very common in old men, depending generally on affections of the bladder, or of the neck of the bladder, or of the prostate. Many cases of supposed vesical paralysis are in reality due to prostatic disease. Retention of urine in old people displays itself by symptoms that are eminently variable. Sometimes these symptoms are strongly marked ; the patients require to micturate frequently, and in doing so experience pain and burning heat which lasts for a long time; there may even be constitu- tional and febrile symptoms. In other instances, again, the symptoms are by no means prominent, especially in those cases where the bladder is but little contractile; the retention is then only indicated by percus- sion, palpation, and catheterism ; the latter alone in many cases being reliable evidence of its presence. But this indication that catheterism. should be adopted as an explanatory means is somewhat delicate, for the operation is not always inoffensive, and the patient suffering but little subsequent troubles may be attributed by the patient or by his friends to the injudicious interference of the surgeon. If, however, the symptoms be well marked, then there is no room for hesitation, and M. Guyon even goes so far as to say that the catheter should be passed in the case of every old man who evacuates the contents of his bladder imperfectly. He thinks that it is not necessary that it should enter the organ on the first occasion, since, if only introduced as far as the neck, it habituates the tissues to the contact of instruments, and indicates, in part at least, the seat of the disease. Stoppage of the flow of water is always a serious symptom in old people, and the best advice that can be given to them is to be sounded either with a simple sound or with a catheter, and that frequently. Indeed, if relief be not speedily afforded to such patients, dangerous symptoms soon make their appearance in the form of rigors, purulent urine, and violent reaction. Purely medical treatment is of no service in such cases, and he gives an instance in point. In 1869, in the month of September, M. Guyon had in his wards a man aged 48, who, after having been treated by ordinary remedies and by rest, left the hospital, but returned in Janu- ary, 1870. He was now suffering from Orchitis and distinct enlargement of the prostate; he passed water frequently; the urine was thick, but was voided in sufficient quantities to lead to the belief that the bladder was thoroughly emptied. On the 1st February there was some fever present, and on the catheter being introduced about four ounces of urine were drawn off, and on a second occasion about six ounces. He was sounded four times, and was then told to sound himself. No other treatment was adopted. On the 7th the urine was clear yellow, and on the 15th he was able to reruain five hours without urinating. Catheter- ism practised in his case twice a day caused no return of the epididy- mitis. In another case, occurring in a dyspeptic subject, all the symp- toms of cystitis were present. For a long time M. Guyon hesitated to sound him, and for two months he was treated medicinally without effect. At length he was catheterized, and the urine drawn off. The symptoms immediately diminished in intensity, and from this moment 24 314 t JMiscellaneous. [Feb., the urine, which had up to that time been troubled and imperfectly discharged, became limpid and even entirely evacuated. A third patient passed blood, and was obliged to remain in the recumbent position. After careful exploration M. Guyon recognized the existence of retention of urine, and passed a catheter. From this time all the symptoms of stone of which the patient complained disappeared. Thus not only stoppage of the flow of water occasions grave accidents, but it simulates other diseases; it causes alterations of the walls of the bladder, and provokes cystitis. When the bladder is greatly distended, however, it is imprudent to evacuate it completely. The frequency with which catheterism should be repeated is an important question. No absolute rule can be laid down, but it may be performed every five hours; but commonly the instrument should only be passed when there is intense desire to urinate. If, however, he experience but little or no inconve- nience, it should be passed at regular intervals. As a rule, the perma- nent retention of the catheter in the bladder is to be avoided, except perhaps in cases where the desire to pass water is very intense and frequent, or when the introduction of a catheter is very difficult. M. Guyon cites a case where it was worn for two years. It should in general be fixed in position till the bladder is habituated to catheterism. As adjuvants to the above treatment, injections may be employed, which may be hot, cold, or medicamented, as occasion may require. (Lucas-Championnière's Journal de Médecine, tome xlii., cahier 2.)—The Practitioner, Jan., 1872. DISINFECTANTS.–M. Langlois summarizes some observations on the different modes of action of various disinfectants submitted to the Con- seil de Sante of the French army. He notices the circumstance that various chemical agents, so designated, act differently upon different putrid emanations with which they are brought in contact; and, more- over, that such emanations have not all the same origin, although they are for the most part produced by the spontaneous decomposition of ani- mal débris, or nitrogenous organic matters. During that decomposition, they disseminate through the air gas more or less infected, formed in great part of ammonia, sulphuretted and phosphuretted hydrogen, to which is added water holding in suspension organic particles, themselves in process of decomposition, as well as living organic corpuscles, germs, spores, etc., these being the products which constitute miasmatic infec- tion, the influence of which is so prejudicial to the public health. The means most frequently used to purify and disinfect air thus tainted are chłorine, hypochlorites, and phenic (carbolic) acid, in variable quanti- ties, according to whether the places to which they are applied are in- habited or not. Chlorine, however produced, destroys the odor of gases by forming with their elements new and inodorous combinations; yet, when present only in small quantities in the respirable air, it is doubt- ful if it be capable of destroying all the miasms which, under the form of microscopic corpuscles, exist in it. If chlorine alone should seem to be insufficient for the purpose, the lighter vapor of phenic acid appears to act rapidly and powerfully in destroying these living principles, although it is without effect upon the foetid gases. Hence, it results that, in order to disinfect and purify a mephitic and miasmatic atmo- sphere, it is necessary to employ simultaneously the vapor of chlorine and of phenic acid. Chlorine disengaged in large quantities in a con- fined atmosphere decomposes not only the mephitic gases, but oxidizes and burns the organic matters which are present with them, its mode of action being the withdrawal of their hydrogen, by which, oxygen being set free, its oxidizing power while in the nascent state is brought into action, 1872.] Miscellaneous. 315 A similar action is obtained by the use of nitrous gases, these by with- drawing the oxygen passing into the state of hypo-nitrous which, in its turn, undergoes a decomposition in contact with the water contained in the atmosphere, into which it is disengaged. Phenic acid acts by checking or arresting decomposition of animal matters in the same way, according to M. Dumas, as tannin. Smoke, soot, tar, and creosote, from containing this acid in greater or smaller quantity, act in a similar manner to it. Certain of the metallic salts are also used for the destruction of mephitic gases, and producing with their constituents inodorous compounds, among others, the salts of iron and zinc. These salts, moreover, prevent alteration in organic matters. Charcoal and certain porous earths absorb offensive gases, and delay putrid fermentation in substances susceptible of that mode of destruction. For the purpose of volatilizing phenic acid, the following combina- tion is recommended, namely: Crystallized phenic acid, 500 grammes; alcohol of 85°, 500 grammes; water, 5 kilogrammes. The impure acid may be employed when procurable, on account of its relative cheapness. —Med. Press and Circular. D.R. J.EROME KIDDER, now so well and widely known as the inven- tor, patentee, and manufacturer of various improvements in electro- medical apparatus and machines, has recently perfected an improvement in the battery cup of his electro-medical machines, the advantages of which are shown by the cuts Nos. 1 and 2, as follows: In Fig. 1 we have the cup containing the battery and fluid in situ for immediate use. The cup is supported on a stand by two strong flat springs, which press against it one on either side, besides being attached thereto by a small brass joint on either side, which serves to keep the cup in position, on which it re- volves in part, as shown in Fig. 2. The plia- ble rubber cork of the battery cup is attached to the battery plates, and holds them in posi- tion, besides acting as a perfect preventive * 3 & — against spilling the Solution ; to facilitate the Position when in use. escape of gas, however, when the battery is in use, there is a small rubber tube connected with the cork, which permits its escape. To phy- sicians who use electricity in their practice, this improved battery will be a decided ad- vantage, especially if they should have to use their machine away from their office. As a point of economy, also, it will prove its worth, as a battery of this kind when properly attend- ed to will outlast four of the older style. The - -, - g doctor has just issued his new illustrated Position when not in use catalogue for 1872. We advise our readers to send to him for one ; it will repay perusal. |Hillºlliuſ “a Fig. 2. º PRITISH MEDICAL DECLARATION RESPECTING THE USE OF ALCO- Horro STIMULANTs.--The following declaration has been signed by upwards of three hundred physicians and surgeons, each one of whom holds some official or representative position : “As it is believed that the inconsiderate prescription of large quan- tities of alcoholic liquids by medical men for their patients has given rise, in many instances, to the formation of intemperate habits, the 316 - Miscellaneous. [Feb., undersigned, while unable to abandon the use of alcohol in the treat- ment of certain cases of disease, are yet of opinion that no medical practitioner should prescribe it without a sense of grave responsibility. They believe that alcohol, in whatever form, should be prescribed with as much care as any powerful drug, and that the directions for its use should be so framed as not to be interpreted as a sanction for excess, or necessarily for the continuance of its use when the occasion is past. “They are also of opinion that many people immensely exaggerate the value of alcohol as an article of diet; and since no class of men see so much of its ill effects, and possess such power to restrain its abuse, as members of their own profession, they hold that every medical prac- titioner is bound to exert his utmost influence to inculcate habits of great moderation in the use of alcoholic liquids. “Being also firmly convinced that the great amount of drinking of alcoholic liquors among the working classes of this country is one of the greatest evils of the day, destroying, more than anything else, the health, happiness, and welfare of those classes, and neutralizing, to a large extent, the great industrial prosperity which Providence has placed within the reach of this nation, the undersigned would gladly support any wise legislation which would tend to restrict within proper limits the use of alcoholic beverages, and gradually introduce habits of temperance.” DR. FRIEDRICH JAEGER, the elder of the two distinguished ophthal- mologists of the name—father and son—died in Vienna on December 26, at the age of 88. He was the son of a physician to Duke Charles Eugene of Würtemberg. At the age of 29, he went to Vienna, and be- came the assistant of Beer, whose daughter he afterwards married. In 1812, he graduated at the University of Vienna. His skill in ophthal- mic surgery soon became known. In 1825, he was commissioned to report on an epidemic of Egyptian ophthalmia which had broken out among the troops; and in the following year an ophthalmological insti- tution was established, which he managed until 1848 with the title of Professor of Ophthalmology. His reputation extended beyond Austria; he was called to Hanover to operate for traumatic cataract on the Crown Prince (now the ex-King). The operation he saw at once would be useless; but in spite of his strenuous remonstrance, he was obliged to perform it, the result fulfilling his expectation of failure. He was the author (in 1840) of a treatise on “Egyptian Ophthalmia "; and oph- thalmic surgery is indebted to him for several improvements in ope- rative procedures and instruments. His son, Edward Jaeger, is the con- triver of the well-known “test-types,” and is the author of some valua- ble works in ophthalmic surgery. SULPHUROUs ACID LOTION IN THE TREATMENT OF CONTUSED WOUNDs. —Dr. John Balfour states that an extended experience has given him great faith in this application. It gives almost instant relief from pain, controls and greatly restrains suppurative action, and, where possible, secures primary union perhaps as efficiently as carbolic acid. The lotion is of the strength of one in twelve; a thin rag (the thinner the better) should be laid over the wound, and kept constantly wet, for the first thirty-six to forty-eight hours. When cold becomes less agreeable, the lotion is used tepid, the rag being wetted every twelve hours and cov- ered with gutta-percha. Where primary union is taking place, about the third or fourth day, a dressing of zinc ointment is to be substituted for the washing ; this allows the skin to heal. When suppuration is established, a zinc lotion may be used after a week or ten days, and the cure wrought out on ordinary principles. Dr. Balfour records the fol- 1872.] Miscellaneous. 31'ſ lowing, amongst other cases: S. B., a lad between eleven and twelve years of age, on the 8th of June, in company with some other boys, was amusing himself with gunpowder; a “peeoge” (or devil) hung fire, and he poured some powder on it from the flask. This of course exploded, and tore open the metacarpal space between the thumb and forefinger of the right hand. The metacarpal bone of the thumb was fractured, and both wrists scorched. A mass of the short flexors of the thumb was forced out of the wound, contused, torn, and blackened. As this muscular substance was much injured and could not be returned with- out using undue force, a good deal of it was cut off; the wound was washed out with the sulphurous acid lotion, covered with a wet rag wet with the same, and the fracture was kept in position by tying the thumb to the forefinger. Had a fair night's rest; the wrists (not complained of yesterday) now painful and beginning to vesicate; dressed with car- bolic acid and oil. Everything went on well, the burns on the wrists healed kindly. Suppuration was most moderate, cicatrization rapid and perfect. Dr. Balfour lately passed the boy into a public work, with a thumb very little, if at all, the worse for the accident.—Edinburgh Med- ical Journal, Nov, 1871. TREATMENT OF ITCH IN CHILDREN.—Dr. Monti believes that Fröhlich was the first who suggested that itch should be treated with balsam of copaiba. Dr. Monti himself, however, has made many experiments to determine how long the itch insect will live in the balsam, and finds that it proves fatal in from two to three hours. Proceeding on this datum, he has treated twenty-seven children suffering from this disease with the balsam, and finds that when it is rubbed into the skin of infants it produces redness and sensation of burning, which disappear in the course of half an hour; and that after a single infriction the itching ceases, and a complete cure, without chance of relapse, occurs in from two to twelve days, without any accompanying disturbance of the urine or digestion. Recovery from scabies nodosa was very prompt; the balsam appeared to exert no curative influence on the eczematous, whilst this plan of treatment was not appropriate to the pustular form of the affection. In all his cases the child was well washed with soap and water, and rubbed all over twice daily with the balsam. Baths were not necessary. Thus it would appear that the treatment of itch in infants is to be specially recommended, since it quickly effects the end in view, causes no eczema, and is less expensive than the similar method of treatment in which the Peruvian balsam is employed. The application of a solution of carbolic acid of the strength of one part in one hundred of water, for the cure of itch, has been recommended by Lemaire and Duviviez. Zimmer washes or bathes children affected with the disease three times a day in a solution containing from five to eight parts of carbonate of soda in one hundred of water. Dr. Monti has treated twenty-six children with carbolic acid. He applies a watery solution in the form of carbolic acid one or two drachms, water a pint, or an ointment in the form of carbolic acid a drachm, simple ointment four ounces. The treatment again, on the average, lasts from two to four days; or, if eczema be present, twelve days. He has never observed any symptoms of poisoning. This plan produces slight eczema, but causes no pain, is very cheap, and does not require baths.—London Prac., from Wien. Med. Presse. ON WACCINATION AND REVACCINATION OF PREGNANT WOMEN.—The question has frequently been put to Dr. Barnes, Is it right to vaccinate pregnant women : Some persons seem to entertain the apprehension that pregnant women incur special and serious risks under vaccination. 3.18 Miscellaneous. [Feb., * To justify exceptional neglect of vaccination in their case, it ought to be shown, not only what this special risk is, but also that it is more serious than the risk incurred by the women themselves by taking the small-pox, and thus of propagating the disease to others. The com- munity as well as the pregnant woman must be considered. To make out, then, a case for special exemption, it ought to be shown that the pregnant woman incurs a particular danger. Where is the evidence of this? Dr. Meigs says: “Do not vaccinate women when pregnant. I have been the witness of dreadful distress from the opera- tion. Eschew it, I entreat you.” Dr. Barnes fears there is some confu- sion in the matter. His own experience has supplied him with many illustrations, which warrant the following propositions: 1. Pregnant women living under epidemic or zymotic influences are more prone to take the prevalent morbid poison than others. 2. Having taken a morbid poison, they are less able to throw it off. 3. Their system is less able to resist its injurious action. Abortion and a most dangerous form of puerperal fever are very likely to follow. Dr. Barnes thinks we may conclude, in the absence of decisive evi- dence of special danger, that pregnant women are entitled to equal pro- tection against small-pox with the rest of the community ; and that vaccination or re-vaccination should be practised on pregnant women, in their own interest, as well as in that of the community of which they form a part.—British Medical Journal. STOPPING TEETH.-The following will be found a very good and inex- pensive amalgam : Thoroughly mix together in the palm of the hand some fine silver filings and globules of pure mercury ; then add a few silver leaves till the whole forms a shining mass of the consistence of putty. With some of this, the cavity of the tooth (free from all ex- traneous matter and quite dry), should be at once filled, for it soon becomes extremely hard. The remainder of the mass can at any future time be made ready for use by first applying pressure with a moderately warm iron, and afterwards mixing with, perhaps, a silver leaf or two ; however, the best way is to keep it in pieces, each sufficient for a single tooth ; gold-leaf may be used instead of silver. Another: Twelve grains of quicksilver and six grains of silver filing are well mixed in the palm of the hand by means of the forefinger. The tooth must then be thor. oughly dried with cotton wool, and the cavity must be completely filled by pressure. No food must be taken for two or three hours afterwards. In a short time the amalgam will be as hard as the tooth itself. VITAL STATISTICs of QUEENSIAND, 1870.-The Registrar-General of Queensland has just issued a volume which almost bears comparison even with the reports of the United Kingdom. It is an able and ex- haustive document, and is creditable to the public officer who has issued it. From an immense amount of information contained in it, we select the following facts, which are interesting as showing the vital progress of a colony which one day promises to be amongst the foremost of the “jewels of the British crown '': The population of the colony on Dec. 13, 1870, was estimated, after careful consideration, at 115,567, of which 69,629 were males and 45,938 females, showing an increase over 1869 of 5,670 persons, or 3,058 males and 2,612 females. The total number of deaths in 1870 was 1,645, or 1,060 males and 585 females. Compared with the deaths in 1869—viz., 1,761—this gives an absolute decrease of 116. Of these, 416 died of zymotic diseases, 188 of constitutional dis- eases, 539 of local diseases, 246 of developmental diseases, 212 from violence, and 44 from unascertained causes. 1872.] Miscellaneous. 3.19. THERE are more uses in a loaf of bread than are dreamt of in our philosophy. Thus, while a number of men were dragging the river at Detroit, recently, for the body of a man who had drowned, an Italian proposed a novel way of finding it. Taking a loaf of bread, he put a quantity of quicksilver in one end, and threw it into the stream. It went rapidly down with the current for some distance, when it sud- denly stopped, described a small circle, and sank like a plummet. The Italian then told the dragging party that they would find the body at that spot. And they did.—Evening Mail. THE REPARATIVE EFFORTS OF NATURE AFTER GASTROTOMY.—The Union Medical exhumes from a medical periodical of 1761 an account of an autopsy made on the body of a famous glutton, a tripe-seller, on whom it had been necessary, twenty years before, to practise gastrotomy, and remove eight inches of the caecum and colon, which were gangrened. When, on the autopsy, the intestine had been tied and inflated, it was discovered that nature, so fertile and admirable in its methods, had substituted for the intestine which had been cut away a prolongation of the peritoneum, and that structure served instead of an intestinal canal. … Poisonous EFFECTS OF ZINC UTENSILs.-The Union Medical calls at- tention to a new source of danger, caused by the substitution of zinc for tin in the manufacture of pots and pans by travelling tinmen. Zinc sheet can be had at seventy centimes the kilogramme, while tin costs three or four francs, so that it is often substituted in the making of kitchen utensils. The fraud cannot be detected by the eye, but a little vinegar boiled in the vessel will immediately corrode the surface, and, if done in the process of cookery, will give rise to symptoms of poison. CAUSE OF INFECTIOUS DISEASES.–Dr. Balfour also showed, Med. Chir. Soc. Edinburgh, a piece of lead soil-pipe which had been inserted into an iron pipe just below the seat of a water-closet. The iron had been corroded, and a way of escape thus made for the poisonous sewer gases into the house. This specimen had been removed from a house in which two fatal cases of diphtheria had occurred last summer; and Dr. Balfour stated that in his experience some such source of gaseous leak- age had been invariably found, when sought for, in every house where diphtheria, typhoid fever, and other allied disorders had prevailed.— Edinburgh Medical Journal, December, 1871. MEDICATING COTTON FIBREs.-J. Gamgee and W. H. Maitland.— Cotton and other fibres are saturated with chloralum or chloride of aluminum, carbolic acid sulpho-carbolates, permanganate of potash, or charcoal, or with solutions of opium, morphia, hydrate of chloral, of other narcotics and sedatives, in order to obtain wadding-felt, cloths, or wool charged with these medicinal agents, for surgical or sanitary purposes.—English Patents, American Artisan. THE proprietors of the Dublin Quarterly Journal of Medical Science have, in accordance with an intention which they have long had under consideration, altered their arrangements, so that the journal shall ap- pear for the future as a monthly, instead of a quarterly publication, under the name of the Dublin Journal of Medical Science. It was com- menced in 1832. The editorship is still in the hands of Dr. James Lit- tle, who has conducted the journal for the past three or four years. STRYCHNIA IN ALBUMINURIA.—Brignolia, in Lo Sperimentale, besides recommending nux vomica in various neuroses, gastralgia, dyspepsia, $ 320 Miscellaneous. [Feb., 1872. cardiac palpitations, periodic cough, etc., states that he has observed it to have a marked effect in retarding the progress of albuminuria, espe- cially the scarlatinal form with anasarca. He cites twelve cases of com- plete recovery. MEDICAL COLLEGES AND GRADUATES IN THE UNITED STATES.—Dr. Toner's statistics for the Department of the Interior show the number of medical colleges in the United States to be : Regular, 60; Pharmacy, 16; Dental, 8; Homoeopathic, 8; Eclectic, 8; Botanic, 2. Forty-eight of the colleges have furnished statistics for 1870, which show 4,989 matriculates, 1,500 graduates, 77 ad Eundem, and 15 honorary degrees. THE Sanitary Department of the municipality of Vienna has deter- mined to purchase 100,000 hundredweight of sulphate of iron for dis- infecting the latrines and sewers; and to have a short and concise treatise on the necessity of disinfection printed and circulated among all the householders. THE premises occupied by Dundas Dick & Co. (so well and favorably known as the patentees and manufacturers of “Dundas Dick dº Co.'s Soft Capsules”) were completely destroyed by fire a few days ago. Business is again under way, and they will be able to supply orders as fast as sent very soon. M. LIEBREICH has been to Paris to see M. Thiers's eyes. According to a telegram, M. Liebreich states there is no cause for uneasiness. We hope that our skilful confrère will enable the President to see his way to the settlement of the French political difficulties. FREDERICK STEARNs, of Detroit, has, we are sorry to hear, been visited with another terrible accident in his business. His premises were blown up by the explosion of a package of gun-cotton, accidentally let fall by one of the workmen, who, with several others, lost their lives. CHOLERA has reappeared in Western Mekron, and intermittent fever is prevalent in the town of Gwadur. Several villages in the immediate neighborhood of Calcutta are suffering from a severe visitation of fever. A few cases of cholera are reported to have occurred at Decca. THE British Board of Trade has decided to substitute chloralum for the solution of zinc at present included in the scale of medicines and medical stores issued and caused to be published by the Board. THE British Medical Journal gives the total number of students regis- tered at the London hospitals during the present season as 1,468. New entries, 468. A MovKMENT has been started to establish a Hospital in London “for the treatment of diseases apart from the ordinary administration of alcoholic liquors.” A Swiss society has offered two prizes of 400 francs and 200 francs each, for an essay on the best meang for moderating the excessive con- sumption of ardent spirits in Switzerland. DR. TILBURY Fox has been nominated by the President a member of the Leprosy Committee of the Royal College of Physicians. THE St. Louis Medical and Surgical Journal begins the year 1872 as a monthly. It is an ably conducted magazine. OBITUARY. —Dr. Walter Kidder, the inventor of the electrical crank battery, commonly known as “Kidder's Electrical Machine,” died on January 29, 1872, of apoplexy, after a painful illness of one week. He was a native of Lowell, Mass. *. Advertisements. MANUFACTURERS OF Ford's Surgical Instruments, U. S. Navy; Bellevue, New York City, and New York State Woman’s Hospitals, and Hospitals in charge of the Commissioners of Public Charities and Correction. IMPORTERS AND MANUFACTURERS OF EVERY DESCRIP- TION OF F U E E E R G O O DS. SURGICAL, DEN TAL ORTHOPAEDIC, VETERINARY, CEIIROPODIST’S, TAXIDERMIST'S, AND ENTOMOLOGIST'S INSTERUMENTS. Trusses and Abdominal Supporters in great variety; Suspensory Bandages in all shapes and styles; All kinds of Instruments to enable the “Deaf.” to hear; The latest and most approved Appara- tus for Deformities; Electro-Magnetic Machines and Galvanic Batteries in the most compact form; Electro-Magnets and Galvanic Batteries combined; Crutches in all kinds of wood. We have on hand all the latest American Instruments, and are constantly receiving from our Agents in France, Prussia, and England all the latest models and inventions in Surgical Art. GooDs IMPORTED OR MANUFACTURED To ORDER. º' Send for Price.Current. 150 WILLIAM STREET, N. Y. 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Francis, Prof. Valentine Mott's Surgical Cliniques in the University of New York. Session of 1859 –60. Illustrated with a steel portrait of Dr. Mott. One 16mo volume, cloth, $1 50. Charles Murchison, M.D., F.R.S., etc. Clinical Lectures on Diseases of the Liver, Jaundice, and Abdominal Dropsy. One 16mo volume, illustrated, bound in cloth. Price $4 Felix von Niemeyer. Clinical Lectures on Pulmonary Phthisis. Translated, by permission of the author, from the Second German Edition, by J. L. Parke. One 12mo volume. Price $1 25, Dr. Adam Politzer, of the University of Vienna, The Membrana Tympani in Health and Dis- ease. Translated by A. Mathewson, M.D., and H. G. Newton, M.D. In one 8vo volume, bound in cloth. Price $2 50. Dr. Friedrich Semeleder, Rhinoscopy and Laryngoscopy. Translated from the German by Edward T. Caswell, M.D. With wood-cuts, and two chromo-litho- graphic plates. One handsome 8vo volume, bound in cloth Price $3 25. .J. 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Price, handsomely bound in cloth, in cloth. Price $10 00. $6 00; sheep, $700. ge e A West-Pocket Medical Lexicon, Edward Seguin, M.D. tº º Being a Dictionary of the Words, Terms, and Idiocy; and its Treatment by the Physiologi- Symbols of Medical Science. Collated from çal Method. In one handsome 8vo, volume of the best authorities, with the addition of New 457 pages, neatly bound in muslin. Price $5 00. Words not introduced into a Lexicon. With g an Appendix. Second Edition, , enlarged. T. Grainger Stewart, M.D., F.R.S.E. 64mo. Roan, 75 cents; or tucks, $1 C0. A Practical Treatise on Bright's Diseases of e & the Kidneys. Illustrated with seven litho. Code of Medical Ethics adopted by graphed plates (one colored). In one 8vo THE AMERICAN MEDICAL Association. (Re- volume, bound in cloth. Price $3 50. vised to date.) A very neat little book, in flexible muslin binding. Price 40 cents. Charles Fayette Taylor, M.D. John Brocklesby, A.M., “Spinal Irritation;” or, Causes of Back-Ache among American Women. Fully illustrated with fifteen lithographic plates, 8vo. Cloth, The Amateur Microscopist; or, Views of the Microscopic World. One 12mo volume, pro- .* fusely illustrated with plates and engravings. 75 cents. Price $1 75. A. Vidal (De Cassis), •º A Treatise on Venereal Diseases. Translated Henry R. Prescott, and edited by George C. Blackman, M.D. Strong Drink and Tobacco. Smoke. Plates. º; Edition. In one handsome 8vo volume In one 8vo volume. Price $3 00. of 500 pages, with eight superb colored plates. g Strºngly bound in cloth, $4 50; or leather, Richard A. Proctor, $500. Other Words 1'; * º §: lates. Second Edition. mo. Price {}\}. Henry Watts, B.A. p A Dictionary of Chemistry and the Allied J. Matthew Duncan, M.D, Branches of other Sciences. In five 8vo vol. On the Mortality of Childhood and Materni- umes. Price, bound in cloth, $65 00. ty Hospitals. 8vo. Price $2 50. 1867.] sº * * * gº º º ; : *. -** * * * * 3: - sº tº sº * ...º *: . . . - - § º . ~~ ºf * *, * * ; :: *. § 3 ºil.’ -* - . * . - - º z-- ºr sº º Fº § - Sº sº tºº. *_º - º º * .. :* - º - .* * * ºf .." * . . . . ." º: - g 5 ay, New York, Płºſłºſz; ††† Sº, Advertising, Szºbscription, and 6 eneral COMMISSION AGENTS, Offer their services to the Medical Profession throughout the Country. They make a specialty of filling orders for Physicians, at Manufac- turers’ prices, for any and every article they may require, such as Books, Medicines, Chemicals, Chemical Apparatus, Surgical Instru- ments, Electro-Magnetic Machines, Galvanic Batteries, Microscopes, and Microscopic Accessories. All orders will receive PROMPT ATTENTION, and be sent securely to any part of the United States, C. O. D. ON ALL BILLs under $10 the expense of collection must be borne by the purchaser. : -, st UNIVERSITY OF NEW York. MEDICAL DEF AFTMENT, 426 East 26th St., opp. Bellevue Hospital, New York City. T H II: TY-FI E S T S E S S I O N, 18 7 1-1872. FA C U L T Y O F M E D 1 C 1 N. E. REV. HOWARD CROSBY, D.D., * Chancellor of the University. MARTYN PAINE, M.D., LL.D., e Emeritus Professor of Materia Medica and Therapeutics. JOHN W. DRAPER, M.D., LL.D., Jºmº ritus Professor of Chemistry and Physiology. President of the Faculty. ALFRED C. POST, M.D., - Professor of Surgery. CHARLES A. BUDD, M.D., Professor of Obstetrics and Clinical - Midnifery. JOHN C. DRAPER, M.D., Professor of Chemistry. ALFRED L. LOOMIS, M. D., Professor of Institutes and Practice of Medicine. willIAM DARLING, A.M., M.D., F.R.C.S., Professor of Descriptive and Surgical Anatomy. - HENRY DRAPER, M.D., º Professor of Physiology. Registrar ºf the Faculty. WILLIAM H. THOMSON., M.D., Professor of Materia Medica and Therapeutics. FREDERICK D. LENTE, M.D., . . . Professor of Diseases of Women and Children. EDWARD G. JANEWAY, M.D., g Professor of Physiological and Pathological Anatomy. D. B. ST. JOHN ROOSA, M.D., Cºmżcal Professor of Diseases of the Eye and Ear. ERSKINE MASON, M.D., Adjunct Professor of Surgery. The Collegiate Year is divided into two sessions—a regular Winter Session and a Spring, Summer, and Autumn Session. The latter is auxiliary to the former, and the design of the Faculty is to furni-h instruction to medical students throughout the year. Attendance on the regular Winter Session is all that is demanded of the candidates for graduation. Those who attend the other session receive a Certificate of Honor, as having pursued voluntarily a fuller course than usual. The Spring and Summer Session is principally of a practical and clinical charae- ter, and affords particular facilities to students who have already taken one course in schools where such practical advantages exist to a less extent. The course consists also party of lectures and ex- aminations on the subjects necessary for graduating in medicine, conducted by the Professors of the regular Faculty and their assistants. The examinations will be addressed to both first and second course students. For the purpose of making the visits to the wards of the hospitals as available as possible, the class is divided into sections. One division at a time is instructed in practical diagnosis, prescrip- tion, and treatment of patients. The course begins in the middle of March, and continues till the beginning of June, when the Summer Commencement is held. During the Summer the College Clinics are kept open. The Autumn or Preliminary Session commences in the middle of September, and continues till the opening of the regular session. It is conducted on the same plan as the Spring and Summer session. The Regular Winter Session occupies four and a half months, commencing on the second of October, and continuing till the middle of February. The system of instruction embraces a thorough Didactic and Clinical Course, the lectures being illustrated by two clinics each day. One of these daily clinics will be held either in Bellevue or ão Charity Hospital. The location of the College building affords the greatest facilities for Hospital Clinics. It is opposite the gate of Bellevue Hospital, on Twenty-sixth Street, and in close proximity to the ferry to Charity Hospital, on Black- well's Island, while the Department of Out-door Medical Charity and the Hospital Post-mortem Rooms are across the street. The students of the University Medical College will be furnished with admis- sion tickets to these establishments free of charge. The Professors of the practical chairs are connect- ed with one or both of these Hospitals, and students are also entitled to attend all the clinics held by other physicians in them. Besides the Hospital Clinics, there are eight climics each week in the College building. The Faculty desire to call attention particularly to the opportunities for dissection. Subjects are abundant, and are jºurnished free of charge, and the Professor of Anatomy spends several hours each day in demonstration in the dissecting room. Fees for the Winter Co L, rse. Full Course of Lectures... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $140 00 Matriculation... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 00 Demonstrator's fee, including material for dissection................................. 10 00 Graduation fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 00 Fees for the Spring, Summer, and Autumn Course. Students who have attended the Winter Course will be admitted free of charge. Those who have not attended the Winter Course will be required to pay the matriculation fee and $30; and should they decide to become pupils for the winter, the $35 thus paid will be deducted from the price of the Winter Tickets. For the purpose of assisting meritorious individuals, the Faculty will receive a few beneficiaries, each of whom will be required to pay $43 per annum and the matriculation fee. For further particulars and circulars, address the Registrar, PROF. HENRY DRAPER, M.D., UNIvERSITY MEDICAL Col.I.EGE 426 East 26th St. New York City. Detroi , Mich. SPRING SESSION, 1872. FACULTY. E. W. JENRs, M.D., President of Faculty, Professor of Medical and Sur- gical Diseases of Women and Clinical Gynaecology. SAMUEL P. DUFFIELD, PH.D., M.D., Emeritus Professor of Chemistry. J. M. BIGELow, M.D., Emeritus Pro- fessor of Medical Botany and Ma- teria Medica. THEODORE, A. McGRAw, M.D., Pro- fessor of Principles and Practice of Surgery. Geo. P. ANDREws, M.D., Professor of Principles and Practice of Medicine. C. B. GILBERT, M.D., Professor of Materia Medica and Therapeutics and Clinical Medicine. J. F. Noyes, M.D., Professor of Ophthalmology and Aural Surgery. N. W. W.E.B.B.E.R., M.D., Professor of Descriptive and Surgical Anatomy. RICHARD INGLIs, M.D., Professor of Obstetrics. Hon. H. B. B.Rown, Professor of Medical Jurisprudence. A. B. PALMER, M.D., Professor of Medical Diagnosis and Clinical Medi- cine. A. B. Lyons, M.D., Professor of Chemistry and Toxicology. W. H. LATHROP, M.D., Professor of Diseases of Mind and Brain. LEARTUs CoNNort, M.D., Professor o Physiology and Microscopical Anato- my. H. O. WALKER, M.D., Demonstrator of Anatomy and Lecturer on Wenereal Diseases. -- The regular annual session of the College will begin on the 20th of March, 1872, and continue four months. Especial attention is given to Clinical instruction, and drill in practical Diag- nosis of medical and surgical diseases. The fees are as follows. Full course of lectures, Matriculation, Hospital fee, Graduation fee, . $50 00 5 00 6 00 25 00 The lecture fees for graduates of other respectable Colleges, and for third course students, will be $35 00. Alumni will be admitted free. No student will be admitted into the graduating class whose first course of lectures has been completed within six months of the beginning of the term. This rule will be strictly enforced, and will remove the main objection that is urged against spring schools. The laboratory will be open for chemical instruction, and daily clinics will be held during the entire year. For further information, address E. W. J.ENKS, M.D., 92 FORT STREET, west. To Wholesale Druggists and Chemists. WE MANUFACTURE AN ASSORTMENT OF ENAMELLED TINCTURE PRESSEs, RETORT STANDS, AND EVA PORATING DISHES, With many other Utensils used by Chemists, and solicit the patronage of the Trade, JAMES C. HAND & CO., |BARROWS, SAVERY&C0. Factors. Iron Founders and Enamellers, PHILADELPHIA, PA. DECKER BROS., Paternt Plate - GRAND, SQUARE,& UPRIGHTPIANO VVarerooms, 33 Union Sq., Eroadway. FACTORY, 322, 324, 326, 328 & 330 W. 35th ST., EXTENDING TO 313, 315, 317, 319 & 321 W, 34th ST. —º-Q-4— “One of the simplest and most truly valuable improvements yet made in the pianoforte is that invented and patented by Decker Bros.”—From the Wew York Tribune. HUNNEWELL’S Cathartic, Narcotic, Tomic, Sedative, Alterative P I L L S AND TOLU ANODYNE. The above so thoroughly defined, so highly approved, and the Formulas subjected to the fullest investigation, the Physician may rely on them with confidence. THEY COMPRISE THE ſ:#" Pill Aloin, cuan, Ferro, [3° Pill Podophyllum catam, Ferro, Known as Eclectic Pills. Dr. Jackson's Formula. ſº Alterative Laacative Pill, - Dr. Gilman Davies’ Formula. ſ:#" Alterative Laacative Pill, Dr. P. S. Haskell's Formula. 3. Alterative Laacative Pill, |#* Compound Quiavine Pill, tº Fluid Canavabis cum Tolu, [º Pill Sedative, Dr. Edward Hall's Formula. Dr. N. I. Aiken's Formula. Known as Tolu Anodyne. Dr. N. I. Aiken's Formula. Five years have clearly proved their importance, and the future will be to keep that good. Formulas in detail, describing samples and plans of getting such, or in quantities, sent on demand JOHN L. HUNNEVVELL, boratory Office, 97 Commercial St., Bostort, Mass. COMMENTS OF THE PRESS ON THE AMERICAN JOURNAL OF OBS TETRICS AND DISEASES OF WOMEN AND CHILDREN. N. Y. Medical Gazette, Jan. 28, 1871, “This is pre-eminently a journal for the family practitioner, whose services are so largely called into requisition by the frequent sickness of women and children. If viewed simply as a current epitome of all things bearing upon the branches of which it treats, it would be of infinite value to every physician engaged in general practice. But beyond this, the important original contributions which have been made to medical science through its columns entitle it to higher estimation. No other American periodical has attracted a more distinguished array of authors, foreign and domestic ; few journals anywhere have maintained such uniform excellence in the character of their contents.” - : N. Y. Medical Record, Feb. 15, 1871, “This quarterly commenced its first issue in May, 1868, under the auspices of the leading obstetricians of this city, and many other equally eminent specialists abroad. The articles con- tained in the different numbers have been singularly good and of a thoroughly practical char- acter, a fact which the profession at large have not been slow to appreciate. The care and discrimination of the working editor, who is also the proprietor, Dr. B. F. D.Awson, has been one of the principal means to this end.” - Boston Medical and Surgical Journal, Feb, 16, 1871. “We consider it one of our most valuable exchanges, including, as it does, articles bearing the names of Elliot, Emmet, Barker, Hammond, Skeene, Thomas, Eustace Smith, the Editors themselves, and other distinguished writers on the diseases of women and children. We com- mend the Journal most heartily to those of our patrons who need sound advice on the special subjects to which it is devoted—and who does not * * Baltimore Medical Journal, Feb., 1871. “We have no hesitation in declaring it the best journal devoted to this branch of medical literature. No further evidence of this fact is needed than a glance at the list of contributors, among whom will be found the well-known names of T. Gaillard Thomas and A. Jacobi, of New York; Storer, of Boston; Elliot, Hammond, Nott, Emmet, and Boziman, of New York, and many others, all of whom have contributed articles that would enrich the columns of any journal, and cannot fail to be read with pleasure and profit by all who desire to be informed on the subjects of which they severally treat.” Richmond and Louisville Medical Journal, Feb., 1871. “No journal in this country has achieved more rapidly a deserved and increasing reputa- tion. Its contents are always valuable and interesting, and the very best representatives of these departments of medicine contribute constantly to its pages. The work can be recommended with entire confidence, and all who desire the best and most recent information in connection with the specialties to whose cultivation the Journal is devoted cannot do better than, by sub- scribing, to have its pages always accessible.” Buffalo Medical and Surgical Journal, Feb., 1871. “The Journal is edited with consummate skill and ability, and receives contributions from many of the most eminent writers and teachers in the profession. The advance of knowledge in this department is so great that practitioners of medicine must give attention to present teach ing, or soon find that their profession is far in advance of them. This journal is a necessity in its department, since in it have appeared, and constantly are appearing, important practical papers, singly of great value, and combined, constituting the progress the art is making from month to month.” Pacific Medical and Surgical Journal, March, 1871. “The judgment and skill displayed in the choice of material have placed this journal in the foremost rank of medical periodicals, and given it a reputation of which the ſtors may well be proud.” B.F.D.Awson, M. D., Editor and Proprietor, ADVERTISEMENTS. THE Chicago Medical Examiner, A MONTHLY JOUIERN AIL DEWOTED TO THE ducational, Simi and india łulatil, OF THE MEDICAL PROFESSION. EDITED BY N. S. DAVIS, M.D., and F. H. DAVIS, M.D. PROSPECTUS FOR 1872. With a view of still further meriting the very liberal and constantly increasing patronage and support which the Profession throughout the country have extended to them during the past twelve years, the Publishers of THE EXAMINER have to announce that with the commencement of Vol. XIII., January, 1872, the Monthly issues of the “EXAMINER,” WILL BE ENLARGED, so as to include 72 Pages of Reading Matter, making it the Largest Medical Monthly in the Northwest. I tº Cºs CCPINT* tº EHINT* Lºs will be of such a character as will directly aid the Physician in the daily practi- cal duties of his profession. A large list of contributors, including many of the most eminent Physicians and Surgeons in the West, insures to the EXAMINER an abundant supply of Original Articles. Eith Numer Will (Olúil II. Additill ſm 1% iſ 14 Pigºs ſ (lilital REVOrts including Abstracts of all the principal Medical and Surgical Cliniques of the Mercy Hospital, the Cook County Hospital, and the Free Dispensaries. THE SELECT DEPARTMENT will contain a careful Digest of the Professional and Scientific News and Literature, both at home and abroad. Terms $3.00 per annum, payable invariably in advance No name will be entered on the books until the money has been received. Ǻ" LIBERAL CoMMISSIONS offered to those who will interest themselves in obtaining new sub scribers for the ExAMINER. For every Club of Four new Subscribers, and $12, we will send an extra copy of the ExAMINER, gratis, for one year. SPECIAL NOTICE TO NEW SU BSC He iſ bºl{ERS. To all new Subscribers who will send *** *** **bscription for 1872 to this office before Dec. 1st, we will mail the October, November, and Love...Jer numbers free. Address PUBLISHERS CHICAGO MEDICAL EXAMINER, 797 Mºzóas/2.342/., C/ºzo.70, Z22. B.—FIRE In consequence of the Great Fire in Chicago, the October number was burned in the Printing Office when it was ready for delivery It will be replaced immediately, however, and the Business of the Journal will go on as usual. GEORGE TIERMANN & CO., F. A. STOHLMANN. ESTABLISHED 1826. ED. PFARRE. . 67 CHATHAM STREET, NEW YORK, MANUFACTURERS AND IMPort ERs of nstruments, OCATIONS, AND DEFORMITIES, Latest Instruments for Local Anaesthesia, and for Applications to the Larynx, Poste. rior Nares, Eustachian Tube, Uterus, Urethra, Bladder, etc., etc. Laryngo. scopes, Ophthalmoscopes, Endoscopes, Hypodermic Syringes, Fever Thermometers, etc. Surgical Instruments of all kinds made to order, and the Latest Improvements and Novelties promptly supplied. TWO SILVER MEDALS AWAR BY THE PARIS EXPosLTION OF 1867, BEING THE ONLY SILVER MEDALS GRANTED To A MIERICA NT ExHIBITors OF SURGICAL INSTRUMENTS, he ºl y ºr w Stohlmann, Ffarre & Co., H. A. STOH LMANN. ED. PFARRE. PHILIP SCHMIDT. 107 E, 28th Street, nr. Fourth Ave., ONLY BRANCH OF GEORGE TIEMANN & Co. FIRST PREMIUM AWARDED BY AMERICAN INSTITUTE, 1870. º: Bºº sº º º & gº º g . º : º & º' tº § ſ § º º Fº W. § ºf . §rº And Microscopic Accessories for Medical and Scientific Investigations, ALSO, - MAGIC LANTERNS, With elegantly colored Illºtstrations of Amatomy for POF2ULAR LECTURES. , Illustrated Price-list sent on application, to any address T. H. McALLISTER, 49 Nassau Street, New York. ADVERTISEMENTs. ELECTRO-MEDICAL APPARATUS, % ===FA ==4. The Portable Form can be obtained without spilling the fluid. Modified and mani. fold qualities of elec- tricity, paten ed in the United States, England, and France. The latest examina- tion and opinion of Professor Doremus : “The only appara tus meeting the de mand of advanced é sº = science.” The only ####". # one adapted to the wants of Practition- €7°8. sº-º-º-º-º-º: :Fººtº:: :==:EE: The following testimonial from R. OGDEN DoREMUs, M.D.. Professor Chemistry and Physics in the N. Y. City College, and Professor Chemistry and Toxicology, Bellevue Hospital Medical College, refers to the superior merits of Dr. Kidder's Apparatus:— “COLLEGE OF THE CITY OF NEw York, Cor. LEXINGTON Ave. AND 23D STREET, “Dr. JEROME KIDDER : New York, August 9th, 1871. “Dear Sir, Within the past few weeks I have carefully examined the construction of several forms of your Electro-Magnetic Machines. “I find that they differ in philosophical principles from any I have before investigated, and that they possess, in addition, many mechanical improvements. “By your ingenious modifications and combinations of the primary current of the Galvanic Battery, accomplished by passing it through helices of wires of differing lengths and thicknesses, I find that the electric effects are materially altered in a manner not accomplished by any other machines. . “These variations I have tested by galvano-metric, electro-thermic, and other Scientific instru- ments. “I have also experienced the varied effects produced upon the human system in my own person, and have witnessed the same in others, on applying the currents of electricity from the various coils, and through conductors of graded lengths and sizes. “Thus the eye can be stimulated to appreciate various amounts of light without pain ; or slight palm may be experienced without so exciting the organ as to perceive light. By changing the flow of the mysterious agent, its influence may be felt at the wrist, in the forearm, or higher up near the shoulder, in addition to all the variations of frequency, direction, and power usually provided for in electro-magnetic machines. “I confess I was surprised at the agreeable nature of the electric current. Most persons dislike the peculiar sensations experienced from the ordinary machines, and, after a first trial, decline a repetition of it. All such would appreciate not only the bearable but the pleasant effects produced by your arrangement. “Thus you have placed in the hands of the skilled physician most valuable modifications of a power which is destined to solve many of the mysteries of our organization. and to relieve many of the ills of life. - “In conclusion, I would state that your method of varying the Primary as well as the Induced currents surpasses all other devices I have studied, as tested by scientific instruments and by physio- logical effects. “I most heartily commend its use to my medical brethren as the instrument for research in this attractive field of medical inquiry. “I have the honor to remain your obedient servant, R. O.GDEN Doſtºmus, M.D.” Tr. KIDDER manufactures also the most approved Primary Cell Batteries, with improved facili- ties for manipulating the currents, and at reasonable prices. Primary Batteries, with an improved patented arrangement for throwing intensity into quantity, and vice versa. Varied and approved extra appliances for special cases. In order to get the genuine Apparatus, send for Illustrated Cir- rular, with Price-List. Address, Dr. J.E.R.OMIE KIDDIER, 544 Broadway, N. Y. - - ADvERTISEMENTs. , ſº . HORSFORD'S AG|D PHOSPHATE (MEDICIWAL). Prepared by the Rumford Chemical Works, Providence, R. l., UNDER THE DIRECTION OF PROFESSOR E. N. HoRSFORD, . Late Rumford Professor at Harvard University, Cambridge, Mass, THE value of Preparations of Acid Phosphates as therapeutic agents is in keeping with well-known :hemical principles, and no article has ever been offered to the public which seems to so happily meet the ;eneral want as HoRSFORD's AcID PHosphaTE. It is not nauseous, like most of the preparations of Phos- phorus, but agreeable to the taste, and with water and sugar makes a cooling and pleasing drink. No danger can attend its use, as it is the same Acid that is found in wheat and other cereals. If we take more into the system than is needed, it is expelled with the secretions of the body. i It is especially recommended for Dyspepsia, Urinary , 'ifficulties, Cerebral and Spinal Paralysis, Men. tal Exhaustion, Wakefulness, Hysteria, and Nervous Disorders in General. Most excellent results have attended its administration for the prostration and nervous symptoms following Sunstroke. We ask the careful attention of all thinking persons to the high character of the following testi. monials: - ... . . M. H. Henry, M.D., - . . . . Editor of the American Journal of Syphilography and Dermatology, New York City, says: “I have, for more than two years, prescribed the Ácid Phosphate, rather extensivelv. in a variety of cases where the use of phosphorus was indicated, and I assure you with the most sauis, autory results. In nervous dis- eases I know of no preparation to equal it.” - . º - . Adolph Ott, : Technical Writer and Editor of the Department of “Physics, Chemistry, and Technology” of the Ger- man-American Cyclopædia, says: “I have tried several phosphites, and even phosphorus in substance, but none of them with such marked success as your Horsford's Acid Phosphate.” The statements made by Qthers as to its effects on the nervous system and the brain, Ifully confirm. Some months l have been enabled to dev te myself to hard mental labor, from shortly after breakfast till a late hour in the evening without experiencing the slightest relaxation, and I would now at no rate dispense with it.” . John P. Wheeler, M.D., Hudson, N. Y., says: “I have given it, with present decided benefit, in a case of innutrition of the brain from abuse of alcohol.” - . . . . . # . - Dr. Wrm. A. Harm mond, - - now, of New York, formerly Professor of Physiology in the University of Maryland, says: “I make use habitually of phosphoric acid and the phosphases, in the treatment of nervous diseases... I prescribe it *onstantly every day of my life. It is very wéll known that, in certain cases of paraplegia (paralysis of the lower extremitiés), and which are due to paralysis of the spinal cord—to a degeneration of the sub- stance of the cord—the disease cannot be so effectually cured by any other means as by the administration of phosphorus.” Dr. Fordyce Barker, New York City, says: “There are very often cases where the human system needs, for its restoration, the administration of the phosphates. The eases that require a phosphatic treatment are those where the waste of the phosphates is greater than the supply. The class is very numerous. First, in all these cases of dērangement of the digestive and assimilative organs, where, in consequence of this derangement, the waste is greater than the supply. The next most frequént is where there is an excessive demand for nerve-power, as in men engaged in professions, and in business excitements; next, in ex cessive demands resulting from prolonged lactation; and another class still, the excessive tax on phys- ical power and muscular effort, without the necessary supply. - - R. Ogden Dorennus, - Professor of 9. in the Qollege of Pharmacy of this city, and in the Medical College of the City of New York (formerly called the Free Academy), and in the Bellevue Medical Hospital, says: “I have had, for many years, professional employment in the matter of examining human urine. The amount of the pº will be increased in the urine, as the result of abnormal exercise of the bod where the brain and nervous system are overexcited. This result of the discovery of a greater pro- portion of the phosphates in urine, after excessive mental labor, has been verified by experiments within my experience, and is in accordance with an ordinary knowledge from examinations of urine, insomuch that we teach these facts in our lectures to medical students.” William H. Van Buren, M.D., of New York, says: “I have been employed professionally to make examinations of the human urine and have generally found the phosphates in excess in cases where the nerve centres (the brain and spinal cord) had been overworked or subjected to undue labor. The opinion which obtains in the profession and which has been confirmed by my own personal experience, is that there is a received rélation be. tween an excess of phosphates in the urine and intellectual exercise.” - Physicians wishing to examine and test this remedy are requested to apply, by letter or otherwise, to the undersigned. - 2 WILSON, LOCKWOOD, EVERETT & CO, G|| Agis, 51 Murray Street, N ev York City. It iſ # #,' 'i *...