*/2 5. 4 :-
*...*.*.*.* à.
lºvoz, 1. JULY, 1877. NO. I.
|
#
|.
g
t
K
THE
LINTON DISTRICT
MEDICAI. Journal.

AºS.
•. A SEMI-ANNUAf, JOURNAL,
2-
Under the control of the Linton District Medical
Society of Missouri.
{ Å, * EDITORS :
ſ S. N. RUSSELL, M. D., Mexico, Mo.
J. H. DUNCAN, M. D., CoLUMBIA, Mo.
Terms, $2.00 Per Year, in Advance,
COLUMBIA :
STATESMAN Boº, #sº Job PRINT.
* y
t ‘.
&
cºs\CONTENTS, ſº
PART I. ORIGINAL COMMUNICATIONS. PAGE.
Article 1. Hysteria--W. W. Macfarlane, M. D. . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . 1
Article 2. Ptosis Mydriasis Strabismus--W. Dickinson, M. D. . . . . . . . . . . . . . . . 5"
Article 3, Expulsion of a Toad from the Alimentary Canal—John Bryant, |
Jr. M. D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * * * * * * * * * * * ... ... 10
Article 4. Therapeutic Properties of Ammonium Carbonate—-W. A. Jack-
man, M. D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Article 5. A case of Malformation--W. F. Humphreys, M. D. . . . . . . . . . . . . . . . 18
Article 6. As Others See US—G. W. Broome, M. D. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
PART II. SELECTED. *-
Malaria--C P. Russel, M. D. . . . . . . . ............................... ......... 22
Summer Complaints of Children.--J. M. Allen, M. D. . . . . . . . . . . . . . . . . .... . . . . . . . 37
Salicine in the Treatment of Rheumatism--A. D. L. Napier, M. D. . . . . . . . . . . . 46
PART III. Records of the Linton District Medical Society....... . . . . . . . . . . . . . . 48
Annual Address of the Retiring President, Dr. W. T. Lenoir, Columbia, Mo. 59
Introduction... . . . . . . . . . . . . . . . . • * * * * * * * * * * * * * * * * * * * * * * * * * g e º e e s m e º a • * * * * * * * * 64
PART IV. Editorial Abstracts and Selections ....................... . . . . . * - - - - - 68

T H E
I.INTON DISTRICT MEDICAL
JOURNAL.
JULY, 4877.
ORIGINAL COMMUNICATIONS.
ARTCLE I.
IIYSTERIA.—BY W. W. MACFARLANE, M. D., MEXICO, Mo.
The names applied to diseases by the ancients were fre-
quently unfortunate, having a tendency to mislead the
physician—as examples we may mention Typhus Fever,
Tic Douloureux, Rheumatism, Hysteria, &c., &c. Many
names have been changed, the modern names indicating
the nature of the disease, to some extent at least.
Hysteria still retains its heathen name indicating its
heathen pathology.
The name, from Šaréga, the womb, would lead one
to believe that the disease was purely uterine, which is not
true. Also that only females are subject to this disease,
which is not true.
Hysteria is not more remarkable for its frequency than
for the numerous forms under which it may appear; re-
sembling most of the diseases which afflict mankind, as-
suming many different forms, and, like the Grecian deity
Proteus, possessing the power of changing itself into
many and opposite appearances.
Hysteria is really an abnormal condition of the nervous
system, and is a disease and not purely imaginary. There
is generally an entire absence of anatomical lesions but
sometimes the disease is secondary to or a symptom or a

2 ORIGINAL C ) MMUN l CATIONS.
-** *-*.
result of uterine disease. An unusually excitable nervous
system predisposes to hysteria and this predisposition may
be created.
When this predisposition exists many causes are suffi-
cient to excite the manifestations of the disease—viz:
Vicious practices, imaginative fiction, shocks to the nerv-
ous system, etc.
The symptoms are various; among the most prominent
may be mentioned, a disturbance of the special senses, all
of which may be so disturbed at the time of attack as to
produce temporary illusions of sight, hearing and smell.
The voluntary motives may be pervcrted, resulting in con-
vulsions, catalepsy, coma and paralysis. These are also
temporary but liable to recur at any subsequent attack.
There is generally more or less insomnia, impaired appe-
tite, cool skin and constipation. The paroxysms may
come on suddenly, without any premonitory symptoms,
continue for an indefinite time, and the recovery may be
as sudden and unexpected as the attack.
(I wish it understood that I mean that this recovery is
only apparent, and only a cessation of the most prominent
symptoms of the disease.)
Possibly other symptoms less frequent might be men-
tioned--viz: Indigestion, obstinate constipation, hardness
and enlargement of the breast, unreasonable laughter,
floods of tears, pains in different parts of the body, dysu-
ria colic or something resembling colic, hiccough, con-
stant cough, deafness, blindness, &c., &c.
CASE.-Miss K. Age I 5; student; very intellectual ;
well advanced in her studies; had been unwell for some
months; frequently had fainting spells in the school room;
became worse and stopped school, but had not improved
in her general health; had menstruated scantily; poor
appetite; slept badly; complained of a constant pain in
the back. Some four months or more after stopping
School, while under some nervous excitement, she fell