* 7 L - THE - - & - * } .** # ^. sº 2. y/ V &" * p MEDICAL WORLD. A Monthly Journal of AMERICAN & FOREIGN MEDICAL, PHYSIOLOGICAL SURGICAL AND CHEMICAL LITERATURE, CRITICISM & NEWS. Vol. I. APRIL AND MAY, siz. Nos. and 10 Subscription Price, $2.00 a Year. Single Copies, 20 cents. C O N T E N T S. PRACTICAL MEDICINE : - On the Treatment of Diabetes by - Lactic Acid (Cantani’s Me- On Diseases of the Muscular Walls thod), DR. GEORGE WILLIAM of the Heart, DR. QUAIN, . 361 BALFOUR, e • • g On the Use of Ergot of Rye, DR. Lectures on . Dermatology, DR. . JOHN DENHAM, .. * . 366 ERASMUS WILSON, . g . 397 On Wascular Naevi, and their Treat- Clinical Lecture on Nervous or Sick- ment by the Actual Cautery, Headaches, DR. P. W. LATHAM, 412 DR. B. F. D.Awson, . 369 MISCELLANEOUs, e e * . 421 MOLLER'S Purest Norwegian L Was awarded a Silver Medal at Paris International Exhibition, 1867, heading twenty-seven competitors. Is prº pared from selected Livers, and bottled at Lofoten Islands, Norway. Was awarded a Gold Medal at Bergen International Exhibition, 1865. Is the purest, and for limpidity, clearness, and delicacy of taste and smell is superior to any. Is highly recommended by the Medical Societies of Norway and England. Is more readily assimilated and more readily digested than any other Cod Liver Oil. - Was awarded the First Prize and the only Medal at London International Exhi- . bition, 1862. - Is recommended by high medical authorities in Europe and America. - Was awarded First Prize, the only one awarded, at Stockholm Great Exhibi- tion, 1868. gº © - W. H. Schieffelin & Co., AWew York, Sole Agents for United States and Canada. JAMES M AIDWIN, PBISHER 81 Broadway, N. Y. <}! J. M. Baldwin, âtates of 3dvertising PUBLISHER, 811 Broadway, New York, Receive subscriptions for every medical journal in the world. Very liberal reductions made on all home journals when several are taken together. THE MEDICAL WORLD. One page, one time, - - - - - - $35 PHalf “ “ - - - - - - - 15 Quarter “ - - - - - - 8 Card, { % sº, º m ms 5 3 months less 20 per cent., 6 months less 30 per cen., 12 months lesst 50 per cent. º Fifty per cent. in addition to above rates will be charged for insertions on the cover pages of Journal, or facing reading matter. g No quack advertisements will be received at any price. Application in every instance should be made to the Publisher direct. J. M. Baldwin, 811 Broadway, N.Y, ra. * * º iD ECKER Paternt º Tº ſº - &T. . . . ." 3 is. 3. * * '. . . . . * ... ". . . §. , º ... . . . ; BRos., IGHT PIANOS, On Sq., Eroadway. FACTORY, 322, 324, 326, 328 & 330 W. 35th ST, EXTENDING TO 313, 315, 317, 319 & 321 W, 34th ST. -à------a v-------- “One of the simplest and most truly valuable improvements vet made in the pianoforte is that invented and patented by Decker Bros.”—From the New York Tribune. Cath artic, Narcotic, Tom ic, Sedative, Alterative P I L. L. S AND TOI, U ANODYNE. . The above so thoroughly defined, so highly approved, and the Formulas subjected to the fullest investigation, the Physicians may rely on them with confidence. THEY COMPRISE THE |3 Pill Aloin catam. Fea’a‘o, |3 Pill Podophyllum cum Ferro, (3 Alterative Laacative Pill, ſ:# Altera five Laacative Pill, |# Alterative Laocative Pill, ſ:# Compound Quirvine Pill. ºf Fluid Connabis cum Toſu, ſº Pill Sedative, Known as Eclectic Pills. Dr. Jackson's Formula. Dr. Gilman Davies’ Formula. Dr. P. S. Haskell's Formula. Dr. Edward Hall's Formula. Dr. N. I. Aiken's Formula. Known as Tolu Anodyne, I)r, N. T. Aiken's Formula. Five years have clearly proved their importance, and the future will be to keep that good. Formulas in detail, describing samples and plans of getting such, or in quantities, sent on demand. JOHN L. HUNNEVVELL, - Laboratory Office, 97 Commercial St., Boston, Mass. ADVERTISEMENTs. Idr. J.E ROME RIDDER's ELECTRO-MEDICAL APPARATUS, -3. The Portable Form can be obtained without spilling the fluid. Modified and mani- fold qualities of elec- tricity, patented in the United States, England, and France. The latest examina- tion and opinion of Professor Doremus: “The only appara tus meeting the de # mand of advanced H science.” The only ## one adapted to the wants of Practition- ########: ºft Fº > ſº $º:--> ÄKitāR # of MPROVE NA §º º opinion of PRof. DoReMus. The following testimonial from R. O.GDEN DoREMUs, M.D., Professor Chemistry and Physics in the N. Y. City College, and Professor Chemistry and Toxicology, Bellevue Hospital Medical College, refers to the Superior merits of Dr. Kidder's Apparatus:— - “COLLEGE OF THE CITY OF NEW YORK, COIR. LEXINGTON Ave. AND 23D STREET, “l)R. J.EROME KIDDER : New York, August 9th, 1871. “Dear Sir, –Within the past few weeks I have carefully examined the construction of Several forms of your Electro-Magnetic Machines. ‘‘I find that they differ in philosophical principles from any I have before investigated, and that they possess, in addition, many mechanical improvements. “By your ingenious modifications and combinations of the primary current of the Galvanic Battery, accomplished by passing it through helices of wires of differing lengths and thicknesses, I find that the electric effects are materially altered in a manner not accomplished by any other machines. “These variations I have tested by galvano-metric, electro-thermic, and other scientific instru- Incht S. “I have also experienced the varied effects produced upon the human system in my own person, and have witnessed the same in others, on applying the currents of electricity from the various coils, and through conductors of graded lengths and sizes. * “Thus the eye can be stimulated to appreciate various amounts of light without pain; or slight palm may be experienced without so exciting the organ as to perceive light. By changing the flow of the mysterious agent, its influence may be felt at toe wrist, in the forearm, or higher up near the shoulder, in addition to all the variations of frequency, direction, and power usually provided for in electro-magnetic machines. - “I confess I was surprised at the agreeable uature of the electric current. Most persons dislike the peculiar sensations experienced from the ordinary machines, and, after a first trial, decline a repetition of it. All such would appreciate not only the bearable but the pleasant effects produced by your arrangement. “Thus you have placed in the hands of the skilled physician most valuable modifications of a power which is destined to solve many of the mysteries of our organization, and to relieve many of the ills of life. “In conclusion, I would state that your method of varying the P, & ...try as well as the Induced currents surpasses all other devices I have studied, as tested by scientific instruments and by physio- logical effects. “I most heartily commend its use to my medical brethren as the instrument for research in this attractive field of medical inquiry. . “I have the honor to remain your obedient servant, R. O.GDEN DoREMUs, M.D.” Dr. KIDDER manufactures also the most approved Primary Cell Batteries, with improved facili- ties for manipulating the currents, and at reasonable prices. Primary Batteries, with an improved patented arrangement for throwing intensity into quantity, and vice versa. Varied and approved * xtra appliances for special cases. In order to get the genuine Apparatus, send for Illustrated Cir- ular, with Price-List. Address, Dr. J.EROME KIDDER, 544 Broadway, N. Y. UNIVERSITY OF NEW YORK, MEDICAL DEF AFTMENT, 426 East 26th St., opp. Bellevue Hospital, New York City. TITIE T Y- FIR S T S E S S I O N, 18 7 1-1872. FA C U L T Y O F M E D 1 C 1 N E . REV. HOWARD CROSBY, D.D., Chancellor of the University. MARTYN PAINE, M.D., LL.D., Emeritus Professor of Materia Medica and Therapeutics. JOHN W. DRAPER, M.D., LL.D., Ameritus Professor of Chemistry, and Physiology. President of the Faculty. ALFRED C. POST, M.D., Professor of Surgery. CHARLES A. BUDD, M.D., Professor of Obstetrics and Clinical Midwifery. JOHN C, DRAPER, M.D., Professor of Chemistry. ALFRED L. LOOMIS, M.D., Professor of Institutes and Practice of Medicine. WILLIAM DARLING, A.M., M.D., F.R.C.S., Professor of Descriptive and Surgical natomy. HENRY DRAPER, M.D., Professor of Physiology. Registrar of the Faculty. WILLIAM H. THOMSON., M.D., Professor of Materia Medica and Therapeutics. FREDERICK D. LENTE, M.D., & Professor of Diseases of Women and Children. EDWARD G. JANEWAY, M.D., & Professor of Physiological and Pathological Anatomy. D. B. S.T. JOHN ROOSA, M.D., Clinical Professor of Diseases of the Eye and Ear. ERSKINE MASON, M.D.. Adjunct Professor of Surgery. The Collegiate Year is divided into two sessions—a regular Winter Session and a Spring, Summer, and Autumn Session... The latter is auxiliary to the former, and the design of the Faculty is to furnish instruction to medical students throughout the year. Attendance on the regular Winter Session is all that is demanded of the candidates for graduation. Those who attend the other session receive a Certificate of Honor, as having pursued voluntarily a fuller course than usual. The Spring and Surm ner Session is principally of a practical and clinical charac- ter, and affords particular facilities to students who have already taken one course in schor is where such practical advantages exist to a less extent. The course consists also partly of lectures and ex- aminations on the subjects necessary for graduating in medicine, conducted by the Professors of the regular Faculty and their assistants. The examinations will be addressed to both first and second course Students. For the purpose of Hyaking the visits to the wards of the hospitals as available as possible, the class is divided into sections. One division at a time is instructed in practical diagnosis, prescrip- tion, and trea'ment of patients. The course begins in the middle of March. and continues till the beginning of June, when the Summer Commencement is held. During the Summer the College Clinics are kept open. The Autumn or Preliminary Session commences in the middle of September, and continues till the Opening of the regular session. It is conducted on the same plan as the Spring and Summer session. • The Regular Winter Session occupies four and a half months, commencing on the second of October, and continuing till the middle of February. The system of instruction embraces a thorough Didactic and Clinical Course, the lectures being illustrated by two clinics each day. One of these daily clinics will be held either in Bellevue or #e Charity Hospital. The location of the Łollege building affords the greatest facilities for Hospital Clinics. It is opposite the gate of Bellevue Hospital, on Twenty-sixth Street, and in close proximity to the ferry to Charity Hospital, on Black- well's Island, while the Department of Out-door Medical Charity and the Hospital Post-mortem Rooms are across the street. The students of the University Medical College will be furnished with admis- sion tickets to these establishments free of charge. The Professors of the practical chairs are connect- ed with one or both of these Hospitals, and students are also entitled to attend all the clinics held by other physicians in them. Besides the Hospital Clinics, there are eight clinics each week in the College building. The Faculty desire to call attention particularly to the opportunities for dissection. Subjects are abundant, and are furnished free of charge, and the Professor of Anatomy spends several hours each day in demonstration in the dissecting room. Fees for the Winter Course. Full Course of Lectures.................................................... ....... ... $140 00 Matriculation... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 00 Demonstrator's fee, including material for dissection................................. 10 00 Graduation fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 00 Fees for the Spring, Summer, and Autumn Course. Students who have attended the Winter Course will be admitted free of charge. Those who have not attended the Winter Course will be required to pay the matriculation fee and $30; and should they decide to become pupils for the winter, the $35 thus paid will be deducted from the price of the Winter Tickets. For the purpose of assisting meritorious individuals, the Faculty will receive a few beneficiaries, each of whom will be required to pay $43 per annum and the matriculation fee. For further particulars and circulars, address the Registrar, PROF. HENRY I: RAPER, M.D., UNIVERSITY MEDICAL COLLEGE 426 East 26th St, New York City. THE EDICAL WORLD. A MONTHILY RECORD OF AMERICAN AND FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL, AN3) CHEMICA1, LITERATURE, CRITICISM, AND NEWS. VoI. I. APRIL AND MAY, 1872. Nos. 9 and 10. 33rattical jūtūitint, ON DISEASES OF THE MUSCULAR WALLS OF - THE HEART". Dr. Quain's Lumleian Lectures at the Royal College of Physicians, March, 1872. LECTURE I. DR. QUAIN, in commencing his first lecture, observed that diseases of the walls of the heart have, in the past, been too much subordinated to affections of its valves. Clinical study of the diseases of the walls, however, teaches us that on them depend all the really serious effects of heart disease, while ex- treme disease of the valves may produce no symptoms so long as the muscular tissue of the heart is adequate to the work it has to do. As the walls are strong and efficient, or as they are weak, dilated, and inefficient, will be the phenomena of disease with which we have to deal. Enlargement of the heart is the first pathological state de- Serving attention, and is usually due to a combination of hy- pertrophy and dilatation. After glancing at the history of the subject, the lecturer described three forms of hypertrophy with which the cardiac walls may be affected. (1.) Simple muscular hypertrophy, the characters of which are well known. (2) Connective tissue hypertrophy—a form not yet definitely 362 Diseases of the Muscular Walls of the IHeart. [April, recognized, although vaguely alluded to by various writers. The connective tissue is greatly increased in quantity, and seen in all conditions of development, surrounding and comprising the muscular fibres. The walls may or may not be altered in color, but they are increased in thickness and far more dense than in the first form. Its cause is probably a chronic inflam- mation of the interstitial connective tissue. (3.) Fatty hyper- trophy, often confounded with fatty degeneration. The mus- cular fibres are tolerably healthy, but the fat between them is greatly increasing in quantity, and is most abundant towards the outer surface. The other factor in cardiac enlargement is dilatation, the character and common origin of which are well known. The causes of enlargement of the heart are: (1.) Agencies acting through the nervous system. The influence of the ner- vous system on the heart is seen in the effects of shock, alarm, anxiety. Constant excitement leads to overaction, and this to enlargement. Statistics furnished by Dr. Farre show that during the last twenty years there has been a very marked increase in the number of males between 20 and 45 who die of heart disease, while in the number of males under 20 and of females there has been little change. Other nervous influen- ces lead to excited action, as those reflected by sympathy from other viscera. (2.) Agencies acting mechanically lead to hy- pertrophy. Increased development of muscular tissue ensues on an increased demand. Such influences are the excessive and habitual exertion—as in many laborious occupations and athletic sports in excess—and obstruction in the circulation either at the heart itself as in valvular disease, in the great vessels as in aortic contraction, or in the distal circulation as in Bright's disease, or in pregnancy. (3.) Agencies acting di- rectly on the nutrition of the heart may cause its enlargement, though these have more frequently the opposite influence. The blood state in Bright's disease may co-operate with the distal obstruction in causing hypertrophy. In adhesions after pericarditis, the heart is commonly enlarged from increase, as the lecturer believed, in connective tissue as much as from in crease in the muscular element. Cases of cardiac enlargement which are not referable to any known cause are probably in many cases also examples of the connective tissue hy- May.] Diseases of the Museular Walls of the II*arº. 333 pertrophy. This opinion, Dr. Quain said, previously formed, was completely confirmed by an examination of one of these hearts, of an enormous size, which has been for many years at St. George's Hospital, and was found on examination to present a great increase in the connective tissue. LECTURE II. In his second lecture, Dr. Quain continued his account of enlargement of the heart. He first described the effects, local and systemic, of the three forms of hypertrophy as far as they are known, contrasting the increased power of the first with the practical weakness of the two other forms, in which, though the muscular tissue may be increased, its power is spent in overcºming the obstacles to its free action. He then passed to the consideration of certain special effects of cardiac enlargement. First, its relation to cerebral haemorrhage. From statistics which he had collected, the following conclu- sions were drawn : (1.) That, in cases of apoplexy, enlargement of the heart is more frequently present than disease of the cerebral vessels. (2.) That, when the heart is enlarged in apo- plexy, the cerebral vessels are as often healthy as diseased. (3.) That, when both enlargement of the heart and diseased vessels are present, valve disease is found only in two-fifths of the cases. Secondly, its relation to phthisis. Enlargement of the heart was found to be present more than three times as frequently in men dying of phthisis as in women. The dura- tion of life in phthisis scemed greater on an average in the cases in which the heart was enlarged, the percentage of deaths under one year being only half that in cases in which no enlargement was present. Tastly, heart disease seems to have no influence in promoting haemoptysis in phthisis. Thirdly, its relation to renal disease. The kidneys were diseased in 34 per cent. of cases of heart disease collected by Dr. Chambers. The result is due to the influence of chronic congestion. - After a few remarks on the diagnosis of cardiac enlargement and its causes, Dr. Quain passed on to the subject of treat- ment. He insisted strongly on the importance of an accurate and early diagnosis and thorough investigation into the action 364 Diseases of the Museular Walls of the Heart. [April, of medicines, by which our faith in physic would become greater and the list of curable diseases be lengthened. In the three forms of hypertrophy we must counteract or remove as far as we can the causative conditions. In dilated hyper- trophy we must lessen the intra-cardiac pressure by diminish- ing the volume of the blood, and at the same time purify it, by acting on the secretory organs, purging, etc. LECTURE III. In the third lecture, Dr. Quain first described fatty degene- ration of the heart. After glancing at the naked-eye and mi- croscopal character of the affection, he stated his belief that it was due to a non-vital chemical or physical change in the com- position of the muscular fibres. Such a change is seen in the formation of adipocere, especially when we consider it in asso- ciation with the slow fatty degeneration which takes place in preparations preserved in spirit. There is a remarkable ana- logy between the character of this process, the formation of oil in olives after gathering, and the slow series of changes which occur in dead vegetable matter which result in its trans- formation into coal. Wagner's observations on the occurrence of fatty degeneration in albuminous substances within the peritoneal cavity, corroborated by Michaelis, were conclusive, though objections have been raised to them. Still more strik- ing evidence that the process consists of a change in nitroge- nous compounds is afforded by the observations of Mr. James Salter on the fatty degeneration which occurs in the pulp cavi- ties of a necrosed tooth. These facts, the lecturer be- lieved, were entirely opposed to the view advocated by Dr. Ormerod, that the fat is a fresh formation, as such, from the blood. - The causes of fatty degeneration are, first, general states of impaired nutrition and depressing adynamic diseases; and, Secondly, local conditions, especially atheroma of the coronary arteries, and the occurrence of endo- and peri-carditis. A dis- eased artery has been found going directly to a local patch of softening. Congestion of the coronary veins may tend to produce it. It is more than twice as frequent in men as in women, and increases in frequency as life advances. The change interferes much with the functions of the organ, is May.j Diseases of the Muscular Walls of the IIeart. 365 diminishing power being shown in certain nervous symptoms especially syncope (a common cause of death), and in short." ness of breath, and attacks of cardiac pain, sometimes of origi- nal character. The local signs are those of weakness, feeble impulse, faint sounds, and weak, irregular pulse. These symptoms, occurring in connection with its causative condi- tions, will enable the diagnosis to be made. In treatment, tonics and rest to the heart are the chief means to be employed, and by their aid great improvement may often be effected. - Rupture of the heart was next considered. The size and appearance of the rupture vary much—it may be so small as only to admit a probe, or it may be an inch or two in length. Its character depends on its local cause. The great majority of the cases occur in persons over 60 years of age. The im- mediate cause of the accident is some increased strain on the heart, usually determined by physical exertion or mental ex- citement. Fatty degeneration is the local condition which usually is found in association with it. Death sometimes oc- curs instantly, sometimes is preceded by symptoms of cardiac suffering, and failure, more or less intense, and lasting for a few hours, or, in rare cases, for several days. The latfer cases have been those in which the process of tearing through was slow or the rupture was through the septum. In about three- quarters of the cases the rupture is in the left ventricle; the right ventricle, right auricle, septum, and left auricle being aſ- fected much less frequently and in the order named. The blood usually escapes into the pericardium, and there separates into clot and serum, the former surrounding the heart. The accident is always fatal. Wounds in healthy hearts have sometimes healed. Aneurism of the heart may exist within the cardiac wall or project on its outer surface, sometimes to such an extent as to resemble a double heart. The sac is formed by the thin car- diac walls, the muscular tissue often being greatly lessened, and the connective tissue increased. Sometimes bony plates are found in it. The pericardium is usually adherent. It occurs with equal frequency at all ages, but is much more com- mon in men than in women. Its origin is probably some local degenerative change, inflammatory in nature, permitting 366 On the Use of Ergot of Rye. [April, dilatation ; sometimes an abscess has opened into the heart. It usually occurs at the apex or base, most frequently the for- mer. Symptoms are often absent, and, when present, are not special, being those of cardiac distress, and would only indi- cate the nature of the affection in conjunction with special local signs. It is nearly always fatal, sometimes slowly by interference with the heart's action, sometimes suddenly by rupture of the sac.—Med. Press and Circular, April 3. ON TIIE USE OF ERGOT OF RYE.3% BY JOIN DENIIAM, F.R.C.S., Late Master of the Rotundo II spi/al. DR. DENIIAM read a paper on the use of ergot of rye. He commenced by observing that, sixteen years ago, he published a few observations on the use of ergot in the Dublin Quar- terly Jourma/, the principal object of which was to show that the injury inflicted on the child in utero by ergot was mechani- cal, not poisonous. We have been long familiar, he said, with the statement that the continued use of ergot of rye acts as a poison to the animal economy ; but, as Phoebus observes, we annot call it a violent poison, since drachms, and even ounces, are required to destroy small animals, such as dogs, rabbits, and pigeons. IIe (Dr. Denham) believed the symptoms pro- duced in dogs compelled to swallow ergot were very similar to those the result of exclusive feeding upon one particular sub-tance, as shown by the experiments of Magendie. That ergot of rye was by no means the deleterious poison that some would lead us to believe was forcibly shown by the experi- ments of Black. He states that he gave 9 lbs. of ergot daily to twenty sheep without any ill effect. Twenty other sheep consumed 13% lbs. of ergot daily for two months without any bad effect. Thirty cows took together 27 lbs. of ergot daily for three months with impunity. Many of the experiments of Wright, in his essay, 53d volume of ſºdinburgh Medical *Abstract of a paper read before the Obstetrical Society of Dublin. May.] On the Use of Ergot of Mºye. 367 and Surgical Journal, tend to the same view. Dr. Den- ham's object, however, on the present occasion, was not to dis- cuss the subject of ergot in its physiological aspect, but rather to bring under the notice of the Association the result of his observations in a practical point of view. He proceeded to say that they had given it again and again in the chronic wards of the Rotundo Lying-in Hospital, as an emmenagogue, bút with no beneficial results worthy of recording. In some forms of haemorrhage, such as were often met with some days or even weeks after delivery, where the uterus remained softer and larger than usual, it had been found beneficial ; and in not a few, where the haemorrhage was caused by an internal polypus, the ergot hastened the expulsion of the polypus; but ..in cases of haemorrhage the result of fibroid enlargement either on the internal or the external wall of the uterus, they found no benefit whatever from the use of ergot. The object to which Dr. Denham particularly directed attention in his former paper on this subject was how and to what extent ergot affected the child in utero, and to that subject he now returned. Dr. Beatty, Dr. F. H. Ramsbotham, the late Dr. Hardy, and Dr. McClintock all maintained that the poisonous effect of ergot is extended from the mother of the child. Dr. IIosack and Dr. Migs, of Philadelphia, support the opinion that death is produced by the violent contractions of the uterus upon the child, and the compression and contortion of the uterine vessels consequent thereon. Dr. Chapman states that in 200 cases in which ergot was given it produced no harm whatever, adding, “No one here believes in the alleged deleterious influence of the article in the foetus.” Dr. Den- ham quoted the description given by Dr. Beatty of the distin- guishing characteristics of still-born children to whose mothers ergot had been administered—the general lividity of the sur- face, the universal rigidity of the muscular system, producing the stiffened limbs and clinched hands in those infants in whom life was extinguished, and the remarkable kind of alter- nating spasms and palsy which supervened in those that were resuscitated. IIe pointed out that in the report of the Rotun- do Lying-in IIospital published by Dr. IIardy and Dr. Mc- Clintock, although they concurred with Dr. Beatty as to the deleterious influence of ergot upon the foetus, there was no 368 On the Use of Ergot of Rye. [April. mention of the symptoms described by Dr. Beatty; and he quoted from the report of the same hospital by Dr. Collins, who, he believed, never gave a single grain of ergot to a pa- tient during his mastership, to show that “children will die even without the aid of ergot both before and after birth.” Dr. Denham had arrived at the conclusion that ergot, if given between the sixth and ninth months, neither affects the life or health of the mother or child, nor does it bring on labor until the full period of utero-gestation is completed. He did not believe that the giving of ergot would bring on abortion in healthy women, even where there had been some threatening of it; but if the process had really set in, then the ergot rapid- ly hastened it. Their experience of ergot had not, he regret- ted to say, increased their confidence in it as a remedial agent in post-partem haemorrhage either before or after the expul- sion of the placenta; but where, from the previous history of the patient, they had reason to apprehend post-partem hae- morrhage, they had never failed to give ergot in the second. stage of labor, and with the happiest effect. It was to Dr. Beatty they were indebted for this valuable suggestion in the treatment of haemorrhage. Their experience of ergot during the period, of pregnancy had led to the following conclusions: 1. When given to a pregnant woman even in repeated doses at any other than the full period, it produces no effect what- ever beyond nausea and loss of appetite ; 2. It produces no. injurious effect upon the foetus in utero; 3. Where the pro- cess of abortion has commenced, the ergot hastens it material- ly and acts very beneficially; 4. When given in the second. stage of labor, it often acts beneficially and hastens the labor; but, if the labor be not soon completed, it is attended with great danger to the child, not from any toxic effect of the ergot, but by the mechanical obstruction it offers to the circu- lation, and the continuous and powerful contraction exerted on the child. Dr. Denham concluded by referring to the al- leged effect of the hypodermic injection of ergotine in stop- ping bleeding in severe cases of haemoptysis, epistaxis, and haematemisis; and recommended the masters of our lying-in hospitals to give it a trial in uterine haemorrhage, the most frequent and most fatal of all haemorrhages.—Med. Press and Circular, April 3, 1872. May.] On Vascular Waevi, 36% ON VASCULAR NAEVI, AND THEIR TREAT- MENT IXY THE ACTUAL CAUTERY. BY B. F. DA WSON, M.D., New York, Attending Physician to the New York State Woman's H ospital, Out-door Department; to the Demilt 195spºnsary, Dept. of Children's Diseases ; to the New York Free Dispensary for Sick Children : Assistant to the Clinique for Diseases of Children: the College of Physicians and Surgeons, New York. THE term naevus is generally used to designate certain con- genital cutaneous marks or discolorations which so frequently disfigure various portions of the body of children. Amongst these abnormalities there is but one variety, however, to which is attached much importance, aside from mere disfig- urement, on account of its vascular nature and its tendency to develop either in exact relation to the growth of the entire organism or considerably faster. This variety of naevus is known as Vascular tumor, Erectile tumor, Venous mole, Telangiectasia of the cutis, and Angiomata. By these terms is understood a circumscribed dilatation of the cutaneous capillaries, or deeper veins and arteries, which affection, according to structure or situation, is classed into arterial, venous, or capillary, and cutaneous, subcutaneous, or mixed naevi. This subdivision is of great practical import- 8. Il CG. - In external appearance, vascular naevi differ greatly, from an insignificant spot of enlarged superficial capillary vessels to a network of similar vessels affecting large portions of the cuti- cle, or even to tumors of considerable size involving the deeper tissues and organs. In the first, we have but a slight, more or less extensive, irregular elevation of the cutis of a light-red or purplish color, while in the latter there is a soft doughy tumor over which the integument is either perfectly normal, or more or less permeated by dilated vessels, and in some cases marked with spots in appearance similar to the first type. The behavior of vascular maevi differs in individuals. In many cases the smallest telangiectasiae will extend with great rapidity over a large extent of surface during the first year of life, and continue so to do, accompanied with great disfig- 370 On Vascular Maev. [April, urement, until interference is absolutely called for.” On the other hand, when even of large size, they may cease to grow after a period of activity, and even undergo spontaneous atro- phy or ulceration, or remain through life exactly the same in appearance and condition as they presented at birth. Although vascular naevi are generally situated on the cutis, yet they may occur on the serous or mucous surfaces of all parts of the body, and, especially when situated on or near the mucous surfaces, they occasion great trouble on account of the swelling and their liability to haemorrhage, and call for ac- tive surgical treatment. The pathological anatomy of cutaneous and subcutaneous vascular navi differs somewhat. The former, as a careful ex- amination will easily show, is composed wholly of dilated tor- tuous anastomosing cutaneous capillaries. According to Bill- roth, an anatomical examination of this variety “shows that they are composed of small lobuli as large as a hemp-seed or pea; and if, after artificial injection or other mode of prepa- ration, we examine them microscopically, we shall find that these lobuli are formed by the vessels of the sweat-glands, hair-follicles, fat-glands, and fat-lobuli being independently diseased, and that the different small, proliferating vascular systems form the above-mentioned lobuli, which are visible to the naked eye.” Further on he remarks that, when “the blood has been emptied from them after extirpation, with the naked eye we can hardly see anything abnormal in the morbid piece of skin that has been removed ; a moderate neoplasia of this variety appears on the cut surface as a pale reddish, soft, lobulated substance, in which we can see no vessels with the naked eye, because the whole disease is usually limited to the capillaries and minute vessels, and to a few small arteries.” The pathological anatomy of the subcutaneous naevus differs considerably from the cutaneous. According to Mr. Birkett f * Dr. T. Holmes, in his “Surgical Treatment of the Diseases of Infancy and Childhood,” in speaking of the danger of naevi destroying life, says: “I have not as yet seen, nor can I discover either in published cases or in the experience of my surgical colleagues, any case in which a congenital naevus proved fatal. . . . This is a significant fact in discussing dangerous ope- rations for its cure.” (P. 43.) + “General Surgical Pathology,” Am. edition, p. 584. f Med...Chirurgical Trans., Lond., vol. 30, p. 193; and Holmes’s “Surg. Dis. Child.,” p. 43, - May.] * On Vascular Maev. 3.71 the following facts have been demonstrated in the anatomy of this form: “1. That they are surrounded by a fibrous cap- sule or lamina, which in a large naevus also surrounds each lobe or portion of the tumor, so that the whole resembles a number of fibrous sacs, and each of these sacs is attached by a neck to the corium, with the fibrous structure of which the capsule of each lobe of the tumor is continuous. 2. That the lobes are separated by septa into reticular spaces, somewhat like those of the corpus cavernosum penis, lined with epithe- dium and communicating with the venous system. 3. That these spaces are not mere dilatation of the blood-vessels. Their connection with the veins is much more obvious than with the arteries.” w Some pathologists give such navi the distinct appellation of Cavernous venous tumors, Cavernous angiomata,” in accord with their peculiarities. In structure such nævi resemble very greatly the erectile tissue of the penis. The careful study of such tumors has so far proved that they are undoubt- edly distended veins, as “the inner walls of the spaces filled with blood are in most cases coated with spindle-shaped cells venous endothelium.” The precise development of these “cavernous venous tu- mors,” however, has not yet been decided, and different ex- planations have been given by Billroth, Rokitansky, Rind- fleisch, and others. Thus briefly we have glanced over the pathological anatomy of the two principal types of vascular naevi, and we next come to the consideration of their diagnosis. This is only difficult in the subcutaneous variety. The color, history, and anatomical character of cutaneous vascular naevi are so distinct that they cannot easily be mistaken for any other abnormality of the cutis. We can, therefore, safely rest the diagnosis on the fact that, in cutaneous naevis, welling and a darker color are produced by the child crying, straining, etc., and that, on compressing with the finger, the elevation of the naevus is considerably diminished as the blood is pressed out of the dilated vessels; but on removing the pressure the blood-vessels again dilate, and the navus assumes its former appearance and color. * Billroth : “Surg. Pathology.” 372 (J7, Vascular AWaev. [April. In the larger subcutaneous vascular navi, however, a more careful method of diagnosis is required, as we may mistake other affections, such as lipomata, medullary cancer, enlarged glands, and encephalocele,” for them. The chief point in the diagnosis is, they can be considerably reduced in size by firm and continued pressure, and on the removal of which they again assume their original dimensions. They also usually give a slight sense of fluctuation, and swell and become firmer on forcible expiration. They are also said, when of large size, to pulsate, and on auscultation to give a decided aneurismal bruit; these latter statements, however, are exceedingly doubt- ful. When diagnosis is uncertain, we may then resort to the exploring needle, or, what I consider better, the hypodermic syringe; to the use of which, in the diagnosis of ovarian and other tumors, the attention of the profession has regently been called by Dr. Henry F. Walker, of New York.” The advised treatment of vascular naevi differs in many fea- tures, and the methods are exceedingly numerous. Whatever the method may be, however, it must have one of the two following objects in view : 1. Either a coagulation of the blood and obliteration of the diseased vessels, and consequent inflammation and atrophy ; or, 2. A removal of the entire affection. - For accomplishing the first object, we have coagulating in- jections, compression, transfixion with needles, ligation of the afferent artery, the galvano-caustic seton, and vaccination. The second object is accomplished by several methods, the ultimate aim of which is “ the substitution of a non-vascular cicatrix for the morbid tissue '': these methods are complete removal by the knife, the écraseur, or the ligature ; or its de- struction by the application of some potential caustic or the actual cautery. - To discuss the relative merits of each of these methods is not the object of this paper, and I shall therefore cursorily dwell on those only which are at present, most highly advocated; * M. Guersant, in “Notices sur la Chirurgie des Enfants,” mentions a case of encephalocele in a child, which was operated on for an erectile tumor; death occurring shortly, showed the true nature of the tumor. + American Journal of Obstetrics and Diseases of Women and Children, vol. iii. No. 1, May, 1870, p. 120. May.] On Vascular Waivi. 373 but will especially describe the use and advantages of the actual cantery, as used and witnessed by myself. Coagulating Injections.—The principal material used for this purpose is the liq. ferri perchloridi. Although it has been advocated by many, yet the danger attending its use, and the superiority of other methods, are fast bringing it into disuse. It acts by coagulating the blood in the vessels, and thus ob- diterating them. Cases of instant death after its employment are on record, the cause of death being the passage of coagula to the heart. In very minute quantities, however, and used with great care, it may be pronounced safe; but even with these precautions, it will sometimes cause a deep and unwel- come slough. - Compression has never been much advocated, and probably has never accomplished more than a palliation of the disease. It certainly can only be resorted to as a harmless method of treating such naevi as do not demand more efficient inter- ference. Dr. Mackenzie, in speaking of treating vascular naevi near the eyes by pressure, says it rarely succeeds, “and the delay occasioned by giving it a trial may prove highly de- trimental. When a cure does follow this sort of treatment, it is probably accomplished more by nature than by the artificial means employed.” - The ligature is undoubtedly a means most frequently re- sorted to for removing large navi, and is a much safer and more convenient treatment than either of the preceding, possessing, as it does, the advantage of removing the navus without haemorrhage, and leaving a readily cicatrizing sore. It may be applied in various ways, which are chiefly dependent on the size and situation of the tumor. When the naevus is sufficiently prominent, but not very large, a single ligature may be passed tightly around it and left in situ until the tumor sloughs off; or, as suggested by Mr. Cooper Forster, of England, it may be removed after four hours of application. This latter plan is said to be less likely to cause a slough, at the same time that the vessels are sufficiently obliterated. Ilarger and more diffuse cutaneous naevi are best ligated by passing sutures through and under them, the ligatures entering and emerging in sound skin. If needles are used, they are to be introduced * Mackenzie on “The Diseases of the Eye,” fourth edition, p. 161. 374. On Vascular Waev. |April, in the same manner; but a strong ligature must be tied very tightly under them, and thus around the maevus. In either case the same result takes place, a sloughing and falling off of the tumor. There are numerous other ways of ligating subcutaneous naevi, to which it is not necessary to refer, as they all ac- complish the same result. The only real disadvantage attending ligation is its slowness and the consecutive pain ; the latter, however, never lasts long, and can easily be controlled by opiates. Vaccination of naevi, as a means of cure, is a method that has for its object the obliteration of the diseased parts by in- flammation. It is advocated by Bouchut, Nélaton, and Vogel —the former considering it an excellent method of treating vascular naevi that are not too voluminous, and one that has not had sufficient merit accorded to it. All of these authori- ties report cases in which maevi of very considerable size were perfectly cured by inoculation with vaccine lymph. The most recent advocate of this method is Dr. Robert P. IIarris, of Philadelphia, who has published a paper on the subject.” He advises subcutaneous vaccination, and reports. an interesting case thus cured, the vaccine lymph having been introduced subcutaneously by means of many-eyed needles devised by him for the purpose. These needles, charged with vaccine, “were passed through the naevus just beneath the skin, at the distance of about a quarter of an inch apart, and allowed to remain until slight suppuration was established, when they were readily removed with little pain and no haemorrhage. Inflammation was established throughout the tumor, which became encrusted with a confluent scab, which upon falling revealed a commencing change that eventuated in the entire cure of the diseased growth.” Surface vaccina- tion is also said to answer well, the virus being introduced through several scarifications. - Although vaccination has proved itself with some to be a successful method, yet it can hardly be preferable to potential caustics or the actual cautery, from the fact that there is yet uncertainty as to the protective power of vaccination thus * American Journal of Obstetrics and Diseases of Women and Children. vol. iv, No. 1, May, 1871, p. 22. - 1May.] On Vascular Waevi. 375, practised against small-pox, and also from the fact that it seems abortive where the child has been previously vaccin- ated, and therefore cannot be recommended with certainty. One fact should not be overlooked, that the scar following vaccination is an exceedingly disfiguring one. Jºecision is perhaps the oldest of all the methods, and still receives the lighest endorsement from many eminent sur- geons. Although it possesses the advantage of being quickly performed, painless, and leaving a simple cicatrix, yet it has the drawback of the risk of primary and secondary hamor- rhage, and the loss of considerable substance when the tumor is large. Some navi, it is claimed, can be enucleated, as ad- vocated by Mr. Teale, Jr., of Leeds;” but as yet this has not been ploved worthy of trial. Subcutaneous division of the base of the naevus is another method, and in some cases would undoubtedly be efficacious if thoroughly performed. In using the knife in any of these methods, if the navus is large and deep-seated, caution must be practised that all of the diseased tissue is included within the incision ; at the same time, that no more of the skin or surrounding tissues be removed than is absolutely necessary. Potential caustics and the actual cautery have proved very Successful in vascular navi. Of the former, nitric acid, potassa fusa, the tartar emetic ointment, and Vienna paste are those most generally used. In very small cutaneous naevi, the application of concentrated nitric acid acts better, perhaps, than any other remedy. I have used it in such naevi situated on the face, with the most pleasing results. It should be ap- plied carefully over the whole surface of the navus only, care being taken not to touch the healthy cuticle. After the appli- cation, the naevus is changed from the red to a yellowish-white color; and when the cure is completed, we have a smooth eschar of nearly natural color. In some cases it may be neces- sary to repeat the application several times, or to cauterize only small portions at different times, until the whole is de- stroyed. Potassa fusa acts more powerfully than nitric acid, and may perhaps be better in deep naevi; but it has the dis- * “Enucleation of Naevi : A paper read before Royal Med. and Chirurg. Society, Feb. 1867’’ (Brit. Med. Jourr.) 376 On Vascular Waev. [April, advantage of being much more painful, and leaving a more conspicuous scar. - Tartar emetic ointment I have never used, but it is recom- mended in the principal text-books. My attention has been called to corrosive sublimate and collodion, one part to eight, by my friend Dr. J. B. Reynolds, of this city, who has lately used it with success in several cases. His last case was one in which a naevus about as large as a silver quarter was situated directly over the anterior fontanelle in a child four months old. The collodion was applied with a brush. An eschär was formed, in a few days the navus was found destroyed, and ultimately healed without any untoward circumstances. It would therefore seem that this also is a method of treatment deserving full trial, as it commends itself for simplicity and safety, as well as from the fact that it does not leave any worse scar than other caustics, and not so disfiguring a one as accination. Vienna paste” acts in like manner, and is recom- mended by Vogel + and others. From its painlessness, it is an attractive remedy, although it possesses no other evident advantage over nitric acid or other caustics. It must be borne in mind, however, that these caustics are most suitable in the treatment of the diffuse cutaneous vascular navi; for in the larger and subcutaneous variety their action is too slow, and the difficulty of limiting their destructive power in the deeper tissues would seem to make it inadvisable to resort to them when we possess a caustic which, while accomplishing the same results, is quicker in its action, more readily controlled, and safer as regards the risk of primary or secondary hamorrhage. The actual cautery, whether the simple heated iron, the galvano-caustic, or the “gas-jet,” + is the means for treating cutaneous and subcutaneous vascular naevi to which I refer. All of the three are efficient and very manageable forms of the actual cautery, but the preference I think must be given to the two former ; and of these, to the heated irons, for the reason that they involve less trouble in handling and can always be readily used, whereas the cumbersome apparatus of * Potass. cum calce and morph... muriat. - + “A Practical Treatise on Diseases of Children.” f A small jet of burning gas, which latter may be carried in a rubber bag ; invented by Mr. Bruce, of the Westminster Hospital, London. * 5 - May.] On Vascular Wayvi. 377 the galvano-cautery limits its use more or less to office or hos- pital practice; this alone is a great objection to the latter. The manner of using the actual cautery irons, and the style of instrument necessary, are exceedingly simple. A charcoal or hard-coal fire near at hand will answer perfectly, or, what is more portable, a large alcohol lamp or a Bunsen's gas-burner. There is an alcohol furnace made especially for the purpose by instrument-makers, which is exceedingly por- table, simple, and gives forth very great heat, and was the means used for heating the needles in the cases reported. It is immaterial, however, in what manner we heat the needles, so long as they are not soiled or rendered smoky. The instruments are simply a stout iron wire, sharply point- ed and inserted in a wooden or ivory handle, and one of the same make, but having a bulbous end instead of a point, the bulb being not larger than a grain of Indian corn. The method of using these instruments, and the advantages of the actual cautery, are best described by recording the fol- lowing out of several cases of vascular naevi, thus treated by Prof. Jacobi and myself during the past two years.” CASE I.—LARGE CUTANEOUs NASVUs OF THE TEMPLE.- John C , 14 months, was brought to the clinique for children at the College of Physicians and Surgeons, in Nov., 1870, for the treatment of a congenital cutaneous arterial naevus cover- ing the entire left temple, and measuring about two inches in diameter. Its growth had been exceedingly rapid and con- tinued to be so, and threatened to extend to the eyelids. The cutis was fully involved in the disease, and presented the cha- racteristic beet-color and granulated surface. Owing to extent of surface involved, Prof. Jacobi decided to apply the actual cautery to only certain portions of the navus at different periods, and thus gradually accomplish its destruction. The child was etherized, and the red-hot bulb-pointed irons were applied, in the presence of the class, to five spots in the peri- phery of the naevus, and held in place until cool (a minute suffices). By this means, corresponding eschars, the size of a pea, were made. The mother was instructed to return the child again in one week. At that time the borders of the * For the sake of brevity, I have omitted unnecessary dates and histories. VOL. I.-29 378 On Vascular AWavč. [April, naevus were found to be very much paler, as was also the in- tervening portions, and the cauterized portions to be covered by healthy scabs. Five or six new eschars were then made more in the centre of the disease, and the child again ordered to be returned in two weeks; at the end of this period a really amazing change had taken place. In color the naevus was very much paler, the surface was smoother and more level with the surrounding skin, and the entire affection seemed to be rapidly fading away. The burned portions showed non-vascu- lar cicatrices. As the disease was thus decidedly disappearing, after presenting the case before the class, Prof. Jacobi con- cluded to wait another week before using the actual cautery again. Unfortunately, the mother never brought the child back, undoubtedly satisfied with what the treatment had ac- complished, and it is safe to believe that the maevus ultimately wholly disappeared. The pathology of the cure of this case was, localized destruction of tissue, followed immediately by coagulation of blood in the adjacent vessels, and consecutive inflammation, consolidation, cicatricial contraction, and absorp- tion. - CASE II.-CUTANEOUs NAEvus OF FOREHEAD.—Wm. C 5. aged 4 months, was brought to me in February, 1871, by his mother, with a capillary naevus located directly over the left eyebrow. It was almost uniformly circular, and about an inch and a half in diameter. At birth it was no larger than “a grape,” and its growth was steady and rapid. The cutis was completely involved, and looked so completely vascular as to seem likely to give rise to haemorrhage from slight friction. The color was bright cherry-red, and it was evidently purely arterial. Having put the child under chloroform, I singed the entire surface with the red-hot bulb-pointed iron, but not to the entire depth of the navus, as on account of its size and the child's age I did not wish to have too much irritation fol- lowing the first application. After the operation the navus was of a uniformly grayish-yellow appearance. Cold water was directed to be kept applied. Six days after I again saw the child. The naevus was considerably less prominent. The local irritation had evidently been very slight, and the consti- tutional disturbance none. I again applied the actual cautery, but more thoroughly than the last time, going considerably May.] On Vascular Mapwi. 379 below the level of the cutis, and to the utmost limits of the disease. Cold water was ordered to be applied, and the child to be brought to me in two weeks' time. When seen at the end of that time, the navus was found to be wholly destroyed, and almost completely cicatrized, and such portions covered with delicate, smooth, and soft cicatricial tissue. I saw the child again six weeks after the operation, and found a uniform and soft scar occupying the seat of the naevus, and its color differing very little from the surrounding skin, being but a shade or so lighter. A few weeks later a very similar case of naevus of forehead was treated in the same manner by Prof. Jacobi, at the clinic in the College of Physicians and Surgeons, and with similar gratifying results. - CASE III.-CUTANEOUS NAEvus OF THE LOWER LIP.-Annie T , aged 22 months, was presented at the clinique for children at the College of Physicians and Surgeons, February, 1871, with a naevus on the outer margin of the lower lip, and occupy- ing a situation close to the left angle. On examination it was found to be the size of a large raisin, and not involving the deeper tissues. The mucous membrane was not involved. It had the history of rapid growth from a small spot at birth up to its present size, and had begun to excite alarm on the part of the child’s parents. After exhibiting and remarking upon it before the class, Prof. Jacobi requested me to destroy it with the actual cautery. This was done by thoroughly cauterizing the entire navus with the bulb-pointed iron already men- tioned, not more than three applications being necessary for accomplishing the same. This case was again seen at the college at the end of a fortnight, and the seat of the navus was found to be occupied by a soft, smooth, cicatricial mem- brane, and no distortion of the lip whatever had occurred. CASE IV.--SUBCUTANEOUs WENOUs N.Evus OF THE LEFT BREAST.—Mary D , 14 months of age, was brought to the College of Physicians and Surgeons, January, 1871, with con- siderable enlargement of the left breast. The history was, that about a year ago the mother noticed a small soft lump in the breast, which since then has continued to grow until the size at present excited her alarm. On examination, in external appearance the left breast is seen to be greatly enlarged, and near the nipple several large irregular veins can be seen beneath 380 On Vascular AWaev. [April, the cutis. On manipulating the swelling, a soft, doughy tumor can readily be felt, in size as large as a walnut, and of uniform shape, and feeling to the fingers similar to a varicocele. On compression with the fingers it was considerably reduced in size. There was no pulsation whatever. It was pronounced by Prof. Jacobi to be a subcutaneous venous naevus, and de- struction by the actual cautery recommended. On the same day the mass was deeply punctured by the red-hot pointed needle in three or four directions through a single opening made by the first puncture. No hamorrhage followed, and the child was ordered to be returned in two weeks' time, a small piece of lint having been introduced into the opening to favor discharge from the tracks of the cautery irons. When seen at the expiration of that time, the swelling had diminished con- siderably in the vicinity of the opening, and was somewhat firmer. There had been and still was a slight discharge from the breast. The child was in perfect health. The needles were again used three or four times as before, especially were they introduced into the base of the mass, and the child ordered to return in three weeks' time. When then seen a still greater change had taken place. The breast was greatly diminished in size, the naevoid mass was almost inappreciable in size, and to the touch only two or three isolated spots of disease could be recognized. There had been a slight dis- charge from the wound since last seen, and the point of punc- ture was noticeably smaller. Dr. John C. Jay, one of the assistants to the clinique, by advice of Prof. Jacobi, introduced the hot needle again, passed it beneath the remaining portions of the naevus, and the child dismissed for three weeks. The mother, however, did not bring the child back until July 19. In the absence of Prof. Jacobi in Europe, I was holding the clinique at the college, and accordingly showed the case to the class. The condition of the patient was evidently satisfactory. Perfect cicatrization had taken place where the cautery had been introduced, the breast was of uniform size with the healthy one, and there was no evidence of existing disease, ex- cepting a very small dark-blue spot near the nipple. This had always been there, but had diminished with the entire tumor. However, to ensure a certain non-return of the naevus, I deemed it best to destroy every vestige of the disease, and May.] On Vascular Wapwi. 381 accordingly applied the actual cautery to this spot in the pre- sence of the students. The mother was highly pleased with the result, and the disease, up to the present time, has shown no signs of returning. CASE W. —SUBCUTANEOUs VENOUs NAEvus OF LEFT LA- BIUM MAJOR OF THE WAGINAE. — Sarah G–, 22 months, was brought to the clinique at the College of Physicians and Surgeons, March, 1871, with a naevus about the size of a bird’s egg, situated just at the middle and outer border of the left labium major. It was of a dark color, considerably pro- minent, and had only been noticed a little over a year. The cutis was not involved. It had not grown very rapidly, but sufficiently so to alarm the parents. Compression considera- bly diminished its size. The bulb-pointed hot iron was ap- plied in the presence of the class, and the entire mass thoroughly singed considerably below the level of the adjacent skin. Cold water was ordered to be kept applied, and the case to be Seen again in two weeks. At the end of this time the case was presented to the class. The navus was found wholly de- stroyed, and almost completely cicatrized over; there was no distortion of the parts, and the case was pronounced cured. CASE WI.-SUBCUTANEOUs VENOUs NABVUs OF THE FOURTI) To E OF THE LEFT FOOT.—Arthur K–, two years of age, came to the clinique at the College of Physicians and Surgeons, May, 1871. His mother stated that when born there was a small “blue speck’’ on the toe, near the root of the nail. It had increased rapidly, until at present nearly the entire toe was involved, only a small portion of the under surface being free from disease. The toe was considerably swollen and of a steel-blue color, and the cutis was nowhere affected. On pressure the mass was soft, and could be considerably reduced in size. The mother stated that compression had been tried for some time without effect. Dr. Grunhut, one of the assist- ants of the clinique, punctured the naevus with the hot needle at several points, and ordered the patient to return in a fort- night. When then seen there was very great improvement, the disease giving no appearance of returning. On October 31, however, the child was brought back with a fresh out- growth on the under surface of the toe, where formerly there had been no disease. This I thoroughly burned with the 382 On the Treatment of Diabetes. [April, bulb-pointed iron, and the case was dismissed. When last seen, the naevus was evidently thoroughly destroyed and ricatrizing nicely. The above cases, although briefly reported, sufficiently prove the efficacy of the actual cautery in the treatment of vas- cular naevi. In none of the cases in which I have seen it used has it appeared to me that other methods of treatment would have given better results or been more appropriate. Perhaps the galvanic cautery may be made an exception ; but as this latter differs only in the means of heating the needles, it should be considered as identical with the former. Certainly for hospital or office practice it is to be perferred, and where obtainable should be used in preference to the fire-heated needles. Dr. Maas, of Breslau, has given, in the Archiv. für AZinäsche, vol. xii., a report of 112 cases of naevus thus treated, and concludes from its use that the galvanic cautery is follow- ed by the best results in this affection, and is much safer than the injection of coagulating fluids. This is certainly a weighty endorsement of the efficacy of the actual cautery. There is one method which I have not mentioned, possess- ing undoubtedly much to commend it, but as yet not suffi- ciently tried to be pronounced upon with any certainty. It is destruction of naevi by “electrolysis.” I have seen one case, a patient of mine, thus treated by my friend Dr. E. C. Seguin ; but as it was only a few days ago, I can as yet make no comments upon a method which I have but just witnessed. —The American Journal of Obstetries and Diseases of Women and Children, vol. iv. No. 4, Nov. 1871. ON THE TREATMENT OF DIABETES BY LACTIC ACID (CANTANIS METHOD). BY GEORGE WILLIAM BALFOUR, M.D., F.R.C.P.E., Physician to the Royal Infirmary, Edinburgh. (Read to the Medico-Chirurgical Society of Edinburgh, November 15, 1871.) TowARDs the end of last century (1796) John Rollo first propounded the theory that diabetes mellitus consisted essen- tially in some morbid change in the functions of digestion and May.] On the Treatment of Diabetes. 383 assimilation, and conceived the idea of remedying this abnormal condition by cutting off from the food the supply of starchy matter from which he believed the sugar to be chiefly formed, employing also emetics, narcotics, and tonics. Rollo thus laid the foundation of that system of treating diabetes which still prevails, which, mainly dietetic, consists also largely in the ad- ministration of tonics and narcotics. In France, this theory and treatment were adopted by M. Bouchardat (1841), who further showed that, for the complete conversion of starch into sugar, from seven to eight times its weight of water is required; thus accounting for the terrible and irresistible thirst of diabetic patients wholly irrespective of their excessive urination, which may be regarded as produced by the excessive ingestion of fluids rather than as its result. • * The more important variations in the dietetic treatment of diabetes in recent times have been—1st. The use of alkalies, chiefly the carbonated alkalies, which is based upon Mialhe's theory (1843), that the sugar formed from the starchy articles of food in a healthy body is destroyed by the natural alkalinity of the blood, a property he supposed to be defective in diabetic patients. This theory has been shown to be wrong in every point, yet the treatment founded upon it has had a consider- able amount of success. 2d. We have Reynoso's theory (1853), that the sugar in the blood of a healthy subject is burned in the lungs, and that it only appeared in the urine because of defective respiration; he therefore recommended a stimulating plan of treatment to increase the respiratory function ; and the employment of the peroxide of hydrogen in modern times, as well as that of the permanganate of potass, is based upon this view of the origin of diabetes, which, although accurate enough in the fact that sugar does frequently appear in the urine of those whose respiration is impeded, is yet in so far defective that the development of grape-sugar into lactic acid, the first stage of its combustion, requires no oxygen. 3d. Claude Ber- nard’s remarkable experiments (1848)—which seemed to prove the nervous origin of this disease, but which Schiff showed could not act without a liver, and acted mainly, apparently, by producing hyperaemia of that organ—gave a considerable im- pulse to the use of narcotics and nerve sedatives, especially such as opium, codeia, and bromide of potassium, which so act 384 On the Treatment of Diabetes. [April, upon the vaso-motor nerves as to reduce hyperaemia, all of which give considerable relief, and have had a certain amount of success. 4th. We have a modern return to the more purely dietetic treatment of diabetes in the employment of skim-milk as the sole article of food, a method of treatment which has been lately extolled by Dr. Donkin, of Sutherland. Now, without entering more at large into the pathology of diabetes, it is obvious that these various modes of treating it are all underlain by one common fact—viz., that in diabetes. the natural glycogenic function is discharged in a morbid manner, and that this morbid discharge of function may be importantly modified in two modes: 1st, by depriving the Organism of that pabulum from which the glucose is mainly derived; and, 2d, by employing such remedies as are capable of altering the nervous energy of the organs at fault: practi- cally it has been hitherto found of importance to conjoin these two methods. The chemical treatment of diabetes by the attempted burn- ing of the sugar by artificially induced hyperoxygenation of the blood, has not been found more successful than the simple dietetic plan without this addition, and for the chemical rea- son stated this could not be otherwise. While the basis of the other chemical treatment, that by alkalies, has been shown to be erroneous, the blood of diabetic patients being not less alka- line than that of others on the one hand, while, on the other, a fluid even more alkaline than blood cannot decompose glucose, so that, if the alkaline treatment have really proved more suc- cessful than the simple dietetic plan, that must have depended on its exercising some modifying power over the function at fault—a modifying power, however, of so doubtful a character that it has not been able to prevent this method of treatment from falling, in this country at least, into comparative desue- tude. - : It is a matter of daily observation, that morbid alterations of function are frequently only to be permanently remedied by a restoration of the body to its normal standard, the great diffi- culty of promoting a cure in such cases being the impossibility of giving perfect rest to one organ while endeavoring to build up the frame, the skill of the physician being shown by the manner in which he solves this complicated problem, giving as: May.] On the Treatment of Diabetes. 385 much rest as possible to the organ at fault, while at the same time improving the general nutrition, and thus restoring the healthy tone to the constitution. It is in this respect that all the treatments hitherto propounded for diabetes have failed; they may have given rest to the organ at fault, but they have too often depressed the general health, and, while giving tem- porary relief, have possibly in many cases hastened the end; and even when a tonic treatment has been mainly relied on, it has failed for want of physiological adaptation. It is in this respect that Cantani’s treatment is pre-eminently useful; it re- lieves without depressing, it gives as nearly as possible perfect rest to the organ at fault, and at the same time builds up the body by an artificial adaptation of physiological means, and restores the healthy tone to the constitution, thus enabling it to return to healthy action. It is by no means put forth as a perfect cure for all cases of diabetes; it is a means of relief to all, but only a cure for some; yet it seems to act curatively in a larger proportion of cases than any other mode of treatment hitherto devised, while the relief to all is more perfect. Professor Alnaldo Cantani, of Naples, agrees so far with Reynoso in believing that in diabetes the question is not so much one of increased production of sugar as of defective com- bustion; this he conceives to be proved by the small number of respirations made by diabetic patients and by their average low temperature, ranging, according to him, from 95° to 96°8 F. in uncomplicated cases; the temperature, of course, rising with any complication—such as tuberculosis— giving rise to pyrexia, but always remaining below the normal of such pyrexia. This defective combustion he believes to de- pend upon the production of a morbid form of glucose, which he has termed paraglucose; this is incapable of being trans- formed into lactic acid, and therefore cannot be burned ; it is consequently passed unchanged in the urine. The result of this is, that the sugar and starch of the food being transformed into this incombustible paraglucose, the heat of the body is in so far maintained at the expense of the albuminates and fats, and from the combustion of the former we have that excess of urea which adds so greatly to the density in many cases of diabetes, while, as the albuminates and fats which the patient receives as food are insufficient for his requirements, those of 386 On the Treatment of Diabetes. [April, his own tissues are also employed, and hence his rapid emaci- ation. - In the early stages of diabetes the quantity of sugar passed in the urine oscillates with the diet, and with an exclusively animal diet is much lessened in twenty-four hours, and may entirely disappear in a few days; in the latter stages, when sugar persists in the urine even after the withdrawal of all amylaceous food, Cantani believes that not only the inosite of the muscles may be transformed into paraglucose, but also that the gelatinous tissues, which Baedeker succeeded in trans- forming into sugar apart from the system, may in this abnormal pathological condition become transformed into paraglucose, and thus account for the persistence of sugar in the urine of those fed exclusively on an animal diet apart altogether from the question of the album,inates themselves being trans- formed into diabetic sugar. Thus, though all diabetics are to a certain extent autophagic, we may yet have this abnormality developed to excess, and may thus have three steps in this dis- ease: first, that in which the sugar oscillates with the quantity of amylaceous food supplied; second, that in which the inosite and gelatinous matter of the animal food are transformed into diabetic sugar; and, third, when not only these but also the inosite and gelatinous matters of the body of the patient him- self are so transformed—a most severe and hopeless form of autophagia. Cantani, with most modern pathologists, recog- nizes the liver as the organ mainly at fault in these cases; but whatever the organ may be, he proposes to give it as complete a rest as possible, by depriving it of its pabulum in subjecting the patient to a rigorous meat diet, thus reducing to a mini- mum the introduction into the system of the sugar-producing substances. But as that is only a temporary expedient, having reference to only one element of this disease, and incapable of arresting the waste and ultimate complete degradation of the body, he further proposes to prevent this waste by supplying a combustible agent in a quantity sufficient for the wants of the body, so that the fats and albuminates may continue to be stored, and the body thus gradually restored to its normal standard; and he hopes that this restoration of the healthy standard of the constitution, coupled with the prolonged func- tional rest to the organ affected, may suffice to prevent any May.] On the Treatment of Diabetes. 387 relapse into its morbid condition even after a return to the Or- dinary dietetic conditions of modern civilized life. The result of Cantani’s experiments have to a large extent proved the correctness of his views. The combustible agent which Can- tani has selected is lactic acid, and it has been wisely chosen, inasmuch as it is in all probability that agent employed in the normal conditions of nutrition, representing as it does the in- termediate stage between glucose and carbonic acid,” so that not only is a complete rest given to the organ at fault, but that very agent is supplied to the system which would have been normally present had the organ at fault been doing its duty after a normal fashion, so that, while as complete a relief as possible is afforded to the organ at fault, there is in no respect any abnormal strain put upon the system. The organ at fault is for the time being merely thrown out of gear, but all the other functions proceed in a natural manner, so that, when the normal tone of the organ has been reacquired, it may again be replaced in the natural cycle without the harmony of the natu- ral sequence of the functions being in any way interrupted either by the cessation or the restoration of its function. The quantity of lactic acid which Cantani administers is from 77 to 154 grains daily, diluted in from 8 to 10 fluid ounces of wa- ter, and taken during the day. His exclusively meat diet means rigorously one of plain meat, roast or boiled, without any sauces of milk or eggs, and certainly without any bread, flour, or any vegetable matter whatever, the only seasoning permitted being salt, oil, and a little vinegar. For drink he allows water, either plain or with a little of the purest alcohol; coffee, tea, and wine being prohibited. His results have been somewhat surprising. In recent cases the cure is stated to be almost certain and speedy; and even where an exclusively meat diet is not persisted in, life is apparently prolonged, and many of the unfavorable results of diabetes are prevented, though the mellituria is not arrested. Dr. Sammut, of Naples, from whose report I quote, states that he has seen an army lieutenant enter the hospital emaciated, weak, and impotent, with polyuria, thirst, and extraordinary hunger. In twelve * “What we have to do is to convert diabetic sugar—i.e., glucose—into lactic acid.”—Headland on the “Actions of Medicine,” 1867, p. 218. + Vide British Medical Journal, February 25, 1871, p. 208. - 38S On the Treatment of Diabetes. [April, days the last trace of sugar had disappeared from the urine, and in six weeks the patient had gained nine pounds. He left the hospital in excellent condition—florid, strong, without thirst or hunger; he continued the treatment for two months more at home, and then resumed mixed diet, and after the lapse of eight months he was in excellent health, and weighed twenty-one pounds more than when he entered hospital, being also without a trace of sugar in the urine, though eating indis- criminately of all that came before him. A tailor from Na- ples was admitted in a desperate condition. He left florid and robust. Since then, for more than seven months, he has been eating promiscuously, and is more fat, rubicund, vigor- ous, and energetic than before his attack. Dr. Sammut also states that he saw in Cantani’s clinique several other diabetics— he mentions five—all much improved, and several believing themselves to be perfectly cured. These results are certainly very remarkable, and, being a continuous series following the employment of a treatment based on rational considerations, are sufficient to claim the at- tention of every medical man interested in the progress of therapeutics. And I may remark that the latest treatment of diabetes propounded in this country—that by skim-milk— bears out Cantani’s views in so far that it is a strictly animal diet, free from amylaceous matter, and containing three to six per cent. of lactin, which, under the influence of the caseous matter, becomes transformed into lactic acid. This treatment is therefore an approach, but a very meagre one, to Cantani’s apparently more perfect system ; and I may add that the results of the two systems in my own practice have fully con- vinced me of the greater applicability and more perfect suc- cess, so far as time allows me to judge, of Cantani’s method. The first case in which I employed it was not a favorable one. The patient has been formerly much benefited by the conjunction of opium in large doses with the dietetic treat- ment. He returned two years afterwards with commencing phthisis, and, though benefited somewhat by the lactic acid treatment, yet he died, as was naturally to be expected. His urine fell in five days from an average of about 250 ounces to 70 ounces in the day, the specific gravity remaining about the same—1-030; this high specific gravity being apparently due May.] On the Treatment of Diabetes. 389 to the amount of urea and uric acid present, a condition of matters usual in this treatment. The deposit of red oxide of copper following the application of Trommer's test which had been copious, ceased entirely, and was replaced by a brownish discoloration due to the excess of uric acid present. No change took place on boiling with liquor potassae (Moore's test). The poor man therefore lost the main symptom of his disease, but he died exhausted after about three months' treat- ment. CASE 2. —David IIume, an engineer, aged 53, was ad- mitted into Ward W. on July 14, 1871, complaining of great thirst, debility, and polyuria. Three years ago he suffered from a stroke of paralysis which affected the right arm and leg. He was able to resume work three months subsequently, but still complains of weakness in the right leg and dulness of hearing in the right ear. His integuments are rather dry, his joints normal, but his limbs are much emaciated, and he sleeps badly at night. Sensation and intelligence normal, but motion much impaired from his great exhaustion, having had to rest frequently in coming up-stairs to the ward. He measures 5 ft. 7 in., and weighs only S st. 8 lbs. His tongue is dry in the centre, moist and clammy at the tip and edges, red and glazed. His mouth and fauces dry. He has a constant bad taste in his mouth. His teeth are decayed. His digestion good, but his bowels usually constipated. His arteries are atheromatous, but the circulatory and respiratory systems otherwise normal. He calculates his total drink at 100 ounces daily, but he passes between 300 and 400 ounces of a pale-colored urine daily, spec. grav. 1:030, and showing a large amount of sugar by the ordinary tests. He states that he has been under medical treatment for upward of a year, but has nevertheless been gradually getting worse, and he dates the commencement of this illness between three and four years ago. Up to the 15th of August he received only ordinary diet and no special treat- ment, but this day he was placed upon a strict meat diet, con- sisting of 2 lbs. of boiled meat and 2 lbs. of steak in the twen- ty-four hours, which was the quantity he found to be sufficient. He was also ordered one teaspoonful of lactic acid in a tum- blerful of water, to be taken in quantities sufficient to assuage his thirst. On the 29th of August his urine still contained 390 On the Treatment of Diabetes. ; [April, sugar, was reduced, however, to 86 oz. in the twenty-four hours, his total drink being now stated to be 78 oz. This day he was ordered a bottle of diabetic koumiss in the day. Of this he, however, only drank about half a bottle daily. On Sep- tember 1—his total drink being 48 oz.--he passed 48 oz. of urine rather deeper in color, of spec. grav. 1:025, and contain- ing no sugar. On October 1, the patient, having continued to improve uninterruptedly, was permitted to add to his diet four so-called bran biscuits, which contain, however, a large amount of starch,” and a cabbage. He takes his acid regu- larly. His total drink is now 36 oz., his total urine passed 40 oz., spec. grav. 1:025, and no trace of sugar. On October 20, two additional bran biscuits were granted to him ; and on October 25 he was permitted to breakfast on porridge and skim-milk, the bran biscuits being stopped, and his meat reduced to 2 lbs. daily, which is found sufficient. His weight is now 10 st. 7 lbs., and his urine keeps free from sugar. He was now put under surgical treatment for a stricture of the urethra, the lactic acid being continued, and bran biscuits gradually added to his porridge and skim-milk and meat diet, till he took six biscuits in the day. His drink and urine both averaged about 40 Oz. in the twenty-four hours, the urine keeping free from sugar. On November 14, his weight was 11 st. in his drawers alone, and, feeling quite well, he was discharged. He was shown at the Medico-Chirurgical Society on the even- ing of November 15, and has orders to report himself occasion- ally, so that his further progress may be ascertained. CASE 3.—Mary A. Early, millworker, aged 15, admitted into Ward XIII., July 18, 1871, complaining of weakness, generally malaise, polyuria, and diarrhoea, states that her present illness dates only from four weeks age, when she was seized with headache, which lasted all day, nausea, great thirst, and diarrhoea. Her appetite being unimpaired, her previous health was good, and her family history unimportant. On admission her skin was hot and dry, limbs much emaci- ated, height 4 ft. 834 in., weight 4 st. 11 lbs. Complains of headache and great thirst. Her tongue is covered with a * Weighing on an average 1 % oz. each. + 1 % pint of porridge, made from 4 34 oz. oatmeal and 1 pint of milk. May.] On the Treatment of Diabetes. 391 slight brown fur, moderately moist. Her bowels loose, sev- eral stools being passed daily. Her urine is pale, spec. grav. 1*030, and contains a large amount of sugar; its quantity is much increased, but cannot be measured on account of the diarrhoea present. Other symptoms normal. The diarrhoea was treated with chalk and opium mixture, and ceased in a few days. Her drink was now found to vary from 100 to 170 oz. daily, and the quantity of urine passed from 120 to 180 Oz. On July 27, she weighed 4 st. 7 lbs., and was placed upon an ad libiţum allowance of meat, of which she managed to consume about 2 lbs. daily, no extras. She had a bottle of soda-water daily, and two teaspoonfuls of lactic acid in a tum- blerful of water as often as desired. The very next day her total drink sank to 32 oz., and her total urine passed to 22 oz. daily ; and on July 29 all trace of sugar ceased to be discover- able, spec. grav. of urine remaining at 1:030, but containing a large quantity of uric acid and crystals of oxalate of lime ; total quantity passed 20 oz., total drink 40 oz., in the twenty- four hours. After this she continued to drink with almost unvarying regularity 40 Oz. in the day, passing from 28 to 40 Oz. of urine, averaging 33.5 oz. daily for the three months, August, September, and October. On August 7, she weighed 4 St. 6 lbs., having lost 1 lb. since being put upon her restricted diet, and on the 12th her weight remained the same. She says she feels quite well, but is unable to walk much or even stand long from a feeling of weakness across her loins. August 19.-Patient weighs now 4 st. 7 lbs., spec. grav. of urine 1:030, no sugar. On August 12, she was offered cab- bage or green vegetables, which she declined, and was then allowed to get half a slice of toast in the day; but this was stopped on the 20th, on account of a slight trace of sugar which was found in the urine on that day. On August 25, the patient weighed 4 st. 8% lbs., and was permitted to have some diabetic koumiss for drink. She did not like it, how- ever, and only managed to drink three bottles of it between this date and October 3, when it was stopped. On Septem- ber 17, patient weighed 5 st., and, sugar having remained absent from the urine, from August 12, she was allowed to have half a slice of brown bread daily. On September 30, patient weighed 5 st. 5 lbs. ; a marked quantity of sugar was 392 On the Treatment of Diabetes. [April, found in her urine, but as it was distinctly traced to her hav- ing eaten a slice of white bread and jelly which she had got from another of the patients, she was permitted to continue the brown bread. October 9.-Weighed 5 st. 7 lbs. Brown bread stopped on account of slight discoloration of the urine when boiled with liquor potassae. October 14. — Patient weighs 5 st. 9 lbs., and on 14th November 5 st. 10 lbs., her height being 4 ft. 834 in. October 17. — The urine keeping free of sugar, the patient was allowed to have four bran bis- cuits in the day, which contain a notable quantity of starch ; and on the 27th these were stopped, and porridge and skim- milk ordered for breakfast.” About the end of a week, how- ever, a trace of sugar reappearing in the urine, the porridge was stopped, and for another week she was relegated to her meat diet, of which she takes about two pounds daily. After doing penance for one week she was again permitted to have her four bran biscuits, which she has continued to this date. November 16.—Her urine keeping free from sugar, 36 oz. in quantity, and spec. grav. 1:030. Obviously this girl is far from being in the same satisfactory condition as Hume ; but considering her youth and the well-known obstinacy of diabe- tes in youthful patients, I think there is every reason to be thankful for the improvement she has made, and also strong grounds for hope that a more prolonged treatment will ulti- mately result in her restoration to health. CASE. 4.--U. M., aet. 25, an out-patient at the Infirmary, states that he has labored under diabetes, so far as he knows, for three or four years, and has been frequently under treat- ment, without much benefit. There was a large quantity of sugar in his urine; he was ordered strict meat diet, with lac- tic acid and water for drink; to take not less than three, or more than four, teaspoonfuls of the acid in the day. Within a week he had gained two pounds in weight, and the sugar had sunk to a mere trace. The following week his weight re- mained the same ; but he was fresh and hearty, the Sugar a mere trace; his thirst had disappeared at once. He has been # Of this she only took about half a pint in all daily. + Cases 2 and 3 have been condensed from the reports of A. J. M. Ben ley, Esq., M.B., the resident physician. May.] On the Treatment of Diabetes. 393 * little more than two weeks under treatment; so all that can be said of him is that his case is hopeful. His stationary weight was probably due to his taking a considerable amount of exercise, at the same time restricting himself to only two pounds of meat in the day. IIe was ordered to take any quantity of meat he could consume ; but as his time for calling has not yet come round, the result is not known. CASE 5.—A. L., admitted into Ward W. on 19th October, 1871; says he has only labored under diabetes for nine months, but is nevertheless greatly emaciated. The lactic acid treat- ment in this case certainly benefited the patient—the sugar entirely disappearing in a few days. IIe could not, however, be prevented from breaking through the rules and indulging in bread and other forbidden luxuries, and he was therefore dismissed on 17th November. - CASE 6.-M. W., a girl aged 17, an out-patient of the Royal Infirmary, came under treatment, first, on the 3d November, 1871; states that she has been ill about five months, and that she has been under treatment for three or four months, but has been getting gradually worse. She measures 4 ft. 834 in., and weighs 5 st. 2 lbs. Her urine is of a pale straw color, and quantity large but unknown, spec. grav. 1-045, giving, with Trommer's test, a copious deposit of the red oxide of copper, and becoming of a dark mahogany color when boiled with liquor potassae. She was ordered a strictly meat diet, with a cupful of skim-milk for breakfast, and no other drink but water: three or four teaspoonfuls of lactic acid to be taken during the day. November 11.—Urine same color as formerly, spec. grav. 1-045; deep yellow discoloration with Trommer's test; no deposit; yellowish brown with the liquor potassae. Has lost one pound in weight, but has had diarrhoea more or less constantly during the week, which may account for it. Thirst greatly lessened, and feels better. November 18.-Weighs now 5 st. 5 lbs., having gained 3 lbs. ; has a good appetite, and eats sometimes as much as 3 lbs. of meat during the day, and always 2% lbs., besides a cup of skim-milk for breakfast; has now no thirst, and feels and looks fresh and well. IIer urine is of a pale yellowish color, acid, spec. grav. 1:030, giving a yellowish color, and no deposit, with Trommer's test, and only a pale straw coloration with liquor potassae. This VOI. I.-30 394 On the Treatment of Diabetes. [April, girl, considering her youth, is obviously progressing favorably, and I hope to be able to give a good account of her at a future period. - CASE 7-R. A., aet. 35, has suffered from polyuria for at least nine months, and has gone down from 10 st. to 8 St. 11 lbs., his height being 5 ft. 10 in. He has such intense thirst that his tongue cleaves to the roof of his mouth, and the more he drinks the thirstier he gets; voracious appetite, and digests well; bowels costive, skin dry, and feels always chilly. Has no sexual desire, and has great languor both of body and mind. For the last three months has been subject to repeated attacks of an epileptiform character; his eyes seeming to go out of focus, and consciousness to be partially lost for a second or two ; these attacks occur on the streets occasionally, but most fre- quently on getting out of bed in the morning, or just after taking a cold bath. October 14.—Urine pale-colored, quan- tity large, but unknown ; spec. grav. 1:040; contains a large amount of sugar. Ordered a strict meat diet, with beef tea or plain soup if desired; three to four teaspoonfuls of lactic acid in water during the day, a little whiskey and water at night, with claret during the day if desired, and also a bottle of dia- loetic koumiss, or as much of it as can be taken. The stimu- lants were permitted as the patient had a good deal of moving about before him, and his condition obviously required them. Within a week he felt much better, his thirst quite gone—in fact, he complained of having, as he thought, too much to drink; and he had gained two pounds in weight. On the 27th of October he weighed 9 st. 3 lbs., was free from thirst, his drink amounting to 56 oz. ; his urine was 66 oz., spec. grav. 1-028; and, on being boiled with liquor potassae, its color resembled No. 4 of Vogel's table of urinary colors. He was now permitted to add fowl, fish, and eggs to his diet, which had been hitherto strictly limited to beef and mutton, boiled or roast. On the 10th of November, his weight was 9 st. 5% lbs. ; and the average amount of urine passed during the fort- night averaged 56 oz., of an average spec. grav. of 1-033. On 14th November, however, he passed 30 oz. of urine at once in the morning, double his ordinary quantity; and on the 5th it was found to be of a pale amber color, acid, spec. grav. 1:032, and gave a slight trace of sugar with Trommer's test, and a May.] On the Treatment of Diabetes. 395 slightly darker tint than on the last occasion with the liquor potassae. Obviously, some article in his diet was disagreeing : he was inclined to blame the koumiss, or perhaps the eggs, of which he had taken eight in one day; while I suspected he had got flour of some sort accidentally introduced into his food at Some hotel. Be that as it may, however, he was at once again placed on a rigid meat diet, and already his urine has gone down one-half. He looks and feels well, and is now almost free from his nervous symptoms, having only once had a slight threatening since coming under treatment. These cases are very imperfect, and are only published on account of the importance and novelty of this mode of treat- ing this hitherto so intractable disease, in the hope of enlist- ing others in the same enquiry, and thus more speedily deter- mining its real value. This treatment is simple, physiological, and its results—viewing them as an unselected and continuous series—are certainly sufficiently remarkable to demand atten- tion, being far before anything I have hitherto been able to attain by any other method whatever. The lactic acid I have employed has been that obtained from the druggist, fluid, not syrupy, of a spec. grav. of 1:027, and with the ordinary musty smell of sour milk. Three to four drachms in the day seem to be quite sufficient for all practical purposes; yet much more may be taken without detriment,” cases 2 and 3 Occasionally taking as much as eight or nine fluid drachms in the day. The remedy is, however, as yet rather too expensive to be employed in larger doses than are absolutely necessary, as it costs ten shillings a pound; a more extended application will, of course, cheapen its production. The great advantage of this treatment is the prospect which it holds out of a comparatively speedy restoration to ordinary mixed diet, with persisting absence of Sugar from the urine— of rapidity of cure, in short ; and this rapidity is in itself a great encouragement to such patients steadily to persevere, in spite of the irksomeness of a diet rigidly restricted to meat, which seems certainly to be required for two or three weeks at least, after which fish, fowl, and green vegetables may be * In particular, I have never seen any rheumatic pains produced; and , if the acid be kept within proper physiological limits, it is impossible that they ever can be, otherwise we would all be rheumatic. 396 On the Treatment of Diabetes. [April, added, and other relaxations gradually and cautiously per- mitted, provided the case progresses favorably. I ſancied that the koumiss was of considerable benefit in Hume's case, and, if its composition be correctly stated, it ought to be a useful diet for diabetics, but a rigid analysis is still requisite. It is prepared by Chapman of Duke Street, London, and is said to consist of milk, fermented in a warm place by the addition of a small quantity of very sour milk; it effervesces slightly, and is pleasant to the taste, being apparently composed of the :aseous matter in a state of extremely fine division, lactic acid, and a certain amount of alcohol, besides the fatty matter and salts ordinarily present in milk. The only apparent drawback to it is the statement that in cold weather it may act as a diuretic—an action which is certainly not required in diabetes. Bonthron’s diabetic biscuits are perfectly palatable, and I fancied they might prove a welcome addition to the very limited dietary permissible under Cantami's treatment. They are said to be prepared from finely ground bran, washed as free from starch as possible, and mixed with albumen and butter. I procured some of these biscuits, and had them analyzed by Dr. Stevenson MacAdam, of Edinburgh ; and the analysis, which I append, shows them to be wholly inadmissible in the early stages of this treatment, while, after a certain stage has been reached, they are not required, the ordinary bran biscuits of the shops, which are much more palatable, being perfectly sufficient, and forming an admirable introduction to more mixed dietary. Analysis of Sample of Bonthron’s Diabetic Biscuits re- ceived from Dr. G. W. Balfour. Moisture, . . . 1884 Oil, . tº is e te g & £y * 6:06 Albuminous compounds, * & e & 35-56 Starch, with some gum dextrine and sugar, . 34°58 Woody fibre, . tº $ º * * * 3-84 Ash, e g * e o & & sº 1.13 - 100.00 Nitrogen, . * e * * te * * 5,69 Phophoric acid in ash equal to ordinary bone phosphate, g º ſº * e : ()";8 (Signed) STEVENSON MACADAM, Ph.D. ANALYTICAL LABORATORY, SURGEONS’ HALL, Edinburgh, 16th Nov., 1871. These biscuits, therefore, contain practically one-third of their weight of starch. —Edin. Med. Jour., Dec., 1871. May.] J.ectures on Dermatology. 397 Q Cl LECTURES ON DERMATOLOGY. Delivered in the Royal College of Surgeons of England, in February, 1872, by ERAs MUs WILSON, F.R.S., Professor of Dermatology to the Royal College of Surgeons of Eng- land. (Medicz, Press and Circular.) LECTURE I. (CONTINUED.) No. 93 is a beautiful example of the prominent variety of erythema, occurring in the form of a diffused blotch several inches in diameter, and would scarcely be recognized as belong- ing to the papulous group were it not for the presence of isolated papules around its circumference. It is highly char- acteristic of the affection—its scarlet and lilac hues, its slight but obvious prominence, its sharply defined and tumid border, and the absence of all lesion of the skin beyond the merc hyperaemia. It is true to the nature of the parent affection in appearing on a joint, and it already shows indications of Sub- sidence within the area, and presents the purplish tints of decline. We are informed that it made its first appearance suddenly, that it was accompanied with tingling pruritus, and that in twenty-four hours the redness vanished, leaving behind it a pale orange stain, like that of a bruise, which remained visi- ble for several days. The patient was a young woman, twenty-four years of age ; she had suffered severely from a painful confinement with serious complications, had been kept in bed for three months, and towards the end of that period had an attack of constipa- tion, with headache and feverishness. Concurrently with these symptoms, the present eruption made its outbreak on the knees, ankles, and arms. No doubt, the erythema acted as a derivative upon the constitutional disorder, and a mild aperient would have been the therapeutic method of dealing with both. The tuberous forms of erythema, namely, erythema tubero- sulp and nodosum, are more chronic in their nature than erythema papulosum ; they, however, take their origin in a similar cause, disordered digestion and assimilation, and are commonly met with in the extremities, more especially in the lower limbs. - Nos. 94 and 95 are casts in plaster and wax of the leg of a young woman, a domestic servant, aged twenty-two ; she had 398 Lectures on Dermatology. [April, recently come to service in London from the country; her di- gestive organs were deranged; she had headache and feverish- ness, and, as a consequence of this state of constitutional dis- order, painful, red, tuberous spots appeared on the legs; the redness of the spots, unlike No. 93, faded towards the circumfer- ence; the prominence was less obvious to the eye, but was distinctly felt in the skin, apparently sinking deeply into the tissues; they lasted for a week or ten days, and, when the red- ness and hardness disappeared, yellowish stains, with slight ecchymosis, were left behind. Erythema tuberosum, therefore, although of the same nature, would appear to affect the tissues more deeply than erythema papulosum ; and, as a consequence, the neurotic manifestations would correspond with the depth of the nerve affected, producing pruritus in the superficial, and Soreness and aching in the deeper, affection. The treat- ment in this case was a few days’ rest in bed, a mild purgative with Salines, and subsequently quinine with sulphuric acid— the girl being feeble and delicate in constitution. Erythema nodosum agrees in general character with erythema tuberosum, but is commonly oval in figure, occupies the limbs, especially the lower extremities, is redder, more painful, more prominent and profound, lingers for a longer period, and leaves behind it at its decline a deeper stain, and very often a decided ecchymosis. The long diameter of the swelling usually corresponds with the axis of the limb, but the casts in plaster and wax numbered 96 and 97 exhibit an erythema nodosum which crosses the limbs, and surrounds the lower part of the leg like a bracelet. The patient in the latter case was a woman, forty-five years of age; digestion and assimilation were bad, she was a good deal debilitated, and the swelling ex- tremely painful. Erythema nodosum is usually isolated, and the number of its prominences few—in the instance under consideration it was solitary. - Erythema admits of a very natural division into four prin- cipal groups, for example, fugitive, fixed, migratory, and tumescent. The papulous, tuberous, and nodose forms which we have just been considering belong to the tumescent group, in consequence of their prominence or depth , while the speci- mens 98 and 99 are essentially migratory, originating in a given spot, and dispersing centrifugally by the circumference May.] Jectures on Dermatology. 399 so as to produce a ring, and preserving a border of moderate breadth. This is the class of migration which is termed ser- piginous, and one which is met with very commonly in affec- tions of the skin. I have had occasion to notice it already in connection with eczema and lichen, and we shall come to it again in subsequent groups, more especially in roseola, syphi- lis, lepra, lupus, epithelioma, and still more strikingly amongst affections of the follicles. It may be stated, therefore, to be one of the phenomena of the pathology of the skin, to sweep along the surface like a ripple or a wave, to depart from a centre and spread by the circumference, while the central area is in the condition of recovering its normal state and appear- ance. The Natural Philosopher has acquired more than one useful lesson from throwing a pebble into a tranquil pool, and observing the ripple that seems to flee from the point of con- cussion of the liquid element; so, from the same experiment, the Philosopher of Medicine may deduce the law which governs the formation of a circle around a central point of morbid action in the skin, and most strikingly so in the curious example of centrifugal erythema which is illustrated in the specimens Nos. 100 to 103. We have already perceived a tendency to growth by the circumference in specimens Nos. 91 and 92, but in the case of No. 98 eccentric development is a predominant character. The illustration is termed erythema roseolosum, on account of its color, and to distinguish it from the more efflorescent erythemata, which have already received the names of circina- tum, gyratum, and marginatum. It must not, however, be supposed that these terms apply to actual differences in the eruption, for, in fact, they simply distinguish modes of mani- festation and growth. When the circles are moderate in num- ber, they retain their circinate form ; when they are numerous, and meet in their growth, and break up into arcs of circles, which retain an appearance of continuity of figure of a complex description, the term “gyratum ” is applied to the eruption; and when a few arcs of circles remain standing alone in a state of chronic hyperaemia, the rest having vanished, the case is one of erythema marginatum. In brief, the isolated circles are termed “circinatum ; ” the tracery resulting from the con- fluence of a number of circles, “gyratum;’ and one or more 400 Dectures on Dermatology. [April, • * arcs of large circles in a chronic state of hyperaemia, “margi- natum.” - - . The patient whose leg is represented in drawings Nos. 98 and 99 was a lad, twelve years of age. He had been exposed to overexertion in the spring of the year. On the following day the eruption made its appearance in the form of circular rose-colored spots, with a pale centre, and Soreness, tingling and Smarting, comparable to the stinging of nettles, while a hot bath converted the spots from a bright rose-red to a purple hue. From the first, a sudden differentiation of area and border made itself evident, and the border quickly assumed the annular character, and was slightly prominent, while the area subsided in elevation, and faded in tint of redness. The eruption reached its height on the fourth day, and then rapidly declined, leaving behind it purplish-yellow, bruise-like stains. Nos. 100, 101, and 102 are examples of an erythema de- veloped in the form of an erythema papulosum, and throwing out a prominent ring from its circumference, without any sub- sidence of the centre. Hence, we are enabled to distinguish in the figure of the eruption a central boss and external ring, and are reminded of the iris of the eyeball. This resemblance has gained for the affection the name of erythema iris. In constitutional and therapeutical relations, as also in seat of de- velopment, it differs in no respect from ordinary erythenia papulosum, but is interesting, pathologically, not only in refe- rence to the primary suspense and subsequent renewal of the hyperaemic congestion, but also because it constitutes a link to more decided forms of eccentric annulation, which we shall have to pass in review at a subsequent period. Gastric disturbance may be said to be at the root of all the examples of erythema which we have hitherto examined; and the cause of such gastric disturbance would seem to be of little or no importance. One form of this group of affections, namely, urticaria, is known to arise from articles of diet, often of the most innocent kind; and an attack, generally severe, occasionally follows the use of mussels as an article of food. With such facts before us, we are prepared to recognize the influence in eruption—production of other substances intro- duced into the stomach in the character of medicines; for example, belladonna, which produces an erythema; iodide of May.] Lectures on Dermatology. 