HYSTERIA. 3
down in a fit. For a week or more she was insane, then
improved slowly for a time, but the convulsions recurring
| she became very insane. Had to be fed, urinated in bed
unconsciously, had the hysterical cough and hiccough,
frequent convulsions, sometimes slight but occasionally
severe; finally, deafness and blindness. She became ema-
ciated; had all kinds of delusions. After being in this
condition for months, being even at death's door for
months, she recovered, and is now in excellent health,
bodily and mentally.
The young lady has a great uncle who was insane.
Her grandfather was slightly insane for a short time. An
uncle died in an asylum. An aunt committed suicide.
This young lady had convulsions simulating epilepsy.
She was evidently insane for some time. She had the
peculiar excitable nervous system with the hereditary
taint. She had hysterical insanity. Dr. Aitken thus de-
fines Hysteria: “Hysteria is a chronic morbid condition
of the brain and nervous system and the phenomena may
simulate the phenomena of almost any other disease, and
these phenomena are usually of short duration and parox-
ysmal occurrence.” In consideration of the symptoms
presented in this case (which is a typical one) are we not
warranted in regarding Hysteria as a form of insanity ?
Indeed, I believe that Hysteria is insanity. “The deep
shades of Hysteria border upon and even enter the con-
fines of insanity.”—Cowly.
A celebrated French physician, Dr. Boismont, says,
“when moral disorders are excited by nervous affections,
that is to say by Hysterical affections, they are accompa-
nied by extraordinary phenomena, hallucinations illusions,
delusions and such like.” And again he says hallucina-
tions themselves are insane. In all works on insanity,
Hysteria is always one of the classificati ons. But enough
for the present on this part of the subject, and a few words
on the treatment; remembering that Hysteria does occur

4 ORIGINAL COMMUNICATIONS.
in male subjects and among children both male and
ical.
female.
The treatment of Hysteria is moral, hygienic and med-
If the disease is the result of physical disorders, these
must be treated on general principles, and in Hysteria, as
in insanity, when the cause is removed the Hysteria is
cured. * --
The moral treatment is much the same in this disease
as in insanity. First gain the confidence of your patient.
Listen patiently to her or his complaints, satisfy her that
you thoroughly understand her case and can benefit if not
cure her, and your work is half done. Tonics and seda-
tives are the most effective—iron, pyro phos. iron, the bit-
ter tonics, with the bromides and valerian in some form I
have found best. Especially is a tonic course indicated if
the subject is emaciated. If the subject is in robust bodily
health, as is frequently the case, the treatment must be
chiefly moral and sedative. In a word, the hysterical pa-
tient must be treated as an insane patient, varying of course
according to the case of each individual.
The consequences of hysteria are much less serious as
far as the life of the patient is concerned, than the vio-
lence of the symptoms would lead us to fear. It is hard
ly ever fatal in itself, but the secondary effects may and
undoubtedly sometimes do prove fatal. -
It was stated in the beginning of this article that the
predisposition to Hysteria may be created. The want of
exercise in the open air and sunshine is a prolific source
of Hysteria. Boarding schools, conducted as they gener-
ally are, are almost or quite a curse to our country.
Young girls, just budding into womanhood, at the very
time of life when they most need active exercise and sun-
shine to develop them into beings fit to fulfill the duties of
life, are converted into mere hot-house plants. The brain
is over-worked, the body not worked at all—the conse-
quence a shattered nervous system, Hysteria.

ARTICLE II.
PTosis-MYDRIASIS-STRABISMUs.—BY WILLIAM DICKINSON,
M. D., St. Louis, Mo.
John White, 28 years of age, of spare figure and low
stature, a book-keeper, first presented himself to me in
April, 1876.
His parents never suffered from cerebral affections, but
died of some form of fever. A brother several years his
senior, however, died of apoplexy at about the age of 50
years. He himself has never suffered from any form of
brain disease, nor from falls or blows upon the head; but
has uniformly enjoyed good health, and is a man of tem-
perate habits. About ten years since he contracted syph-
ilis; all evidences of which, after treatment continued
during four weeks, apparently disappeared and have never
in any degree since returned.
In the spring of 1875 a friend observed and called his
attention to the condition of the pupil of the left eye, it
being much larger than that of the other, though he him-
self had not noticed this peculiarity, nor any other affec-
tion of the eye. About ten days before his first visit, hav-
ing one night retired as usual in the perfect exercise of all
his faculties, he discovered on the following morning that
he had contracted a severe cold and that he could not
completely raise the left eye-lid; indeed it drooped so low
as to interfere with vision. A day or two later, his appre-
hensions being aroused he tested his vision and then for
the first time appreciated the fact, (probably present for a
year) that he could not with the left eye clearly discern
small objects, and with it could only read large print; but
objects at a distance were perceived with nearly the same
distinctness as with the other. w
When first seen by me the most manifest symptoms
were Ptosis—the lids of the left eye being nearly in appo-
sition,-and Mydriasis—the diameter of the pupil being
three or four times that of the right; (the latter, however,