401 potassium, which causes a papular folliculitis; arsenic, which gives rise to an erythema of the skin, erythema arsenicale; and the balsam of copaiba, which also excites an erythema, taking its origin in the follicles. When we observe the primary effect of the substance to be a folliculitis—a something acting on the glandular element of the skin, we may be led to infer that the action thereby excited is eliminative, and that the folliculitis really represents an effort on the part of the glandular apparatus to cast off a poisonous or irritative material present into the blood. But it is equally evident that the follicle is the most easily approached and most vascular portion of the skin, and, there- fore, that an irritative action would be excited within its walls more quickly and intensely than on the papillary stratum of the superficies of the skin. With the latter view I am myself disposed to concur; and I look upon the action of iodine, arsenic, and copaiba on the skin as an illustration of simple ir- ritation, or possibly of overstimulation of the cutaneous tissues. Another observation which would seem to confirm this conclusion is the well-ascertained therapeutical effect of arsenic and iodine upon the skin. Arsenic as a cutaneous stimulant or tonic is capable of curing many chronic affections of that organ, and the specific influence of the iodide of potassium is equally well recognized in the cure of syphilis of the skin. The balsam of copaiba administered as a curative agent in chronic inflammation of the genito-urinary mucous membrane is also known in some instances to occasion erythema of the skin; and the accidental cure of lepra vulgaris during the administration of the balsam of copaiba for such a purpose led an eminent French dermatologist, Hardy, to the recommenda- tion of copaiba as a treatment of lepra. The remedy has not been in use sufficiently long to determine its usefulness, and my own experiments have not given me results which I can regard as favorable to its success. The model, No. 105, is an example of an erythemata which may be termed “copaibicum,” and which is doubly interesting to English surgeons from its comparative rarity amongst our- selves. It is constituted of papulae and maculae of a bright crimson color; the papulae represent inflamed follicles, and the maculae, which are punctuated in the centre, that portion 402 Lectures on Dermatology. [April, of the vascular stratum of the corium which immediately surrounds the follicles; sometimes the macula is elevated in the centre so as to constitute a papula; and, on different parts. of the model, maculae will be observed to be coherent, some- times in small blotches, and sometimes in rings. T.ECTURE II. —PIILYcTENOUs AFFECTIONs. THE third group of cutaneous diseases, the phlyctenous affec- tions, is represented in our collection by two examples of vesi- culous lesion, namely, pemphigus and herpes. The examples of pemphigus are numbered 109 to 119, with a recent addition, No. 518, and those of herpes 120 to 127. The lesions in the vesiculous form of cutaneous affections are three in number, namely, erythema, vesicle or bulla, and crust, and its patholo- gical state is consequently trimorphic. If we analyze the pathological characters of the affection, we shall discover it to be an erythema attended with serious effusion beneath the epi- dermis, the effused fluid raising the horny layer of the cuticle into a blister or bleb. It would be interesting to discuss why, in some cases, erythema should subside without leaving behind it any mark of its presence; why, in other instances, the ery- thema should be followed by dry exfoliation of the cuticle; and why, in a third series, as in the one before us, it should be accompanied with vesication, and in herpes, with suppura- tion and sometimes with ulceration in addition to vesication. An explanation ready to our hand, and conforming with the existing theory of disease, is that the question is one of vital dynamics, and that the changes referred to represent degrees of vital or nervous force. In ordinary erythema, the standard of nerve power or vital power is lowered to a certain degree, while in phlyctenous erythema it is lowered still more, passively in the case of pemphigus, actively in the instance of herpes. After death, as we well know, a state of loosening and sepa- ration of the cuticle takes place, which is referable to cada- veric transudation, and in some forms of cachexia, as well as in some of gangrene, for example, in chilblain and carbuncle, the development of bullae may be likened to a similar process. The first specimen of pemphigus that we have to examine is pemphigus iris—a form of the disorder which supplies us with May.] J.ectures on Dermatology. 4ſ)3 a curious example of the transition of erythema into the vesi- cular affection. Nos. 100 and 101 are instances of erythema iris, of a migratory form of erythema, in which the pro- gression is centrifugal, and as it were salutary, and the resulting consequence a singular eccentric arrangement of rings. But the eruption subsides without structural change and without disturbance of the epidermis. Not so, however, in pemphigus iris; the development of the central blotch and the successive formation of eccentric rings are exactly the same, but another pathological feature is superadded, the central blotch vesicates, and becomes covered with a bulla or bleb. Sometimes the rings surrounding the central blotch also vesi- cate, and the curious phenomenon results of a central vesicle or bulla, encircled by one and sometimes by several vesicated rings. The case ceases to be one of erythema iris, for the vesicle transforms it into one of pemphigus iris, and, as may be supposed, where a considerable number of eruptive spots are thrown out on the skin, some will retain the erythematous character, some will be bullae with vesicated rings, and be- tween these extremes others will be found to represent every variety of intermediate stage. An example of pemphigus iris is shown in the drawing No. 109, displaying the inner side of the thigh and leg of an adult man. In this case the eruption was general, but most abun- dant on the lower extremities; more frequently it is local and limited to the hands and feet. The outbreak is always asso- ciated with constitutional debility and irritability, and some- times with cachexia, and in general there is more or less ente- ric disturbance, and a participation in the disease, of the mucous membrane as indicated by aphtha, sometimes by uraemia, and sometimes by slight haemorrhage from the ali- mentary canal. The drawing illustrates very fairly the progressive stages of the eruption, its erythematous origin, the subsequent vesicle, the eccentric erythematous rings, the conversion of the more central rings into annular vesicles, the varied tints of the more distant rings, then the retrogressive stages, the opacity of the vesicle, its collapse, sometimes its rupture, the desiccation of the vesicle and its contents, and their consequent conversion into a thin brown scab. Occasionally the rings are each the 404 Zectures on Dermatology. [April, production of a separate day, so that, when the process has lasted for some time, it would be possible, by counting the rings, to determine the day of appearance of the first spot and the number of days the patch had existed. In the large patch seen in the drawing, there are seven white rings, representing Seven days, and seven circles of fading red between them, the uppermost white ring being bounded by a narrow areola of pale crimson. While in another patch, measuring only half an inch in diameter, there were nine different tints of color, which, from the centre to the circumference, were red brown, white, deep red, lighter red, deep red, pale red, deep red, yellowish white, and crimson blush. - - Another very interesting illustration of pemphigus iris is shown in the model No. 518. The eruption in this case is seen in every stage of development, from slightly prominent red spots, little more than a line in breadth, to circular blotches nearly three-quarters of an inch wide. In the smallest spots there is redness merely, then follows a white vesicular centre with red margin; after that the central cuticular dome subsides, while around it an annular vesicle is produced, and this again is encircled by a red margin. Sometimes the cen- tral vesicle collapses incompletely, leaving a disc of white cuticle partly separated from the rete mucosum, in which case three rings may be distinguished encircling a central white disc, the color of the rings being, firstly, a brown red, then one which is white, prominent, and vesicular, and, thirdly, a red halo. Upwards of fifty pocks in various stages are scat- tered over the surface of the hand, and in four places the vesi- cles have become abraded, and a brown exudation crust has been produced. - From the small size of the central vesicle, this form of erup- tion is sometimes, but incorrectly, denominated “herpes” iris, and the present model, on account of its vesicular centre, has received the name of “hydroa” in the Paris collection. Pemphigus iris has been first selected in our description of pemphigus because it occupies an intermediate place between erythema and phlyctena, and thereby forms a link between the typical erythema and the typical pemphigus. I may re- mind you that we have seen examples of eruption that seem to be the merest modification of erythema papulosum, but May, Lectures on Dermatology. 405 which assume the peculiar figure to which the term “iris.” has been applied, and which, consequently, we have distin- guished as erythema iris. Nevertheless, another simple lesion, namely, exudation, added to that already existing, is sufficient to convert erythema iris into pemphigus iris. Were it not for this transitional character, we might have treated pemphigus iris as the modification of an eruption, which is represented in a typical form by pemphigus vulgaris. Pemphigus vulgaris is illustrated very fully in our collec- tion by the series of drawings, casts, and models, numbered 110 to 119, which not only mark the physical appearance of the disease, namely, its hyperaemic origin, its vesication and retro- grade progress, but also the constitutionally cachectic tenden- cies of the disease. - The patient, from whom the drawings 110 and 111 were made, was a strumous boy, seven years of age. When three years old, he received a blow on the knee, the injury produced swelling, and four years later the limb was condemned to am- putation. With occasional intermissions, his life, up to the period of this report, was spent in hospital, and three years after, being invalided for his knee, the pemphigus made its appearance. The eruption was recurrent, lasting the first time for nine weeks, and subsequently for five weeks, with in- tervals ranging between ten days and two or three months. In all, he had six attacks, the eruption being chiefly developed On the limbs, and was much debilitated in constitution. The plaster casts, Nos. 112 and 113, of the forearm of a child, display very strikingly the figure and bulk of the vesi- cles, or rather blebs of pemphigus. Some of the bullae are isolated, others confluent; near the wrist is a compound bleb of large size, formed by the blending of four bullae, which were originally separate; whilst in various places others may be seen undergoing progressive retrogression. The casts in wax and plaster, numbered 114, 115, and 116, representing part of the lumbar region and thigh of a young woman, aged twenty, bear upon their face an evidence of the fatal cachexia, which constituted a part of her history. The skin is discolored, almost swarthy, from the abundance of pig- mentary deposit, the bullae are small and imperfectly develop- ed, some are in the state of collapse; dark brown stains indi- 406 Lectures on Dermatology. [April, eate where others have subsided; and, amid the rest, there are superficial ulcerations in various stages of healing, and deeply indented cicatrices. On the thigh, and within a small extent of surface, there are about eighty spots présenting every stage of progressive and retrogressive development. As we usually meet with it, pemphigus is local in its deve- lopment, limited to a part of the body, as the limbs; sometimes attacking the upper limbs, but more frequently the lower limbs. Occasionally, however, the eruption is general, as in the case of cachectic pemphigus already described, and in that from which the models Nos. 117 and 118 were made. The patient in the latter instance was a female servant, aged forty- six, and the disease proved fatal in nine days, the affection being named by Guibout acute general pemphigus. Although general, the bullae were most abundant on the extremities, a few only being scattered over the face, upper part of the neck, and trunk; their average size was that of an almond, but some were much larger. Guibout notes that one day the bulla on the hand was a large, flat, uniformly elevated erythematous patch, bordered by a rose-colored areola, and on the next be- came distended to its present dimensions. The young woman had a general appearance of health ; she had been troubled for four months with nocturnal pruritus, beginning in the legs, and thence extending to the whole body; for these symptoms she took baths and applied ointments, and the pemphigus fol- lowed immediately upon the use of an ointment containing turpentine. On admission into hospital, she was suffering under enteric derangement, with a pulse of 1.12; three days later the tongue was coated, and the pulse 104; the next day the tongue was white; the day following the pulse was 100; there was much prostration, with delirium and a hot skin; the day afterwards she became comatose, the delirium continuing, and she died in the night without reaction. After death, the chief internal morbid appearance was congestion of the mucous membrane of the small intestine. * The model No. 119 is another example of pemphigus deve- loped in this instance on the lower half of the right leg. Lail- ler terms it “acute pemphigus.” Over a limited extent of surface are scattered nine bullae, ranging in size between that of the hemisphere of a large pea and that of a large hazel-nut, May.] - Lectures on Dermatology. 407 and about the same number of circular excoriations caused by the rupture of other bullae. The contents of the bullae are semi-purulent and opaque, the distended bullae are without areolae, but the excoriations are surrounded by an erythema- tous desquamating border, within which is seen an edge of collapsed cuticle, and within the latter a thin brown scab. On one or two the scab is thicker, almost amounting to a crust : from others an ichorous sanguinolent discharge is seen to be issuing, and in two places there are clusters of three or four excoriations in which the erythematous borders and excoriat- ed bases have become blended so as to form inflammatory blotches. If now, from our new point of view, we contemplate the groups of cutaneous disease which the present enquiry has brought under our notice, eczema, as representing common inflammation of the skin, revelling in almost every form of lesion of which the integument is capable, and erythema pre- senting the most elementary form of disorder, namely, simple hyperaemia, with or without disturbance of cell function, and advance toward phlyctenous affections in the instance of pemphi- gus with the curiosity and interest which attach to the ques. tion: What will cutaneous inflammation do next 2 What it will do and can do is now before us in the illustration of pem- phigus; the hyperaemia or erythema of the skin will be rapidly succeeded by the effusion of an aqueous lymph over the whole surface, as if the latter had been subjected to the irritation of a blister; the erythematous base is circular in its figure, and the blister or bulla is equally round. If the erythematous base be small, the blister will be correspondingly small, and if, as is very commonly the case, the erythematous blotch increase by its circumference, the blister wºl likewise increase until it ar- rive at the very edge of the erythematous base, and attain a magnitude of very considerable extent. And this is one of the peculiarities of pemphigus, that the blister appears to arise from the unaffected skin, often without a trace of areola or without any margin of hyperaemia around its circumference. In the models before us, we have blisters of very considerable size, but we occasionally hear of their reaching the bulk of an egg, of an Orange, and even a greater magnitude. We may realize the idea of pemphigus by a word, such, for 408 J.ectures on Dermatology. [April, example, as idiopathic blister or spontaneous blister, and just as we know the effect of a blister of cantharides, or of a jet of boiling fluid, or of a flame of fire, to be at first redness and then a blister; so in pemphigus we see the blister rising spon- taneously without either epispastic, or scald, or burn. We may, however, very reasonably infer that, although there has been no irritant applied, yet that a similar change has taken place in the skin;' and, as we know that the effect of these irritants is to lower the vital dynamics of the skin, so must we, in the absence of any external agent, arrive at the conclusion that some cause capable of reducing the vital force of the skin is present in the organism; and, furthermore, that such cause being the agent of a lowering of the vitality of a part of the body, ap- proaching to a partial death of the skin, will be a matter of serious portent to the life of the individual. The conclusion is inevitable. Pemphigus is a grave and serious affection, an associ- ate of cachexia, always a symptom of a depressed vitality of the organism, and not unfrequently a sign of a fatal state of dis- order of the economy. The whole of the cases that we have examined are suggestive of a grave and frequently fatal de- rangement of the organization, and those which follow corro- borate this anticipation. In pemphigus we have the opportunity of noting certain phenomena resulting from the nature of the exudation which, however simple in themselves, are nevertheless worthy of our observation. The exuded fluid which, in its qualities, corre- sponds with the serum of the blood, is at first perfectly trans- parent, but gradually becomes opalescent, and at a later period is more or less distinctly yellow from the development of pus globules. In its transparent state it displays like an optical lens the congested base upoff which it has arisen, and en- ables us to observe that the base is one while crimson and another while purplish in its hues; but as opalescence sets in, this feature of the eruption is lost. A similar observation be- comes a mark of diagnosis in the instance of the minutest of the phlyctenae, that which, from its millet-seed size, is termed miliaria. The cuticle in miliara is remarkable for its tenuity; its little rounded vesicles resemble beads of sweat upon the skin, hence its cognomen, Sudamina ; and the one while trans- parency that transmits the red color of its base, and another May.] Lectures on Dermatology. 4.09 while opalescence that recalls the appearance of drops of milk, have gained for it the distinctive appellations of miliaria rubra and miliaria alba. These appearances are well illustrated by the models on the table, and I beg to call particular attention to the model 117, with respect to which it is especially noted by Guibout that the large bulla on the back of the hand, measuring about three inches square, was one day a large, flat, uniformly, but very slightly elevated blotch, bordered by a rose-colored areola, in fact, an erythema, and the next day the enormous vesication that we now see before us. The transparency, the bright color, and the benignant puru- lency of the bullae of pemphigus are always grateful to our eye as being of good augury and teeming with hopeful expec- tation. But the purplish, and purple, and leaden colored tints are less satisfactory. Sometimes the fluid of the blisters is reddened or empurpled by admixture with blood, which may be the result either of accidental pressure or friction, or the consequence of haematolysis, which betokens a state of cachexia in a more or less advanced degree. We are all familiar with the ugly, flat, leaden-colored bleb of a devitalized chilblain, or the sanguineous bleb of a carbuncle, or the equally ill-condi- tioned bleb of a cachectic rupia—these are so many examples which find a comparative illustration in pemphigus when it Occurs in a cachectic constitution. Another point of interest that attaches to the history of pemphigus is the mode of retrogression of the bleb. The more natural course of the retrograde change would be the gradual collapse of the vesicle. It becomes wrinkled, it con- tracts, it subsides, it falls down upon the surface from which it arose, it dries up into a thin scab which covers the base for awhile, being kept in its situation by the agglutination of its inspissated contents, and finally it drops off in the shape of a thin flat scale when the base upon which it rested has healed and has become reinvested with normal epidermis. I am de- scribing the most favorable course of retrogression of a pem- phigus—one which presents the least possible departure from the standard of health, in fact the history of the healing pro- cess of a common blister; but you will perceive at once how a variety of small accidents may alter the harmonious working of the curative operation. The bleb may be accidentally VOL. I.-31 410 Lectures on Dermatology. [April, bruised, or broken, or displaced, and then the covering of the inflamed skin will be a crust resulting from the exudation of inflammatory products. Or an exudation of inflammatory products may accompany the ordinary mode of healing by evaporation, and the scab may attain considerable thickness. Sometimes, also, in a state of low vitality at the cutaneous tis- sues, there may occur Superficial gangrene and sloughing suc- ceeded by ulceration. The French dermatologists have described a form of pemphi- gus which they denominate pemphigus foliaceus. The disease itself is of the low and cachectic type; the eruption is serpigi- nous in its character, creeping outwards upon the neighboring skin; the contents of the bullae are aqueous and non-plastic, and the cuticular dome of the bulla, falling into wrinkles as it descends upon the inflamed base, and drying into a thin grayish and tawny scab, has suggested the idea of a dried leaf, and the corresponding designation of the form of the eruption with which it is identified, that of “pemphigus foliaceus.” I may also mention in this place, and as a note for future comment, that I have seen pemphigus in association with scabies, and also with prurigo. In these instances, the blisters were the consequence of a neurosis, and this explanation will help us to understand the nature of some cases of local pem- phigus which are rare, but which have been described under the name of pompholyx. - Another phlyctena of smaller dimensions than the phlyctis of pemphigus, but one of an interesting and important charac- ter, has been termed herpes; and herpes is illustrated in our collection by a series of specimens beginning with No. 120 and extending to No. 127. It is no part of my intention or wish to disturb the signifi- cation of a term which was settled by Willan, and has been accepted by all dermatologists since the days of our distin- guished countryman; but it is a habit with me, and one be- yond my control, to endeavor to search out the meaning of the words which I am required to employ, believing most faith- fully that where those terms have descended from medical philosophers of such acknowledged greatness as our ancient masters, AEsculapius and Hippocrates, they must embody some intelligible signification. Passing in review the various terms May.] Lectures on Dermatology. 4:11 that I have had occasion to use hitherto in the course of these lectures, namely, eczema, psoriasis, pityriasis, scabies, lichen, impetigo, erythema, urticaria, pemphigus, and herpes, I find two instances in which I would put in a firm protest against the nomenclature adopted, one of these being lichen and the other herpes. The term lichen has been settled by Willan to signify an eruption of pimples, but the real meaning of the term is made manifest when we trace back its derivation to the word Wetzen, lingere, to lick, as though it were intended to refer to a something which adhered to the surface, as the tongue in licking adheres to a plate of glass. The illustration is perfect in the instance of the growth of a vegetable lichen on the bark of a tree, while nothing can be conceived more opposite to the genius of the word than a mere crop of pim- ples—the “papula " of Celsus. My other exception is taken with regard to herpes. Her- pes, as settled by Willan, is made to signify an eruption of vesicles. But herpes is derived from *Pºet", serpere, to creep, from which we obtain the adjective serpiginous or creeping. Now, herpes, as we at present understand the use of the term, is no more a creeping or serpiginous form of eruption than is erythema or eczema, both of which present themselves occa- sionally in the act of obeying a pathological law of the skin, namely, that of creeping onwards by the circumference into the neighboring skin, whether at the same time they heal within the area or not. The true herpes was denominated “Serpigo’” by the Latims, and the synonymous terms herpes esthiomenos and herpes exedens both occasionally crop up as the accus- tomed designation of lupus, epithelioma, and dermatosyphilis. I feel, sir, that observations of this kind cannot be out of place when addressed to a body of scientific men whose daily bread is the harvest of learning, and who are always foremost in the bands of those who seek to improve and elevate the intellectual nature of man. As a teacher, I should hardly be doing my duty were I not to endeavor to explain as I went on the technicalities which have been imported into a subject so closely identified with medicine and surgery as dermatology; while in the class-room, it is an obvious necessity to be pre- pared to satisfy the eager questions of those who have a claim to all the information we can bestow, and with whom the 412 Clinical Lecture - [April, demands of wherefore and why are very reasonably of constant OCCUll’I’êIlC62. CLINICAL LECTURE ON NERVOUs OR SICK- HEAD ACHES. Delivered at Addenbrooke's Hospital, Cambridge, Eng. BY P. W. LATHAM, M.D., F.R.C.P.L., Physician to the Hospital; Deputy for the Downing Professor of Medicine; etc. GENTLEMEN: We have lately discharged from the hospital a young man, aged 17, who, during the short time he remained here, suffered no pain or uneasiness. He was somewhat anaemic, and of rather stunted growth, but he was sharper and more intelligent than the generality of his class: with these exceptions, there was nothing about his general condition which calls for remark. He had been troubled, however, with four slight attacks of what are variously called nervous head- aches, sick-headaches, or bilious headaches: an affection which does not often come under our observation in the hospital, though I suspect that, if carefully enquired after, the percent- age of patients liable to the disorder would not be found so small as is generally supposed to be the case. In private practice, however, the affection is by no means uncommon. It affects both males and females; and perhaps in an university town, owing to the large proportion of individuals of studious and sedentary habits, it may be more prevalent among males than in other places. At all events, it is a complaint which often comes under my notice; and in the forms to which I am going to refer, I believe much may be done to moderate the intensity and frequency of the attacks. - The symptoms accompanying some forms of this disorder have been detailed ad vivum by Sir John Herschel, the Astronomer Royal, Sir C. Wheatstone, Professor Dufour of Lausanne, and others; and in the /’hilosophical Transactions of 1870, p. 247, you will find an extremely interesting paper by Dr. Hubert Airy (“On a Distinct Form of Transient Hemiopsia”), wherein he faithfully and most graphically records his own experience of the affection, and quotes the May.] on Mervous or Sick-Headaches. 413 descriptions which have been given by the above-distinguished persons. With many of the comments contained in the paper I entirely agree; but there are some points upon which I can supplement the information there given; and my chief object in bringing the subject under your notice is with a view of trying to explain how the symptoms may be produced. The headache is preceded for a variable period by certain disorders of sensation, the most striking of which is a transient disturbance of vision, which sometimes takes place. In some persons, the malady stops short here, and is not followed by headache; in others, the headache appears to be developed without any premonitory symptoms, until careful enquiry reveals the contrary. The complaint, then, has two stages: 1. The stage of disordered sensation ; 2. The stage of head- ache, nausea, etc. I will first consider the forms attended with disturbance of vision. Even this commences in different ways in different individuals, or even in the same individual. Here is Sir John Herschel’s account: “I was sitting one morning very quietly at my breakfast-table, doing nothing, and thinking of nothing, when I was startled by a singular shadowy appearance at the outside corner of the field of vision of the left eye. It gradu- ally advanced into the field of view, and then appeared to be a pattern in straight-lined angular forms, very much in general aspect like the drawing of a fortification, with salient and re-entering angles, bastions, and ravelins, with some suspicion of faint lines of color between the dark lines. The impression was very strong, equally so with the eyes open or closed; and it appeared to advance slowly from out of the corner till it spread all over the visual area, and passed across to the right side, where it disappeared. I cannot say how long it lasted, but it must have been a minute or two. I was a little alarmed, looking on it as the precursor of some disorder of the eyes; but no ill consequence followed. Several years afterwards, the same thing occurred again; and I recognized, not, indeed, the same precise form, but the same general character—the fortification-outline, the dark and bright lines, and the steady progressive advance from left to right. I have mentioned this to several persons, but have only met with one to whom it has occurred. This was a lady of my acquaintance, who 414 Clinical Lecture [April, assured me that she had often experienced a similar affection, and that it was always followed by a violent headache, which was not the case with me.” - At a subsequent period (November 17th, 1869), he writes to Dr. Airy as follows: “Since I wrote to you, I have been very frequently visited with the phenomenon in a greater or less degree. . . . It always now begins with a small glimmer near the middle of the field of view, and spreads out.” In other cases the attack begins by inability to see the spot on which the eyes are fixed, while all around is clear and dis- tinct as usual. The area obliterated soon increases, and is one- sided ; so that, to the patient, if he be walking along the streets, his friends appear with only one eye each, or he sees one-half only of their faces. The names on signboards become half obliterated ; and the patient is like Abernethy, who, when trying, after an accident, to read his own name, “could See as far as the me, but could not see a bit of the thy.” The edge of the part obliterated soon assumes the fortification-out- line, this outline being faintly luminous; objects at the centre of vision become less completely obliterated, but a glimmering vibratory movement, somewhat resembling the undulations of heated air as seen above a hot stove, appears within the zigzag outline; and this movement gradually extends over the whole. field of vision. This zigzag outline has been variously de- scribed to me. One patient stated that it appeared as though. the zigzags on a Norman arch were slowly moving along the arch, whilst another set were slowly moving over them in. an opposite direction; and the glimmering vibratory movement which filled up the field of vision, very closely resembled, he said, the appearance seen on looking through two pieces of gauze slowly vibrating in opposite directions. I will now read you a few extracts from the account which Dr. Airy gives of his own sensations. The first attack came on when at school, the last morning before the holidays: “I noticed it first by being unable to see the ‘A’ in ‘tan A,” when I looked at the top. At first, it looked just like the spot which you see after having looked at the sun, or some bright object. I thought it might be an eyelash in the way, or something of that sort; but I was soon undeceived when it began to increase. I then bethought me that it must be the May.] on Wervous or Sick-Headaches. 415 same thing that suffered from, so I let it alone, knowing that it would go off in time, which it did, leaving a most terrible headache behind it, which is the worst part of it, the blindness itself giving no pain whatever. When it was at its height, it seemed like a fortified town, with bastions all round it, these bastions being colored most gorgeously. If I put my pen into the space where there was this dimness, I could not see it at all ; I could not even distinguish the color of the ink at the end. All the interior of the fortification, so to speak, was boiling or rolling about in a most wonderful man- ner, as if it were some thick liquid all alive. It did not be- long to one eye, but to both, the right eye having the most. . . . Since then, I have very frequently been revisited by this affection. . . . When this blind spot makes its appear- ance close to the centre of vision, as soon as it begins to spread and shows a serrated margin, it at once presents the irregular horse-shoe shape, with one arm adherent to the sight-point and the other receding from it outward. The teeth of the adhe- rent arm are small and fine; those of the receding arm grow larger and larger. But when the blind spot takes origin at some distance from the centre of vision, as it spreads it pre- serves its contour unbroken, stellate, nearly circular, until its margin nears the centre of vision ; then the serration at the point nearest the centre shows irregularity, and a breach appears in the outline : one branch of the incomplete circle takes a smaller pattern of zigzag and recedes. . . . The climax is generally reached in twenty or twenty-five minutes from the first beginning; then the large arm, having over- spread the margin of the field, begins to fade, and leaves the lower part to recover slowly from the storm. The small arm is the last to perish ; it remains in strength while the large arm is dying away; but soon the outward spread carries it in turn to the upper margin of the field, and it there exhibits the same fervor that characterized the career of the larger end. The whole duration of the phenomena is just half an hour, often with curious exactness. The sight feels somewhat dazed for ten or fifteen minutes after the final disappearance of the phenomenon. Throughout the earlier part of this visual de- rangement I feel no discomfort at all; my faculties are free to observe the phenomena closely and carefully. It is not till 416 Clinical Lecture [April, near the end, when the boiling is at its height, that the eyes feel oppressed, and the head has a presage that it is going to ache. The headache comes on gradually; it is not localized in any particular part ; it lasts for five or six hours, or more, accompanied with slight nausea.” Sir C. Wheatstone says: “This evening I had a curious affection of vision. Whilst I was writing, characters near the centre of vision became invisible. Thus, on fixing my eyes on figure 6 in the group 4%, 4 and 7 were completely obliterated. After a short time the spot became larger, spreading towards the left in both eyes until it occupied a large oval space. . . . The only difference between the phenomena, as they appear to me and as they are described by Dr. Airy, is that in my case they are always unaccompanied with color.” You will notice from these descriptions that there are dif- ferent ways in which this stage commences; viz., either by a glimmering near the outside corner of the field of vision, or by a glimmering near the middle of the field of view, or by objects at or near this point becoming obliterated. Again, in some persons the phenomena are accompanied with color; in others this is not the case, the fortification outline only being somewhat luminous. In others, again, in slight attacks there is no color, but in the more marked ones colors are seen not only at the outline, but generally vibrating over the field of vision ; and in still more decided attacks numerous stars are seen floating in all directions. Another very important point about these attacks is, that in perhaps from one-fourth to one-third of the cases during this glimmering stage, there is tingling in some portion of the body—the part is asleep. In a young female that I saw, the tingling affected one arm and the side of the tongue; and, curiously enough, both her sister and her father were affected in precisely the same way. The tingling was on the same side as that on which the glimmering in the eye began. In another case, the patient complained of a feeling of pricking and scratching on that side of the face corresponding with the glimmering. In others, speech or hearing may be affected. The Astronomer Royal (Philos. Mag., vol. xxx, p. 21) says: “In one attack on myself, which occurred while I was conversing with an acquaintance in a railway carriage, I soon became painfully sensible that I had May.] on Wervous or Sick-Headaches. 4.17 not the usual command of speech—that my memory failed so much that I did not know what I had said or had attempted to say, and that I might be talking incoherently.” In refe- rence to another case, Dr. Airy says: “Sometimes the speech is affected and the memory at the same time; on one occasion the mouth was seen to be drawn to one side.” . The last question I have to allude to about this vibrating stage is, Are both eyes equally affected Dr. Airy thinks they are. Sir John Herschel says: “I have sometimes had an impression that one eye only was affected—the right eye being affected with the right-handed, and the left with the left-handed, spectrum ; but I never could devise any means of coming to a conclusion as to this point, and on the whole I lean to the opinion that both eyes are concerned in either case.” But a few months later he writes: “On the 16th ultimo, on waking, I found the ‘fortification pattern certainly in my left eye only, and much more vivid with the eye open and looking at paper than when closed. I think, for reasons which will be given when I come to explain the phenomena, that at all events at first and in slight attacks one eye only is affected, but that the tremor and boiling are so oppressive as nearly to extinguish the corresponding vision in the other.” Now this disturbance of vision is often associated with a feeling of chilliness, cold hands and feet, etc.; it may last from five to thirty minutes or longer, and then be succeeded by the stage of headache, which shows itself as follows. When the vibra- tory movement is at its height, a little aching is felt in the head, on the side opposite to that on which the glimmering first appeared : it is slight at first, but gradually increases in intensity. Some persons have said that the sensation was as though a point in the temple were being bored with a gimlet, and the gimlet slowly increasing in size. The pain gradually spreads from this point, which may be covered with the finger, and pressure upon which affords relief, first over one side of the head, and then, but not always, extends to the other. As the headache increases, the ocular disturbance declines, nausea is felt ; this increases with the headache; there are retching and vomiting, the latter sometimes, though rarely, giving relief; the head throbs; the slightest movement increases the pain ; and any attempt to move from the recumbent posture 418 . Clinical Zecture [April, increases the gastric uneasiness ; the mouth feels clammy; the eyeballs ache, and are tender on pressure, one more so than the other; the pupils are rather contracted, and generally un- equally so ; the patient lies apparently more dead than alive; his face pale, and the head hot. After a varying number of hours he is somewhat relieved by troubled sleep; he wakes up next morning free perhaps from headache; but he is list- less; his brain is weary, and he feels as if he had undergone a hard mental struggle. There may be now an interval of a few days, weeks, or years, before the disorder again shows itself. - The headache varies much in character, degree, and dura- tion. In some persons the pain is not localized in any par- ticular spot, but seems generally diffused over the head; others have not noticed that there is more pain on one side of the head than the other, or that the aching radiates from one painful Spot until their attention has been directed to the fact, and then they distinctly recognize it; others, again, have neither vomiting nor nausea; and lastly, the duration of the headache may be very short or not extend more than two or three hours, or it may be entirely absent. The disorder may even stop short at the vibratory stage, the vision be restored, and no further inconvenience felt. On the other hand, the headache may be, and in many indi- viduals always is, developed without the ocular disturbance, but other sensations are substituted for it. The patient has a feeling of chilliness; the feet are cold, and there is mental depression; a dread of impending evil; he is restless and uneasy; “cannot quite tell,” as he says, “what he would be at; ” he has what is expressively called the “fidgets.” This condition may continue half an hour or more, and then the slight boring piercing pain is felt in the head with which the aching begins, and the disorder runs its course as in the forms previously mentioned. In other cases, this feeling of depres- sion or uneasiness lasts for several hours, the patient goes to bed, and in the early morning wakes with the headache fully developed. I will now state the conditions under which this disorder shows itself. The great majority of persons who have come under my notice suffering from the headache were at the time May.] on Wervous or Sick-Headaches. 419 more or less anaemic; there was a general want of tone—a relaxed condition of the muscular and the arterial systems, especially of the latter; the pulse being rather small and soft, often decidedly slow, but much accelerated on slight exertion or excitement. Even in those who were not anaemic and appeared robust, there was still this want of tone about the pulse. The sufferers possess what is called the nervous temperament; their brains are excitable, their senses acute, and their imaginations free. The attacks are induced by pro- longed mental work, protracted mental excitement, or any intense strain on the feelings, such as grief, anxiety, passion, etc. Bodily fatigue, late hours, loss of sleep, the depression which follows over-excitement, a debauch, etc., are all predis- posing causes; and it is curious that the attack is not generally developed during the paroxysms of mental excitement, but afterwards, when the excitement has passed off, and the mental strain is somewhat lessened. Again, in females, the attacks are more frequent at or after the catamenial period. Now, it is to be observed that all these causes, and causes like to them, are of a depressing nature; exhausting the powers and, therefore, lowering the tone of the system ; putting it Out of tune, disturbing the harmony in the functions, and, at the same time, exalting the susceptibility of the nervous system. What results? We possess, besides the cerebro-spinal system of nerves, a sympathetic nervous system, the ganglia of which can conduct, transfer, and radiate the effects of im- pressions, their power being controlled and regulated by the superior force in the cerebro-spinal centres. Let the general tone of the body be lowered, and with it the regulating power of the brain be impaired, then the conduction and radiation of impressions through the sympathetic ganglia are no longer interfered with, and, instead of tranquil, even, harmonious action in the various organs, as in perfect health, we have convulsive, excited, and painful movements. Let me say one word or two now with regard to the physiological action of the sympathetic nervous system. Its branches, constituting the so-called vasi-motor nerves, reach their ultimate destina- tion supported on the large and small arteries, and control, in a remarkable manner, the action of the muscular coat of these vessels. If the sympathetic nerves distributed to any part, as, 420 Mervous or Sick-Headaches. [April, for example, the neck of a rabbit, be divided, the small arteries of the corresponding side of the face and of the lining mem- brane of the external ear become dilated, blood accumulates in them, and there is an elevation of temperature. The retina becomes more sensible to light; the pupil, in consequence of the action of the oculo-motor nerve on the circular fibres, con- tracts, and a flow of tears takes place. If the distal portion of the cut nerve be now irritated by galvanism for a minute or So, the vessels contract so as to diminish their calibre, the radial fibres of the iris contract, and dilatation of the pupil takes place. I shall now proceed to apply this to the disorder we have been considering, and to show first of all that we have con- traction of the vessels of the brain, and so a diminished supply of blood produced by excited action of the sympathetic ; and that the exhaustion of the sympathetic following on this excitement causes the dilatation of the vessels and the head- ache. GOOD EFFECTS OF ELECTRICITY IN A CASE OF SPONTANEOUS GAN- GRENE.—In Lo Sperimentale, January, 1872, Dr. Virlet mentions a case of spontaneous gangrene which had lasted a year. The person attack- ‘ed was 58 years of age, of lymphatic temperament, not presenting any symptom of disease of the heart or great arteries, affected neither with albuminuria nor diabetes, he was placed by certain physicians under treatment with iron, sea bathing, change of air, opiates, and dry per- chloride of platina. On June 1st, 1858, Dr. Virlet saw him for the first time, when three toes of the left foot had fallen off, leaving in their place an eschar, whence issued a reddish, sero-sanguinolent liquid char- acteristic; the left foot was cyanotic up to the tarso-metatarsal region. On June 3 he first was galvanized; on the 10th a sensible amelioration was already noticed, and a diminution of the cyanosis; on the 20th the patient being forced to be absent, was not galvanized, when the blue color of the toes became darker; on July 15th the right foot was cured, and the left going on pretty well. On October 1st the patient went to 'business again ; when seen again in Dccember he walked well. In the treatment both feet were placed in electric baths, and the eschars were treated with coal tar, after being touched with perchloride of iron. According to Dr. Virlet, the curative action of electricity is with- out dispute, and in this case it acted, by producing the double phe- nomenon of re-establishing and accelerating the circulation, according to Claude Bernard's experiments. TEETOTALISM IN FRANCE.---The French anti-tobacco association is widening the field of its operations, and now includes alcoholic liquors among the abuses which it aims at remedying. This is the first temper- ance society established in France. May.] Miscellaneous. 421. jūig tellatteottº Sétlettions from 790 me and j}oreign. 3)0ttrital g. DR. KRAUS ON INFANTILE SYPHILIS, AND DR. HERMANN, OF VIENNA ON TREATMENT OF SYPHILIS.—By C. R. Drysdale, M.D., M.R.C.P., Phys. Met. Free Hosp., Lond.—The Vienna school is at present much occu- pied in the discussion of the nature and treatment of syphilis. Dr. Kraus, editor of the Wien. Allge. Med. Zeit., in the issue of March 5th, observes that he believes that a newly-born syphilitic child may infect its own mother (which I doubt greatly), and that he thinks that all such infants should be brought up by hand, and not given to any nurse (in this last I agree). Great cleanliness is requisite in treating syphilitic children. Local treatment consists in the touching of lips, anus, etc., with a hair pencil dipped in a solution of caustic of some kind. Calo- mel, says Dr. Kraus, is undoubtedly the best remedy for syphilitic children. Corrosive sublimate and Iodide are bad. Only in very, very uncommon cases, when diarrhoea or vomiting exists, is the use of oint- ment of mercury useful, and 0.30 grammes are to be rubbed in in va- rious parts. He mentions that Monti says than an unction is unsuitable for the delicate organisms of children. Kraus says that preparations of iodine do not suit suckling children. In this I entirely disagree with him, as I have found one-grain doses of iodide of potassium succeed well in many cases. Calomel is to be given in doses of one-fifth of a grain four or five times a day for a fortnight, and then lactate of iron in small doses. Dr. Hermann, of the Wieden Hospital, in the same journal of the 27th February, says: “I could fill a volume with all the ways and means. taken by the opponents of my experiments.” These gentlemen used every means to put a stop to his non-mercurial treatment of syphilis in the Wieden Hospital. That such attempts have not succeeded he attri- butes to the fact that in the syphilitic section of the hospital the time taken for the cure of the disease is one-third shorter than in the other hospitals of Vienna, and that this division of the hospital has given a lesson to all who care for evidence against mercury, by its 25,000 cases which have been successfully treated there. Dr. Hermann proposes, then, that a systematic carrying forward of experiments on the nature and treatment of syphilis be instituted, and that statistics be collected in the three large Viennese hospitals for the next ten years. By this means, he maintains, the question of syphilis may be solved, and a rational diagnosis and treatment attained to ; mercurial poisoning will be less frequent, and an attempt will be made to solve the problem of prostitution.—Med. Press and Circular, April 3, 1872. HYDROCHLORATE OF NARCEINE FOR HYPODERMIC INJECTIONs.—Dr. Petrini, in the Bulletin de Thérap., advocates this salt as superior to sul- phate of atropine or muriate of morphia. In very small doses, five milligr. to one centigr., its calmative power is manifest. It is superior in its power to control sickness to salts of morphia. When all prepara- tions of opium or morphia fail as hypnotics, a small dose of the salt of narceine will succeed. In the smallest doses its effects are also to slightly raise the temperature, as well as the frequency of both the pulse and respiration, but at the same time to reduce arterial tension. Hot BATHS IN DROPsy.—In the last volume of the Jahrbücher für Rinderheilkunde, Dr. A. Steffen, treating on this subject says that the youngest child and the most feeble person may be safely treated in this way. The only caution needful for the weakest is not to repeat the 422 Miscellaneous. [April, baths too often, as the loss of bodily weight may go on for one or more days after a single bath. The bath should be at about 28° R., and in- creased up to 32° or 34° R. whilst the patient is in it, and the latter should afterwards be well covered in bed, so as to sweat him for two or three hours. These baths are indicated by general oedema, and by free exudation in the peritoneal cavity, in the pleural cavity, and in the pericardium, provided in the last case that the disease has not progressed too far. Tonics, such as iron and quinine, can be used at the same time. Dropsy from improper nourishment or care, and dropsy after severe sick- ness, the expression of a loss of heart power, will often disappear by ju- dicious general treatment and nursing; sometimes the hot bath may be used with advantage. In the dropsy appearing during scarlet fever, without kidney affection, on the first appearance of the oedema the bath should be used, a practice which the experience of the Children's Hos- pital at Stettin strongly confirms. The use of the hot baths for dropsy after scarlet fever is not, however, followed by uniform results. In some cases the first bath is followed by profuse sweating and loss of weight; in other cases two or three baths are required before any re- duction commences. In a third set the swelling and exudation steadily increases for a time, in spite of the use of the hot bath; and after a de- crease has apparently set in, a renewal of the increase may take place. In all these cases, however, with very rare exceptions, the disease finally yields to the treatment. In dropsy dependent upon organic disease, the hot-bath treatment is often of great service in freeing the patient from the torture of the dropsy, even when it can have little or no effect upon the final issue. In dropsy associated with acute kidney disease, especially after scarlet fever, caution must be practised in the use of hot baths, although they are often very useful. They are contra-indicated by capillary bron- chitis, or the commencement of oedema of the lungs; when these are present, they have a very rapidly fatal influence. When the urine is be- ing passed in very small amount, they must also be avoided, as tending to lessen still further the excretion, and favor thereby uraemic eclampsia. In such cases Dr. Steffen has used the warm (not hot) baths, with cold- water douche and leeches to the head, benzoic acid internally, and has not lost a single case. The contraindications to the use of the hot bath are: fever, acute disease of the brain, high grade of transudation and exudation into the pericardium, threatening of Oedema of the lungs. In some cases, when the lungs have been entirely free, the oedema will come on during the bath, betraying itself by great sudden dyspnoea. The patient in such cases should be immediately taken out of the bath, and cold water poured upon his neck, head, and back. - ON ABSORPTION THROUGH THE SKIN FROM FULL BATHS.—Dr. Chrzonzewski details some experiments in the Wiener Med. Wochen- schrift. The anus and the urethra being covered up, and in thick- haired animals the skin shaved, in a two per cent. solution of muriate of morphia the animal died in eighteen to twenty hours; in one per cent. of strychnia, in two and a half to four hours; in one per cent. of nicotine, in one to one and a half hours; in two per cent. of cyanide of potassium at 2° C., in a half to one-third of an hour; more quickly at a higher temperature. A boy, aet. fifteen, remained six hours in a sitz bath (65° C.) of infu- sion; of digitalis (one-half pound to four buckets of water); fourteen hours afterwards the influence on the heart manifested itself, the pulse fell from 84 to 60, gastric and cerebral symptoms came on and lasted two days. - In order to test the method of absorption, such experiments as the May.] Miscellaneous. 423. following were instituted : Ferro-cyanide of potassium was injected into the vein of a dog, and the animal placed in a bath containing an iron salt; in three to five hours the veins and capillaries of the skin were stained an intense blue, the cellular tissue remaining colorless. The following conclusions were arrived at: 1. The skin of man and animals is permeable to substances in watery, and still more easily in spirituous solutions. 2. Elevated temperature hastens absorption. 3. Absorption may take place in various ways—diffusive (Indigo carmine), through the blood-vessels (formation of Prussian blue), and through the lymphatics (ammoniacal solution of carmine). 4. The lymph vessels have their origin in the cells of the connective tissue. SchöLMANN on SULPHATE OF QUININE IN CHOLERA.—In the All. Wien. Med. Zeit., Feb., 1872, Dr. Schölmann says that in 1866 several American physicians, in the cholera epidemic of the Mississippi Valley, had obtained remarkable results from sulphate of quinine. The author lost in the epidemic of 1866, in Western Texas, out of 220 cases of choleraic diarrhoea and cholerine only three cases when he used the sul- phate of quinine in gramme doses every two or three hours. Occasion- ally a quarter-grain dose of morphia was subcutaneously injected. When the diarrhoea did not disappear quickly, small doses of calomel were given hourly. Rest in bed and careful diet were observed. The author looks upon the way in which quinine acts as being due to its antiseptic properties; and he looks upon cholera, not as a parasitic dis- ease, but as an acute tonic gastro-enteritis, with which is conjoined, in the period of asphyxia, an universal spasm of the vessels of the most marked form, a tetanus of the arteries. In whatever manner the poi- sonous particles enter the system is immaterial, the first symptoms of their entry are confined to the mucous membrane of the intestines, and it appears probable that at first the cause of the disease is a local and distinct one. A slight incubation precedes the disease, on which the catarrhal stage follows. 