6 ORIGINAL COMMUNICATIONS.
was abnormally small,) the pupil was also very sluggish
responding but little to the access or the absence of
strong light—the same was true of the right——but both
readily affected by the instillation of atropia. In the af-
fected eye, the power of accommodation was almost en-
tirely wanting, he being scarcely able with it to discern
No. 8 of Snellen. The function of the second (optic)
nerve had escaped complication. During the two days |
succeeding, Strabismus divergens supervened together
with inability to freely turn the globe upward or down-
ward; but by conscious effort of the associated muscles
the globe could be restored to the median position, In
consequence of this strabismus, diplopia (double vision)
was presentedto a degree which seriously interfered with his
business. His sense of hearing was also greatly impaired,
the hearing distance of the right ear being only four and
and that of the left three inches. The functions of the
other cranial nerves were retained in their normal exercise.
The physiognomy of the affection being so well defined
the diagnosis was not difficult; lesion of the third cranial
nerve was the occasion of the symptoms present. The
ptosis and imperfect excursion of the globe upward were
due to paresis of the divisions of the superior branch inner-
vating the levator palpebrae and the Superior rectus, respect-
ively—the divergent strabismus, the imperfect excursion
of the globe downward and its rotation upon its antero-
posterior axis were the result of paresis of the several di-
visions of the inferior branch of the same nerve; and
since the ophthalmic ganglion derives its motor-endow-
ments immediately from this nerve, the mydriasis and im-
perfect power of accommodation must be referred to the
common paresis of all the branches indicated. The nerve
under consideration is more liable to paresis and paralysis
than any other, and is generally the result of pressure. If
we locate the cause in the orbit we must assume a com-
mon cause acting upon all the branches of the third nerve,
sparing the fourth and sixth which innervate the superior
• * * * *** ** - - *** - - - -
t

PTOSIS-MYD RIASIS-STR. A. IBISM U.S. 7
* = hºmºe
oblique and the abducens muscles respectively. Though
such anomalous partiality might be possible, in this case
it is scarcely probable. We must therefore seek for the
seat of the lesion within the cranium and most probably
at the base of the brain. It may be the result of a sero-
albuminous exudation or of hemorrhagic extravasation ;
but with greater probability I attribute the symptoms
to the development of a gummy tumor or of a syph-
ilitic node in this region at some point between the
origin of the nerve and its entrance into the orbit, by
which, through mechanical pressure or by inducing nutri-
tional changes in the nerve itself, the normal performance
of its function is interfered with. The effects of lesions of
the third nerve which are of intra-cranial origin may be
sudden or slow in their appearance. The first may partake
of an apoplectic character or may arise from violent exer-
tion, mental emotion, excessive mental application, sun-
stroke, injuries to the head, &c. The second advances
with the progress of the cerebral disease; among the
causes may be enumerated basilar meningitis, aneurism,
exostosis, tubercular or other deposits, and cysts at the
base of the brain. In the early stages of either of these
forms the symptoms may remit and afterward recur. In
the first class of cases there may be a perfect recovery;
in the second, those of slow development, there is little
expectation of recovery or of permanent amelioration by
treatment.
Lesion of the nucleus of this nerve at its origin would
induce the symptoms given, but peripheral disease is by
far the most frequent, and of all causes syphilis is the
most common. Von Grafe thinks that about one-third of
the cases of paralysis of the motor-oculi, are due to this
cause. In many cases it is quite impossible to ascertain
with any degree of accuracy at what precise point the
lesion is situated ; nor is it important ; one may be con-
tent with the knowledge that the patient has suffered from
venereal disease, and with this fact persistently kept in view

8 origiNAL CoMMUNICATIONs.
we frequently find under appropriate treatment a very rapid
recovery ensuing. * ,
In all cases of paresis or paralysis of the oculo-moto-
rius, our prognosis must of course depend upon the con-
ceived cause or causes. If these can be removed or re-
leived, a favorable prognosis can be given. If the cause
is situated within the orbit, (e-g) a tumor not malignant,
or an abscess, or if functional and the resultant of a reflex
action, the prognosis is favorable. Those causes, in fine,
that are of peripheral origin and especially those depend-
ant upon rheumatic affections, furnish us with the most
favorable prognosis, especially if the patient applies soon
after the invasion of the disease. If on the other hand,
the affection is due to some grave cerebral lesion accom-
panied by manifest symptoms of nerve degeneration or
softening and if it has existed for a long period the prog-
nosis must be unfavorable. ..y
Treatment.—-Since ptosis was the chief symptom ob-
served and that for which I was primarily consulted, my
treatment was predicated upon the diagnosis that the paral-
ysis of the levator palpebrae was of rheumatic origin, su-
pervening upon the existence of the gummy tumor desig-
nated above and this was made chiefly on account of its
sudden invasion; the patient had been exposed to currents
of air; he had taken cold, and ptosis was present. We
are frank, however, to confess that the pathological changes
which occur in these rheumatic paralyses have not re-
ceived a satisfactory explanation, and we do not know ex-
actly whether deposits or other changes take place in the
substance of the muscles distributed to the affected part,
or whether the fibrous tissues which invest the nervous
trunks are the seat of the rheumatic inflammations. Hav-
ing formed my diagnosis, I administered a brisk cathartic
and applied to the eye a solution of calabar bean, with
the view of securing contraction of the pupil, the dilata-
tion of which had for months existed. This was followed
by Pot. Iod. and Brom. alone and in combination, and