4łº ELEPHANTIASIS.—In Virchow's Archiv, 1872, Dr. Lair says that the first symptom of elephantiasis is a special erysipelas. The second stage is characterized by a thickening of the corium with increased quantity of epidermis. The stage of acme is marked by a hypertrophic combination of both coats of the skin : the papillae at the same time are also hypertrophied, but they remain sharply marked, and the layer of fat disappears by degrees. . The papillae keep their physio- logical appearance longest. The freedom of some spots on the skin from elephantiasis swelling is explained by the pressure which the skin exercises on some of its parts. The deep layer of the corium in diseased spots is distinguished from the superficial, not only by the general di- rection of the fibres and the serous infiltration, but also by the coloring, which is between yellowish and brown, which is caused by a large development of elastic tissues. At the commencement of the second stage of the disease there are formed, in the rete of the skin, heaps of lymphatic cells, which are seated in the upper layer of the hypertro- phied connective tissue. These cells are also found in ordinary erysi- pelas, in sclero-derma and oedema of the skin. ON THE TREATMENT OF FEVER BY COLD BATHS OR ICE-BAGS.— Dr. W. Leube, in the Deutsches Archiv. für Klin. Medicin., considers the use of bags of ice much superior to cold baths, as the patient is not moved and fatigued so much ; the shock is not so great to the nervous system, and, the circulation of but a portion of the surface being inter- fered with, there is less danger of internal congestion. e Dr. W. Leube's position in a military hospital, during the late war, 424 Miscellaneous. [April, brought under his care a large number of fever cases, who were success- fully treated by the cold bath, but French prisoners objected so much to the bath that he was led to devise a new method of reducing the temperature. Two parallelogrammatic water-tight bags of India-rub- ber cloth were prepared, one 70 cm. long and 45 cm. broad, the other 60 cm. long and 45 cm. broad unfilled. These bags were filled with a freezing mixture of powdered ice and salt. Five or six pounds of ice powdered, and passed through a sieve, were put into each bag, and then one to one and a half pounds of salt added. Two bandages were then laid transversely across the bed, and the ice-bags were placed on them in such a way that the shorter should correspond to the trunk, the longer to the legs of the patient, who was laid upon the ice-bags after they had been covered with a waterproof and a linen sheet. By means of the bandages the man was then tied down, one band passing over him above the knees, and the other above the navel. The patient was then covered with bed-clothes allowed to remain upon the ice-mattress from an hour to an hour and a half. The treatment was scarcely ever objected to. The following are the details of one case: Time, Temperº *… 6.15 39:20 Pulse 96. ... 6.20 392 Lower of the ice-bags, upon which patient had been lying, placed on front of the legs. 39.0 38-95 Pulse 87, full. 38-97 Patient commenced to tremble. 38-95 & '. * , 6.45 38.80 Cold mattress removed. 7 38.7 7.30 38.7 8 38.8 Referring now to the earlier use of cold baths, we find, according to the Allgemeine Medicinische Central-Zeitung, that their use was well test- ed in the epidemic of petechial typhus in Breslau, 1868-69, for in the first portion of the epidemic, 498 cases were treated expectantly, in the last period 246 by cold baths. Every two hours, if the temperature rose above 38° C., the patient was put in a bath at 15° R., for fifteen minutes. After bathing, the temperature fell from 18 to 2° C., and re- mained so one-half to one and a half hours. The duration of the fever did not appear to be lessened, but its mortality decidedly so. 16:47 per cent. died of cases treated expectantly; only 9:28 per cent, when the bath treatment was commenced the first week; 14.66 per cent, when it was not begun until the second week of the disease. Complications, such as pneumonia, were most rare under the water treatment. TINCTURE OF IoDINE IN WOMITING.—Schneider, of Offenburgh, in a patient who was taken with salivation and vomiting after intermittent fever, which vomiting continued for several weeks incessantly, in spite of various remedies, administered the tincture of iodine in doses of ten drops on sugar thrice daily, and obtained after the first dose the cure of these symptoms. In the same way, too, he treated with great success a soldier laboring under intermittent fever, which had resisted all the antipyretics from quinine to arsenic. The intraparenchymatous injec- tion of iodine in the treatment of hypertrophied tonsils had been used with great success by Dr. Rumbold. The liquid injection is composed of 10 centigrammes of iodine, 2.40 grammes of iodide of potassium, and 30 grammes of water. After each injection, slight inflammation succeeds, which soon disappears. Twelve to seventeen injections are May.] . Miscellaneous. 425 required to restore the tonsils to their normal size, two injections weekly. This practice has the advantage of retaining intact the sub- stance of the tonsils. PHOSPHORUS PoſsoRING.—Vetter, in two cases of poisoning by phospho- rus, obtained a cure by administering the essential oil of turpentine, after having made the patient vomit. The formula made use of was:-- Mucilage 300 grammes, essential oil of turpentine 10 grammes. To be taken in four draughts, in the course of an hour. PHTHISIS PULMONALIS IN THE ITALIAN ARMY.-In the Rivista Clin. di Bologna, Feb., 1872, Dr. Tosi mentions that of 11,358 deaths in mili- tary hospitals in 1862–63–64, 2,173 were caused by phthisis pulmonalis, and not less than 1,218 affected with this disease were sent home to their own country. This gives the mean annual deaths in the Italian army from 1862 to 1864 as 3,786, and 19:10 per cent. of this was attribu- table to phthisis. The Sardinian army in ten years, of 5,171 deaths, counted 492 from pulmonary phthisis; i.e., 9:50 per cent. The French army in French garrisons has 22.90 per cent, of deaths from phthisis. The Prussian army, according to Baudin, has 23:50 per cent. ; and the Bavarian army has a proportion of 26 per cent. The Russian loses 31 per cent. of its soldiers by phthisis; and the Swedish army, in the gar- rison of Stockholm, from 1829 to 1851, out of 2,207 deaths, had 827 by consumption ; that is, 37-50 per cent. The annual mean force of troops in Italy, again, from 1862–64 being 262,747, there were 724 of these died, of phthisis, or in the proportion of 2.80 per 1,000. In the Sardinian army, from 1834–43, the proportion was 1.60 per 1,000. The French army in French garrisons, about 2 per 1,000. The Prussian army, according to Carper's statistics, loses 3:10 per 1,000. The English army loses in the garrisons at home 6:20 per 1,000 annually from phthisis pulmonalis. The Russian army shows the great proportion of 12:50 per 1,000. The entire mortality in the French army had diminished from 1846 to 1864 no less than 48 per cent. The army is in great part composed of the males from 20 to 30. In the city of Milan and Corps Santé in the three years 1863–4–5, the annual mean of the general mortality among males, with the exception of soldiers, from 20 to 30 was 380, of whom 124 died of phthisis. In the city of Turin in the year 1864, the general mortality of males from 20 to 30 was 220, of which 87 by phthisis; that is, in the one case a propor- tion of 32.60 per 100, and in the other 39.50. It would appear from. this examination, that the army was less decimated by phthisis than the male civil population of Milan and Turin. But it must be remembered that from 1862 to 1864, not less than 1,218 soldiers affected with phthisis were sent home to their own houses. However, it would seem that phthisis is less common in the Italian than in other armies, and it is probable that phthisis is more common in the army than among males of like age, 20 to 30, in civil life. DR. BONFIGLI's SUMMARY OF THERAPEUTICS. —In the Riv. Clin. di Bologna, February, 1872, Dr. Bonfigli mentions that Jones recommends belladonna in gradually increasing doses in spermatorrhoea. Atropine is recommended by Hosch in many cases of myopia. Philipson recom- mends belladonna in constipation. Echeverria and MacDonald recommends conium as the best narcotic” remedy for epileptics. The juice of the fresh plant is used. Mr. Veagh considers datura tatulae the best remedy for asthma, far better than stramonium. . Dr. Reichard, of Riga, has found chloral hydrate of great use in cholera; four grammes of chloral produced sleep in a few minutes, and the patient recovered. VOL. I.-32 426 - Miscellaneous. [April, Dr. Lutz has found great benefit from the use of bromide of potassium in epilepsy. His doses are large, from 10 to 20 grammes daily. No great inconvenience has been produced, except some few papules on the skin. In one case of nocturnal incontinence of urine, it was very useful. Dr. Northrop says that a gramme of this salt every hour will get rid of tape-worm. Dr. Palmberg has used ergot of rye with success in three cases of chronic diarrhoea. To children he gave 50 centigramme doses of the ergot in watery extract in one day ; to adults he gives 1:20 grammes. Dr. Vance alleges that he has obtained cures in some cases of palsy by the subcutaneous injection of strychnine, in the dose of five mille- grammes of the phosphate. TREATMENT OF VENEREAL ULCERs BY DR. HEMARD.—In the Med.- Chirurg. Centralbl., 1871, Dr. Hemard asserts that for the last twenty years he has obtained the cure of soft and hard sores by simply irrigat- ing the parts with cold water. A vessel of cold water is fixed to the walls of the room, at such a height that the water which comes from it through a tube attains a certain force of projection. The patient has no more to do but to wash his ulcers every three or four hours under this stream; in a few days the ulcer becomes clean, and quickly heals. All other treatment is superfluous. In ulcers of the prepuce, which are out of sight, after irrigating, a little starch flour is introduced. When the superficies of the ulcer has lost its characteristic aspect, a stratum of Collodion is painted on it, and it soon heals. DR. GUISEPPE Poggſ, on CALO MEL INJECTIONS.—Dr. Poggi, writing to Dr. Scarenzio (Giornale dell. Mall. del, Pel.), says that in his wards a man, C. V., soldier in a cavalry regiment, entered in August, 1870, with syphilitic ulcerations and mucous patches in the fauces. Three injec- tions were practised with the syringe ; the first on 26th August; the second on 5th September. An abscess succeeded to each injection, which opened spontaneously; but the cure was complete on the 6th December. P. V., a soldier, in the same regiment, entered hospital the 18th No- vember, 1870, for mucous papules (some months after being attacked with indurated sore on the penis). Injection of calomel was used on the 26th November. An abscess after this was opened 6th December. The mucous papules disappeared without any further treatment, and he left completely cured in January, 1871. C. A., a soldier, in the same regiment, entered hospital 29th Novem- ber, 1870, for scattered papular syphilis over the whole body. The first injection was made on December 1st. The abscess formed on the 6th day, and as it was very painful (indeed, an exceptional affair), it was opened on the 8th. This, too, had the appearance of sanguineous abscess. He got perfectly well without any other treatment, and left hospital, 4th January, 1871. In three cases the dose of calomel was 25 centigrammes (about four grains), and the injection was made at the external and posterior aspect of the arm, and external aspect of the thigh. T. P., a soldier, entered hospital for indurated ulcers on the glands *nd inguinal buboes, 24th August, 1869. The bubo suppurated, and then followed sinuous abscesses which required numerous incisions. Injections of calomel suspended in mucilage of gum arabic were made use of in doses of 30 centigrammes (5 grains). The first on the 3d October, 1869; the second on the 7th October; and the third on the 22d of the same month. He left completely cured on 26th March, 1870. The long duration of treatment was caused by the loss of substance in May.] Miscellameous. 42'ſ the soft, parts. In this case the abscesses were all open, and washed with solution of sublimate, 15 centigrammes to 300 grammes of dis- tilled water. DR. Cort EJARENA ON SACRIFICATION OF THE Os UTERI.-In the Pabellon Medico a case is mentioned where the above-named gentleman succeeded in notably alleviating symptoms of congestion of the cervix uteri by scarifying the cervix, instead of applying leeches. We notice that Lister's plan of dressing wounds is in favor with Spanish surgeons. QUININE IN CHOLERA.—Professor Bolkin, in the cholera epidemic which took place in St. Petersburgh in 1871, made use of the sulphate of quinine, which he administered in doses of 20 to 30 centigrammes at a time, three or four times a day, and even more frequently if the sub- stance was vomited ; in many cases he also made use of a subcutaneous injection of the remedy. After using this remedy the mortality among His patients fell to 17.3 per cent. NITRATE OF SILVER IN BED-SOREs.-Betz regards nitrate of silver as the best remedy for bed-sores. Instead of making use, however, of Tint dipped in the solution of lunar caustic, he prescribes an ointment composed of five decigrammes of the nitrate of silver, fifteen grammes of lard, and thirty of wax ; which he spreads on linen, and applies to the sores, taking care that the piece is rather larger than the sore. This is repeated morning and evening. . Oxysul. PHATE OF IRON — Dr. George D. Hodge remarks, in the Georgia Medical Companion, that our best iron compounds are those having the red ovides at their base; and especially is this true when our aim is the restoration of impoverished blood. In this consists the efficacy of most mineral waters, as well as the advantages of the oxysul- phates, over many others. The first formula is no novelty, but was used by Sylvester sixty years ago. It is: LIQUOR FERRI OXYSULPH. B Crystallized Sulphate Iron, dr. iiass.; Nitric Acid, dr. iij. ; Pure Water, oz. jss. Stir well the iron and acid, by constant rubbing in a glass mortar, for at least 20 minutes—gradually add the water, and filter through white filtering paper. The result is a clear limpid fluid, which may be given in doses of from 5 to 10 or 15 drops, twice daily, in a little water or in- fusion of quassia—is easily prepared, and will be found, for general use, preferable to the muriated tincture of the shops—harmonizes chemi- cally with, and confers solubility on quinine, sulph. magnesia, etc., and may be relied on as one of the very best restoratives for debility and torpor of the liver, following successfully treated cases of hepatitis, or miasmatic fevers, in which the biliary organs have suffered. In malarial diseases Dr. Hodge recommends: B Sulph. Quinine, grs. xxx.; Liq. Oxysulph. Iron, dr. j. ; Fowler's Sol., dr. j. ; - Water, oz. ij. M. - S.—A tea-spoonful thrice daily, after meals, occasionally adding a small dose of sulph. magnesia to obviate costiveness. The iron and arsenic may be varied to meet the leading indication: B Spts. Mindererus, oz. ij. ; Liq. Oxysulph. Iron, dr. j. M. This gives a beautiful florid mixture, palatable, and in doses of a 428 Miscellaneous. - [April. tea-spoonful or so, thrice a day, not apt to disappoint as a general tonic. The ammonia promotes the action of the iron and imparts to it a decided capillary and renal tendency. We have found the liquor Oxysulph. in doses of from 3 to 6 minims with a drachm or two of the liquor ammonia acetat., every 3 or 4 hours, a valuable remedial agent in combating the forming stages of tonsillitis, scarlatina, typhoid fever, and puerperal inflammations. In these affections, I am convinced of the efficacy of this combination as superior to the mur. tinct. used in the Same way. SYRUP IODIDE IRON. B. Iod. Pot., grs. xxx.; Liq. Oxysulph. Iron, dr. ii.; Simple Syrup, oz. j. and dr, ij. M. Dissolve the iodide in the syrup and add the iron. This syrup is of a beautiful red color—will keep without deposition for years, and is a most excellent tonic and alterative, in doses of 20 to 60 drops twice a day. We will close by adding, if the brom. pot. or brom, ammonia be substituted for the iodide (correspondingly as to quantity) in the above formula, a rich gold-colored compound will result, and prove itself on trial a remedy of the first class in all anaemic, chlorotic, and nervous conditions resulting from uterine affections or otherwise. A NovKL HYPNOTIC.—Dr. Cowran, in his “Medical History of the Himalayas,” speaking of a native tribe in the northern district of the peninsula, says, when a mother goes into a field to work, or is other- wise unable to take her child with her, she selects some sheltered spot near a stream, in which she places a little straw for a bed for her infant, and then directs, by means of a piece of split bamboo, a current of wa- ter, of from one to two or three inches in diameter on its uncovered occiput and temples. This produces a soporific effect, which generally lasts as long as the water continues to flow. The sleep is said to be very soothing, and children who have been much subjected to its influence are known to have been usually free from the annoyances incidental to the period of dentition. TYPHOID FEVER AND BOWEL HAEMORRHAGE.-At the Central Medical Society of New York, Dr. Weed lately presented a paper on the treat- ment of haemorrhage of the bowels in typhoid fever, in which he referred to the grave complication of this hamorrhage and its cure. It might be affirmed that in an exhaustive fever this symptom was an alarming one. It had occurred even in convalescence ; various astrin- gents had been recommended, but their operations were not always satisfactory. He gave the history of a case where blood was passing largely, and the prognosis was most unfavorable. The styptic proper- ties of the oil of turpentine occurred to him, and he resolved to give it a trial ; he gave tea-spoonful doses repeated twice in thirty minutes, and then in smaller quantities, as the cases seemed to require; several other cases of a similar and very severe character, in which turpentine had al- ways been given with complete success, were related. CATHARTICs For ALBUMINURIA.—Dr. Moore, at the last session of the New York Medical Society, related a case where the condition of albu- minuria was removed by the cathartic treatment. He had previously advocated cathartics, especially Epsom salts. Dr. Benedict gave the history of a case of similar character; the patient had been going rapidly downward, and he had almost given her up, when he heard the recommendation of Dr. Moore, and immediately gave her the remedy, and found relief from her dropsy and the difficul- May.] - Miscellaneous. 429 ty of breathing she had experienced. In the course of six or seven days the dropsy had ceased, and the traces of albumen were less mark- ed. She omitted the salts for a time, and was taken care of by a phy- sician of Utica, who treated her differently. Her symptoms returned, and again Dr. Benedict treated with the salts, and found marked relief, but she was finally worn out and passed away. Dr. Campbell had two cases, one of which had been treated after Dr. Moore's plan. Sulphate of magnesia, he thought, had driven away the presence of albumen, but severe headache had continued; in the ‘Seventh month she had been taken with convulsions; he had put her under the influence of chloroform for three or four hours, and he had given all the sulphate of magnesia she could take; she continued through the day unconscious and no convulsions, and the next day seemed to be improving, but some shock occurred. The test “showed two-thirds albumen; coma occurred; one hand and foot were not used by the patient; artificial delivery followed, when she sank and died in a comatose condition. Dr. Mowris enquired whether this treatment had been successful after Scarlet fever, and Dr. Moore replied in the affirmative. BLOOD-LETTING.—Dr. Byrd, Professor of Obstetrics, in Washington University, once more raises the banner of bleeding, and says the prac- tice is more satisfactory than any other. Indeed, he asserts in the Med- tical and Surgical Reporter that in all inflammatory diseases it is the most scientific and efficient agent, and that the necessity for it is as great at the present time as ever it was in the past. In certain conditions of the brain found in most cerebral diseases, it is, we think, not only indispensable, but the only remedy necessary. HAEMOPTYSIS IN PHTHISIS.–In one of the papers on “Phthisis Pul- monalis,” which recently appeared in the columns of the Medical Press and Circular, Dr. R. Locke Johnson speaks of the increased tendency of patients to hamoptysis, during the spring time and the early summer time. Having for some years past made observations on this point, he has occasionally been enabled to retard altogether or to lessen this lesion by attending closely to the secretions, the skin, and the pulse of Whis patients. * AIR IN THE WEINS.–At a recent meeting of the Société de Chirur- gie, Paris, M. Trélat related (British Medical Journal) a case of sudden death caused by the intrusion of air into the veins. M. Trélat was in the act of removing a submaxillary tumor when suddenly the patient changed color and the heart sounds ceased. Arti- ficial respiration and electrization of the phrenic nerve induced a few respiratory movements, and a slight return of color appeared after this treatment had been persisted in for fifteen minutes. The necropsy re- vealed the partial division of a small vein which opened into the exter- nal jugular. There was an oblong clot in the jugular segmented by air blebs. Bubbles of air were also found in one of the mediastinal veins, the posterior cardiac vein, and a notable quantity was also found in the Aright cardiac cavities. Chloroform had been administered, so the ques- tion raised was if death might not be attributed to that drug. M. Per- rin and M. Marc Sée considered such to be the case. M. Giraldés be- Tieved entrance of air into the veins acting with the chloroform pro- duced the fatal result, and stated that in three cases of death from chloroform he found the presence of gases in the heart of each case. In the vena cava, and even in the veins of the pelvis, M. Roux had made a similar observation, but M. Depaul pointed out that the air in this case occupied only the veins going to the heart and the wounded vein. The 430 Miscellaneous. [April. employment of artificial respiration by means of a tracheal catheter and bellows was advocated by MM. Perrin and Depaul. PITTING FROM SMALL-Pox. —Dr. Grimshaw (British Medical Journal). states that he considers pressure is the main point to be relied on—by lessening the vascularity of the part and preventing the maturation of the pustules—in cases where pitting from small-pox is feared. Strap- ping in parts where it may possible to do so answers this purpose fully, and the next best thing to strapping is to employ xylonite, a collodion which, although somewhat elastic, quickly forms—when employed over the cuticle—a dense and tight skin, more dense, tight, and tenacious than the collodion of the Pharmacopoeia. It acts like strapping, and produces abortion of the pustules. To parts of the face where strapping cannot be employed with advantage, xylonite will be found to be the next best mode of treatment. The late Dr. Grave's remarked that in a patient whose knee had been strapped for a surgical operation, being attacked by small-pox, the portion over which the strapping extended was free from even the rash. PRODIGIOUS GALL-STONES.–At a recent meeting of the Pathological Society of London, Dr. Thorowgood exhibited for Dr. R. Locke John- son, two gall-stones removed from a female patient aet. 67, and who had suffered no inconvenience from their presence during her lifetime. They completely occluded the gall bladder, assumed its shape, were: composed principally of cholesterine, and weighed at the period of re- moval 580 grains, the larger one weighing 420 grains. Probably these are the largest gall-stones ever removed from a female patient. CRoup.–MM. Mouttet and Rosiere, of Montpellier, report that they have cured croup, when tracheotomy was refused by the parents as a useless cruelty, by repeated iusufflations of powdered nitrate of silver. The application was at once followed by the detachment and expulsion of false membrane, and was repeated a quarter of an hour after with a similar result. Three or four hours later another insufflation was fol- lowed by so much relief that hope was entertained, and the child from this time made a steady recover. ALCOHOLIC PARAPLEGIA.—Dr. Wilks, of Guy's, in a paper in the Lancet, endorses the conclusions lately published by Dr. Hanfield Jones, in reference the production of epilepsy and other nervous diseases by the abuse of alcohol. Dr. Wilkes has met with cases where the alcohol, acting chiefly on the spinal cord, made paralysis the leading symptom, and he combats in his own trenchant style the notion that it is not safe. to suddenly leave off the accustomed stimulus. “No harm,” he says, “but only good will ensue from its withdrawal.” He considers that. the same rule should apply to all persons. - Some striking cases are mentioned, in which the absolute and instant withdrawal of alcohol snatched the patients from the very jaws of death. One was a professional man, who, after drinking hard, became so ill that he took to his bed, had epileptiform attacks, ate nothing, and was constantly retching, his wife standing over him administering brandy and champagne from time to time to keep him alive a little. longer. Dr. Wilkes succeeded, after several attempts, in inducing his. wife and two medical attendants to stop every drop of alcohol. When this was done the patient soon cried out for drink; but, after imploring in vain for some time, he was violently sick, and then sank into a sound sleep. Upon waking he took a little beef-tea, in a few hours ate some solid food, and within a week was back again in his practice. The purport of Dr. Wilks's paper is to draw attention to the fact of May.] Miscellaneous. - 431 paralysis, and more particularly spinal paralysis, occurring as a result of alcoholism ; and therefore that, when a medical man is called in to See a case of this kind, he should remember intemperance in drinking as a possible cause, just as he would if he found an enlarged liver. If the affection should turn out to be in any way peculiar in its pa- thology, it will certainly deserve a distinct appellation ; but even should the morbid changes in the cord, together with the resulting symptoms, resemble what is seen in other forms of paralysis, he would still recom- mend the adoption of such a term as alcoholic paralysis as significant of its cause, for we are warranted in so doing by the use of the expression puerperal, syphilitic, or uraemic epilepsy (eclampsia) in reference to the origin of the fits when arising under special circumstances. EARLY DIAGNOSIS OF TYPHOID.—In an abstract of a clinical lecture at Cambridge, published in the Lancet, Dr. P. W. Latham insists on the value of the thermometer, observing that during the first four of five days the general symptoms which may then accompany the disease —viz., the rigor, the languor and feebleness, headache, epistaxis, giddi- ness, pain in the back and aching of the limbs, the appearance of the tongue, the state of the bowels, the condition of the urine, etc., may not be very distinct, or any one of these morbid symptoms may be entirely absent. In a considerable number of cases, in fact, it would be impossi- ble to say, without using the thermometer, whether the patient were suffering from typhoid fever or not. But the thermometric course of the disease at this time, unless it supervenes on some other malady, is very regular; and by taking the temperature at 8 A.M. and 6 P.M. for three days the presence of typhoid fever may be decided. On the other hand, one single observation may, with very great probability, negative the existence of the disease. - - The following is the formula (from Wunderlich) of this initial stage : Morning. Evening. 1st day . . . . . . 98.6° F. . . . . . . 100.4° F. --- 2d “ . . . . . . 99.49 . . . . . . 101.4° º: 3d “ . . . . . . 100-48 . . . . . . 102.6° 4th “ . . . . . . 101.69 . . . . . . 104° If, then, a person, previously quite well, feels uneasy, perhaps has a rigor, and in the evening we find his temperature about 100.4° or 101° F., falling the next morning about a degree, rising again in the evening, and approximately following the above course, the disease may be diag- nosed with tolerable certainty. -- On the other hand, the disease is not typhoid fever (1) on the second, third, or fourth evenings the temperature approximates even to normal (98.6°F.); (2) if during the first two days the temperature rises to 104° F.; (3) if between the fourth and six days the evening temperature of a person under middle age does not reach 103°; (4) if the temperature on two of the first three evenings is the same ; or (5) if it is the same on the second and third mornings. From the fourth to the tenth day the evening temperatures are tolerably uniform, the highest being most generally on the evenings of the fourth, fifth, or sixth days, and reach- ing from 104° to 105.5°F., or even higher. The morning temperatures are from 18 to 2-6°F. lower than the evening ones; on the fifth, sixth, and seventh days, the variations between the morning and evening temper- atures being less than take place from the sixth or seventh to the ninth or tenth days. During this period (from the fourth to the tenth or twelfth day), if the general symptoms are obscure, an absolute diagnosis may not be readily made, and the disease may be confounded with sev- eral others, unless thermometric observations extend over several days. 432 Miscellaneous. [April, ENURESIS.—Dr. Woodman, in a clinical lecture at the London Hospital, published in the Medical Press, recommends the following method of investigating cases:— - 1st.—Enquire carefully into the duration and frequency of the incon- tinence, and into the previous history of the child and the family. 2d. — Carefully note the diathesis, and general bodily condition of the patient. 3d. – Examine the urine by test papers, by other tests, and by the microscope if necessary. 4th.-Make a careful examination of your patient, including the anus and rectum amongst the pudenda, and, if need be, exploring the blad- der also. I need not enjoin upon you all possible delicacy and tender- ness in these examinations. You must explain the necessity to the parents—and you will often astonish them by evidences of neglect of cleanliness, or of the existence of sores of which they were ignorant. 5th and lastly.—Suit your treatment to the case; removing or sooth- ing all causes of irritation, and at the same time endeavoring to im- prove the general health, for it is quite true that delicate and tuber- cular children, or those weakened by long and severe illnesses, such as the exanthemata, suffer most. Above all things do not countenance corporal punishment for this bodily infirmity. It is as cruel as it is usually use- less; and I am in the habit of saying that the parents or nurses ought to be beaten, and not the little patients. : . Dr. W. mentions the following aua'iliaries to treatment, useful in a great number of cases: There is first the warm-bath ; a sitting-bath is all that is generally needed. It should not be too warm, indeed 90° or at all events 98° is guite warm enough. Next, I have found it of great service to forbid the little patients to drink anything after their tea (say at five or six o'clock), unless thirst be extremely pressing. i On the importance of waking them up once, twice, or more in the night to make water, I need not dwell. This is not so cruel as it seems; the child is soon asleep again in most cases. It is also well not to let them lie on the back. The trigone of the bladder is the most sensitive part, and, besides, it is possible the posterior regions of the spinal cord get unduly congested. A reel (such as used for cotton) fixed in the middle of the back sometimes prevents this, and the child my be turn- ed over on the side. For local sores, the glycerine of tannin, aided by cleanliness, is very valuable. I wish it did not stain the sheets so much. As tonics, mineral acids with bark, and the perchloride of iron, are the best I know ; and, if sweetened, children seldom refuse to take them, which is a great advantage. As a sedative, belladonna is, perhaps, often better than opium. You may give from one-eighth to one-fourth of a grain of the extract even to very young children, three or four times a day. This is the most successful empirical remedy I know, and obscure cases always deserve a trial, increasing the dose within the limits of safety. Should the urine, however, be saccharine, ammoniacal, or phosphatic, opium must have the preference. For ascarides you will use local injections. Salt and water enemata are as good as anything else. In epileptic cases, cod-liver oil (if the fits are tubercular in origin) will perhaps deserve to be considered as more than an auxiliary. In a communication to the British Medical Journal Dr. Savage states that to a healthy girl, aet. 64, who from infancy had been addicted to bed-wetting, he ordered the lower part of her spine to be sponged daily, and with the most satisfactory result. ~ CASE of QUADRUPLETs. – On January 5th (says Mr. Lowndes, British May.] Miscellaneous. 433 Medical Journal), I was summoned by a midwife of the Lying-in Hospital to a woman who had just been delivered of four children. She was 25 years of age, a widow, having lost her husband a few months since. This was her third labor, the other two having been normal in all respects. When first called, the midwife found the os dilated and the head presenting. She ruptured the membranes, and a small but fully matured living female child was speedy expelled. Finding, from the state of the abdomen, indications of a second child, she examined per vaginam, and found another bag of membranes and a breech presenting. The membranes having been ruptured, a small male child was quickly delivered, in a state of incipient decomposition; in half an hour a third foetus in a similar condition was expelled by the breech, and was fol- lowed rapidly by a fourth, in a putrid state. THE NUTRITION of Muscul,AR AND PULMonARY TissuB IN HEALTH AND IN PHTHISIs.—Dr. William Marcet, F.R.S., read two papers before the Royal Society and the British Associations respective- ly—on the “Nutrition of Muscular and Pulmonary Tissue in Health and in Disease.” He sums up the results of his observations as fol- lows: - 1. Blood and tissue must be considéred as colloids. 2. Animal tissues are formed by three classes of constituents. The first has been called the tissue proper; it is insoluble in water. The second has been called the nutritive material ; it is soluble, and consists of a mass of colloid substances — the composition of this nutritive material being the same as that of the tissue proper. The third has been called effete material, and consists of crystalloid substances which, it is concluded, are on their way out by diffusion. 3. Muscular and pulmonary tissues consist of albumen, phosphoric acid, and potash, in the colloid and crystalloid forms, together with a small proportion of magnesia; and a fact not stated in this paper is, that I have succeeded in obtaining, artificially, phosphoric acid and potash, in the colloid condition, by dialyzing a mixture of chloride of potassium and phosphate of soda. I have no doubt that magnesia may also be obtained colloid, by some similar means: it is certainly colloid in the tissue proper of flesh, and in its nutritive material. 4. The phosphoric acid and potash in the effete material of muscular tissue occur precisely in the necessary proportions to form a crystalloid pyrophosphate of potash, or a crystalloid tribasic phosphate of potash with two equivalents of fixed base. This is, of all the results which I have obtained, the most interesting, as proving the correctness of the method of investigation which I have adopted, and placing beyond doubt, it appears to me, the truth of my views as to the constitution of animal tissues. - 5. In pulmonary tissue, the effete material contains much more potash than it is necessary to form a pyrophosphate—the excess being, in all probability, eliminated as a crystalloid carbonate. 6. In muscular tissue in phthisis, the water has a tendency to separate from the solid tissue; or that peculiar relation between the water and solid constituents which preserved the dry state and normal con- sistence of the tissue, undergoes a gradual alteration, apparently because of an incipient loss of colloid condition, due to a physical change. The pulpy state of tubercular lungs undergoing softening appears to be due to a loss of the colloid attraction of water for the cheesy material which had been exerted before the softening commenced. 7. Muscular tissue in phthisis is nourished according to the same process as in health, although its rate of nutrition is slower. 8. Pulmonary tissue, in the state of cheesy consolidation and soften- 434 Miscellaneous. - [April, ing, undergoes nutrition, which, however, is slower, and not of the same nature as it is in health. Lungs thus affected are found to be nourished much in the same way as muscular tissue—the phosphoric acid and potash effete occurring nearly in the necessary proportions to form a pyrophosphate. 9. Finally, death from phthisis is apparently due in a great measure to the physical forces residing in the constituents of the tissues, en- croaching upon and getting the better of the vital phenomena, so that the ebb of life in phthisis may be considered but a gradual return to the physical state of matter. É. TRACHEoToMY. — Mr. John Wood, in a lecture delivered at King's College Hospital, and published in the Lancet of March 9th, describes the operation of laryngotomy as much more simple, less dangerous, and more quickly and readily performed, in cases of impending suffocation, than any other upon the windpipe; and it is one which may be per- formed by almost any bystander with ready nerve, decision, and a tolerably sharp penknife. He prefers; the crico-thyroid space, immedi- ately below the projection of the thyroid cartilage called the “pomum Adami,” instead of the vertical incision an inch long directed by the text-books; Mr. Wood makes a single transverse cut across the lower part of the hollow depression felt by the finger put above the cricoid ring, through the skin and membranes at once right into the windpipe, and extended sufficiently laterally to introduce the tube. The advantages which he claims for the transverse over the vertical incision are : 1st. That the throwing back of the head (as is usual in patients under a sense of impending suffocation) tends to close the lat- ter, and thus interfere with inspiration, whilst, on the other hand, the same movement tends rather to open more freely a transverse incision. 2d. The wound will remain open without a tube in many cases. The tube if used, should be broader in the transverse than in the vertical diameter, and shorter in the length between the shield and the curve than the one adapted for tracheotomy. If the transverse incision is found to be too limited, it may be exten- ded by a medium vertical one downwards through the cricoid, or upwards through the thyroid, or both, as the exigency of the case may require. The operations of tracheotomy are performed respectively above and below the isthmus of the thyroid body, the former being the preferable, as it involves the fewest dangers during and after the operation ; the trachea is more superficial, consequently more easily reached, and the nearer you get to the larynx, the steadier laterally does the trachea. become and the easier to fix and penetrate. A vertical incision about two inches in length in the median line of the neck is made, the sterno-hyoid and thyroid muscles exposed, and the areolar interval indicating the meeting of the latter cut through, and the muscle held aside ; the fascia investing the thyroid gland and connecting it with the trachea is now seized and cut through horizon- tally ; the end of the knife handle is then placed under the isthmus, and made to push it downwards, and at the same time to separate it sufficiently from the trachea, so as to permit of the division of the three upper rings. The fascia covering the fibro-cartilage, or upper cartila- ginous spaces, is seized as low down as possible, and a little on one side of the median line, with the hooked forceps, the teeth of which projecting well downwards will bite easily into its substance. The scalpel is then passed down, guided by the interval between the blades of the forceps, and the wind-pipe punctured vertically, and the incision extended upwards as far as the cricoid cartilage, or even through it if suf- May.] * Miscellaneous. 435. ficient room has not been obtained by pushing down the thyroid isthmus. At this stage the inexperienced operator is apt to lose his self-posses- sion, and let go the trachea, but for the satisfactory conclusion of the operation the hold should be firmly retained until the outer part or spring sheath of the tube is introduced ; the inner tube should not be introduced until some of the spasms consequent upon the operation have passed away. In the lower operation, the primary incision should extend down- ward nearly to the top of the sternum in a short neck, whether infantile or adult. The inferior thyroid veins should be torn rather than cut, and the inner tube introduced immediately, the pressure it exerts having the effect of arresting the haemorrhage. Other dangers attend this opera- tion, such as the contiguity of the left innominata vein and artery, the greater depth of the trachea, and its more mobile nature at the point to be operated on. In young children, the size and high position of the thymus, and the small size and yielding nature of the walls of the trachea itself. In persons beyond the middle age, there is usually ossi- fication of the tube, or other morbid change near the thyroid gland; in such cases it is advisable to be provided beforehand with a pair of strong cutting scissors or forceps. Mr. Wood enumerates also several dangers which are secondary upon the lower operation, viz., infiltration of air into the anterior medi- astinum and general sub-pleural tissue, or of blood or pus into these tissues; a progressive ulceration, arising from the constant friction of the tracheotomy tube in breathing, extending downwards from the shaft, or forwards from point of the tube against the anterior wall of the trachea. Another danger is the separation of the shaft of the trachea tube from the shield at the joint which unites them, permitting the shaft to slip entirely into the trachea. He quotes several cases of this kind, which have already been referred to in a late number of the Doctor. He thinks this incident is owing, in a great measure, to the shaft of the tube for the lower operation being much too short, and recommends. that it should be an inch and a half in length from the shield to the culm of the curve, instead of barely half or three quarters of an inch, as is the case with the tubes at present in use. ELIMINATION OF ALCOHOL.--Dr. A. Dupré of Westminster Hospital, says the Medical Times, has recently presented a very important paper to the Royal Society, “On the Elimination of Alcohol.” Obviously, one of three results may follow the ingestion of that liquid—either all the alcohol may be oxydized, and none eliminated unchanged; or a portion only may be oxydized, and the rest eliminated unaltered ; or all the al- cohol may be eliminated unchanged. If all the alcohol be eliminated. unaltered, it follows that, if a certain amount of alcohol be administered daily, the quantity eliminated would increase from day to day, till eventually a state of equilibrium would be attained, and the amount eliminated each day would equal the amount ingested. If, on the con- trary, all the alcohol were either oxydized or eliminated within a period of twenty-four hours, no increase in the daily elimination will take place as a consequence of the alcohol diet. The author undertook two series of experiments, in which the quantity of alcohol eliminated by both kidneys and lungs was determined. His results are thus summed up : “The amount of alcohol eliminated per day does not increase with the continuance of the alcohol diet; therefore all the alcohol consumed daily must, of necessity, be disposed of daily; and as it certainly is not 436 .* Mºscellaneous. - [April, eliminated within that time, it must be destroyed in the system. The elimination of alcohol, following the ingestion of a dose or doses of al- cohol, ceases in from nine to twenty-four hours after the last dose has been taken. The amount of alcohol eliminated, in both breath and urine, is a minute fraction only of the amount of alcohol taken.” Dr. Dupré confirms M. Lieben's observations that a substance exists in the urine of man, and in the urine of various animals, which is not alcohol, though it yields iodoform. The author found that after six weeks of total abstinence, and even in the case of a teetotaler, this substance, the precise nature of which has not been determined, is elim- inated in the urine, and perhaps also in the breath. The quantity met with in the urine is very small, and it was found that after the elimin- ation due to the administration of alcohol had ceased, the amount of the substance eliminated in a given time at first remained below the quantity normally excreted, and only gradually rose again to the nor- mal standard. The presence of this body in urine must throw great doubt on many of the previous determinations of alcohol in urine. It passes over with the first portions of the distillate, it yields acetic acid on oxydation, gives the green reaction with bichromate of potash and sulphuric acid, yields iodoform, and its aqueous solution has a lower specific gravity and a higher vapor tension than pure water. PERIODICAL HEADACHE.--Dr. F. Bradnack asserts, in the Buffalo Med- ical Journal, that the pathological condition in this malady is, if not always, almost always congestion ; sometimes active, that is, arterial, and sometimes passive, or venous congestion ; though probably in most cases a combination of both these forms; the arterial form usually pre- dominating. He finds invariably : 1. Throbbing of the carotid and tem- poral arteries; 2. Congestion of the eyes, in some cases occasioning co- ryza ; 3. A sensation on the part of the patient of intense intracranial tension, described popularly by sayiug that the head “feels as if it would burst;” 4. Redness of part of, or of the entire face; 5. A partial loss of the power of co-ordinating muscular movements, occasioned, he conjectures, by extreme vascular pressure upon the cerebellum ; 6. Oc- casional vomiting ; 7. tinnitus aurium, often very violent. Aside from these positive signs and symptoms, he says there are many others which go, either negatively or indirectly, to substantiate the position advanced. Among these are : 1. Anorexia ; 2. Muscae volitantes, occasioned doubtless by congestion of the retinae; 3. Extreme coldness of the ex- tremities; 4. Often a decrease of heat, as indicated by the thermometer, of large portions of the cutaneous surface, indicating a retreat of the 'blood inwards somewhere ; 4. Numbness and partial temporary paralysis of the upper extremities, caused, unquestionably, by intracranial pressure. 5. Difficult respiration, amounting in some instances to dyspnoea. This latter symptom, taken in connection with the fact of the existence of abnormal heat in the upper portion of the cervical spine and lower ex- ternal regions of the occipital bones, appears to Dr. Bradnack to indi- cate, in common with the adjacent and superjacent congestion, an abnormal pressure on the medulla oblongata, implicating the origins of the pneumogastric and spinal accessory nerves. THE UVULA.—Dr. Noble Smith condemns, in the British Medical Journal, the practice of snipping the uvula, and advocates its complete removal in eases where any operative procedure is called for. He re- lates two cases simulating consumption, which were at once cured by the removal of the elongated uvula; and says that in mere snipping the organ grows again, and no good results. On the other hand, Sir G. D. Gibb argues in the Lancet, that the uvula has important functions in May.] Miscellaneous. 43'ſ deglutition and vocalization, and that its true muscular end does not often become elongated, but only the membrane, and perhaps adipose tissue; consequently, that snipping this part and leaving the muscular fibres intact is quite sufficient, and that no inconvenience arises from this practice. Low ENSTEIN (Centralblatt, 35, Sept. 2, 1871) shows that the mucous membrane of the vagina is not destitute of lymph-follicles, as is gene- rally asserted in anatomical text-books.—Recent researches of Ranvier at the Société de Biologie confirm the statements of Stricker and Klein (of which he does not seem to be aware), that the nerve-cord is enclosed in a true serous cavity with an epithelial oavity.—Fleischl (Centralblatt, 42, Oct. 14) describes a delicate film covering the brain-surface, which he calls cuticulum cerebri et cerebelli.-An elaborate paper by Mr. Parker, on “The Development of the Skull of the Common Frog,” appears in the Philosophical Transactions. Poisonous EFFECTS OF BELLADONNA APPLIED ExTERNALLY.-In the Revue Medicale de Toulouse, M. Giscaro records, says the Pharmaceutical Journal, two cases in which persons had suffered from the poisonous effects of belladonna, applied externally. In one case, where a small patch of belladonna, the size of a two-franc piece, had been applied to the temple for a neuralgic pain, the patient, eight hours afterwards, showed decided symptoms of atropia poisoning, which lasted two hours, In the other case, where an excessive quantity of ointment had been used for a uterine affection, similar symptoms came on in one hour, but quickly disappeared with the removal of the dressing. i CHLORIDE IN PIACE OF BROMIDE OF POTASSIUM.–Dr. Lander has substituted the chloride for the bromide of potassium in the treatment of epileptics with a success which he declares to be identical. He begins with smaller doses, but doses of 75 to 105 grains daily have been borne without inconvenience for months in succession. He states that it is more active, one-sixth of the price, and without the inconvenient secondary effects of bromide of potassium. He believes that in the stomach bromide is converted into chloride of potassium, and that for many reasons it is desirable to administer it at once in that form.— British Med. Jour. THE SITTING Post URE IN PROLONGED CATHETERISM.–Mr. R. Hanslip Sers says, in the Medical Press, that he permits the patient to sit upon a chair in a semi-recumbent posture, with the nates close to the edge and the knees widely divergent. This admits of any requisite manipulative process. In stricture, he has faith in prolonged sittings, at least in otherwise healthy country persons in the prime of life, to enable one leisurely to exert that steady pressure—gentle yet efficient—so familiar to the expert. The sitting posture answers admirably, and is superior to the upright, and also to the flat position. MoDE of ADMINISTERING CREOSOTE—As creosote is now frequently employed in the treatment of typhoid fever, and is exceedingly distaste- ful to some patients, the Canada Medical Journal gives a formula, which, in a great measure, covers its flavor, and is easily prepared. This is it: Creosote, 3 drops; Essence of lemon, 2 drops; Orange-flower water, 1 ounce ; Spring water, 3 ounces. A spoonful to be taken at frequent intervals throughout the day.—The Doctor. PHOSPHATES IN PREGNANCY. — Mr. Metcalfe Johnson, of Lancaster, 4.38 Miscellaneous. [April, recommends, in the Medical Times, the hydrated phosphate of lime of the British Pharmacopoeia as a remedy for the sickness of pregnancy. He gives it doses of from three to ten grains each, three times daily, sus- pended in water, and flavored according to the patient's taste. In some cases the relief has been so striking that patients have sent to ask for “some of that medicine that relieves the sickness.” Mr. Johnson thinks the drug may supply phosphates to the nervous system, and also the embryo, and that, if phosphates be not supplied, the child may grow at the expense of the mother's Osseous and nervous system.—The Doctor, 1871. TREATMENT OF HYPERPYREXIA.—Gildemeister and Wertheim (Jour- nal of Anatomy and Physiology, March, 1871) find that, when the tem- perature of the body is lowered by cooling, there is an increased pro- duction of carbonic acid gas, both in health and fever. In fever, however, though the cold both increases the combustion and production of heat in the body, it withdraws more heat than is produced, and, therefore, cools the body and does good. Judzinowitsch states that perspiration has no relation to the temperature in fever. It may be increased when the temperature is lower, and decreased when it is higher, as was seen in two cases of acute rheumatism and one of pleuro- pneumonia.-British Med. Jour. EPILEPsy IN CHILDREN.—Dr. Voisin (Jour. de Med. et Chir. Prat.) has observed that bromide of potassium succeeds in general less well in children than in adults. According to him, the doses should be as fol- lows: From two to three years of age, from 7 to 15 grains daily ; from five to ten, 30 to 75 grains; from six to fifteen, 120 to 180 grains. Coffee, alcohol, and tobacco are to be religiously forbidden to epileptics. Large doses will often cure children if carried out carefully, and for a sufficient length of time.—The Doctor. WE regret to hear that Professor Huxley's health has given way under the strain of continuous exertion, and that he has been advised to absent himself for a time from all occupation as the best means of restoration. Mr. Huxley will spend two months in the mild climate of Egypt, whither he has repaired; and there is every reason to hope that he will return restored to health and vigor. FROM the researches of MM. Rabuteau and Massot, described at the Academie des Sciences on January 2, it results that the cyanates of potassium and sodium are not poisonous. They are transformed in the system into alkaline carbonates. THE Pria, Capuron of the Academie de Medecine will be awarded in 1873 for the best essay on any subject connected with obstetrics. The proposition of definite subjects has been found to bring only compila- tions and essays without originality. ABsor PTION may, according to Goltz (Pflüger's Archiv, and Journal of Anat. and Phys., Nov., 1871), take place after the complete cessation of circulation. This statement is founded on the result of injecting strychnia into frogs after tying the heart and vessels. “TEN gallons of kerosene, three pounds of potash, one ounce of strychnine, mixed with soft water.” It was according to this cheerful, not to say convivial, formula, that a quantity of “whiskey" seized last week in Newton, Mass., was compounded, the recipe having also been found in the possession of the unfortunate dealer. If you want “gin,” add quantum sufficit of oil of juniper | The mystery is that men who drink this diabolical fluid do not drop down stone dead at once. May.] New . Publications. 