PTOSIS-MY DRIASIS-STRA EISM U.S. 9
* *
later by Hyd. Prot, Iod., and Bi-Chlor., and subsequently
by the regular and persistent use of galvanism. Obvious
amelioration of the symptoms speedily followed, the pa-
tient recovered to a good degree the normal use of the
levator palpebrae muscle, and progressively the power of
accommodation, he being able to read much smaller print
than at first. He also regained ultimately almost perfect
exercise of the internal rectus muscle, thus annihilating
the strabismus, and also the complete use of the other
ocular muscles involved. During the treatment partial
relapses occurred on several occasions, from which he
soon recovered, and he is now able to discern with the
affected eye much of No. 1 Snellen, the smallest print in
common use. ...”
A cure seems to have been achieved; but none can
promise exemption from liability to a return of the same
affections or to the Supervention of a more grave cerebral
disease. A brother died suddenly of “apoplexy;” here
is manifested a family proclivity to complicate or aggra-
vate any existing conditions that his own habits may have
induced. He confesses that he has experienced the con-
sequences of vicious indulgences, and though he has en-
joyed an immunity from the effects of syphilis for a dec-
ade of years, who shall declare that his escape from its
tenacious and venomous folds is even now wholly secured?
The coral insect in the fulfillment of his mission, building
unseen, diligently constructs his tiny shell, his home, his
| fortress and his tomb; till in process of time the marine
mountain reef defies the storm and wrecks both noble ship
and her crew in the unequal encounter. Who then shall
assert that the present aggregation of symptoms presented
in this case is not the legitimate product of the infection
in earlier years received, which, clandestinely existing dur-
ing the subsequent years, has insidiously and unsuspect-
ingly elaborated those vital elements, that, resisting the
best appliances of our art, shall know no limit or cessa-

10 ORIGINAL COMMUNICATIONS.
tion, till the citadel of life itself shall be overmastered and
overthrown. *
ARTICLE III.
ExPULSEoN of A ToAD FROM THE ALIMENTARY CANAL.-BY
JNo. BRY ANT, J.R., M. D., INDEPENDENCE, M 9.
Julia R—. age 9 nine years, had been complaining of
headache and general malaise for two weeks or more; no
appetite; bowels rather constipated. Her mother fearing
typhoid ſever sent for me on the 7th of April. I found
her as above, also with leucorrhoea, no fever. The leucor-
rhoea and general symptoms induced me to diagnose the
case as one in which those small worms (ascaris vermicu-
laris) were irritating the rectum to such a degree as to
produce the leucorrhoea. I ordered a dose of oil and tur-
pentine next morning, with directions to watch for the
worms at ever stool, and to let her have stools in a vessel
in the room. This dose, as the father told me, brought no
worms. I then ordered a repetition of the dose next
morning. This produced a passage which pained her so
much she cried; when she rose from the vessel she ob-
served she had passed something large and dark which
so frightened her as to render her very nervous, or, as the
Inother states, she trembled, for some little time. The
passage of this created slight hemorrhage. Her mother
sent the specimen to me immediately to know what it
could be. I found it to be the skin and bones of a full
grown toad, with contents wanting. She was soon well
after this,
Now how this little patient could have swallowed the
toad without knowing it, is a mystery to me; she insisted
she knew nothing of its entrance. She has more than
usual intelligence, and, will render me all the assistance-in
her power to diagnose any ailment she has. I will state
that the rains in February and March rendered the water

11
at school slightly muddy, but not enough I think to hide
a toad. The vagina was examined directly after its pas-
sage, showing no irritation there. It passed through the
alimentary canal and was digested except skin and bones.
It also must have been several weeks in passing, for she
complained so long. How did it get there P
ARTICLE IV.
THERAP EUTIC PROPERTIES OF AMMONIUM CARBONATE.—BY
W. A. JACKMAN, M. D., Ito CHEPORT, MO.
Ammonium Carbonate has never been used as far as my
knowledge extends until late years, except to fulfill cer-
tain indications in the advanced stages of disease, upon
the supposition that its value depended solely upon its
stimulant properties, and thus aided in sustaining the vital
powers in cases where there was extreme prostration. It
was advised simply as an auxiliary to other measures, and
recommended as a stimulant in all low forms of disease
without reference to other indications. That it is a valua-
ble stimulant to the heart and arterial system—perhaps as
much so as any drug we possess—I believe; but that the
older writers did not fully understand its therapeutic value
I am well convinced. I am satisfied that this application
of the remedy is far too limited, and that its stimulant
properties constitute but a small proportion of its remedial
value. They would have regarded a man unworthy a
place in the profession who, a half century ago, in the
days of bleeding and tartar emetic, would have recom-
mended a powerful stimulant in the acute stage of a highly
inflammatory disease. This, however, is but an evidence
of the revolution that is continually going on in both theo-
retical and practical medicine, and of the contrariety of
opinion with reference to the treatment of disease among
medical men. -
That there is great want of uniformity of method of
treatment, even among those who practice the same system
!

12 ORIGINAL COMMUNI CATION S.
as to constitute it an approbrium medicorum, none will deny
who read medical works, and attend the meetings of med-
ical societies. Theory, correct theory, is all important in
the practice of medicine, but what the practical medical
man wants, and the afflicted need, as a result of investiga-
tions by physicians, is unerring truth, axioms which when
reduced to practical application will be found as exact as
it is possible to attain in medicine.
The effect of a remedy in its application to disease is
one of the most important things to be considered by the
physician, and this can only be learned at the bedside.
To attain to something like certainty in practical medicine
should be the aim of every scientific and conscientious
physician, and our first inquiry should be, upon what coſt-
dition of the human system does each disease depend; what
is its cause 2 And secondly, what remedial measure is best
calculated by its #nown properties and effects upon the human
organism to remove the abnormal condition ?
Accuracy of observation is the first duty of the physi-
cian, for it is by the daily continued practice of accurately
observing disease, and the effects of remedies in our clin-
ical experience, and recording them in book form, that has
contributed to advance practical medicine to its present
honorable but far from perfect condition. It is well under-
stood and generally admitted that the study of disease in
its special pathology, etiology, symptomatology, and thera-
peutics, constitute the only true rational and scientific
method of advancing practical medicine. What then is
the chief therapeutic value of the remedy under consider-
ation ? It is believed to be the best defibrinizer of the
blood we have, and there are not wanting well educated
and scientific physicians who believe that it comes nearer
being a specific—if it be possible to attain to such a thing
in medicine—than Quinine as an anti-periodic. But in
order to a correct understanding of the subject, it will be
necessary to briefly discuss the pathological condition
present under certain morbid conditions of the blood, or

AMMONIUM CARIBO NATE. 13
rather one of its organic elements, to-wit: fibrine. Now,
I do not propose to go back into the past and discuss the
truth or falsity of either the solidist or humoral pathology;
but believe it to be the duty of the physician to ascertain
as far as possible, preparatory to the treatment of disease,
the morbid condition present, and if possible the cause of
said condition. But what is fibrine, and what is the pa-
thological condition when morbidly increased or decreased?
Fibrine is that portion of the liquor sanguinis or blood-
plasma, which solidifies, forming the coagulum or clot
observed when a quantity of blood is drawn into a vessel
and allowed to stand a short time. Certain of the phe-
nomena pertaining to the coagulation of the blood without
the vascular system are important in their pathological re-
lations, and might not be void of interest in this discussion;
but the limit allotted to this paper forbids a further refer-
ence to it, than to add that the buffy coat and cupped
| blood formed the base of the therapeutics of our fathers
in medicine; and believing, as long as they existed, bleed-
ing to be the great remedy, persisted in the withdrawal of
the vital fluid from the vessels; not knowing as we now
do that, as venesection increases the fibrine and diminishes
the globules, the more they bled the worse the trouble.
Next we wonder at the perfect revolution in the pro-
fession with reference to venesection. But their premises
being false, their deductions drawn therefrom could not
well be otherwise, hence the conclusion that their thera-
peutics were erroneous. Hyperinosis—so called by Si-
mon—constitutes that condition known as an abnormal
increase of fibrine in the blood; the average proportion of
which in health is about two and a half parts in one
thousand. This condition characterises acute inflamma-
tions. In different cases of acute inflammation the in-
creased proportion is found to vary from three to twelve
parts in one thousand. Acute articular rheumatism pre-
sents the largest increase of filbrine; pneumonia ranks
next with reference to that feature, and capillary bronchitis

14 ORIGINAL COMMUNICATIONS.
next. But coagulation within the vascular system—insep-
arably connected as it is with our subject—I propose
briefly to consider in this connection, as it is known to
take place during life in the cavities of the heart and ves-
sels. Certain concretions, or in other words small coag-
ula, consisting of fibrine are found deposited on the
valves and at the orifices of the heart. This may take
place as a result of the exudation of lymph, or the deposit
of calcareous matter; but doubtless occurs also when the
blood is surcharged with fibrine as in acute articular rheu-
matism. It likewise occurs in endocarditis under similar
conditions. - -
These coagula are oftener found in the left cavities of
the heart as the result of two causes; first inflammation
and valvular lesion are of more frequent occurrence in
these than the right cavities; and secondly, arterial blood
contains more fibrine than venous blood. These fibrinous
deposits may accumulate and form masses as large as a
bean, or even much larger, and occasion obstruction in
proportion to their weight and volume, and sometimes
torn off by the current of blood, thus constituting em-
boli or plugs, and being carried along the arteries with the
flow of blood at length reach a situation where the size of
the vessel prevents their further passage, Thus arrested,
the first effect is the obstruction to the flow of blood to
the parts supplied by the vessel, and may thus give rise to
important pathological effects dependent on its sudden in-
terruption; resulting secondarily in apoplectic seizures
and paralysis in a cerebral artery. An ulterior effect of
embolism in the cerebral arteries is softening; and in
other parts gangrene may be a result of the continued
deficiency in the supply of blood.
These coagula which are found after death fixed in the
arteries of the brain and elsewhere, are found to be simi-
lar in their miscroscopical characters to co-existing fibrin-
ous deposits within the cavities of the heart. A second
variety of embolism, termed thrombi, occurs when the
*:

AMMONIUM CARIBO NATE. - 15
* ºmºsºme a mºme
plugs are derived from the veins, though upon this variety
we cannot amplify. It will readily be seen, however, that
emboli formed in the left cavities of the heart and arteries,
produce obstruction in the arterial circulation; whereas,
the emboli—or rather thrombi—formed in the veins, pro-
duce obstruction in the pulmonary circulation. Sudden
death may be produced by a clot sufficient to cause plug-
ging of the pulmonary artery, and local inflammation with
suppuration may occur from the smaller masses in the
branches of this artery. In this Virchow explains the
occurrence of multiple abscesses in the lung in cases of
pyaemia. -
Embolism belongs among the more prominent modern
discoveries relating to the nature and source of morbid
condition. Much attention has been directed to it in re-
cent years, and facts are constantly accumulating which
tend to show the importance of the subject, both patho-
logically and practically. Coagula are usually found
in greater or less abundance in the cavities of the
heart after death, and are in general formed after
death or during the act of dying; but are sometimes
formed during the progress of disease; and a sudden
and unexpectedly fatal terminationin in certain cases,
are due to their formation. In pneumonitis for in-
stance, it occurs not very infrequently, owing to the high
degree of hyperinosis, producing obstruction to the pul-
monary circulation. The sudden occurrence during the
progress of a disease, especially the one first mentioned,
of great irregularity and febleness of the heart's action,
attended with anxiety, oppression and great dyspnoea—
death taking place after a few hours from the notable
change in the symptoms, and no other cause for the
change being apparent—should lead to a strong suspicion
of this accident. Perhaps there is no physician of experi-
ence who has not met with this accident in his early ex-
perience, but was then unable to account for the sudden
fatal termination of the disease, The liability to this acci-

16 oRIGINAL communications.
dent in diseases where there is a high degree of hyperinosis
suggests the inquiry whether measures to guard against
its occurrence are available. The fibrine in its normat
state is a liquid, but why that is so has long been an ob-
| scure question with physiologists. The preservation of
| that liquidity, or in other words to prevent its coagulation
| within the heart and blood vessels, presents an important
| pathological consideration, suggesting to the observant
| physician valuable therapeutic indications.
From a large number of experiments made some years
ago by a distinguished physician–Dr. Richardson, of
London—the conclusion has been drawn that it is due to
| ammonia in the blood. Accepting this explanation as
probably true, ammonia has been given as a remedy with
a view to maintain the liquidity of the fibrine in the blood,
in cases where there may be reason to fear the formation
of heart-clot. Will it accomplish this object? There are
not wanting many who believe that it will, and so far as it
has been tested has been abundantly established; and if
indeed on further trial it is confirmed, it will readily be
conceded that its remedial value has been greatly under-
rated, and that it is the sine qua non in the treatment of a
certain class of diseases. I think, however, it will be
found to be best adapted to the treatment of diseases of the
pulmonary organs, as capillary bronchitis, pneumonitis
gangrene of the lungs, &c. But allow me to ask by way
of eliciting information, why it might not be a valuable
remedy in acute articular rheumatism P For the blood is
known to be surcharged with fibrine in that disease, re.
Sulting in its deposition in the heart and blood vessels
with its resultant evils.
It is now being given, and has been for quite a number
of years, with a success that commends it to the consider-
ation of all, especially in pneumonitis; a disease which, if
published statistics are to be relied on, was alarmingly
fatal under the old treatment of venesection, powerful
sedatives, &c., &c.; the mortality being under the treat-