439 GLAsgow Infirmary admitted during last year 6,014 patients, being 248 fewer than in 1870, owing to the subsidence of the relapsing fever epidemic. The daily average of patients in the hospital was 482, as against 513 in 1870. The total expenditure was £18,802 6s. 10d., the extraordinary revenue including a donation of £5,000 from Mr. John Freeland, of Nice. - DR. LIEBREICH, having been consulted in respect of an inflammation of the eye from which the French President has been suffering for some days, has declared that there is no cause for uneasiness. ANTIDOTE TO CARBOLIC ACID.—A strong solution of saccharate of limo, it is asserted, is a thoroughly reliable antidote against the poison of the carbolic acid, when by accident taken internally. LIGATURE OF THE ExTERNAL ILIAC ARTERY.—On the 10th of this month, in the operating theatre of Sir P. Dun's Hospital, Mr. Butcher ligatured the external iliac artery high up, for a large inguinal aneurism extending above Poupart's ligament. The patient is aged 68, and the case is going on most favorably. DYSPEPSIA of LIQUIDs.-The Lancet has an article by Dr. Thorow- good, with the above heading. It appears that the writer has met with some cases of dyspepsia marked by almost complete inability on the part of the stomach to digest any kind of fluid. The patients com- plained of the discomfort caused by the fluid taken remaining unab- sorbed in the stomach, so that they could feel it splashing about with- in them. Allusion is made to a work on Dyspepsia by M. Chomel, where this uncomfortable feeling due to the presence of unabsorbed liquid in the stomach is aptly described. The great point in the treatment seems to have been the limiting the patients to a dry system of diet, cutting off almost entirely all supply of fluid. Under this practice the three cases recorded in the paper seem all to have made perfect recoveries, though the process of restoration to health was not rapid. Certain medicines of the tonic class, such as gentian, rhubarb, and nux vomica, and occasionally pills of galbanum with assafoetida, or at night a pill containing opium, seem to have been of some service, but the dry plan of diet is the true curative method in these cases. * NEW PUBLICATIONS. WE, have to hand a Catalogue of valuable Medical and Surgical Works from Mr. James Campbell, of Boston. He offers many good second- hand editions of various works in the list at a very low price. We would advise our readers who want cheap books to write to him. CHURCHILL's PUBLICATIONs. Lindsay & Blakiston, of Philadelphia, who are the agents for the above, state that they have a large quan- tity on hand of the leading books published by the Messrs. Churchill. Send for their catalogue. HISTORY OF MEDIGINE, FROM THE EARLIEST AGES. To THE COMMENCE- # MENT OF THE NINETEENTH CENTURY. By Robley Dunglison, M.D., * LL.D., late Professor of Institutes of Medicine and Medical Jurispru- . dence in the Jefferson Medical College of Philadelphia, etc., etc. Now first collected and arranged from the original manuscript, by his son, 440 Wew Publications. [April, May. Richard J. Dunglinson, M.D. Philadelphia: Lindsay & Blakiston. 1872. Pp. 250. James M. Baldwin, 811 Broadway, New York. EARTH As A Top ICAL APPLICATION IN SURGERY. Being a full Exposi- tion of its Use in all the Cases requiring Topical Applications admitted in the Men and Women's Surgical Wards of the Pennsylvania Hospital during a period of Six Months in 1869, by Addinell Hewson, M.D., one of the Attending Surgeons in the Pennsylvania Hospital. With four Photo-Relief Illustrations. Philadelphia : Lindsay & Blakiston. 1872. Pp. 309 THE URINE AND ITs DERANGEMENTs, with the Application of Physiolo- gical Chemistry to the Diagnosis and Treatment of Constitutional as well as Local Disease. By George Harley, M.D., F.R.S, late Professor in the University College, London, etc., etc. With Illustrations. Philadelphia: Lindsay & Blakiston. 1872. Pp. 334. PULMoRARY CONSUMPTION, ITs NATURE, VARIETIES, AND TREATMENT. With an Analysis of One Thousand Cases to Exemplify its Duration. By C. J. B. Williams, M.D., F.R.S., Fellow of the Royal College of Physicians, etc., etc., and Charles Theodore Williams, M.A., M.D., Oxon., Fellow of the Royal College of Physicians, etc., etc. Philadel- phia: Henry C. Lea. 1872. Pp. 315. A PRACTICAL TREATISE ON THE DISEASEs OF Wom EN. By T. Gaillard Thomas, M.D., Professor of Obstetrics and Diseases of Women and Children in the College of Physicians and Surgeons, New York; Phy- sician to the Roosevelt Hospital, New York; Attending Surgeon to the New York State Woman's Hospital; Obstetric Surgeon to the Stranger's Hospital, etc., etc. Third edition, enlarged and tho- roughly revised, with 246 illustrations. Philadelphia: Henry C. Lea. 1872. Pp. 784. x - THE PRINCIPLES AND PRACTICE OF SURGERY. By John Ashhurst, Jr., Surgeon to the Episcopal Hospital, to the Children's Hospital, etc. Illustrated with 533 engravings. Philadelphia: Henry C. Lea. 1871. Pp. 1,011. - A TREATISE on HUMAN PHYSIOLOGY. Designed for the Use of Students. and Practitioners of Medicine. By J. C. Dalton, M.D., Professor of Physiology and Hygiene in the College of Physicians and Surgeons, New York, etc., etc. Fifth edition, revised and enlarged. With 284 illustrations. Philadelphia: Henry C. Lea. 1871. Pp. 728. DR. RIGBY's OBSTETRIC MEMORANDA. By Alfred Meadows, M.D., Phy- sician to the General Lying-in Hospital and to the Hospital for Women, etc., etc. Fourth edition, revised and enlarged. Philadelphia: Lind- say & Blakiston. 1872. Pp. 104. MEMORANDA on Poisons. By the late Thomas Hawkes Tanner, M.D., F.L.S. Third and completely revised edition. Philadelphia: Lindsay & Blakiston. 1872. Pp. 149. . Forty-sixTH ANNUAL REPORT of THE SURGEONs of THE MASSACHU- SETTS CHARITABLE EYE AND EAR INFIRMARY." Boston : James. Campbell. - Advertisements. MANUFACTU RERS OF | instruments. INSTRUMENT-MAIKERS TO THE U. S. 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One handsome 8vo volume, strongly bound in muslin, bevelled, edges, illustrated with 142 fine wood engravings. Price $400. ADVERTISEMENTS. T H E journal of ſurditime. - Edited by THAD. M. STEVENS, M. D. C. E. WRIGHT, M. D. GUIDO BELL, M. D., Associatiº EDITOR. Subscription . . $ 1.50 per year. Single copy, à cerits. Published Monthly by the Editors, to whom all communications should be addressed, at Indian (tpolis, Ind. For the Physician and Apothecary. NMEDICAL H ERALD, ANID J O U R N AL OF F HAF NV AC Y - A Monthly Journal, devoted to the advance meant of Medicine à Văd Pharmacy in the Great West. Its circulation is through Mºeszer/, //Zssozzzº, J/es/erº Zozºa, Aºzz/- sas, A eózoºs/ta and Co/orado. It reaches not only the Physicians of this extensive region, but the larger part of the Druggists also. Advertisers who desire to bring their wares and products before the physician and pharmacist, will find this journal of special value to them. 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Testimonials in large numbers from Physicians and Medical Journals could be furnished, but this charlatanism, this quackery of the Press, now so common, cannot be adopted, and it should meet with the unsparing condemnation of every respectable physician. - The editor returns his earnest thanks to the friends and patrons of the Journal, and asks a continuance of their kindness and support. Letters should be ſtoldressed to him, at Louisville, KY, The Only Journal of its Kind in the English Language, T H E AMERICAN JOURNAL OF OBSTETRICS DISEASES OF WOMEN AND CHILDREN EDITED BY B. F. D. A. W. § O N , MI. D. ATTENDING PBYSIGIAN YO THE N few York STATE wom EN’s HOSPITAL, AND TO THE NEW YORK FREE D IS PENSA.R.Y Fok S1C1& Ciil L 1) REN. - ASSOCIATE EID 1 "I'O RS : E. NO EG G E RATH, M. D., LATE PROFESSO tº OF O BSTISTRICS AND DIS1: A SES OF WOMEN AN 1) CH II, 1, 1: EN IN NEW York, W A. J A C C B I, M. D., ol, NICAL PROFESSOR OF DISEASES OF CHILI) {{RN IN THE COLLEGE OF PHYSIGIANS AND SUBGEONS, N. Y. --> ..º.e.'" …"--~~~~~~~~ Encouraged by the reception which the Journal has already met with from the profession and the onedical press, the Publishers have determined to spare no expense to make it take foremost rank with the first-class publications of Intedical literature. - - Originally containing but 96 pages, the Journal has been enlarged to 192, making 76S in each volume. 'I'he Journal is published quarterly (May, August, November, and February), and -- ENTERS UPON ITS FOURTH YEAR AND FOURTH VOLUME With the issue of May, 1871. It is divided in to “ () it tº; 1N A L CoMAſun ICATIONs,” “CorresponDENCE,” * T tº ANSACTIONS OF THE NEw York AND PHILADELPHIA () issºrrºritic AI, Soci ETI Es.” “REVIEW OF LITERA- Tú RE PERTAINING TO PREGN ANOY, LA Gott, Til E PUERPERAL STATE: I) is EASEs of Wox{EN ; AND DISEASE5 PEGULIAR To Cui LDREN,” and a couplete Review of the Foreign and Domestie Works of value; Lee- vares, Clinical Reports, Operations, etc., will occasionally be inserted. The Three Departments will be equally represented in each Nurnber. Among the contributors of papers in the numbers already issued are: Prof. T. G. THOMAS, College Physicians and Surgeons, N. Y.: Prof. G. T. E.I.i.10t, Bellevue Hospital Medical College; Frof. W. A. HAMMen D, Bellevue Hospital Medical College : Prof. A. J Aco B1, College of Physicians and Surgeons, N. Y.; Prof. For DYoF BARKER, Bellevue Hospital Medical College; Prof. E. 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's gº °, ſº gº º s § ºf y * ºf T^* * * * * APPARATUS FOR FRACTURES, DISLOCATIONS, AND DEFORMITIES, Latest Instruments for Local Anaesthesia, and for Applications to the Larynx, Poste. rior Nares, Eustachian Tube, Uterus, Urethra, Bladder, etc., etc. Laryngo. scopes, Ophthalmoscopes, Endoscopes, Hypodermic Syringes, Fever Thermometers, etc. Surgical Instruments of all kinds made to order, and the Latest Improvements and Novelties promptly supplied. BY THE zº ARIs ExPos ITION OF 1867, BEING THE ONLY SILVER MEDALS GRANTED To AMERICAN Expr1B ITOR'S OF SURGICAL INSTRUMENTS. *...*.* v v-w Stohlmann, Pfarre & Co., F. A. STOHLMANN. ED. P.F.A.R.R.E. PHILIP SCEI MIDT, 107 E, 28th Street, nr. Fourth Ave., owTT.V. RTR ANCTH OF GEORGE: TIFTWT ANN & CO. FIRST PREMIUM AWARDED BY AMERICAN INSTITUTE, 1870. MICROSCOPES And Microscopic Accessories for Medical and Scientific Investigations, ALSO, MAGIC LANTERNS, With elegantly colored Illºvstrations of Amatomy for POPULAF LECTURES. Illustrated Price-list sent on application, to any address T. H. MCALLISTER, 49 Nassaw Street, New York. COMMENTS OF THE PRESS ON THE AMERICAN JOURNAL OF OBS'ſ ETRICS AND DISEASES OF WOMEN AND CHILDREN. N. Y. Medical Gazette, Jan. 28, 1871. “This is pre-eminently a journal for the family practitioner, whose services are so largety called into requisition by the frequent sickness of women and children. If viewed simply as a current epitome of all things bearing upon the branches of which it treats, it would be of infinite value to every physician engaged in general practice. But beyond this, the important original contributions which have been made to medical science through its columns entitle it to higher estimation. No other American periodical has attracted a more distinguished array of authors, foreign and domestic ; few journals anywhere have maintained such uniform excellence in the character of their contents.” - N. Y. Medical Record, Feb. 15, 1871, “This quarterly commenced its first issue in May, 1868, under the auspices of the leading obstetricians of this city, and many other equally eminent specialists abroad. The articles con- tained in the different numbers have been singularly good and of a thoroughly practical char- acter, a fact which the profession at large have not been slow to appreciate. The care and discrimination of the working editor, who is also the proprietor, Dr. B. F. Dawson, has been one of the principal means to this end.” Boston Medical and Surgical Journal, Feb. 16, 1871. “We consider it one of our most valuable exchanges, including, as it does, articles bearing the names of Elliot, Emmet, Barker, Hammond, Skeene, Thomas, Eustace Smith, the Editors themselves, and other distinguished writers on the diseases of women and children. We com- mend the Journal most heartily to those of our patrons who need sound advice on the special subjects to which it is devoted—and who does not * * Baltimore Medical Journal, Feb., 1871. “We have no hesitation in declaring it the best journal devoted to this branch of medical literature. No further evidence of this fact is needed than a glance at the list of contributors, among whom will be found the well-known names of T. Gaillard Thomas and A. Jacobi, of New York; Storer, of Boston; Elliot, Hammond, Nott, Emmet, and Boziman, of New York, and many others, all of whom have contributed articles that would enrich the columns of any journal, and cannot fail to be read with pleasure and profit by all who desire to be informed on the subjects of which they severally treat.” Richmond and Louisville Medical Journal, Feb., 1871. “No journal in this country has achieved more rapidly a deserved and increasing reputa- tion. Its contents are always valuable and interesting, and the very best representatives of these departments of medicine contribute constantly to its pages. The work can be recommended with entire confidence, and all who desire the best and most recent information in connection with the specialties to whose cultivation the Journal is devoted cannot do better than, by sub- scribing, to have its pages always accessible.” Buffalo Medical and Surgical Journal, Feb., 1871. “The Journal is edited with consummate skill and ability, and receives contributions from many of the most eminent writers and teachers in the profession. The advance of knowledge in this department is so great that practitioners of medicine must give attention to present teach ing, or soon find that their profession is far in advance of them. This journal is a necessity in its department, since in it have appeared, and constantly are appearing, important practical papers, singly of great value, and combined, constituting the progress the art is making from month to month.” Pacific Medical and Surgical Journal, March, 1871. “The judgment and skill displayed in the choice of material have placed this journal in the foremost rank of medical periodicals, and given it a reputation of which the 'tors may well be proud.” B. F. D.Awson, M. D., Editor and Proprietor, CODMAN & SHURTLEFF's Amaim of Hui. for Amhalation, Hal Amºthesia, &c. By the Atomizer, any medicated liquid may be converted into the finest spray. In this state it may be inhaled into the smallest air-cells, thus opening a new • era in the treatment of all diseases of the throat and lungs. THE COMPLETE STEAM ATOMIZER FOR INHALATION, &c. (See Fºg. I5. ) It consists of the sphere-shaped brass boiler A, steam-outlet tube B, with packing box C formed to receive rubber packing through which the atomizing tube D passes, steam-tight, and by means ol which tubes of various sizes may be tightly held against any force oi steam, by screwing down its cover while the packing is warm; the safety-valve E, capable of graduation for high or low pressure by the spring or screw in its top, the non-conducting handle F, by which the boiler may be lifted while hot, the medicament-cup and cupholder G, the support H, iron base I I, the glass face-shield J, with oval mouth- piece connected by the elastic band K with the cradle L, whose slot- ted staff passes into a slot in the shield-stand M. M., where it may be fixed at any height or angle required by the milled-screw N. . The waste-cup, medicament-cup and lamp are held in their places in such a manner that they cannot fall out when the apparatus is car- ried or used over a bed or otherwise. All its joints are hard soldered. It cannot be injured by exhaustion of water, or any attainable pres- sure of steam. It does not throw spirts of hot water, to frighten or scald the Fig, 15. The Complete Steam Atomizer, patient. Aſor Izz/alation, & "c. Is compact and portable, occupies space of one-sixth cubic foot only, can be carried from place to place without removing the atomiz. Patented March 24, 1868, and Mar. Jó, 1869. ing tubes or the water, can be unpacked or packed without loss of time. Will render the best of service for many years, and is cheap in the best sense of the word. Price $6 oo. Neatly made, strong, Black Walnut-Box, with convenient handle, additional, $2 50. Brass Parts Nickel-Plated, additional, $2 50. SHURTLEFF'S ATOMIZING APPARATUS (See Fig. 5), for Inhalation, and with suitable tubes, for Local Anaesthesia, and for making direct, local applications of atomized liquids for a great variety of B purposes. [See our Pamphlet.] - The most desirable hand Apparatus. Rubbers warranted of very &est quality. Valves imperishable, every one carefully fitted to CCD M A N & SH U R T LEFF, - -> * ... ſº its Seat, and work perfectly in all positions. :* BOST ON . *... --ºntº § ------ass The Bulbs are adapted to all the Tubes made by us Fig. 5, shuttleff's Atomizing Apparatus, for Local Anaesthesia in Surgical Operations, Teeth Patented March 24, 1868. Extraction, and for Inhalation. Price $4 oo. Each of the above Apparatuses is supplied with two carefully made annealed glass Atomizing Tubes. and accompanied with directions for use. Every Steam Apparatus is tested with steam, at a very high pressure. Each Apparatus is carefully packed for transportation, and warranted perfect. Also, HAND BALL ATOMIZER, No. 5, without face-shield, * e g tº iº e e g tº $ 3 50 THE BOSTON ATOMIZER, with two glass Atomizing Tubes, º * * & tº $ & tº 2 5c. “HE TREMONT ATOMIZER, with two glass Atomizing Tubes, . . . . . . . 2 oo sila SS ATOMIZING TUBES to fit any of our Apparatus, warranted perfect, each, & & te * 25 rūCKEL-PLATED TUBES, for Local Anaesthesia and for Inhalation, each, . . . . 75C. to 2 on RHIGO LENE, for Local Anaesthesia, best quality, packed, e ge e tº e e * I OC NASAL DOUCHE, for Treating Diseases of the Nasal Cavity, eight different varieties, each with two Nozzles, packed & * e g * gº * } e $1 20, I 5o, I 75, 2 oo, and 3 50 N.B.—To save collection expenses, funds should be sent with the order, either in form of draft, post. office order, or registered letter. (For complete illustrated price-list of Apparatus, Tubes, etc., see Pamphlet.) tº Will be sent by mail, (post-paid) on application, A Tº A M P HILIET', Containing two articles, by distinguished foreign authority, on “INHALATION OF ATOMIZED LIQUIDS,” witH FoRMULAE OF THOSE SUCCESSFULLY EMPLOYED. Also, an article by Dr. J. L. W. THUDICHUM, M. R. C. P., on “A New Mode of Treating Diseases of the Nasal Cavity," WITH HIS FORMULAE. Also, an illustrated description of the best apparatuses for the above purposes, and for producing Joca i 24naesthesize by Atomization with Ether, by the method of DR, RICHARDSON, of London; or with Rhigolene, as described by DR. HENRY J. BIGLow, in the Boston Medical and Surgical journal of April 19, 1866. 21/2 ozer 24tomizing Zaszruzzezañs are made with the utmost care, with a view to their complete efficiency, convience and durability, and every one is warranted. A Gold Medal has lately been awarded us by the Middlesex Mechanics’ Association, for Atomizing and Surgical Instruments, as will be seen from the following report, signed by a leading New England Surgeon and Physician: - -- - ‘‘ ‘503. Codman dé Shurizeſ), Zºoseon, .7zass. One Case Surgica? Zasłreemen’s azed 242627, izers. “The Committee have no hesitation in awarding for this superb exhibition the highest premium. The various other instruments for Inhalation of Atomized Liquids, and for Local Anaesthesia, were all apparently faultless, both in design and workmanship. The exhibitors are regarded as more especially deserving of the highest token of merit for having produced nothing except of their own manufacture.- Go?d .%eda 2. (Signed, GILMAN KIMBALL, M. D., Chairman.” Also by the Mass. Charitable Mechanics' Association.—Exhibition of 1869.--A Siſa'ez' .7/eda!, the Highes Jſedal awarded for Surgical Instruments. x: 2k * ;A A. L S O H'O F, S A.I., E : *Cammann's Stethoscopes: *French Rubber Urinals, with valves, male, Disarticulating, . . . . . . $7 oo for night or day, . . . . . . . OO *Knight's Modification, , . º e • 9 5o Male, day only, - º - e $2 50 to 4 oo Simple Throat Mirrors, Nickel-Plated, . • I OO *French Rubber Urinals, female, for day Ophthalmoscopes, Liebreich's, . . $5 od to 7 oo only, - e - e º e - 4 Oo Holt's Dilator, improved, . e e * 2O OO *Ice and Hot-Water Bags, . . . $2 20 to Io oo Barnes’ “ set of three, with Inflator and *Vaccinators. Whittemore's Patent Auto- Stop-cocks, º - - º e - OO matic, for Crust or Lymph fresh from Large Ear Mirrors, Troitsche's, . $3 50 to 5 oc arm.—Instantaneous, certain, and al- Hypodermic Syringes, , . g . $3 oo to 14 Oo most painless (post-paid), & * e 3 oo *Miller's Intra-Uterine Scarificator, in case, *Powder Syringes, * º -> e - 2 OO (postpaid) º - º º º - 7 oo Laryngoscopes, complete, . . 16 oo to 25 oc Lente's Intra-Uterine Caustic Instruments, *Dr. Oliver's Laryngoscopic Lantern, . . 4 oo - $1 25 to 3 5o The same, with Auto-Laryngoscopic Sponge Tents, plain and carbolized, each, . 25 attachment, . e º º e - OO Pinckham's improved Uterine Scarificator, The same, with ditto and three Laryn- in case, . e º e - * * 8 oo goscopic Mirrors, in case, . º . 9 OO *Dr. Cutter's Retroversion and other Pessaries 3 co *Dr. H. R. Storer's Combined Speculum, . 6 oo Gaiffe's Electro-Medical Apparatus, e I5 OO * Sezza for Descz-Żtize Circular. Amputating, Trephining, Exsecting, Pocket, Dissecting, Throat, Ear, Eye, Uterine, Obstetric, and all other special and general sets of Instruments on hand and made up to order. Trusses, Spinal and abdominal Supporters, Shoulder Braces, Suspensory Bandages, Elastic, Hose, Medicine Trunks and Pocket Medicine Cases, Otoscopes, Endoscopes, Dr. Sayre's Splints for Hip-Joint Disease, Fever. Ther- mometers, Respirators, Syringes, Crutches, Universal Syringes, Galvanic Batteries and Apparatus, French Conical and Olive-Tipped Bougies and Catheters. Skeletons, Skulls and Anatomical Charts on hand; Manikins, Anatomical and Pathological, Models imported to order; prices on application. All Instruments, Implements and Materials used by Dentists, always on hand. Apparatus for Club Feet, Weak Ankles, Bow Legs, Spinal Curvature, and other deformities, made to order. Apparatus for Paracentesis Thoracis, approved by Dr. Bowditch and accompanied with directions kindly furnished by him. Having our Manufactory with steam power, and a corps of experienced workmen connected with our store, we are able promptly to make to order new Instruments and Apparatus, and to supply new inventions on favorable terms. INSTRUMENTS SHARPENED, POLISHED AND REPAIRED, CODMAN & SHURTLEFF, Makers and Importers of Surgical and Dental Instruments, 13 & 15 TREMONT stEEET, BOSTON. AD VERTISEMENTS. HORSFORDS ACID PHOSPHATE (MEDICINAL). Prepared by the Rumford Chemical Works, Providence, R, l, UNDER THE DIRECTION OF PROFESSOR E. N. HORSFORD, Late Rumford Professor at Harvard University, Cambridge, Mass, THE value of Preparations of Acid Phosphates as therapeutic agents is in keeping with well-known :hemical principles, and no article has ever been offered to the public which seems to so happily meet the feneral want as HoRSFORD’s ACID PHOSPHATE. It is not nauseous, like most of the preparations of Phos- phorus, but agreeable to the taste, and with water and sugar makes a cooling and pleasing drink. No danger can attend its use, as it is the same Acid that is found in wheat and other cereals. If we take more into the system than is needed, it is expelled with the secretions of the body. lt is especially recommended for Dyspepsia, Urinary ... ificulties, Cerebral and Spinal Paralysis, Men. tal Exhaustion, Wakefulness, Hysteria, and Nervous Disorders in General. Most excellent results have attended its administration for the prostration and nervous symptoms following Sunstroke. We ask the careful attention of all thinking persons to the high character of the following testi. monials : W. H. Henry, M.D., Editor of the American Journal of Syphilography and Dermatology, New York City, says: “I have, for more than two years, prescribed the Ácid Phosphate rather extensively, in a variety of cases where the USe º was indicated, and I assure you with the most satisfactory results. In nervous dis- eases I know of no preparation to equal it.” Adolph Ott, Technical Writer and Editor of the Department of “Physics. Chemistry, and Technology" of the Ger- man-American Cyclopaedia, says: “I have tried several phosphites, and even phosphorus in substance, but none of them with such marked success as your “Horsford’s Acid Phosphate.” The statements made by Qthers as to its effects on the nervous system and the brain, I fully confirmn, ... Some months I have been enabled to dév te inyself to hard mental labor, from shortly after breakfast till a late hºur in the evening Without experiencing the slightest relaxation, and I would now at no rate dispense with it.” John P. Wheeler, M.D., Hudson, N. Y., says: “I have given it, with present decided benefit, in a case of innutrition of the brain from abuse of alcohol.” Dr. Wrm. A. Harm nond, now of New York, formerly Professor of Physiology in the University of Maryland, says: “I make use habitually of phosphoric acid and the phosphates, in the treatment of nervous diseases. I prescribe it eonstantly every day of my life. It is very well known that, in certain cases of paraplegia (paralysis of the lower extremitiès), and which are due to paralysis of the spinal cord—to a degeneration Qf the sub- º: º cord—the disease cannot be so effectually cured by any other means as by the administration Of phosphorus.” Dr. Fordyce Barker, . New York City, says: “There are very often cases where the human system needs, for its restoration, the administr.ti u of the phosphates. The cases that require a phosphatic treatment are those where the waste of the phosphates is greater than the Supply. The class is very numerous. First, in all those cases of dérangement of the digestive and assimilative organs, where, in consequence of this derangement, the waste is greater than the supply. The next most frequent is where there is an excessive demand for nerve-power, as in men engaged in professions, and in business excitements; next, in ex cessive demands resulting from prolonged lactation ; and another class still, the excessive tax on phys- łcal power and muscular effort, without the necessary Supply. R. Ogden Dorem us, Professor Of º in the College of Pharmacy of this city, and in the Medical College of the City of New York (formerly called the Free Academy), and in the Bellevue Medical Hospital, says : “I have had, for many years, professional employment in the matter of examining human urine. The amount of the phosphätes will be increased in the urine, as the result of abnormal exercise of the body, St where the brain and nervous system are overexcited . This result of the discovery of a greater pro- portion of the phosphates in urine, after excessive mental labor, has been verified by experiments within Iny experience, and is in accordance with an Ordin-try knowledge from examinations of urine, insomuch that we teach these facts in our lectures to medical students.” William H. Van Buren, M.D., of New York, says: “I have been employed professionally to make examinations of the human urine and have generally found the phosphates in excess in cases where the nerve centres (the brain and spina cord) had been overworked or subjected to undue labor. The opinion which obtains in the profession and which has been confirmed by my own personal experience, is that there is a received rélation be tween an excess of phosphates in the urine and intellectual exercise.” Physicians wishing to examine and test this remedy are requested to apply, by letter or otherwise, to the undersigned. WILSON, LOCKWOOD, EVERETT & C0, G'. Ag'ts, 51 Murray Street, New York City. I . . tº , ; . . . . tº #7 .33° S , . " - - : … tº g *; ~} . . . …, , ; * * ‘. . j \; ; * ... ** * º | º y * ; "yº # vv. & 1 a º, THE MEDICAL . . . . . A Monthly Journal of `s . . - AMERICAN & FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL ſ / AND CHEMICAL LITERATURE, CRITICISM & NEWS. Vol. I. JUNE, 1872. No. 12. * Subscription Price, $2.00 a Year. Single Copies, 20 cents, PRACTICAL MEDIGINE: MISCELLANEOUs, . . . 470–480 - - Fº Hundred º: Of º: T. r. 244--. º —Paracentesis in Pleurisy an Impy- Lectures on Inflammation, DR. ema.--On the Treatment Of Asthma.- CHAS. MURCHIson, & . 441 Buculine Vaccine.—New Remedy for - - . . . & Cerebro-Spinal Meningitis.—Subcuta- . Clinical Lecture on Nervous or Sick- neous Injection of Morphia and Chlo- . . Headaches, DR. P. W. LATHAM, 452 roform.—Medical Deputies in Spain.— Lect y y §: Mºrtº, Of jº in Lectures On Dermatolog DR. ifferent States.—Dr. Gauster, of Vien- 9.y, - na, on Chloral Hydrate.—Displaced { $ ERASMUS WILSON, . & . 460 - Liver Simulating Pregnancy. MöLLER's Purest Norwegian Was awarded a Silver Medal at Paris International Exhibition, 1867, heading twenty-seven competitors. - - Is prepared from selected Livers, and bottled at Lofoten Islands, Norway. Was awarded a Gold Medal at Bergen International Exhibition, 1865. | Is the purest, and for limpidity, clearness, and delicacy of taste and smell is | Superior to any. sº Is highly recommended by the Medical Societies of Norway and England. Is more readily assimilated and more readily digested than any other Cod Liver Oil. - - - Was awarded the First Prize and the only Medal at London International Exhi- bition, 1862. - . Is recommended by high medical authorities in Europe and America. Was awarded First Prize, the only one awarded, at Stockholm Great Exhibi- tion, 1868. . - . W. H. Schieffelin & Co., AWew York, •, Sole Agents for United States and Canada. JAMES M. BMIDWIN, PBISHER, 3Iſ Broadway, N.Y. GEORGE TIEMANN & CO., F. A. STOHLMANN. Established 1826. ED. PFARRE 67 CHATHAM STREET, NEW YORK, MAN OF ACTURERS AND IMPORTERS OF ºf 'º. º. - ºf fºxºa “º gº ºx ºf 3. º º: ğ.º. º; Fºº gº § Fº }: º: &º, º ºr Nº & tº ": ºarneſſ P APPARATUS FOR FRACTURES, DISLOCATIONS, AND DEFORMITIES, Latest Instruments for Local Anaesthesia, and for Applications to the Larynx, Poste. rior Nares, Eustachian Tube, Uterus, Urethra, Bladder, etc., etc. Laryngo. | scopes, Ophthalmoscopes, Endoscopes, Hypodermic Syringes, Fever ! Thermometers, etc. Surgical Instruments of all kinds - made to order, and the Latest Improvements and | - Novelties promptly supplied. TWO SILVER MEDALS AWARDED EY THE EºgºşHºſſºſ ºjº” flºº BEING THE ONLY SILVER MEDALS GRANTED TO A #IERICAN EXHIBITORS OF SURGICAL INSTIR UMENTS. Stohlmann, Pfarre & Co., F. A. STOHLAIANN. ED. PFA.R.R.E. PHILIP SCHMIDT. 107 E, 28th Street, nr. Fourth Ave., ONLY BRANCH OF GEORGE THEMIANN & CO. ECKER BROS., yº - …, * , *"... ..º.º. tº & ºr Yº 8. - ; "| 3 || | | | | | | . º ºg "; , ; § º: , ; ; ºf is º : . K.'s § :-ºrd tºd. º: º: º, . . .º sº. º º º * ºf * VVarerooms, 33 Union Sq., Eroadway. FACTORY, 322, 324, 326, 3282& 330 W. 35th ST, EXTENDING TO 313, 315, 317, 319 & 321 W, 34th ST. *- wr--~~ “One of the simplest and most truly valuable improvements yet made in the pianoforte is that invented and patented by Decker Bros.”—From the New York Tribune. LIEBIG'S COMPANY'S Has Bar on Liebig’s signa- ture in blue ink across the label on each jar thus, Is manufactured under Baron Liebig's special control and guarantee. Has received the highest prizes everywhere for excel- lence of quality. Is the only extract that will keep good in any climate. Physicians in prescribing and purchasers should be careful to purchase only the extract that has Liebig's signa- ture on the jar, as none other is genuine. For sale by the leading Grocers and Druggists every- where. |S THE ORIGINA, AND Only Genuine ARTICLE, J. MILHAU’s SONS, Sole Agents, 183 Broadway and 15 Dey Street, New York. EHUNNEWELL’S § Cathartic, Narcotic, Tonic, Sedative, Alterative P I Ta Ts sº AND TOLU ANODYNE. The above so thoroughly defined, so highly approved, and the Formulas subjected to the fullest investigation, the Physicians may rely on them with confidence. THEY COMPRISE THE º Pill Aloin, cum Ferro, [3° Pill Podophyllum catam. Ferro, 3. Alterative Laacative Pill, tº Alterative Laacative Pill, ºf Alterative Laacative Pill, 3° Compound Quinine Pill. 3. Fluid Connabis cum Tolu, [3; Pill Sedative, Known as Eclectic Pills. Dr. Jackson's Formula. Dr. Gilman Davies' Formula. Dr. P. S. Haskell's Formula. HDr. Edward Hall's Formula. Dr. N. I. Aiken's Formula. Known as Tolu Anodyne, Dr. N. I. Aiken's Formula. Five years have clearly proved their importance, and the future will be to keep that good. Formulas in detail, describing samples and plans of getting such, or in quantities, sent on demand. JOHN L. HUNNEVVELL, Laboratory Office, 97 Commercial St., Boston, Mass. TJNIVERSITY OF NEW YORK, MEDICAL DEF AFTMENT, 426 East 26th St., opp. Bellevue Hospital, New York City. TH II: TY-FIRST SESSION, 1871-1872. FA cu LT Y of M E D 1 c 1 n E. REV. HowARD GROSBY, D.D., Chancellor of the University. MARTYN PAINE, M.D., LL.D., Emerºus Professor of Materia Medica and Therapeutics. JOHN W. DRAPER, M.D., LL.D., . WILLIAM DARLING, A.M., M.D., F.R.C.S., Professor of Descriptive and Surgical natomy. HENRY DRAPER, M.D., Professor % Physiology. Registrar of he Faculty. the Faculty WILLIAM H. THOMSON., M.D. Professor of Materia Therapeußics. FREDERICK D. LENTE, M.D., - - Professor of Diseases of Womeſ, and 3. EDWARD G. JANEWAY, M.D., . Professor of Physiological and P...nological Anatomy. D. B. ST. JOHN ROOSA, M.D., Clinical Professor of Diseases of the Eye Aſmeritus Professor of Chemistry and Physiology. President of the Faculty. ALFRED C. POST, M. * - - Medica wnf D. 'Professor of Surgery. CHARLES A. BUDD, M.D., Professor of Obstetrics and Clinical Midwifery. JOHN C. DRAPER, M.D., Professor of Chemistry. ALFRED L. LOOMIS, M.D., &nd Ear. Professor of Institutes and Practice ERSKINE MASON, M.D., of Medicine. Adjunct Professor of Surgery. The Collegiate Year is divided into two sessions—a regular Winter Session and a Spring, Summer, and Autumn Session... The latter is auxiliary to the former, and the design of the Faculty is to furnish instruction to medical students throughout the year. Attendance on the regular Winter Session is all that is demanded of the candidates for graduation. Those who attend the other session receive a Certificate of Honor, as having pursued voluntarily a fuller course than usual. The Spring and Sunnmer Session is principally of a practical and clinical charac- ter, and affords particular facilities to students who have already taken one course in schools where such practical advantages exist to a less extent. The course consists also partly of lectures and ex- aminations on the subjects necessary for graduating in medicine, conducted by the Professors of the regular Faculty and their assistants. The examinations will be addressed to both first and second course students. For the purpose of Enaking the visits to the wards of the hospitals as available as possible, the class is divided into sections. One division at a time is instructed in practical diagnosis, prescrip- tion, and treatment of patients. The course begins in the middle of March, and continues till, the beginning of June, when the Summer Commencement is held. During the Summer the College Clinics are kept Open. The Autumn or Preliminary Session commences in the middle of September, and continues till the opening of the regular session. It is conducted on the same plan as the Spring and Summer Session. The Regular Winter Session occupies four and a half months, commencing on the second of October, and continuing till the middle of February. The system of instruction embraces a thorough Didactic and Clinical Course, the lectures being illustrated by two clinics each day. One of these daily clinics will be held either in Bellevue or the Charity Hospital. The location of the pollege building affords the greatest facilities for Hospital Clinics. It is opposite the gate of "ºº" Hospital, on Twenty-sixth Street, and in close proximity to the ferry to Charity Hospital, well's Island, while the Department of Out-door Medical Charity and the Hospital Post-m are across the street. The students of the University Medical College will be furnishe sion tickets to these establishments free of charge. The Professors of the practical chai: ed with one or both of these Hospitals, and students are also entitled to attend “he other physicians in them. Besides the Hospital Clinics, there are eight clinics each week in the College The Faculty desire to call attention particularly to the opportunities for dissection. abundant, and are furnished free of charge, and the Professor of Anatomy spends day in demonstration in the dissecting room. Fees for the Winter Course. $ Full Course of Lectures................................................... . . . . . . . . . . Matriculation..... . . . . . . . . . . . . . . . . . . . . . . ............................... . . . . . . . . . . . . . . . Demonstrator's fee, including material for dissection.................................. ls. Graduation fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • * * * * * * g e a = e º a sº a tº w is a • * * * * * * * * * * * 30 • tº Fees for the Spring, Summer, and Autumn Course. Students who have attended the Winter Course will be admitted free of charge. Those who have not attended the Winter Course will be required to pay the matriculation fee and $30; and should they decide to become pupils for the winter, the $35 thus paid will be deducted from the price of the Winter Tickets. w For the purpose of assisting meritorious individuals, the Faculty will receive a few beneficiaries, each of whom will be required to pay $43 per annum and the matriculation fee. lºor further particulars and circulars, address the Registrar, PROF. HENRY DRAPER, M.D., 426 East 26th St, New York City. É : ! # ‘UNIVERSITY MEDICAL COLLEGE à : : : s INT © Nº.7V7" E. E. A. I.D Tº" - A NEW WORK By the late PROFESSOR DUNGLISON. HISTORY OF MEDICINE FROM THE EARLIEST AGES TO TIIE COMMENCEMENT OF THE NINETEENTH CENTURY. BY ROBLEY DUNGLISON, M.D., LL.D., I, ATE PROFESSOR OF INSTITUTES OF MEDIC IN E ANT) M. EDICAI, J U R IS PRUDENCE IN THE JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA, &c. &c. NOW FIRST COLLECTIED AND ARRANGED FROM THE ORIGINAL MANUSCRIPT BY HIS SON, RICHARD J. DUNGLISON, M.D. The publication of a posthumous work of the late distinguished author and teacher, PROFESSOR ROBLEY DUNGLISON, must be a matter of general interest to the profession, to whose advancement he devoted so many years of his valuable life. While occupying a professorial chair in the University of Virginia, it became his duº ºrding to the terms of his appointment, “to teach to the best of his ability, h due diligence, Anatomy, Surgery, THE HISTORY OF TH AND THE OF MEDICINE, Physiology, Materia Medica, and Pharm full manus& ºt of his historical lectures, as there delivered, has bee revised for publication by his son, Dr. RICHARD J. DUNGLISON, who, expedient to abandon their original didactic form, has made such slight aſt, of the text as seemed necessary to embody the facts presented in regular form. * { The work traces the history of important discoveries and improvements' in medicine, of medical theories, of medical writers and practitioners, authors, and founders of special systems, of celebrated schools of medical learning, &c. &c. To those who are already in possession of Professor Dunglison's other works, this History of Medicine will form a supplementary volume of great interest and at- traction; while to all others it offers an entertaining field of research on subjects which always have the charm of freshness and novelty. As an historical and literary work it has claims for consideration from members of other liberal professions, who will find in it a vast amount of valuable information on other than purely medical subjects. It is issued in a small octavo volume of nearly 300 pages, printed on tinted * paper, handsomely bound in cloth, bevelled boards, and is sold only by subscrip- tion. Subscribers furnished by mail, post-paid, on receipt of price ($2.50). Agents for New York City and vicinity, W. & J. M. BALDWIN, Publishers, Subscription and Advertising Agents, 811 BROAD WAY, NEW YORK. T MEDICAL WORLD A MONTHLY RECORD OF AMERICAN AND FOREIGN MEDICAL, PHYSIOLOGICAL, SURGICAL, AND CHEMICAL LITERATURE, CRITICISM, AND NEWS. - VOL. I. NEw York, JUNE, 1872. No. 11. 33ractical ſtatuitine. L E C T U R E S O N IN FL A M M A TI O N . BY CHARLES MURCHISON, M.D., LL.D., F.R.S., Physician to St. Thomas's Hospital, and Joint Lecturer on Medicine at St. Thomas's Hos- pital Medical School, etc. 1. Definition.—2. Etymology.—3. Frequency and Importance.—4. Pa- thology. Mirºwte Changes. Results : a. Resolution ; b. Suppura- tion ; c. Fibroid Substitution ; d. Ulceration ; e. Gangrene. In- flammation of Serows and Mucous Membranes.—5. Cawses.—6. Symp- toms. A. Local Signs of Inflammation : a. Redness ; b. Swelling ; c. Heat ; d. Pain. B. Constitutional Pyreacia. C. Deranged Func- tions of Inflamed Part.—7. Varieties.—8. Treatment. I. Définition.—Inflammation of a tissue consists in the in- creased transudation into it of materials from the blood, and an alteration of its nutrition, consequent on some irritation. Many definitions of inflammation have been given by differ- ent writers. It was long taught that inflammation consisted essentially in an exudation of lymph, which might either be- come organized or soften into pus. This definition, however, is not applicable to all forms of inflammation; for, although in Some the matter transuded from the mińute vessels does take 442 JCectures on Inflammation. [June, the form of lymph, yet lymph is rarely seen in inflammation of mucous membranes, of brain, and of cartilage. Nor can in- flammation be defined as a local hyperaemia with stasis of blood in the capillaries; for, although these phenomena are common in inflammation, it has been shown that, even in vas- cular tissues, exudation of liquor sanguinis, although favored by increased arterial afflux, may occur without it; and, more- over, we know that inflammation may take place in tissues which are non-vascular, the increased supplies being then drawn from the vessels of the adjacent parts. The Ylefinition which I have now placed before you is most in harmony with our present knowledge of the subject. II. Etymology.—The term “inflammation ” is derived from the Latin word inflammo, to burn ; and was originally em- ployed many years ago, from the fact that, in external inflam- mations, increased heat or burning is one of the most obvious and prominent phenomena. - III. Frequency and Importance.—Next to pyrexia, inflamma- tion is the most common morbid process which comes under the notice of the medical practitioner. Most diseases, in fact, either commence as inflammation or are complicated with in- flammation in Some part of their course ; while others simulate inflammation so closely as to require considerable skill to dis- criminate them. In after-life, you will constantly be called upon to decide whether inflammation exists or not. Death is, in a great many instances, due to inflammation ; and in not a few instances death is prevented by inflammation. A local inflammation gluing the peritoneal covering to adjacent parts often prevents a fatal escape into the peritoneal cavity of food from an ulcerated stomach, of faeces from an ulcerated bowel, of pus from an hepatic abscess, or of gall-stones from an ulcer- ated gall-bladder. You will perceive, then, how important it is that you should acquire an accurate knowledge of the in- flammatory process. This, I have no doubt, you have already done from attendance on the lectures on General Pathology. In this lecture I shall do no more than recall to your minds the leading facts of the process, and more especially those which have a practical bearing upon the diseases which we shall here- after have occasion to discuss; and for additional details I would refer you to the able articles of Dr. Burdon Sanderson 1872.] Lectures on Inflammation. 443 and Mr. Simon, in the second and fifth volumes of the second edition of Holmes’s “System of Surgery.” IV. Pathology.—The minute changes which take place in a tissue as the result of inflammation have long been studied ; and our knowledge of them has been rendered much more accu- rate by the researches in recent years of Lister, Cohnheim, Stricker, and Sanderson. The plan of investigation has con- sisted in producing inflammation artificially in the transparent web of a frog's foot, or in the mesentery or tongue of the same animal, or in the wing of the bat. The changes observed have been as follows: 1. Disorder of the circulation. 2. Transudation through the minute vessels of liquor San- guinis and blood corpuscles. 3. Alterations in the nutrition of the tissues. 1. Disorder of the Circulation.—The first change consists in an acceleration and increase of the circulation of the irritated part. The vessels immediately begin to dilate without any antecedent stage of contraction; the dilatation being progres- sive, and commencing in the minute arteries, but followed by a similar change in the veins. The rate of movement of the blood is at the same time altered. At first it is much quicker than natural, so that both the actual quantity of blood existing in the part, and that passing through it in a given time, are increased. There are satisfactory grounds for believing that the acceleration of the blood-stream is due to an irritation of the centripetal nerves of the injured part, reflected by the vaSO-motor centre through the centrifugal nerves to the vessels, and influencing them in some way (not yet sufficiently under- stood), so as to facilitate the flow of blood through them. The second change observed is a retardation and diminution in the flow of blood through the part. The retardation usually commences rather suddenly, and is "first observable in the veins; but the rapidity of the current may be often seen to vary in contiguous vessels: the current in some being rapid, and in others oscillating to and fro; while in others the blood is stagnant. The small arteries and capillaries often exhibit at * An excellent summary of the minute changes which take place in in- flamed tissues will also be found in Dr. T. H. Green’s “Introduction to Patho- logy and Morbid Anatomy.” London. 1871. 444 Lectures on Inflammation. [June, the same time irregular bulgings and contractions. At last the current becomes everywhere arrested; and the red corpuscles accumulate in the capillaries, and become so closely packed that their outlines can barely be distinguished. This is the condition long known as inflammatory stasis, and is believed to be due to some impairment or alteration in the vital pro- perties of the walls of the blood-vessels with which the circu- lating blood comes in contact. Around the area of stagnation there is congestion, or fulness of the vessels with slow move- ment of the blood; and at a further distance around there is, to adopt Sir James Paget’s expression, determination, or ful- ness with rapid movement of the blood. - 2. Transudation through the Minute Vessels of Liquor Sangwºn is and Blood-corpuscles.—In a state of health, transu- dation to a certain extent is constantly taking place through the coats of the minute vessels into a tissue; but in in- flammation, as soon as retardation of the current of blood commences, this transudation is increased. The transuded matter varies in different cases. Sometimes it is mainly serum, as in certain inflammations of the pleura and in the submucous infiltration of an inflamed mucous membrane; at other times it is coagulable lymph, as in inflammations of the pericardium, peritonaeum, and pleura. The exudations of in- flammation differ from the liquor sanguinis of normal blood, in containing more albumen and a great excess of chlorides and phosphates. Pus is said to contain three times as much chloride of sodium as the serum of blood ; while in pneumonia the lungs are strongly impregnated with chlorides, which dis- appear from the urine. But it is not the liquor sanguinis alone which transudes. The blood-corpuscles, and especially the white corpuscles, pass through the coats of the vessels, and escape into the inflamed tissue. Many years ago (1841), it was shown by Dr. C. J. B. Williams that, when the capillary cir- culation was becoming retarded, the white corpuscles in the vessels became increased, and showed a remarkable disposition to adhere to their walls; and that white corpuscles also appeared outside the vessels, indistinguishable from those within. But he did not see his way to admit that the cor- puscles outside and inside the vessels were identical. Dr. William Addison (1842) and Dr. Augustus Waller (1846) 1872.] Lectures on Inflammation. 445 were the first to describe the emigration of white blood-cor- puscles through the walls of the blood-vessels; and both of these observers maintained that the escaped blood-corpuscles became pus-corpuscles. About the same time, it was shown by Virchow that pus-corpuscles and white blood-corpuscles are indistinguishable. The statements of these observers, how- ever, made little impression, and were soon forgotten ; and it is only since the independent researches of Professor Cohnheim, of Berlin, in 1867, that the transudation of blood-corpuscles has come to occupy an important place in the pathology of inflammation. For the details of the method of transudation, I must refer you to Dr. Sanderson’s memoir; * and I shall now confine myself to stating that it has been satisfactorily demon- strated that, as soon as retardation of the circulation com- mences, and before complete stasis, the white corpuscles crowd in large numbers against the vascular wall, and pass through the wall, not by little rents or fissures, but by a process of amoeboid digestion of the protoplasm of the wall. The red corpuscles also sometimes pass through the walls of the capil- laries, thus accounting for the occasional presence of blood in inflammatory exudations. 3. Alterations in the Wutrition of the Tissue.—The nutri- tive changes, although they differ according to the structure of * “Simultaneously with the retardation, the leucocytes (white corpuscles), instead of loitering here and there at the edge of the axial current, begin to crowd in numbers against the vascular wall, as was long ago described by Dr. Williams. In this way the vein becomes lined with a continuous pave- ment of these bodies, which remain almost motionless, notwithstanding that the axial current sweeps by them as continuously as before, though with abated velocity. Now is the moment at which the eye must be fixed on the outer contour of the vessel, from which (to quote Professor Cohnheim's words) here and there minute colorless button-shaped elevations spring, just as if they were produced by budding out of the wall of the vessel itself. The buds increase gradually and slowly in size, until each assumes the form of a hemispherical projection, of width corresponding to that of a leucocyte. Eventually, the hemisphere is converted into a pear-shaped body, the stalk end of which is still attached to the surface of the vein, while the round part projects freely. Gradually the little mass of protoplasm removes itself further and further away; and, as it does so, begins to shoot out delicate prongs of transparent protoplasm from its surface, in nowise differing in their aspect from the slender thread by which it is still moored to the vessel. Finally, the thread is severed, and the process is complete. The observer has before him an emigrant leucocyte.” (Sanderson, loc. cit.) 446 Lectures on Inflammation. [June, the part affected, all indicate an abnormal activity of cell-life. The first change is one of cell-proliferation. This is particu- larly active in tissues which, like skin and mucous membrane, are naturally maintained by a multiplication of their cellular elements; but, even in such a tissue as cartilage, the cells, which under normal conditions undergo no alterations in form, become enlarged and altered in shape, while new cells are formed in their interior by enlargement and subdivision of their nuclei and protoplasm ; and the matrix softens and liquefies. By a continuance of this process, the natural struc- ture of the connective and supporting tissues, such as areolar tissue, bone, cartilage, and muscle, is completely destroyed, while the newly-formed elements either degenerate into pus or die, or become developed into a permanent tissue of inferior organization to that of the original structure. Such is a brief outline of the minute changes which take place in inflammation. We may now consider from a practical point of view some of the results of the inflammatory process. 1. In the first place, inflammation may terminate in what is called resolution. Here there is congestion and retardation of the flow of blood, but the quantity of material transuded through the coats of the vessels is small, or is absorbed without affect- ing any material alteration in the nutrition of the tissue. This is the most favorable mode of termination of inflammation. When the process of resolution is very sudden and rapid, it is sometimes called delitescence; and when the inflammation which thus suddenly recedes from one part of the body makes its appearance in another, as in articular rheumatism and in mumps (where the inflammation is sometimes transferred from the parotid to the mamma or testicle) there is said to be metas- tasis. This diversion of the inflammation from one part of the body to another we sometimes endeavor to imitate in treat- ment by what is termed counter-irritation, derivation, or nevulsion. 2. Suppuration is a very common result of inflammation, and almost invariably occurs when the process is intense and acute. It is unnecessary for me to describe to you the minute cha- racters of pus; but I may remind you that it consists of minute rounded corpuscles suspended in a liquid similar to liquor san- guinis; that these corpuscles cannot be distinguished from the 1872.] Lectures on Inflammation. 447 white corpuscles of the blood; that they can multiply by divi- sion; that they are masses of contractile protoplasm, which, like amoebae, can alter in form, and have the power of spon- taneous movement; and that they can, therefore, migrate in the tissues. The liquid of the pus is the transuded liquor sanguinis, but the corpuscles are derived from two sources. Some, and especially those met with in the early stages of in- flammation, are the white corpuscles which have escaped from the vessels—blood-corpuscles, in fact, in the wrong place; but others are due to the proliferation of the cellular elements of the inflamed tissue, whose nutrition has become altered in the manner already described. By a process of cell-growth, then, the natural tissue of a solid organ may become liquefied into pus. When skin or mucous membrane is inflamed, the pus, as soon as formed, is discharged; but in inflammation of other parts the pus collects in a cavity, and the collection is called an abscess, or it becomes infiltrated through the tissues of the in- flamed part in what is called purulent infiltration. An abscess usually finds its way in time to the skin or a mucous surface, and discharges itself; but if it remain long imbedded in the tissues, the liquid becomes absorbed, the cells atrophy and undergo a fatty disintegration, and in time the abscess may dry up into a cheesy or calcified mass. 3. Fibroid Substitution is another result of the inflamma- tory process, and especially when this follows a chronic course. Here the inflamed part, instead of liquefying, becomes solidi- fied from the gradual formation of new fibrous tissue, which takes the place of the natural structure. The young cells, which have escaped from the vessels, or formed in the part, in the manner already described, become aggregated, and pre- sent a distinct nucleus in their interior (granulation-tissue); channels become hollowed out in this new tissue lined on each side by cells, into which blood penetrates from the neighbor. ing vessels, and in this way new vessels are gradually formed, while at the same time the granulation-tissue becomes slowly developed into a fibrillated tissue. Some of the young cells become elongated and spindle-shaped ; others disappear; and the intercellular splits up into delicate fibrils, in which at certain intervals granulation-cells remain permanently embedded, and constitute fixed connective tissue corpuscles. This is the pro- 448 Lectures on Inflammation. [June, cess which takes place in the so-called cirrhosis, or interstitial inflammations, of the liver, lungs, and kidneys, and also dur- ing the healing of wounds by the “first intention,” and in the organization of the granulations by which the cavity of an ab- scess is filled up after the discharge of the pus. It is by the same process also that the lymph which is thrown out in an inflamed Serous membrane becomes organized, so as ultimately to form fibroid thickening of the membrane and firm adhesions between its opposed surfaces, in what is called adhesive in- flammation. An important feature of this process is that the cellular mass, during its conversion into fibrous tissue, under- goes contraction ; and thus it is that the site of a cut on the skin is for ever marked by a puckering called a cicatrix, while similar cicatrix-like depressions may be seen on the surface of an internal organ which has been the seat of interstitial in- flammation. 4. Ulceration is the term applied when the liquefying result of inflammation described under the head of Suppuration in- volves any of the surface-textures of the body, such as the skin, mucous membrane, articular cartilage, or the lining membrane of an artery, to such an extent as to produce a loss of sub- stance. The breach of surface is called an ulcer. Like a closed abscess, an ulcer may burrow deeply, and eat through all the tissues with which it comes in contact. An ulcer heals or cicatrises by granulation-tissue becoming developed into fibrous tissue, as already explained. 5. Gangrene, Mortification, Sphacelus, or Sloughing, is another result of inflammation. The vitality of the inflamed part may be so impaired, and the stagnation of blood so com- plete, that the part dies. Mortification is, therefore, most apt to occur when the inflammatory process is intense, and when there are in operation other causes of impaired vitality and weakened circulation, such as a weak state of the circulation throughout the body, an unhealthy condition of blood, or pres- sure upon the inflamed part. As soon as vitality is entirely destroyed, all pain in the part ceases, and the ordinary chemi- cal changes of putrefaction take place in the dead mass, which, acting like a foreign body, excites fresh inflammation in the surrounding tissues. By suppuration and ulceration, a line of demarcation is ultimately formed between the dead 1872.] Jectures on Inflammation. 449 and living tissue, and ultimately the former is completely detached. Mortification is not an equally common result of inflamma- tion in all parts of the body. It is most common in the vascular connective and supporting tissues—skin, areolar tissue, and bone. The next most common site is the mucous membrane of the digestive canal. Thus sloughing is not a very rare re- sult of scarlatinal ulceratian of the fauces, and is a very com- mon result of the inflammation of the intestines which occurs in enteric fever and dysentery. It is a very rare result of in- flammation of the lungs, and is scarcely ever met with in the liver, spleen, kidneys, heart, or brain. Gangrene, however, may occur independently of inflamma- tion. Among other causes, may be mentioned occlusion of the afferent artery by embolism or other processes; diminished power of the heart in conjunction with diseased arterial coats, as in “senile gangrene”; occlusion of the small arteries and capillaries by pressure, or by the presence of certain poisons, such as ergot, in the blood; extreme heat or cold, and power- ful corrosive substances. When gangrene is due to a deficient supply of blood, the dead part shrivels up, and the gangrene is said to be dry; but when it is due to inflammation, or when there is at the same time venous obstruction, the part may re- main tense from accumulation of fluid, and the gangrene is termed moist. There are certain modifications of the inflammatory process, according to the tissue involved, which are of some practical importance, and which I must briefly mention. I refer more particularly to the varieties of inflammation observed in serous and mucous membranes. 1. In Serous Membranes, the inflammatory process com- mences with hyperaemia. Liquor sanguinis and white cor- puscles transude from the vessels into the serous cavity; and the epithelial cells of the serous membrane enlarge and become granular, and multiply by endogenous growth. Instead of being smooth and glistening, the membrane becomes opaque and rough, from the deposit of coagulated lymph gluing the opposed surfaces together, or forming a slightly adherent, rough, or reticulated membranous covering. Along with this there is usually more or less serous fluid, which is turbid from the 450 Lectures on Inflammation. [June, presence of migrated blood-corpuscles and flakes of lymph. Sometimes none of this liquid is thrown out; and, when pres- ent, the quantity varies greatly. Occasionally the quantity is so great that the serous sac is greatly distended, and there is danger from its pressure on adjacent parts. When recovery takes place, this liquid is absorbed; but the fibrine undergoes organization in the manner which I have already described, and produces permanent thickening of the serous membrane, and firm bands of adhesion between its opposed surfaces. It is rare for the exuded matters to take the form of pus; but sometimes this does happen, and more especially when the patient’s system has been in a very low condition—when air, or Some putrid matter, such as the contents of the bowel, has obtained access into the serous cavity, or when the inflamma- tion has been excited by some morbid poison, such as that of small-pox, in the blood. 2. In Mucous Membranes we find two distinct forms of in- flammation—the catarrhal and the membranous. Of these, the former is by far the more common. a. Of catarrhal inflammation the characters are mainly three, viz.: increased vascularity; tumefaction of the membrane from submucous transudation, and an increased secretion of mucous from the free surface, at first clear and tenacious, but gradually becoming opaque yellow, less viscid, and puriform, There is nothing here like an exudation of fibrine from the blood. The exudation takes the form of an increased formation of mucus, although of course the materials for this are transuded from the blood. On minute examination, it is found that from the first the epithelium-cells become enlarged and granular and abnormally multiplied; and that the number of mucus-cor- puscles is greatly increased, some of these corpuscles being ap- parently escaped blood-corpuscles, but the majority being formed by endogenous multiplication within the epithelial cells. As the inflammation advances, these little rounded cor- puscles become still more numerous, and indistinguishable from those of pus. The only differences, in fact, between a mucus- corpuscle and a pus-corpuscle are, that the latter is smaller, and has several nuclei instead of one. At the same time, the fol- licular glands in the mucous membrane become distended with secretion, and may impart a “granular ’’ appearance to the in- & 1872.] Jectures on Inflammation. 451 flamed mucous membrane. Little drops of pus may form in the inflamed follicles, and, at last bursting, may leave small ulcers. The process of proliferation commencing in the epi- thelial cells may also extend to the subepithelial connective tissue, and thus produce more extensive breaches of surface or ulcers. It is important to remember that the redness and swelling indicative of catarrhal inflammation during life may be no longer visible in the dead body. b. In membranous, croupal, or diphtheriffic inflammation, there are also hyperaemia and tumefaction of the mucous mem- brane; but its peculiarity consists in this, that the free mucous sur- face becomes lined with a distinct membranous layer of more or less thickness, but often resembling wash-leather. The so- called “false membrane’’ is generally described as composed of fibrine assuming a fibrillated arrangement, and enclosing in its meshes epithelial cells more or less transformed into pus; but the recent observations of Wagner, Cornil, and Ranvier (with which my own agree) seem to show that in most in- stances, at all events, there is no fibrine at all, but that the membrane is made up entirely of altered epithelium-cells, some of which become infiltrated with an albuminoid substance, lose their nuclei and cell-wall, and become converted into homoge- neous branching masses.” This cellular structure accounts for the fact that, however thick and consistent these false mem- branes may be during life, they are usually breaking down and becoming disintegrated by the time that a post-mortem exam- ination is made. Membranous inflammation is often preceded by catarrhal, of which it appears to be merely an intensified form ; and we constantly observe every stage of gradation be- tween the two. In croup, the inflammation may be membra- nous in the larynx, and catarrhal in the bronchi, with a grad- ual transition from one to the other. Moreover, you must remember that, although membranous inflammation is often excited by a specific poison, as in diphtheria, yet an inflamma- tion which is anatomically identical may be produced by other causes, such as severe irritants of a non-specific character. Children, who sometimes swallow by mistake boiling water from the spout of a kettle, are liable to die of croupal inflam- mation of the larynx. * See Cornil and Ranvier, Manuel d'Histologie Pathologique, 1869, p. 90. 452 Clinical Zecture on [June, CLINICAL LECTURE ON NERVOUS OR SICK- FHEAD ACHES. Delivered at Addenbrooke's Hospital, Cambridge, Eng. BY P. W. LATHAM, M.D., F.R.C.P.L., Physician to the Hospital; Deputy for the Downing Professor ºf Medicine; etc. (Continued from last No., page 420.) IT is well-known that the vision is disturbed by a diminished supply of blood to the brain—as, for instance, in the faintness which is induced by hamorrhage. The patients become giddy ; everything appears dark before them ; perhaps they have, moreover, flashes of light before their eyes, or noises in their ear, and then become insensible, and sink to the ground. How often do we hear from persons who are dying from asthenia such expressions as the following: “How dark the room is"; “I can’t see"; “open the shutters”; telling us too plainly that the heart is powerless to drive the blood on- ward to the brain. Now, in one instance which came under my notice, the person who had been occasionally troubled with the form of headache we are considering, stated that he once fainted. “I was very much fatigued, and had run quick- ly up some steps, when I tumbled on the floor; the faint was only momentary ; I immediately recovered myself, and took the nearest seat. On sitting up, everything became dark before me, so Ileant forward and put my head between my knees. I then noticed the appearance before my eyes; it had precisely the same character as the wavy glimmering which preceded the headaches, but was much darker, more marked, and ex- tensive ; it only lasted half a minute or three-quarters, then entirely passed off, and no headache followed.” Here is an- other account which strongly supports the view I take of the phenomena: “I had not been troubled for two or three years with these blinding headaches until one morning, as I was sitting at breakfast, the symptoms showed themselves. I had been overworked for some little time, and felt chilly and irri- table as I sat at table. I was looking sidewise at the window, watching the falling snow, when I noticed that one of the 1872.] Mervous or Sick-Headaches. - 453 panes of glass appeared as though warped and waved, the lines of snow becoming indistinct at the part; as I moved my eyes, the other panes of glass presented the same appearance; then on looking at the wall, I recognized my almost forgotten enemy; there was a distinct glimmering at the right side quite at the edge of the field of vision. I immediately lay down on the couch with my head low ; the appearance of glimmering gradually extended itself over more than half the field of vision, and continued for about twenty minutes. I noticed that it was less distinct when I lay on my left side than when I lay on my right; when it was declining, as I turned to my right side, the movement was more plainly per- ceptible. The headache on the left side had been gradually increasing; my feet were very cold, and when the glimmering had almost disappeared, I got up and drew an easy-chair to the fire, but had not been seated more than a minute, when the glimmering became more distinct and appeared to extend. I at once lay down again, when the disturbance of vision soon ceased, and the headache took its place.” This disturbance of vision, then, is due to defective supply of blood to one side of the brain from the contraction of the cerebral arteries, proba- bly of the middle cerebral. In the case which I have just read to you, there was loss of tone about the cerebro-spinal system from overwork; the brain is no longer able to inhibit the action of the sympathetic; a slight cause serves now to ex- cite the action of the latter nerve; it affects more particularly the cerebral artery of the left side, causing glimmering on the right side of the field of vision. The glimmering is lessened by adopting a posture which allows the blood to flow readily towards the part affected. The patient rises before the optical disturbance and the excitement of the sympathetic are entirely over; in the erect posture the blood is driven with less force to the brain, and, with the lessened pressure on the arteries, these contract more strongly, owing to the still excited state of the sympathetic, and the glimmering increases. The patient lies down again, the blood is driven with increased force to the brain, the resistance of the arteries is overcome, the action of the sympathetic is exhausted, and the same condition results as is observed after section of this nerve. The vessels become distended, the head throbs and aches, and the pupil contracts. 454. Clinical Lecture on [June, If we take this view of the disorder, you will perceive that it has (as was first suggested to me by my friend Dr. Edward Liveing) a relationship, though happily a very distant one, to epilepsy. The contraction of the cerebral arteries, the ting- ling in some portion of the body, and twitchings of the mus. cles, which, as you see, are sometimes associated with it, sug- gest the resemblance; whereas it differs widely from that terrible disorder in that it never threatens life, it is never associated with unconsciousness, and I have never heard of its passing into epilepsy. On the contrary, with advancing age the attacks, as a rule, become much less frequent. They cease generally after fifty or sixty, and in women not uncommonly at the change of life. - There is no d prior? reason why the sympathetic nerve of one side only should be affected, and therefore the disturbance of vision only affect one eye, except that in nervous disorders generally, such as chorea, epilepsy, tic-douloureux, etc., one side of the body is often much more affected than the other; but the statement of Sir John Herschel, the fact of posture in- creasing or diminishing the intensity of the glimmering when it exists at one side or other, the succeeding headache com- mencing unilaterally, all tend to support the view that the affection at least commences on one side of the brain. The other side may, and probably does, become involved, if the glimmering spread over the whole field of vision. If the attacks, however, begin with the disappearance of objects at or near the centre of vision, I think, then, that both sides are equally affected; and this may explain the fact why with some persons the headache is uniformly diffused and does not make itself felt at one spot more particularly than another. Another question arises: Why is there in some cases (1) dis- turbance of vision without headache following ; in others, (2) disturbance of vision followed by headache; in others again, (3) headache preceded by disordered sensation, but not by dis- turbed vision ? I think this may be explained by the more or less relaxed condition of the vascular system in the different cases. If the muscular fibres of the arterial system be only slightly relaxed, a very little irritation of the sympathetic nerve may be sufficient to diminish the supply of blood and cause the disturbance of vision, etc.; but the exhaustion of the nerve 1872.] Mervous or Sick-Headaches. 455 would also be slight, and consequently the blood-vessels would not be dilated sufficiently to produce headache. Let the mus- cular fibres, however, be in a feebler condition, then after the effort of contracting they will relax more completely, and head- ache will result ; and lastly, if they be in a still weaker state, then the action of the sympathetic may not excite contraction sufficient to diminish the supply of blood to such an extent as to cause disturbance of vision, etc., but sufficient to produce mental depression, coldness of the extremities, etc.; or a very slight effort at contraction may be followed, from the state of the vessels, by considerable dilatation and headache. The condition 3 might also be explained, however, by the sup- position that different branches of the blood-vessels in the brain are affected than is the case when the conditions 1 and 2 show themselves. Lastly, though looking on this as a nervous disorder, it is easy to see that, if the theory advanced be true, or near the truth, gastric derangement, or any other derangement which will irritate the sympathetic nervous system, may be an excit- ing cause ; and it is well known that irritation in the stomach or intestines has a powerful effect on the sympathetic nervous system, so that the terms “ sick-headache” or “bilious head- ache,” implying that the disorder has arisen from derangement of the abdominal organs, may not in some cases be altogether inapplicable. Adopting, then, this theory—and you must recollect, gentle- men, that it is advanced not as certain and proved, but Only as possibly true—what are the indications for treatment with which it supplies us? Let us consider separately the remedial measures to be adopted (1) during the stage of disturbed sensa- tion, (2) during the stage of headache, and (3) during the inter- vals between the attacks. * 1. During the Stage of Disturbed Sensation.—In the forms attended with disturbance of vision, you will find that in the same individual the longer this stage lasts, the greater will be the headache; and therefore we must endeavor to shorten it as much as possible. If the condition, then, depend upon de- ficient supply of blood to a part, such means must be adopted as shall assist and increase the flow of blood to the part; and this can be done in some measure by posture and stimulants. 456 Clinical Lecture on [June, Directly the glimmering appears, the patient should lie down with the head as low as possible, and if the glimmering be on the right or left of the field of vision, he should lie on the opposite side. Let him take at once a full-sized glass of sherry; if at hand, half a bottle of soda-water is a useful addition. Champagne would be preferable, being more diffusible; but its administration would often involve a little delay, and at the commencement of an attack it is a great point to save time. A large tablespoonful of brandy diluted may, if the patient prefer it, be substituted for the sherry. If alcoholic stimulants be objected to, or if it be not advisable to recommend them, then a teaspoonful of sal volatile in water may be prescribed instead. If the patient be chilly or his feet cold, the couch should be drawn before the fire and a hot bottle applied to the feet. By these means the heart is enabled to drive the blood with greater force to the brain, and the duration of the vibra- tory movement is thereby materially lessened. After it has passed off, the patient should lie still for a time, so that the glimmering may not return, This injunction will only be necessary when the headache is slight; if it be severe, attended with much nausea or vomiting, the patient will be little dis- posed or able to leave the recumbent position. If, instead of the disturbance of vision preceding the headache, there be a feeling of depression or irritability, fidgets, etc., the adminis- tration of such cerebro-spinal stimulants as henbane, Valerian, assafoetida, spirit of chloroform, or ether, will often cut short the attack; ten or fifteen drops of the tincture of henbane, with the same quantity of spirit of chloroform, will soothe the nervous irritability in the slighter forms, and may be re- peated in three or four hours, if necessary. If there be great mental depression, then Valerian or assafoetida should be tried. Stillé says: “Nothing is more astonishing in the operation of remedies than the promptness and certainty with which a dose of valerian or assafoetida dispels the gloomy visions of the hypochondriac, calms the hurry and agitation of nervous ex- citement, allays commencing spasms, and diffuses a Soothing calm over the whole being of one who but an hour before was a prey to a thousand morbid sensations and thick-coming fan- cies of danger, wrong, or loss.” I give the preference to valerian, and prescribe from half a drachm to a drachm of the 1872.] Mervous or Sick-Headaches. 457 ammoniated tincture. The assafoetida may be given in the form of the spiritus ammoniae foetidus of the Pharmacopoeia, also in half drachm or drachm doses. As a rule, alcoholic stimulants are not advisable here. A small quantity will cause flushing, heaviness, slight confusion of thought, etc., without relieving the depression; and though the severe head- ache may be averted, alcoholic stimulants do not answer so well as the remedies previously mentioned. 2. During the Stage of /ſeadache.—If the headache be slight and the patient soon able to sit up, there is little to be done; a cup of coffee or tea, cheerful conversation, a walk, drive, or ride, may often help to remove the pain. If, however, the headache, nausea, etc., be severe, then the administration of further remedies is called for. The patient should keep perfectly still and quiet, with the room darkened; for every sound or sight causes pain, and the slightest movement is suf. ficient to produce gastric uneasiness. Sometimes free evacuation of the contents of the stomach, especially if it contain undi- gested food, is followed by relief. Dr. Fothergill says, “An emetic and some warm water soon wash off the offending mat- ter and remove these disorders,” which may be very well where there is any offending matter to wash off, but it is not very often that this is the case; the nausea frequently continues long after the contents of the stomach have been discharged; an inverted action of the duodenum is set up ; the bile appears in the fluids excreted; the patient believes that all his troubles are due to “its overflow ’’; “it’s all liver,” he says, and it is Sometimes difficult to persuade him to the contrary. Generally, then, you should try to relieve and check the vomiting. Iced Soda-water, with or without two or three drops of dilute hydro- cyanic acid, or spirit of chloroform; cold tea; the effervescing citrate of potash, with hydrocyanic acid, may often afford marked relief. The headache may be lessened by applying cloths dipped in cold water, or evaporating lotions, to the head; if the extremities be cold and the headache severe, a warm, stimulating foot-bath can be tried so soon as the nausea will allow the patient to sit up. If the attacks occur in the early part of the day, as soon as the pain has subsided it is generally better for the patient to sit up, or move about, or take exercise in the open air. A young lady, on consulting me for this disorder, VOL. I.-34 458 Clinical Lectures on [June, said: “Nothing relieves these headaches except a good gallop on my pony. I have sometimes to lie still for three or four hours before the pain is bearable; but directly I am able, I mount my pony, and always return home better.” During the attack the appetite is diminished, the idea even of food provok- ing disgust. Still, after the nausea has passed away and the headache has continued a few hours, a plate of soup or some easily-digested food often has a good effect in equalizing the cerebral circulation. A remedy which may very often be given with advantage if the headache be severe is bromide of potas- sium in doses of 5, 10, or 15 grains, to which 30 or 40 minims of sal volatile may in some cases be added with advantage; and if the nausea still continue, these may be given in combin- ation with the effervescing citrate of potash. A saline purga- tive at the commencement of an attack is sometimes an effectual remedy; but, as a rule, the use of purgatives is ob- jectionable. So far, the measures which I have suggested are only pallia- tive. We come now to the consideration of such as are pre- ventive, or to the treatment necessary during the intervals between the attacks. First of all, you must try to find out the exciting cause, and endeavor to remove it. Hours of study or work must be abridged; excessive bodily fatigue, loss of rest, everything, in fact, must be avoided which the sufferers know from individual experience will act as exciting causes. Where the attacks are associated with excessive mental work, they should be regarded as danger-signals, showing necessity for relaxation. In the next place, you must endeavor to improve the tone of the bodily and the nervous systems by proper medicinal and hygienic means; and the chief remedies which I employ are steel, strychnine, and cod-liver oil. The success, however, following these remedies depends a great deal upon the way in which they are administered. For a day or two after the attack the stomach and bowels may possibly be disor- dered, and not in a fit state to tolerate such remedies. This must first be corrected. The simple vegetable bitters, such as gentian, with small doses of henbane and some aromatic, may be of service, and, if necessary, one or two grains of blue pill, with four or five of compound rhubarb pill, may be given at night. We may then try steel. If the attacks have been very 1872.] Mervous or Sick-AJeadaches. 459 frequent, or if there be any scrofulous tendency, I give the iodide of iron in the following form ; B. Ferri et ammon. cit- rat. gr. V. ; potassi, iodidi, gr. ii.; aquae 3.j. ; and I add, accord- ing to circumstances, 15 to 20 minims of tincture of henbane, or 20 or 30 minims of aromatic spirit of ammonia. If the stomach be at all irritable, I give this in the effervescing form, adding to each dose 20 grains of bicarbonate of potash, and directing it to be taken with a tablespoonful of lemon-juice or a corresponding amount of citric acid; the dose to be taken twice a day, about 11 and 4. I soon leave off the effervescing form, and then add to each dose 5 minims of liquor strychniae, omitting the henbane and sal volatile, and continuing the iodide of potassium according as it seems to be indicated or not. In other cases, I give the citrate of iron and ammonia with Strychnine at the beginning, and sometimes combine them with infusion of calumba. The iron is indicated by the greater or less anaemia of the patient; but the Strychnine is, in my opinion, a very important remedial agent in the disorder. In small doses it acts as a simple tonic, increasing the appetite and improving the digestion; it dilates the vessels, and thus increasing the supply of blood, it augments the activity of the spinal cord (Harley). It promotes the capillary circulation, and therefore its use is advisable for persons troubled with cold hands and feet (Anstie); and if it fulfil these conditions, it is clearly indicated in the disorder which we are considering. Cod-liver oil also often acts very beneficially. “It has been found by experiment that great exertion and prolonged labor can be endured without fatigue when starchy and fatty foods are alone eaten. . . . and there is reason to think that cod-liver oil is more easily absorbed than other similar sub- stances” (Ringer). “It improves the digestive process, in- creases the proportion of red corpuscles in the blood, and in- vigorates the whole nutritive function” (Wood); and I believe it particularly sustains the energy of the brain during pro- longed mental exertion. Agentleman in the foremost rank at the bar told me that, whenever he was engaged in a jury-trial which was likely to tax his energies to a greater degree than usual, the thing which best sustained him was a good dose of cod-liver oil taken in the morning before going into court; and others engaged in mental work have confirmed this view. I, 460 Lectures on Dermatology. [June, therefore, regard cod-liver oil as having, besides its other prop- erties, a nutrient and tonic action on the cerebro-spinal nervous system. As a remedy for these nervous headaches, I only prescribe it once a day, beginning with a small teaspoonful immediately after breakfast, and gradually increasing the quantity to a tablespoonful, but not beyond, unless in excep- tional cases. - You must take care to regulate the action of the bowels, but by no means have recourse to strong purgatives. Five grains of the Socotrine aloes pill, given at night, are generally sufficient. If the bowels be habitually constipated, then no remedy seems to answer so well as the aloes and iron pill. Five grains given twice a day, half an hour before meals, will act freely; and in a few days' you will have to diminish the dose, for the remedy possesses this advantage, that its effect is augmented instead of being lessened by continual administra- tion, especially when Strychnine is given at the same time. The natural waters of Friedrichshall or Marienbad may in many instances be of service, given as laxatives. Besides the remedies to which I have called your attention, others have been recommended, such as arsenic and quinine, caffein, etc. Where anaemia is not a prominent symptom, they may sometimes be of service. - Lastly, you must lay down stringent rules for your patients with regard to diet and exercise, and you must impress upon them the importance of these rules being strictly observed. * LECTURES ON DERMATOLOGY. Delivered in the Royal College of Surgeons of England, in February, 1872, by ERAs MUs #: F.R.S., Professor of lyermatology to the Royal College of Surgeons of ngland. - LECTURE III. I AM afraid, sir, that you, and the rest of my audience, have fair ground for accusing me of repeating with reference to this or that disease—that it is one of a deeply interesting nature and highly important to be known; but if I have said this before in regard to bygone subjects, I must echo it again in connection with herpes, and the more so because, although 1872.] Lectures on Dermatology. 461 not so common as eczema, it comes before you more frequently in daily practice. And I take this opportunity of making a remark bearing upon the question of numerical statistics. The dermatologist in the midst of a community, from the reputation attaching to the nature of his practice, is in the position of having every example of chronic cutaneous disease, such as eczema, brought under his notice in the course of time. But with such an eruption as herpes, which is regular and brief in its course, and often very trivial in its manifesta- tion, the numbers which reach him will be comparatively few. IIence it is not in his note-book, however carefully kept, that we must look for the exact truth in reference to the frequency of disease; and, therefore, I say, that herpes, although un- doubtedly less common than eczema, will probably come under your notice more frequently than the latter disease. In a few words, it may be said that herpes is a cluster of vesicles, ranging in size between a pin's head and a pea, de- veloped on an erythematous base; for the most part unilate- ral in distribution, and limited in extent to the district sup- plied by a single nerve, or by two or three contiguous nerves. This definition is illustrated in the drawing No. 120, and in the model 121, representing herpes zoster, or herpes intercos- talis. In the former of these, the eruption is seen in its characteristic progressive stages, namely: as nascent vesicles clustered on an erythematous base, as fully developed vesicles, discrete and confluent, transparent and opaque, colorless, yel- lowish in different degrees, or purplish, and finally as incipient Scabs. In the model 121, the eruption covers a greater extent of surface than in the former case, occupying about the fourth, fifth, and sixth intercostal spaces, and extending from the region of the posterior border of the scapula to the ensiform cartilage. The blotches are continuous throughout the whole extent of the eruption, but a few isolated blotches of Small size and a few scattered vesicles may be seen along the upper and lower boundary of the patch. The nipple is completely surrounded, and the illustration may be regarded as a severe example of the disease. The patient was a man, 60 years of age; he remained in hospital for ten days, and left much improved. He was under the care of Lailler, and was treated 462 J.ectures on Dermatology. [June, by the application of an alcoholic solution of perchloride of iron, one part in five. Herpes zoster may be very fairly taken as the typical form of herpes; its subjective designation being derived from its frequent occurrence around the waist of the patient, hence its name Zoster, a belt, and zona a girdle, and its latin synonym cingula, with the popular corruption of cingula, namely, shingles. If we were in search of an illustration of the iden- tity of disease in modern times with that of an ancient period, we should find it in zoster. Zoster has evidently always re- tained the same signification, and awakened the same pre- judices. The duality of the nervous system explains the well- known fact that zoster is limited to one-half of the body; and the extreme improbability of the development of the circle complete, no doubt suggested the aphorism attributed to Pliny, “Zoster appelatur, et enecat, si cinxerit.” This apho- rism of Pliny has become a popular belief amongst ourselves, and the dread of the disease is greatly relieved when it is found to confine itself to its accustomed limit, namely, one-half the circle of the waist. Next to its obedience of the neurotic law of occupying only One-half of the waist without completing the girdle, the point most worthy of our attention is its development in little blotches, which, in fact, correspond with small branches and twigs of the cutaneous nerves, and, if we call to mind the dis- tribution of the intercostal nerve with its cutaneous branches, we have the key to the explanation of the exact seat of mani- festation of the hyperaemic blotches on which the vesicles are developed and undergo their succeeding changes. Thus, a painful sensation of heat may be experienced somewhere near the linea alba; the anatomist will tell us that it is there that the intercostal nerve gives off its anterior cutaneous twigs, and it is in the small district of skin supplied by those nerves that our patient becomes aware of a burning and tingling which first of all direct his attention to the spot and announce the beginning of the eruption of shingles. In a very short time, however, he feels a similar sensation in the neighborhood of the spine; now, the posterior cutaneous nerves are communi- cating their sense of grievance to the skin; and, about the same time or immediately after, the integument supplied by the Supplement to the Medical World. ON THE PATHOLOGY AND TREATMENT (). F. . The Different Forms of Croup. BY A. JACOBI, M.D., Clinical Professor of Diseases of Children in the College of Physicians and Surgeons, New York. The above exhaustive and unequalled treatise was pub- lished in THE AMERICAN JOURNAL OF OBSTETRICS AND DISEASEs of Woy EN AND CHILDREN, of May, 1868. The demand for it having been great, it was necessary to reprint it twice. e S- e - * - & t Having a few copies left, they are offered at the low price of One Dollar. The treatise comprises 45 pages. An article by Prof. F. G. Thomas, on Placenta Praevia, is also in the same reprint. JAMES M. BALDWIN, P. O. Box 52, Station D. 811 Broadway, New York. #87 2.] Eectures on Dermatology. 463 middle cutaneous nerves becomes similarly affected. The original blotches are consequently isolated, and the space be- tween them is shortly after filled up by other patches and scat- tered vesicles, all evincing the same phenomena objectively and subjectively. In the lithographic' drawing the isolated position of the blotches is maintained; but in the model a con- siderable number of blotches have become confluent, and the inflammation of the skin is consequently diffused, more so in fact than we usually find it to be the case, Again, if we take into consideration the breadth of the eruption in both these cases, we arrive at the conclusion that more than one intercostal nerve must be involved in disorder; in the drawing there may probably be two, and in the case represented by the model, perhaps three or even four. The local history of herpes is pretty much the same in every instance of its occurrence, and may be stated as being either slighter or more severe. If you have ever—and who has not? —had one of those little burning and throbbing inflammations of the lip which are the common sequel of a feverish cold, you have experienced, on a very small scale and in a very mild de- gree, the operations of herpes. First, there is heat, burning, and throbbing, then there is swelling, next two or three small vesicles appear on the surface, and, in spite of every effort you may make to check its progress, the annoyance is prolonged for a week or ten days. So of the much larger blotches on the skin of the trunk of the body appertaining to herpes zoster, a number of red puncta may be seen in the skin, these in a very short time become glittering vesicles, filled with a transparent and colorless lymph, they grow and enlarge to the size of small peas, then the lymph becomes lactescent and opaque, subsequently yellow from the development of pus, and sometimes purple from the presence of blood; next they begin their retrograde stage—they collapse, they shrivel, they shrink, and finally they dry up into small, hard, amber-colored scabs, deeply embedded in the skin, and retaining their hold for some time before they fall off, leaving a pitted mark of variable depth and size, generally so com- plete that it remains as a permanent white cicatrix for the rest of life. This pathological process is not very dissimilar to that which 464. Lectures on Dermatology. [June, we have already studied in relation to pemphigus, and the variations pointed out in respect of the latter eruptions are equally applicable to herpes. A difference, however, is pal- pable—herpes is the consequence of a nervous shock, and not the consequence of a constitutional disorder or cachexia; more- over, it obeys an orderly course which may be estimated by days, ten to twenty in number, and pursues a regular succes- sion of lesions, namely, hyperaemic congestion, exudation of lymph, vesiculation, pustulation, encrustation, and cicatriza- tion, and then finally ceases without a prospect of relapse, and without derangement to the constitutional health. Some of the specimens before us, and especially the plaster casts, numbered 123 to 127, illustrate admirably the distribu- tion of the eruption in isolated blotches, the number and fig- ure of the vesicles developed on each blotch, the distension of the vesicles, their occasional coherence and confluence, and the dense and embedded scabs which mark the completion of the retrograde process. The wax cast No. 122 exhibits a scattered eruption of herpes affecting the arm, herpes brachialis. The plaster casts, 123 to 126, mark the course of an example of herpes cruralis. The eruption occupies the thigh, and the casts show the daily progress of the blotches and vesicles. The history of the case also is characteristic :—A boy, 15 years of age, was chilled by sitting on the grass on Good Fri- day, April 10, 1846; the next day he had severe pain over the whole of the front part of the thigh, which was attributed to rheumatism. On the evening of Saturday, a blush of redness in patches was apparent on the skin ; on Sunday, minute vesi- cles in clusters were perceived here and there upon the red patches. The vesicles soon became distended with a trans- parent and colorless fluid and reached their full size, looking towards evening like so many pearls. On Monday, some of the vesicles were already becoming shrivelled, and had a purplish hue, while others, fully distended, possessed a rich, grape-yellow tint. On Tuesday, all the vesicles were on the decline, with the exception of a few tardy clusters, which were now attaining maturity. On Wednesday, the fourth day of the eruption, the greater part of the vesicles had dried up into reddish-yellow wrinkled scabs. On succeeding days the scabs - 1872.] Zectures on Dermatology. 465 became gradually darker and harder, and were closely embed- ded in the skin; by Saturday a few only of these scabs remained; and on Sunday, the day of completion of the week, traces only of the eruption remained. No. 127 is a very striking plaster cast of herpes cruralis, situated at the upper part of thigh in the inguinal region. The blotch of eruption is solitary; it is oblong in figure, and displays the erythematous base as well as the cluster of vesi- cles, the hyperaemic base being slightly elevated. These specimens inform us as to the fact, that no part of the integument is free from the invasion of herpes; that it may occur upon the face, upon the neck, on the shoulder and arm, around the waist, and upon the flank and lower extremity, and its relations to the nerves of those regions is so obvious, that it has received names conformable with the chief trunks which supply the different parts of the skin. Sometimes it makes its appearance and disappearance without other pain than the mere local suffering in the skin; sometimes it is ushered in with neuralgia, and is mistaken for that painful affection, until the eruption is developed, and, at other times, it ends with neuralgia, and the neuralgia is prolonged for many months and even years. The neurotic relations of herpes are among the most interesting and important of its characteristics. In the examples of neuralgic herpes, it is evi- dent that the trunk of the nerve is involved; in other examples, as in herpes labialis, there is good reason to believe that only the peripheral fasciculi and cutaneous plexuses are concerned; and in other instances again, we have proof of the morbid state of the spinal nerve being transmitted to the nerves of the organic system, or vice versa, and notably in the case of the upper intercostal nerves to the cardiac nerves. Experience would lead to the belief that, in comparison with other regions of the body, herpes zoster, or, more exactly, herpes intercostalis, occurs with greater frequency than herpes attacking the regions supplied by the rest of the nerves, and although herpes zoster may be developed on either side of the body, yet it would seem to be more common on the left than on the right. Now, supposing this fact to be established, it would be worthy of consideration how much of this predis- position might be due to communication between the affected 466 Lectures on Dermatology. - [June, nerves and the Organic plexus of nerves which is distributed to the stomach and digestive organs, and the morbid influence resulting from such intercommunication. The exciting cause of herpes is generally cold, and cold would operate more inju- riously upon nerves subjected to the frequent irritation of organs in a state of derangement, than it would upon nerves in a perfectly healthy condition. I make these remarks with a view to further investigation, but the fact is established, that predisposition, however occasioned, enters for a considerable part into the causation of the disease. Amongst others of the notabilia of herpes, is the very great infrequency of its repetition. In general terms it may be said to occur very seldom more than once in a lifetime. That is to say, the form of herpes which is due to an affection of the trunks and larger branches of nerves; but, on the other hand, where the smaller branches of nerves are chiefly concerned, and the nervous plexuses of the skin, a periodical occurrence of the eruption is one of the commonest pathological phe- nomena, as in the instance of herpes praeputialis, or a recur- rence in every instance of a common cold, as in herpes labialis. So, again, with regard to other general phenomena of herpes, although the eruption may never have been known to encircle completely the trunk of the body at one particular zone; cases are on record, wherein it has been seen on both sides of the body at the same time, but in different regions. Moreover, although it is usually observed in a single region only, and affecting a single nerve, or two or three contiguous nerves, I have met with a case published in the Journal of Cutaneous Medicine (vol. iv. page 158), in which it presented five sepa- rate tracks around the hemicycle of the trunk, between the collar-bone and the groin. The case was that of a gentleman farmer, aet. 53, who had been the subject of attacks of eczema for twenty years. In the month of March, after some exposure to cold, he was seized with pain on the right side of the trunk, with a burning, Smarting, and tingling sensation in the skin. This was followed by the eruption of shingles, which encircled the side of the trunk in a series of tracks, ranging between one and three inches in breadth; of these tracks as seen on the dorsum of the trunk, one took the course of the supra-scapular muscle to the top of the shoulder, a second that of the infra- 1872.] Lectures on Dermatology. 467 scapular muscle also to the top of the shoulder; the third passed below the scapula to the axilla; the fourth followed the line of the last ribs and lower border of the costal cartilages; and the fifth, the curve of the crest of the ilium. In front of the trunk, the two scapular tracks crossed the upper part of the pectoral muscle towards the sternum. The axillary track divided into two branches, one of which passed above, and the other below the nipple. The hypochondriac track continued forwards to the epigastrium, and the iliac track also divided into two branches, one of which crossed the flank below the level of the umbilicus, and the other followed the line of Pou- part's ligament in the inguinal region; the five tracks of the dorsum of the trunk being represented by seven on its ante- rior face. - If we turn to the phlyctenous affections before us in a therapeutical point of view, we shall discover our previous ob- servations with regard to the pathology of pemphigus and herpes to be fully confirmed; with pemphigus we find our- selves in face of a disease essentially constitutional in its ori- gin and maintenance, and demanding as a first consideration constitutional treatment, while in herpes, constitution reme- dies are mere adjuvantia, and entirely secondary to local management. Our constitutional review of the nature of pemphigus dis- covered that everything was unsound in the functions of as- similation, Sanguification, and nutrition, and to the res- toration of these great and important functions our treatment must be addressed. We shall require good and nutritious food, wholesome air, proper attention to ablution, and tonic remedies. Bark, quinine, sul- phuric acid, iron, and ammonia will enter for a large share into our prescriptions. The digestive organs must be regulated by mild aperients, and only in cases where there is a special loss of nerve-tone and nutritive power in the skin shall we need the crowning aid of arsenic. In cases of herpes, where any functional derangement is pres ent, and especially where functional disorder may be regarded in the light of a predisposing cause of the eruption, such disorder must be attacked, and if possible removed. I have remarked that herpes is sometimes associated, or to use an old-fashioned 468 Lectures on Dermatology. [June, phrase, sympathetic with visceral disturbance, as, for example, with bronchial and congestive disorder of the lungs, in which case, although bearing only indirectly on the herpes, there is ample Scope for constitutional treatment. Again, in the neu- ralgia of herpes, with a view to allay the irritability of the nervous system, we may be under the necessity of having re- course to the bromide of potassium, to the hydrate of chloral, or to more decided sedatives, and in violent neuralgia to ten- grain doses of sulphate of quinine. The local treatment of both pemphigus and herpes calls into exercise our routine measures for the management of vesicles and exuding surfaces. The dredging-box occupies a promi- nent place amongst our armamenta, then comes a desiccant powder, such as oxide of zinc, simple or diluted with starch, next a lotion of lime water with oxide of zinc, and, in case of need, the oxide of zinc ointment rendered cooling and gently stimulating by the addition of an eighth part of spirits of wine. In the majority of cases, little more than these remedies will be required; they fulfil the intention of rest and protection so important in surgical affections, and, when additional protec- tion is demanded, we may obtain it by a simple dressing with dry lint, or an ointment of zinc or resin, maintained in posi- tion by strips of adhesive plaster, or by a bandage. In cachectic cases of pemphigus, and in the ulcerative herpes of elderly persons, the local treatment may require the addi- tion of local tonics, that is, of moderate stimulants, such as–a dusting with the powder of cinchona bark, the addition of Carbolic acid to the ointments, or a lotion of chloride of zinc, the intention of these remedies being not only to give tone, but to counteract a tendency to decomposition and gangrene. In the treatment of herpes zoster, a dusting with diluted Oxide of zinc powder, or the lotion of lime water and oxide of zinc, covered with a layer of cotton wool, may be regarded as specific, and a similar zinc and lime water lotion applied to local blotches, or in situations where an external covering cannot be employed, is the best treatment that can be devised. On the lip, and in herpes praeputialis, I have sometimes suc- ceeded in arresting the cutaneous inflammation at its outset by painting the spot with tincture of iodine, and Lailler, as will be seen by the description of model No. 121, has had re- 1872.] Lectures on Dermatology. 469 course to an alcoholic solution of perchloride of iron, consist- ing of one part to five. In neuralgic herpes, our armamentum chirurgicum is some- times set at defiance, fomentations of very hot water will occa- sionally confer a temporary relief, but the only remedy of real value is the subcutaneous injection of morphia, which I have several times practised with success; while in cases of frontal neuralgia, Mr. Bowman has obtained good results from the section of the frontal nerve. To be continued. DocToR HANs PowRIL, the Medical Director of the Department of New York, Grand Army of the Republic, in his Annual Report, ending 30th April, 1872, to the Surgeon-General of the honorably discharged wounded and disabled members of 130 Posts in the State of New York, who served during the War of the Rebellion, reports as follows: Number of members who have lost the right arm in battle, . . 115 {{ {{ who have lost the left arm in battle, . . . 96 < 4 { % who have lost both arms in battle, . . . . 2 {{ {{ who have lost one leg in battle, . . . . . 147 { { {{ who have lost both legs in battle, . . . . 2 {{ {{ who have been wounded in battle, 8 . . . . 1,578 {{ { { who have lost a leg and an arm in battle, . . 4 {{ $ (, injured other than in battle, . . . . . . 246 ExCISION of THE ASTRAGALUs.—IN September last Mr. Hancock, of Charing Cross Hospital, removed the right astragalus of a patient aged forty-seven years, who had fallen off some steps and had dislocated that bone outwards and forwards, and fractured it at the same time. The bone was nearly twisted upside down. By making an incision directly over it, the bone was removed, the wound was brought together by means of wire sutures, covered with a pad soaked in a weak solution of carbolic acid, the limb was placed on a back splint with a foot-piece, and swung in a Salter's cradle, but kept constantly moist by the before-named solution. On removal of the pad a small amount of pus escaped, the wound was found completely filled up, and a line of granulations only marking the situation of the original incision. The foot was subsequently incased by a plaster-of- Paris bandage, its shape is satisfactory, and firm pressure on the heel causes neither pain nor inconvenience. . 