AMMONIUM CARBONATE. 17
ment of Rasori as I in 2%. In contrast with this let us
compare the results of the method of treatment here ad-
vocated. One physician, a man of age, of large experince,
fine attainments and comprehensive views, reports the loss
| of two cases only out of ninety-six well marked bad cases,
| treated on the ammonia plan; nothing else being given
after opening the bowels with a mild laxative. No alco-
holic stimulants were allowed in any stage; quinine was
given to control malarial complications, or as a tonic in the
fast stage only. He treated over two hundred other cases
on the mixed plan, giving alcohol and ammonia, sedatives,
as tartar emetic and veratrium, with quinine, throughout
| the disease, with variable success. Another physcian re-
gards it as “decidedly the most effective plan,” having
treated “72 cases with a loss of two only.” Another re-
| ports 78 cases treated, 35 of which were treated on the
| ammonia plan with one fatal result; the remaing 43 were
treated on the old plan with all the remedies usually given,
| with four deaths. Another still gives as his experience in
one year, one fatal case out of 73; in six months, the year
following, 33 with the loss of two.
These results certainly commend themselves to our se-
rious consideration in comparison with the former plan,
as the experience of respectable practitioners, all of whom
certainly could not have been mistaken; indeed one of
them says his observations had been extensive and care-
fully made. This treatment certainly gives the most favor-
able results of any method yet presented to the profession.
These observers tell us that under the use of this remedy
the febrile excitement, heat of surface and temperature
are reduced; the skin becomes moist; the pulse becoases
less frequent but full and strong; that the respirations are
likewise rendered easy, regular and less frequent. It also
diminishes the viscidity of the sputa, promotes expectora-
tion, and the oxygenation of the blood; and by relieving
the hyperinosis prevents many of the complications liable
to occur during the progress of the disease.
18 ORIGINAL COMMUNICATIONS.
They also tell us that if given “early in the disease, and
regularly in full doses, it will in almost every case so
limit the exudation process as not only to greatly lessen
the amount of hepatization, but to insure a prompt and
rapid absorption of the exudation, and occasionally it will
entirely prevent hepatization, and terminate the inflam-
mation by resolution.” Whether this remedy will ac
complish all that is claimed for it above, future, ob-
servation alone must determine, but upon the points
claimed they cannot be mistaken. My experience with it
is perhaps limited in comparison with some but I have
! been using it for some time, and my success with it has
inspired me with confidence in it as a remedy of great
| value.
ARTICLE V.
A CASE OF MAILFORMATION REPORT FD TO THE LINTON DIS-
TRICT MEDICAL ASSOCIATION AT THE APRIL MEETING
BY W. F. HuMPHREYs, M. D., of Concord, Mo,
The monstrosity represented by the above cut was born
in Callaway county, Mo., on the 9th of February, 1877.
The parents are in robust health, and of the first respecta-
bility, and have two finely formed healthy children. The
"| age of the mother about twenty. There was nothing um-
usual during the period of gestation nor until labor had
fairly set in ; the movements of the child being distinctly
felt. Dr. Baker, of McCredie, who was in attendance,
finding a shoulder presentation, administered Chloroform


—r—
MAIL FORMATION. 19
and delivered by turning, the child showing no signs of
life. -
I saw and examined the child a few hours after birth,
but unfortunately an autopsy could not be had.
DESCRIPTION.—Above the Umbilicus the development
was in all respects perfect. The cord was small and not
in the median line; the abdomen was quite prominent and
there was a gradual tapering to the end of the single
lower extremity. The Pelvic bones were not so developed
as to enable me to distinguish any of them ; there was
neither crest of the Ilium nor Pubic Arch. The lower
extremities were not differentiated; there was one broad
Os Femoris that formed apparently a hinge joint with
the lower extremity of the Sacrum; its length was the
normal length of the thigh. The articulation correspond-
ing with the knee was apparently destitute of Patella and
flexed forward instead of backward. One broad bone
took the place of the Tibia and Fibula. If there was a
gastrocnemius muscle it could not be determined which
side of the leg it occupied. Below the ankle there was no
development of bone, but an appendage of integument,
cartilage and muscle, bearing about as much resemblance
to a foot as a moccasin does.
While the natural position of the extremity seemed to be
that represented in the cut, it could be extended almost to
a line with the body.
There was no appearance of an effort to develop either
Anus or Genito—Urinary organs; consequently there was
no outlet from bowels or bladder and no place for them.
QUERY.—Does this case, showing as it does a tendency
to retrograde, confirm the Darwinian theory of progress-
ive development P

20 O RIGINAL COMMUNICATION S.
ARTCLE VI.
As OTHERS SEE Us.--BY G. WILEY BRoom F., M. D., Mors-
ERLY, Mo.
If we should open the ledger and compare the contribu-
tions made to the Surgery of our country with those
added by the profession of other states, how would the ac-
count stand P Let us see.
The first known amputation at the hip joint belongs to
Kentucky, performed by Dr. Walter Bradshaw of Nelson
county, in 1806. In Hartford, Ohio county, Ky., the dar- |
ing and hazardous operation of removing the entire clav-
icle was successfully performed for osteo-sarcoma by
Charles McCleary, M. D., on the 4th of May, 181 I.
To Ephraim McDowell, then of Danville, Ky., is the
world indebted for an operation performed in the well
known case of Mrs. Crawford, of Danville, in December,
1809—-the removal of an Ovarian Tumor; an operation
now performed all over the civilized world to the saving
of thousands of lives, before which time they were doomed
to a lingering death.
John Briggs, Jr., M. D., has priority for the operation of
extirpating the Uterus at Bowling Green, Ky., in 1830.
The pioneer in Lithotomy, and who operated an hun-
dred times without a death or failure, was a Kentuckian—
Dr. Benjamin W. Dudley.
In Tennessee, in February, 18 IO, without known prece-
dence or professional counsel or aid, Dr. W. H. Deadrich
successfully removed nearly one-half of the Inferior Max-
illary bone from a lad of fourteen years of age. The
patient fully recovered. This was the first operation of
the kind ever performed.
It was in Tennessee, in Rutherford county, that intus-
susception was successfully relieved by Gastrotomy by Dr.
John R. Wilson, in December, 1831. The report says of
this wonderfully skillful and hazardous operation: “Other
means having failed, seventeen days after obstinate
obstruction in the boweſs, the abdomen was opened by an