470 JMiscellaneous. [June, füístellaneous selections from j90mt and jForeign jottritalfi. e *mº FIVE HUNDRED CASES OF REWACCINATION. By RICHARD J. HALToN, L.K. & Q.C.P.I., L.R.C.P.E., L.R.C.S.I., Physician to the Dis- pensary, and Medical Officer of Health to Kells. WHEN the alarm caused in Ireland last spring by the fearful mortality of the small-pox epidemic in England was at its height, and it was feared by many amongst us, with what has unfortunately proved a well- grounded fear, that we would not escape a visit from the disease, the majority of the cases with which this paper deals presented them- selves at the dispensary for revaccination. At that time revaccination was held to be a tolerably efficient protec- tion against the small-pox. . " Having heard that this opinion has now been abandoned in several Quarters where the highest professional eminence has given great author- ity to that abandonment, I deem it the duty of every one who has had any experience of the question to give the results of that experience. This I will endeavor to do, for my part, as shortly and succinctly as possible, premising that my experience has not been confined to the number of cases heading this paper, but I take them, as they were for the most part observed with scrupulous care, and the results, where possible, accurately noted. As each case presented itself, the state of the arm was noted in refer- ence to vaccination marks, and the result was that 179 had scars that were mostly circular, and did not seem to go deeper than the true skin, 106 had scars so slight that they had often to be carefully looked for, amounting in many cases to a mere puckering, and 66 had deep scars that were mostly irregular in shape, and seemed to penetrate through the skin into the cellular tissue beneath. In 24 of the cases no scar was to be found, though they stated them- selves to have been vaccinated in infancy. Out of the whole number 50 stated that they had never been vacci- nated, and of these 8 were born since 1864.” I have excluded 75 cases from the above enumeration, as the state of the arm was not recorded with sufficient accuracy. The cases were all vaccinated in the usual way, from healthy infants with well-formed vaccine vesicles, and they were requested to pre- sent themselves for examination on that day week. The great majority complied, but 143 of the cases presented themselves at irregular times, that is, on other days than the eighth, and some few of the number failed to present themselves at all, and have been consequently excluded. The results may now be briefly detailed. Of 179 who had, when re- vaccinated, circular scars going to the depth of the true skin, 10 present- ed perfect vaccine vesicles, pearly in color, inclining to the circular in shape, depressed in centre, filled with clear lymph, and without or with very little areola. Their ages varied from 7 to 15. All the others of that class presented the imperfect vesicle in its various forms, sometimes white like a blister, sometimes filled with yel- low serum, sometimes a pustule, once a tubercle, and often a Scab. There was usually considerable inflammatory redness, stretching down * When the Registration first made compulsory vaccination possible. 1872.] JMiscellameous. 471 the arm, sometimes to the elbow; but beyond a little itching and an oc- casional feeling of tightness, no distress was experienced. Of the 106 who presented slight puckered marks, 9 had, on the eighth day after vaccination, perfect vaccine vesicles. The remainder presented irregular vesicles as above. Of the 66 cases who had deep scars, 6 showed the perfect vaccine vesi- cle. Their ages ranged from 7 to 15. The remainder showed imperfect vesicles. Of the 24 cases who stated themselves to have been vaccinated in childhood, but who had no scars, 16 presented the perfect vaccine vesi- cle; 2 the imperfect vesicle, and the remaining 6 failed to present them- selves on the eighth day. There were some in each class who so failed, but whom I saw at other times. - Eighteen of all the cases failed to take on the first occasion of being vaccinated, or at least did not show any evidence of action onwie eighth day. On the operation being repeated, it was, in nearly all the cases, successful. The vaccine matter was introduced by making several paral- lel scratches with a blunt lancet, so that the blood appeared at the bot- tom of the scratch, but did not flow. The lymph in the greater number of the cases was then taken carefully as it flowed out from the summit of the vesicle on the arm of the child who supplied the infection, and rubbed into the scratch with the flat of the lancet. Great care was taken that no blood was mixed with the lymph. In some cases it happened, in spite of the greatest care, that, in open- ing the vesicle, a drop or two of blood escaped along with the lymph. By leaving the vesicle untouched, however, for a minute or two, the blood coagulated, and then the lymph could be taken, without any admixture, flowing out clear and pure beside it. The operation caused no pain, and in the whole number of cases, and in many more that do not come within the scope of this paper, there did not occur a single instance of its being followed by any unpleasant complication, as swelled glands, abscess, etc. The arms now and then looked very sore and angry; but the patients assured me that, beyond the tightness and itch- ing mentioned above, they suffered nothing. The constitutional disturbance, if any, was so slight that it passed without notice. ar I may here mention one incident, though it does not belong to revac- cination, which is of value in showing the care that is required in performing this little operation. - Most of the cases here recorded being done on two or three several days, there was consequently a great pressure of work at the dispensary, and I was obliged to procure assistance in vaccinating them. On the first day I observed one of my assistants, in vaccinating a baby, pressing the flat part of the lancet on a vesicle, already exhausted by previous vaccinations, to try and squeeze some matter from its base. I remon- strated with him, but not soon enough to prevent the mischief, as he had the operation just completed. I, however, took particular note of the child, a fine healthy infant, just six months old. It was brought to me some days after, covered with a moist eruption, with brown Scabbing, and suffering from a good deal of constitutional disturbance. Not one of the other children who were vaccinated along with it from the very same infant, while the lymph was freely exuding, showed the slightest sign of eruption. When I have heard since of cases where revaccina- tion produced considerable inconvenience, swelled glands, etc., etc., it struck me forcibly that it might be owing to some similar carelessness on the part of the operator. Having now detailed our precautionary measures, I will proceed to state the results, up to this time, on the public health of the town. 472 Miscellaneous. [June, Situated, as we are in Kells, in constant railway communication with Dublin and Belfast, we could scarcely hope to escape altogether while the small-pox was so prevalent in both places. In effect, we have had two cases of small-pox imported, one from either city, who were at once removed to hospital on their arrival here; but, except in one instance, the disease was not communicated. In that one case the subject was a boy about twelve years of age, who lived op- posite the hospital where the small-pox patient was conveyed. He was the only member of his family except the baby (three months old) who was unprotected by vaccination; but by some neglect it was omitted in his infancy; and though his father repeatedly urged him to present himself at the dispensary, when the revaccinations were in progress, a boyish fear of the supposed pain of the operation prevent- ed him. Jºe paid dearly for his folly. He had been out playing in the neighborhººd of the hospital one day, and he came home in the evening sick, with a severe pain in his back. It was supposed, at first, that he had hurt himself leaping, and consequently I heard nothing of the case for two days. I saw him on the evening of the third day, and had him at once removed to hospital. The next morning the eruption of small- pox appeared. I at once revaccinated all his family, and vaccinated the baby. I also vaccinated and revaccinated the people in the neighboring cabins, and took the sanitary measures that appeared necessary; had the houses lime-washed inside and out; ground and sewers flushed with carbolic acid solution, etc., etc. . Not another case appeared; and as three months have now elapsed, we may be considered to have escaped that centre of infection. The poor boy himself has recovered from a bad at- tack of confluent small-pox, deeply pitted and scarred, and with the loss of an eye. When it is considered that the whole family live in a wretched single- roomed cabin, and slept all together in one bed with him for those two nights, father, mother, and four other children, their escape will ap- pear very remarkable. There is one curious circumstance about the baby, however, which is not without interest. It will be remembered that it was nearly three days in almost actual contact with the sick boy before it was vac-, cinated. - The vaccine ran the usual course, showing a perfect vesicle; but a fortnight after, the mother brought the child to me to show me two pustules, exactly resembling the pustules of small-pox, one situated on the upper lip and the other at the junction of the alae nasi with the cheek on the right side. They have since healed, but have left two marks behind them. I may shortly mention another case which, if less striking, is not devoid of interest. A lady, who lived some miles from this, had a near relative in Dub- lin ill with the small-pox. She went up to bring the invalid home to breathe the pure air of the country during convalesence, and, as a precautionary measure, all the family and servants were revaccinated. But this poor lady, from some prejudice she had conceived against the operation, withstood the most urgent entreaties of her family and medical attendant (from whom I have the case) to allow herself to be thus pro- tected. - Two days after her return she sickened, and in five days was dead from a very malignant form of Small-pox. Not a single member of the family, and not one of the servants, though inhabiting the house, attending the sick room, etc., etc., took the dis- €3. Sè, - 1872.] Miscellaneous. 473 Before I conclude, I may mention that I always insisted on perfect re- pose of the revaccinated arm, as far as that was possible, and enjoined, in the case of adults, abstinence from stimulants. I may also say that I could not in any case succeed in producing any approach to a perfect vesicle in a vaccinated child under seven years old; indeed in those cases the lymph seemed to excite very little action of any SOrt.* I think that from the foregoing facts the following conclusions may be justly drawn : — First,--That a large proportion of the population are utterly un- protected by vaccination. Second,--That vaccination Scars, no matter how deep, are no guaran- tee that the possessor is protected by vaccination. Third, That in some constitutions the vaccine influence wears out, º is clearly shown on revaccination, when a perfect vesicle will be pro- duced. Fourth, That the operation of vaccination, when properly performed with lymph, taken from the summit of a vaccine vesicle, without areola, on the eighth day, from a healthy child, is entirely unattended with danger, and in the majority of cases with very slight inconvenience. Fifth, That there are reasonable grounds for believing that revacci- nation is, to a considerable extent at least, an efficient protection against small-pox. —Dublin Journal Medical Science, March, 1872. PARACENTESIS IN PLEURISY AND EMPYEMA. By HENRY WILLIAM FULLER, M.D., F.R.C.P., Physician to St. George's Hospital. THE questions which arise in connection with tapping are so import- ant, and there is so much need for a clear recognition of the facts which bear upon the subject, that I must ask permission to make a few remarks as a supplement to the abstract of my clinical lecture, reported in the British Medical Journal of February 3. It is conceded on all hands that, when the fluid effused into the pleural cavity is simple serum, it is advisable to take precautions against the admission of air. No valid reason exists why air should be admit- ted; and, as the patient can be readily relieved without its admission, it would be obviously unwise to incur even the slightest risk by making a free opening into the pleura. Observation, however, has led me to attach very slight importance to the entrance of air into the pleural cavity; and I am satisfied that the feeling which exists in the minds of many as to its danger originates in prejudice fostered by tradition, rather than in the results of bedside experience. At the commencement of my professional career, the doctrine was taught that the admission of air into a serous cavity was almost neces- sarily fatal. So strong a hold had this theoretical view on the current practice of the day, that the pleura was rarely punctured—never, indeed, until the patient was almost beyond the possibility of recovery. By de- grees the mischievous absurdity of this doctrine became apparent; and the continued successes of Mr. Spencer Wells and others in cases of ovariotomy have gone far to dispel the illusion, that air admitted into a serous cavity usually sets up putrefactive changes in the secretion of that cavity. Still, many persons remain who cannot emancipate themselves from the thraldom of tradition, and whose minds remain * When performing vaccination, I always wear a large soft handkerchief at the button- hole, as when using the laryngoscope. In this, after each operation, I carefully wipe the lancet, after having dipped it in water, as recommended by Dr. Labbatt. VOL. I.-35 474 Miscellaneous. [June a prey to that morbid fear of consequences which induced our pre- decessors to withhold from their patients the relief afforded by puncture of a distended pleura. In the British Medical Journal of February 17, j)r. Douglas Powell proclaims himself one of those who are terrified at results which I venture to think they have never witnessed, and which exist only in their own imagination. He objects to the admission of air because “it tends to produce such changes in the fluid as cause it to become noxious, and set up fresh pleurisy.” I can only say that, during the whole period of my connection with St. George's Hospital— now upwards of twenty years—I have never seen the fearful mischief thus theoretically predicted by Dr. Powell. In cases of simple serous effusion, I have thought it wiser to defer to the prejudice thus enunciated by Dr. Powell, and have founded my teaching upon it, for the simple reason that in cases of serous effusion no harm could result from my so doing. Dut in practice I have taken no special pre- caution to prevent the admission of air. Every case has been tapped which has not yielded to ordinary treatment, and the operation has been performed in the simplest manner. The integument has been divided by a scalpel, and then a full-sized trocar has been driven into the chest, and the fluid has been allowed to run until the stream has begun to fail. The trocar has then been withdrawn, and the opening closed. In one case only has fresh inflammation been set up or a fatal result followed the operation, and in that instance I believe the mimia medici diligentia was chargeable with the unfavorable issue. Urged by a friend who was watching my practice to try the effect of repeated tappings to a moderate amount, instead of at once evacuating the contents of the chest, I ordered twenty grains of the fluid to be drawn off and the open- ing at once closed. After the lapse of a fortnight, as there was no evidence of absorption of the remaining fluid, about twenty ounces were again withdrawn, but still without appreciable results. There- fore, after another week, a third quantity of fluid was drawn off. Shortly after this the young woman had a rigor, the secretion from the pleural membrane became sero-purulent, and then purulent, and she speedily died. In this case every care was taken to exclude the air ; and, curiously enough, this was the only instance in which I have met with an unfavorable termination to the operation, whether in hospital practice or in private. My belief is, that the repeated tapping was chargeable with the fatal issue. Just as the abdomen or an ovarian cyst may be tapped once or twice with almost certain impunity, notwithstanding the admission of air, so, also, may the pleural cavity; ibut the constant alteration in the tension of the parts caused by the repeated withdrawal of the contained fluid leads, in the one case as in the other, to interference with the nutrition of the part, and so to irritation and inflammation. Dr. Playfair (see British Medical Journal for February 17) objects to the admission of air even in cases of empyema ; and, whilst admitting that when the lung is bound down by firm adhesions there is no alterna- tive but to make a free opening and admit air, he maintains that, where the adhesions are less numerous or less firm, as is often the case in children, the whole of the pus may be drawn off by continuous sub- aqueous drainage—or, in other words, by means of a drainage-tube opening under water—without admitting air. Practically, I believe, this is rarely possible. . It is extremely difficult to put a drainage-tube into the pleural cavity without admitting air, however carefully air may be excluded afterwards. Nevertheless, the plan of keeping the end of the drainage-tube under water may be had recourse to with ad- vantage, especially in recent cases, where recovery is likely to prove Grapid. By this means the pus is enabled to escape as soon as it 1872.] Miscellaneous. 475 is formed, and the object of a free opening into the pleura is at- tained. Less air finds entrance into the chest than when a mere fistulous opening is formed through the chest-walls, and thus the impediments to the expansion of the lung are lessened. Dr. Douglas Powell's proposition to employ suction-power, as with an aspirator or a siphon, to empty the chest, is wrong in principle and dangerous in practice. If it be desired to remove only a portion of the fluid contained in the chest, as was done in Dr. Powell's cases, no suction-power is needed, as a considerable quantity will run off spon- taneously through any opening in the chest-walis. If it be pre- tended that by means of suction-power the whole of the pus can 'be drawn off, I do not hesitate to say that those who make that assertion labor under an erroneous impression. No power at our dispo- sal can either remove or overcome the physical law which precludes the existence of a vacuum in the chest. Without suction-power, the Chest may be emptied by tapping to a degree which varies in different cases, but is always commensurate with the extent to which the lung will expand and the parietes of the pleuritic cavity will fall in. Beyond this, the only thing which suction-power can effect is, to exert traction on the surrounding tissues, and notably on the lung, which must be irritated or damaged in exact proportion to the de- gree of force exerted, and may be torn, bruised, and lacerated if much Suction-power be employed. Indeed, it is obvious that this prac- tice must be attended by much risk without any corresponding advan- tage. “There is the risk,” as Dr. Powell admits, “ of the lung as it ex- pands becoming injured by contact with the cannula, and there is some risk of haemorrhage into the pleura.” These risks, together with that of dangerous traction on the lung, which was forcibly illustrated by the case brought by Dr. Easton before the Liverpool Medical Society, and which was threatened, as evidenced by the pain induced, in both Dr. Powell's patients, cannot be lightly ignored. I have seen this plan adopted in two instances: in both of these pain was occasioned by the operation, in both fresh irritation of the pleura was set up, and in both the patients died. Certainly the test of my experience is con- clusive against the views entertained by Dr. Powell. Ever since I have been Physician to St. George's Hospital, I have had recourse to tapping in every case of empyema which has come under my care, and have always admitted air. In no instance has a fatal result ensued. The pa- tients have eventually got rid of the fluid in their chest, and have made a good recovery; in the more recent cages in a few weeks; in the more chronic, in as many months. With these eloquent clinical facts before me, it is impossible to attach much importance to the theoretical bugbears which so manifestly disturb Dr. Powell's mind and in- fluence his treatment. His theory is that which disturbed our fore- fathers, viz., that “irritation is almost always caused by the presence of air in the pleura,” causing “fresh effusion to take place”; that there is “danger of air setting up decomposition in the remaining fluid"; that “so long as air is present” in the pleura, “the patient is, in the chief respect for which the operation was performed, worse off than before ” (see “Trans. Clins. Soc.,” vol. iii. p. 249); and that, when air has been admitted into the pleura, “the lung was never of any use for the purpose of respiration.” Surely, if these phantom theories had any foundation, a large proportion of numerous cases must have proved fatal, and in those who recovered one lung at least must have been absolutely useless. But, in fact, as already stated, the patients have all recovered; and although, in some of the old-standing cases, considerable distortion of the chest has ensued in consequence of the imperfect expansion of the lung, yet in others the recovery has been 476 Miscellaneous. [June, so complete and the return of respiration so perfect, that Dr. Powell himself would scarcely have discovered on which side the effusion had existed. - Dr. Powell exclaims, “It is surely physically impossible for the lung to expand or the chest to collapse if air be admitted in the place of fluid. What is to expand the lung what to press in the chest ?” The answer to this would occupy much space, and is scarcely needed, since the result of tapping proves conclusively that under the condition referred to by Dr. Powell the lung does expand, and the chest-walls do fall in. I would wish to correct an impression which appears to have been produced by the words made use of in my lecture. I state that in cases of empyema the best practice is to make a free opening into the chest, so as “to empty out the fluid entirely, to enable the lung to expand to its fullest extent, and to enable the two surfaces of the pleura to come together. To withdraw twenty or thirty ounces, and to leave sixty or seventy, would not be of the slightest service.” Dr. Powell evidently imagines that by this statement I mean to recommend that a free open- ing be made into the pleura and be kept open, so that with each respi- ratory act air shall pass freely to and fro into the chest. This is not my practice, nor is it my wish to recommend it. At the time of tapping, I endeavor to draw off the last drop of pus, and let the cavity drain thoroughly through the opening, the air meanwhile passing freely into the chest. But as soon as the fluid contents of the chest are thoroughly evacuated, a piece of oiled silk is inserted into the wound, and the opening is closed by means of a pad of lint steeped in a weak So- lution of carbolic acid, and covered with plaister. This, together with the oiled silk, is removed and reapplied daily, so that air finds access to the pleural cavity—freely at all events—once only in the twenty-four hours; viz., when the wound is dressed. If a drainage-tube be used, the end is always placed in water—the object in both cases being to allow the pus to drain off as it is formed, but at the same time not to throw unnecessary obstacles in the way of the expansion of the lungs by the constant and unnecessary admission of air. This, then, is the prac- tice which I advocate; but for the sake of those who have not seen, as I have, cases of empyema opening spontaneously, and who imagine that the constant admission of air must necessarily prevent the expansion of the lung, I would add that in my student-days I have seen such cases make good recoveries, and regain a considerable amount of breath- ing power on the affected side, although from first to last a free fistulous opening has existed in the chest, for the closure of which no means were adopted.—British Medical Journal, March, 1872. *-*- ON THE TREATMENT OF ASTHMA. IBy GEORGE GASKOIN, Esq., Surgeon to the British Hospital for Diseases of the Skin. IN the summer of 1870, I was summoned to a lady suffering from an acute attack of asthma. For several nights she had been restricted to the sitting posture, bent over a table, with the forehead resting on her hands. The distress was very great indeed. She was subject to fre- quent attacks of the kind, complicated to a very moderate extent with catarrh and bronchitic exudation. Her physician, a gentleman who holds high professional rank, was out of town. Nothing had been omitted in the treatment, which of late was simply palliative. She was recognized as constitutionally asthmatic, and little hope was entertained of permanent amendment. The asthma first occurred on the subsidence of nervous symptoms a few years previous. It had not, as far as I 1872.] Mºscellaneous. 477 am aware, any marked organic basis. There was observable on the legs an eczematous eruption. Under these circumstances, I directed that the chloroform liniment of the British Pharmacopoeia should be rubbed briskly into the chest for an hour's space, if possible; and this was done daily by a very efficient attendant, who had sufficient intelli- gence to comprehend and carry out the treatment. Very early, much relief was experienced. On the return of her physician to town at the end of three days, she was already so very much changed for the 'better that he directed the treatment to be continued. From that time it consisted in the daily repetition of the rubbing process for a month or nearly so, without aid from medicine, and with little restric- tion as to diet. Beyond the information I received that she was daily improving, I had really little or nothing to do with her professionally after one or two visits. Under the hands of her attendant, she speedily got rid of the asthma. The patient went out of town in the autumn, and enjoyed perfect health and spirits. She took much walking exer- cise, with exposure, in the cold of the ensuing winter; and, what is very singular, two years have since elapsed with no return of the asthma. I shall now make a few observations on this method of treatment. For some years, in Paris, asthmatics have been in the habit of resorting to a rubber in the Boulevard Saint Michel, a certain Widow Pau, who pursues there very much the method which I have laid down, only that her nostrum is a secret. She is resorted to by a few wealthy people from this country, and has honorable mention in some of our West End clubs. At the end of the treatment, her patients are pre- sented with a little book or brochure containing her successes, which may be said to be fairly written for a book of its class. The cure is apt to disappoint for a few days; but generally great benefit will be found in a fortnight, or even in less time. There is a hiat that it is best suited to cases with catarrhal and bronchitic complication. The instance which I have here brought forward seems exactly to corre- spond with those which are boasted of and detailed historically by Madame Pau. .* Before giving directions as to how this treatment should be carried out, I will speak as to the rationale. Counter-irritation, especially by blister, issue, and moxa, are of such well-established repute in the treatment of asthma, that I need not dwell on them ; but, besides this, a jolting vehicle, anything that leads to displacement of the air stagnant in the vesicles, is proved to give relief in many instances. I should advise, then, that the frictions should be made with such roughness as the case admits. Slight blows with the palm of the hand, or the end of a towel on the ribs are quite allowable; and the friction should be extended to the front of the neck at the lower part, where the vagi enter the chest. I do not think that the composition of the liniment need trouble us, provided it be warm and work easily. Anything like Roche's embrocation would answer very well. I am not without some experience of asthma, and I am persuaded that the present method will be found a valuable addition to our thera- peutic means. If proved not to be novel, it must be conceded that it has fallen into utter neglect.—British Medical Journal, March, 1872. BUCULINE WACCINE.—Extracts from a letter addressed to the mem- bers of the medical profession by Dr. Lanoix, Member of the Legion of Honor, who was for years chief of the “Service des Vaccinations” of the hospitals in Paris, until his appointment as physician-in-chief to the small-pox hospital at Bicêtre: 478 . . Miscellaneous. [June, “. . . . I am deliberately convinced that the future usefulness of all Vaccination is involved in the question of direct animal vaccination. This conviction of the importance of the new method, my jealousy for the good name and efficiency of its practice, and my proud interest in the successful results which it has already accomplished, induce me to present to your attention the following remarks. When I introduced it into Paris, in 1864, it was so entirely unknown that many vaccinators (M. Bosquet, among others) went so far as to deny the possibility of preserving Cow-pox in its integrity by successive inoculations from heifer to heifer. This subject has since achieved great progress, though in some quarters it is still a matter of controversy, because it has not proved successful as practised by some physicians. The fault, however, lies not so much with the new method as with the inexperience of those who attempted to practise it. The question at issue is not the correct- ness of the principle, but the errors in practice. . . . One of the necessary conditions for success is that the cow-pox be of recent trans- mission from a case of original, spontaneous cow-pox. Therefore, to guard against any loss of power or properties in the cow-pox, and to put the proposed institution here at the start on an equal footing with the one in Paris, I brought with me on the steamship Washington, the 2d of March last, two calves with the cow-pox. One of these had been vaccinated with virus from a case of spontaneous cow-pox just dis- covered by Doctor Almagran of Orleans; from this calf, the other was inoculated at the proper time in the presence of Dr. Follet, surgeon of the steamer, during the voyage. The vaccinations practised on board by Dr. Follet and myself, with virus direct from the calf, proved exceedingly Satisfactory. It is this same virus, direct from the calf, and brought here in a living state, which continues to be transmitted from heifer to heifer. It would be very desirable that animal vaccine should be used in all cases instead of humanized vaccine, since it is an incontrovertible fact that the humanized vaccine has degenerated in many countries. Whether the cause of this deterioration lies in the vaccine itself or in the manner of preservation, or whether it lies in the performance of vaccination, it undoubtedly exists, and constitutes a terrible source of danger in the presence of constantly recurring epi- demics of small-pox at different points. . . . Entrusted since 1865 with the direction of the vaccination service (service vaccinal) of the hospitals of Paris, and in 1870 with the organization throughout the city of a vast vaccination Service, so as to accomplish six thousand vaccinations and revaccinations daily with animal vaccine, I have enjoyed exceptional opportunities for acquiring knowledge on the subject. . . . In first vaccinations, animal vaccine takes like human vaccine, with the difference that the eruption maintains itself longer and resembles the eruptions described by Jenner and the earlier vaccin- ators. Moreover, it will take where the humanized vaccine has signally failed, examples of which are given in my treatises. In Philadelphia I obtained a most satisfactory result with the virus transmitted from one of the calves I brought from France, in the case of an infant who had been ineffectually vaccinated nineteen times, and, beyond doubt, not only care- fully, but with the best obtainable vaccine. In revaccinations, in persons between twenty and thirty years of age, who have been vaccin- ated but once (in infancy), it took well in forty per cent. of the number, when the best humanized vaccine succeeded in thirty only, showing a difference in favor of the new method of thirty-three and one-third per cent. over the humanized vaccine. The superiority of the new method is equally manifest where much larger percentages of successful revaccinations between those ages have been reported. The larger the numbers, the more we are led to question the efficiency of the humanized 1872.] Miscellaneous. 479 virus used in the first vaccinations, and the consequent existing necessity for careful revaccinations becomes all the more apparent. A know- Íedge of these facts is of the highest importance to public hygiene, and will, as soon as they are appreciated, lead to the adoption of animal cow-pox for revaccinations, . . . 1. Because it precludes the risk of transmitting syphilis with vaccine. In a thesis on the subject, . . . I have demonstrated that, in the present state of science, it is totally impossible to give any accurate description by which to recognize in the human vaccine, on the eighth and ninth days (the usual days for collecting and transmitting the virus by ordinary vaccination), whether or not it partakes of a syphilitic character. . . . 2. Because it admits of the production of vaccine in unlimited quantities at short notice and of unimpaired vigor. It is a grand resource to be able to augment at will the supply of vaccine to meet an epidemic of small- pox with its constantly multiplying foci of contagion. 3. Because it yields, when properly practiesd, a more active vaccine virus than the vaccine in present use, and gives a greater percentage of success in re- vaccinations, and probably secures greater immunity from variola.” In conclusion, the writer recommends the dried virus on ivory points or slips. He says that these have been found to be the most satisfactory mode for preserving the virus and for making vaccinations; and that quill-points have been found objectionable, the fatty matter naturally covering their surface preventing ready adherence of the virus, while crusts present a serious objection in their composition, which consists in a larger proportion of solidified pus than of Vaccinal lymph. In another communication, Dr. Lanoix makes the request that physicians should, “if only in the interest of science, keep memoranda of all their vaccinations, the source whence the vaccine is obtained in each case, and the final results. By this means, within a few years, a knowledge would be arrived at of the respective values of the vaccine virus derived from various sources, and of the relative protective power against small- pox possessed by each.” NEW REMEDY FOR CEREBRO-SPINAL MENINGITIS.—At a recent meet- ing of German pharmacists and physicians, Dr. O. Liebreich, to whom medicine is indebted for the introduction of chloral, called attention to the properties of a narcotic agent termed “croton-chloral-hydrate,” which is made by passing chlorine in allyl, and is decomposed by alkalies into dichloride of allyl and formic acid, hydrochloric acid being also formed. The first effect of its administration to animals is marked anaesthesia of the head, while sensation is preserved over the rest of the body. Next, there is a general loss of reflex irritability, the pulse and respirations remaining unchanged. If a large dose be given, death is produced by paralysis of the medulla oblongata. The animal may be preserved alive by artificial respiration, the action of the heart remaining unaltered; whereas the final effect of chloral is to produce paralysis of the heart. That death in animals poisoned by croton- chloral-hydrate arises from paralysis of the medulla oblongata, is shown by the fact that contraction of the diaphragm is not produced by gal- vanism of the central end of the vagus; whereas it follows irritation of the phrenic nerve. When the animal has so far recovered that the breathing has become natural, then irritation of the central end of the vagus produces contraction of the diaphragm. The effect of this agent had also been tried on the human subject in the Berlin Hospital. In a child to whom it was given, complete anaesthesia of the parts supplied by the trigeminus nerve was produced, while the reflex irritability of the rest of the body was retained. The pulse and respirations were 480 -- JMiscellaneous. [June, 1872. unchanged in number throughout. Further researches on insane persons gave the same result, and Dr. Liebreich concluded therefrom that croton-chloral-hydrate has the property of inducing profound narcosis without interfering with other organs than the brain ; while a corre- spondingly deep narcosis produced by chloral is accompanied by general anaesthesia and by dangerous lowering of the heart's action.—Medical Advance. [The dose, we learn from practitioners who have used it for insomnia, facial neuralgia, and in cerebro-spinal meningitis, is five or six grains for an adult.] - . SUBCUTANEOUS INJECTION OF MoRPHIA AND CHLoROFORM.–In E! Progreso Medico, April 1, we see it mentioned that Dr. Nussbaum has, from a desire to lessen the dangers of chloroform by diminishing the dose necessary to obtain anaesthesia, made use of subcutaneous injections of morphia simultaneously with chloroform inhalation. The combina- tion of the two substances, it seems, has been studied by Claude Ber- nard with good results, and has been applied to surgery and also in ob- stetrics. From experiments made by MM. Labbé and Goujon, of which an account was given to the Academy of Sciences (Gaz, Méd. de Paris), it results that, by making an injection of small doses of morphia before giving chloroform, we obtain a far longer sustained anaesthesia, with very little chloroform ; and it is certain that the dangers of this medica- ment are in direct relation with the quantity breathed by a patient. This is a great step, says the Progreso Medico, since great risk is spared to the patient, whilst at the same time the local and general sensibility of the patient is lessened. MEDICAL DEPUTIES IN SPAIN.—We read in the Restaurador Pharma- ceutico, 14 April : “The class of pharmaceutists ought to rejoice at the result of the elections, since there figure as deputies elected for the prov- ince of Toledo, D. Pablo Fernandez Izqueerdo; for that of Badajos, D. Cesar Martin Somobinos; and for Gerona, D. Joachin Escuder. These three are called Republicans, but we shall call them pharmaceutists for the good of their native land, which has no miracles to expect from government, and only has to trust to the ability of its members and their professors.” COMPARATIVE MORTALITY OF PIITHISIS. IN DIFFERENT STATES.—Dr. Constantin Paul (Rev. de Thérap.) mentions that in France the mortality from consumption is 10 per cent., whilst in Paris it is 13.4 per 100. If the statistical records of other countries are credible, in Rome it is 6 per 100; in Naples, 8; in Venice, 8; in Turin, 9; in Geneva, 9:7; in Eng- land, 11; in Belgium, 16; in Berlin, 17:5; in Vienna, 20; in Hamburg, 22; and in Boston, U. S., it is 23 per cent. In general, the mortality from phthisis is less in temperate climates. DR. GAUSTER, OF VIENNA, on CHLoRAL HYDRATE.—In the current number of the Memorabilien, Dr. Gauster mentions a case of tetanic spasms in a woman pregnant five months, which he succeeded in suc- cessfully treating by subcutaneous injection of morphia, and one drachm of chloral given in Liebreich's formula. In seven days of treatment the attacks of tetanus were arrested. DISPLACED LIVER SIMULATING PREGNANcy.—Dr. Vogelsang, of Biel, Switzerland (Memorabilien), relates the case of a patient in whom there was a tumor in the right iliac region, which the woman, aged 45, had thought to be the enlarged uterus. Amenorrhoea existed. On per- cussion it was found that the liver was absent from the right and left hy- pochondria. The woman was a strait-laced person. Advertisements. Shepard ºudley MANUFACTURERS OF Ford's Surgical Instruments, INSTRUMENT-MAKERS TO THE U. S. Navy; Bellevue, New York City, and New York State Woman’s Hospitals, and Hospitals in charge of the Commissioners of Public Charities and Correction. IMPORTERS AND MANUFACTURERS OF EVERY DESCRHP- TION OF F U B B E H G O O D S. SURGICAL, DENTAL, ORTHOPAEDIC, WETERINARY, CHIROPODIST’S, TAXIDERMIST'S, AND EN TOMOLOGIST'S INSTERUMENTS. wr Trusses and Abdominal Supporters in great variety; Suspensory Bandages in all shapes and styles; All kinds of Instruments to enable the “Deaf.” to hear; The latest and most approved Appara- tus for Deformities; Electro-Magnetic Machines and Galvanic Batteries in the most compact form ; Electro-Magnets and Galvanic Batteries combined; Crutches in all kinds of wood. We have on hand all the latest American Instruments, and are constantly receiving from our Agents i France, Prussia, and England all the latest models and inventions in Surgical Art. GooDs IMPORTED or MANUFACTURED To ORDER. ºf Send for Price-Current. 150 WILLIAM STREET, N. Y. CODMAN & SHURTLEFF's . . . . . . . . . . . . . . 4. Amaim of Hui. for inhalation, Hal Anthºi. &t, By the Atomizer, any medicated liquid may be converted into the finest spray. In this state it may be inhaled into the smallest air-cells, thus opening a new era in the treatment of all diseases of the throat and lungs. THE COMPLETE STEAM ATOMIZER FOR INHALATION, &c. (See Zºº. I 5.) It consists of the sphere-shaped brass boiler A, steam-outlet tube B, with packing box C formed to receive rubber packing through which the atomizing tube D passes, steam-tight, and by means "o which tubes of various sizes may be tightly held against any force on steam, by screwing down its cover while the packing is warm; the safety-valve E, capable of graduation for high or low pressure by the spring or screw in its top, the non-conducting handle F, by which the boiler may be lifted while hot, the medicament-cup and cupholder G, the support H, iron base II, the glass face-shield J, with oval mouth- piece connected by the elastic band K with the cradle L, whose slot- ted staff passes into a slot in the shield-stand M. M., where it may be fixed at any height or angle required by the milled-screw N. . The waste-cup, medicament-cup and lamp are held in their places in such a manner that they cannot fall out when the apparatus is car- ried or used over a bed or otherwise. All its joints are hard soldered. - \ It cannot be injured by exhaustion of water, or any attainable pres- sure of steam. g s It does not throw spirts of hot water, to frighten or scald the Fig. 15. The Cemplete Steam Atomizer, patient. Is compact and portable, occupies space of one-sixth cubic foot only, can be carried from place to place without removing the atomiz- Patented March 24, 1868, and Mar. 16, 1869. ing tubes or the water, can be unpacked or packed without loss of time. A'oz Azz/a/ations, &c. Will render the best of service for many years, and is cheap in the best sense of the word. Price $6 oo. Neatly made, strong, Black Walnut-Box, with convenient handle, additional, $2 50. Hrass Parts Nickel-Plated, additional, $2 50. SHURTLEFF'S ATOMIZING APPARATUS (See Fig. 5), for Inhalation, and with suitable tubes, for Local Anaesthesia, and for making direct local applications of atomized liquids for a great variety of purposes. [See our Pamphlet.] The most desirable hand Apparatus. Rubbers warranted of zery &est gua/ity. Valves imperishable, every one carefully fitted to its seat, and work perfectly in all positions. The Bulbs are adapted to all the Tubes made by us for Local Anaesthesia in Surgical Operations, Teeth Patented March 24, 1868. Extraction, and for Inhalation. Price $4 oo. Each of the above Apparatuses is supplied with two carefully made annealed glass Atomizing Tubes, and accompanied with directions for use. Every Steam Apparatus is tested with steam, at a very high pressure. Each Apparatus is carefully packed for transportation, and warranted perfect. Also, HAND BALL ATOMIZER, No. 5, without face-shield, • * * * * * * tº gº $3 5o THE BOSTON ATOMIZER, with two glass Atomizing Tubes, º e te tº * * * º 2 50 i"HE TREMONT ATOM12ER, with two glass Atomizing Tubes, te e e * & g 2 CO * LASS ATOMIZING TUBES to fit any of our Apparatus, warranted perfect, each, gº & 25 RICKEL-PLATED TUBES, for Local Anaesthesia and for Inhalation, each, . & • e 75C. to a on RHIGO LENE, for Local Anaesthesia, best quality, packed, sº & e e * e NASAL DOUCHE, for Treating Diseases of the Nasal Cavity, eight different varieties, each with two Nozzles, packed e * * tº * e * * $1 20, 1 50, 1 75, 2 oo, and 3 so 1 OO N.B.--To save collection expenses, funds should be sent with the order, either in form of draft, post- office order, or registered letter. - (For complete illustrated price-list of Apparatus, Tubes, etc., see Pamphlet.) ſ:#" will be sel t by mail, (post-paid) on application, A PA M PHLET, Containing two articles, by distinguished foreign authority, on - * W . wrfºrmulas of THOSE SUCCESSFULLY EMPLOYED. - *º. %;... ---, º . - - Yºtº , ; Also, an article by Bººk L. W. THUDICHUM, M. R. C. P., on *ś. - “A New Mode of Treating Diseases of the Nasal Cavity,” witH His ForMULE. | Also, an illustrated description of the best apparatuses for the above purposes, and for producing, Zocal 34zzoesãesia by Atomization with Ether, by the method of DR, RICHARDSON, of London; or with Rhigolene, as described by DR. HENRY J. BIGLow, in the Boston Medical and Surgical %urma? of April 19, 1866. ſ 24?? ozer 24?ozygëzing Z72strumezzęs are made with the utmost care, with a view to their complete efficiency, convience and durability, and every one is warranted. A Gold Medal has lately been awarded us by the Middlesex Mechanics’ Association, for Atomizing and Surgical Instruments, as will be seen from the following report, signed by a leading New England Surgeon and Physician: - - - ** 3603. Codman & Shurzieff, Žoszon, .7zass. 22, a Case, Secrgicatº Zws?reements azzd 24&ozzzzzers. - - & } - . . . . - { % The Committee have no hesitation in awarding for this superb exhibition the highest premium. “... " ... ', 'The various other instruments for Inhalation of Atomized Liquids, and for. Local, Anaesthesia, were all ap arently". : faultless, both in design and workmanship. The exhibitors are regarded as more especially deserving of the highes, :k º 'a . ** . . . . ... ºr '3 × ; : * : *, token of merit for having produced nothing except of their own manufacture.-: Gołó.7%eda?. - .** (Signed GILMAN KIMBALL., M. D., Cºzzārzozart.” Also by the Mass. Charitable Mechanics' Association.—Exhibition of 1869.--A Siła'ez: JA edia?, the ƺes) Medal awarded for Surgical Instruments. | -- " A I, § C IH' C F. SS A T a LED : *Cammann's Stethoscopes: . . *French Rubber Urinals, with valves, male, Disarticulating, - . . - . $7 co for night or day, - tº OC *Knight's Modification, , . - º . 9 50 Male, day only, - - - e $2 50 to 4 oc Simple Throat Mirrors, Nickel-Plated, . • I OO *French Rubber Urinals, female, for day Ophthalmoscopes, Liebreich's, . . $5 od to 7 oo only. • • - e - - - 4 Od Holt's Dilator, improved, . - * . . 2C OO *Ice and Hot-Water Bags, . . $2 20 to Io oc Barnes’ “ , set of three, with Inflator and *Vaccinators, Whittemore’s Patent Auto- Stop-cocks, e - e - e + 5 Oo . matic, for Crust or Lymph fresh from Large Ear Mirrors, Troitsche's, . $3 50 to 5 co arm.—Instantaneous, Certain, and ał Hypodermic Syringes, . . . . $3 oo to 14 oo most painless (post-paid), . - ... 3 Od *Miller's Intra-Uterine Scarificator, in case, *Powder Syringes, • * - - 4. 2 GK. (postpaid) . . . . . . . tº - 7 'oo | Laryngoscopes, complete, , , . 16 oo to 25 og Lente's Intra-Uterine Caustic Instruments, | *Dr. Oliver's Laryngoscopic Lantern, . 4. 'OO - - - $1 25 to 3 50 The same, with Auto-Laryngoscopic Sponge Tents, plain and carbolized, each, . 25 attachment, . . - - - * OO Pinckham's improved Uterine Scarificator, The same, with ditto and three Laryn- in case, * . . . e - te - 8 oo goscopic Mirrors, in case, . - . 9. Co *Dr. Cutter's Retroversion and other Pessaries 3 oo *Dr. H. R. Storer’s Combined Speculum, . , 6 oe Gaiffe’s Electro-Medical Apparatus. - I5 Oo - N. * Sezza! 727- Descrºftºve Cºrczelaz”. Amputating, Trephining, Exsecting, Pocket, Dissecting, Throat, Ear, Eye, Uterine, Obstetric, and all other special and general sets of Instruments on hand and made up to order. - 2 - . Trusses, Spinal and abdominal Supporters, Shoulder Braces, Suspensory Bandages, Elastic Hose, Medicine Trunks and Pocket Medicine Cases, Otoscopes, Endoscopes, Dr. Sayre's Splints for Hip-joint Disease, Fever. Ther- mometers, Respirators, Syringes, Crutches, Universal Syringes, Galvanic Batteries and Apparatus, French Conical and Olive-Tipped Bougies and Catheters. | Skeletons, Skulls and Anatomical Charts on hand; Manikins, Anatomical and Pathological Models imported to order; prices on application. All Instruments, Implements and Materials used by Dentists, always on hand. Apparatus for Club Feet, Weak Ankles, Bow Legs, Spinal Curvature, and other deformities, made to order, Apparatus for Paracentesis Thoracis, approved by Dr. Bowditch and accompanied with directions kindly furnished r - by him. . Having our Manufactory with steam power, and a corps of experienced workmen connected with our store, we are able promptly to make to order new Instruments and Apparatus, and to supply new inventions on favorable terms. INSTRUMENTS SHARPENED, POLISHED AND REPAIRED, •-TS CODMAN & SHURTLEFF, Makers and Importers of Surgical and Dental Instruments, 13 & 15 TREMONT STREET, BOSTON. } } COMMENTS OF THE PRESS ON THE AMERICAN JOURNAL OF OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN, N. Y. Medical Gazette, Jan. 28, 1871, “This is pre-eminently a journal for the family practicioner, whose services are so largety ca':ed into requisition by the frequent sickness of women and children. If viewed simply as a current epitome of all things bearing upon the branches of which it treats, it would be of infinite value to every physician engaged in general practice. But beyond this, the important original contributions which have been made to medical science through its columns entitle it to higher estimation. No other American periodical has attracted a more distinguished array of authors, foreign and domestic ; few journals anywhere have maintained such uniform excellence in the character of their contents.” N. Y. Medical Record, Feb. 15, 1871, “This quarterly commenced its first issue in May, 1868, under the auspices of the leading obstetricians of this city, and many other equally eminent specialists abroad. The articles con- tained in the different numbers have been singularly good and of a thoroughly practical char- acter, a fact which the profession at large have not been slow to appreciate. The care and discrimination of the working editor, who is also the proprietor. Dr. B. F. D.Awson, has been one of the principal means to this end.” Boston Medical and Surgical Journal, Feb. 16, 1871, “We consider it one of our most valuable exchanges, including, as it does, articles bearing tne names of Elliot, Emmet, Barker, Hammond, Skeene, Thomas, Eustace Smith, the Editors themselves, and other distinguished writers on the diseases of women and children. We com- mend the Journal most heartily to those of our patrons who need sound advice on the special subjects to which it is devoted—and who does not P’’ Baltimore Medical Journal, Feb., 1871. “We have no hesitation in declaring it the best journal devoted to this branch of medical literature. No further evidence of this fact is needed than a glance at the list of contributors, among whom will be found the well-known names of T. Gaillard Thomas and A. Jacobi, of New York; Storer, of Boston; Elliot, Hammond, Nott, Emmet, and Boziman, of New York, and many others, all of whom have contributed articles that would enrich the columns of any journal, and cannot fail to be read with pleasure and profit by all who desire to be informed on the subjects of which they severally treat.” Richmond and Louisville Medical Journal, Feb., 1871. “No journal in this country has achieved more lapidly a deserved and increasing reputa- tion. Its contents are always valuable and interesting, and the very best representatives of these departments of medicine contribute constantly to its pages. The work can be recommended with entire confidence, and all who desire the best and most recent information in connection with the specialties to whose cultivation the Journal is devoted cannot do better than, by sub- scribing, to have its pages always accessible.” Buffalo Medical and Surgical Journal, Feb., 1871. “The Journal is edited with consummate skill and ability, and receives contributions from many of the most eminent writers and teachers in the profession. The advance of knowledge in this department is so great that practitioners of medicine must give attention to present teach ing, or soon find that their profession is far in advance of them. This journal is a necessity in its department, since in it have appeared, and constantly are appearing, important practical Papers, singly of great value, and combined, constituting the progress the art is making from month to month " Pacific Medical and Surgical Journal, March, 1871. “The judgment and skill displayed in the choice of material have placed this journal in the foremost rank of medical periodicals, and given it a reputation of which the 'tors may well be proud.” B. F. DAWSON, M. D., Editor and Proprietor, DVERTISEMENTS. - Tūmati Pantet & (Olgºver FO R | 87.2 A NEw VoluntE BEGINs witH THE JANUARY NUMBER. O.O It is the Medical IN ETE IFE. Iſ C A. It has long been the minent Organ Oldest Monthly sº. ... gº * , º tº º - º: §: mººdºº Prom OF THE 9°rofession of the West and ſouth. .O. It is almost ex&lusively ORIGINAL in its matter. T II E e. (fittiititafi Hjagpital (Éliſting, AND THE DISCUSSIONS OF THE ACADEMY OF MEDICINE, AND OTITER, ACTIVE Medical Societies, are mirrored, so that its contents are peculiarly valuable to the busy practitioner. —.O.O.— Price, $3.00 a Year, )0:—:0( For ADVERTISING RATES address the Publisher. REMITTANCEs as far as possible, should be by Post Office Order. ADDRESS Dr. E. B. Stevens, Editom', Cincinnati, O. ADVERTISEMENTs, The cidest Weekly Medical Journal in the Unite THE Boston MEDICAT 2. ' AND E D IT E D B Y * F R A N C Is H. E. R O VV N, M. D., Surgeon to the Chidren's Hospital and to the Boston Dispensary. On the first of January, 1872, the BOSTON MEDICAL AND SURGICAL JOURNAL entered on its FIGHTY-SIXTH VOLUME, N E S E R E S , having been issued in an unbroken succession since February, 1828. T H E J O U # N A L now appears in a form of S I X. T E E IN P A G E S W E E K L Y, IN DC UE LE COLUMNS, AND IN 24mount and Character of the J/arterial which it contains, ranks with the First Medical Periodicals in the Country, It includes in its Dist of Contributors Men of Em. Žnence in the Varoius Branches of Medical Science. Price, per year, payable in advance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $4.00 With the Arderican Journal of Obstetrics. . . . . . . . . . . . . . . . . . . . . . . . . . 7.00 * DAVID CLAPP & SON, F UE LISHERS, 334 Washington Street, Bostom,