AS OTHERS SEE U.S. 21
ºmºmºmºsºms smºsºmsºmº
incision two inches above and three below the umbilicus,
when the Ileum was found invaginated and threatened
with mortification ; it was drawn out carefully and relieved.
The wound was then closed with sutures and plasters and
the patient soon voided the mercury he had taken the
night before.”
In the city of New Orleans, La., in the year 1831, Dr.
Charles Luzenberg laid open a strangulated hernia and
finding the intestines completely mortified did not hesitate
to remove six inches of dead intestines, stitch the serous
surfaces together, and the patient fully recovered in 35
days. The first successful excision of the Ulnar and Ra-
dius was performed in New Orleans by Dr. Compton in
I833. *.
The first and probably the only successful removal of a
kidney was performed by Dr. G. T. Gilmore, of Mobile,
Alabama.
In Alabama the distinguished J. Marion Sims, now of
.
New York City, first established the curative treatment of :
Vesico-vaginal fistula.
It is generally conceded that Dr. Nott, of Mobile, Ala.,
first suggested the removal of 2 or 3 segments of the Os
coccygis for an otherwise intolerable coccydynia in 1843.
Prof. G. C. Blackman and those living before and cotem-
poraries with him have done much toward improving the
art of surgery. But it is a fact everywhere conceded, we
must acknowledge, the greatest number of original and
brilliant exploits in surgery have been inade in small
towns, and more particularly at the south.
Now in comparing our account with valuable surgical
contributions made by other states, must it be confessed
that the leaf set apart in this ledger for original contribu-
tions from the surgeons of Missouri does not have a
single case of originality recorded upon it 2
It is true that Hodgen for his modification of Smith's
anterior wire suspension splint; for his modifications in
the operation for lacerated perineum; for his simplification

22 SELECTED.
of all appliances in surgery, and his eminently practical
teachings; that Dr. Hammer, amongst other creditable
surgical operations, for his excision of the scapula; that
Joseph Wood for his wonderſul success in Lithotomy, de-
serve the highest commendation.
But for unprecedented exploits and brilliant triumphs in
surgical practice the surgeons of Missouri are wanting.
This is a fact and it may give us renewed earnestness and
a jealous ambition to endeavor to deserve a share of the
honor in promoting the advancements of the triumphs in
Surgery.
SELECTED.
MA f, ARIA.(*)—BY CHARLEs P. RUSSELI, M. D.
The terms malaria and miasm in medical phraseology
include the causes of a large class of affections—what
are known more particularly as 2/motic diseases, which
depend upon a variety of specific organic poisons whose
essential nature, composition and form are most inappre-
ciable as yet by scientific research, The general under-
standing, however, of these terms is more limited; and, in
conformity with the popular idea, I shall in the present
paper confine their application to the cause of those wide-
spread disorders, intermittent and remittent fevers--the
former of which is so well known as “chills and fever” or
“fever and ague.”
-*
(*) A po; .ion of a paper read before the New York Public Health Associa-
tion, April 13, 1876.

S I LECTIED, 23
“Time out of mind,” as Watson remarks, “it had been
matter of common observation that the inhabitants of wet
and marshy situations were especially subject to these
definite and unequivocal forms of disease.” The same
natural agencies which are at work elaborating, evolving,
and dissemminating malaria must have been equally in
operation ever since the surface of the earth assumed its
present condition. Vast and remote wildernesses that
have never known human presence teem, as of yore, with
deadly exhalations that almost preclude the bold attempts
of enterprising men to lay bare their secrets. There are
some parts of India, as Bishop Heber informs us, which
even monkeys and other wild animals instinctively desert
between April and October of each year. The tigers go
up to the hills; the antelopes and wild hogs make incur-
sions into the cultivated plains; and those persons,
such as dać-bearers and military people, who are obliged
to venture into the marshy jungles, agree that not so
much as a bird can be heard or seen in the frightful soli
tude.
The celebrated Pontine Marshes may be regarded as the
classic home of malaria. The older historical records
describe this tract as occupied with numerous towns by
the Volsci. It was evidently a fertile region; for we read
in Livy that the early Romans sent thither during a season
of scarcity for a supply of corn. Three hundred and
twelve years B. C., the Censor Appius Claudius Caecus
constructed the Appian Way across the length of the Pon-
tine region, the soil of which must have been sufficiently
compact to support the heavy causeway. At some period
of the subsequent century and a half, the country seems
to have undergone great deterioration either from natural
or civil causes, and to have become partially inundated;
for, abount I70 B.C., we find the Consul Cornelius Cethe-
gus applying himself to draining the marshes, and restor-
ing the land to cultivation and salubrity. The result of
his efforts was, that new and flourishing towns arose on

24 SELECTED.
the ruins of the ancient Volscian cities. The civil wars,
however, and the devastation which accompanied them,
again caused the hydraulic works of Pontine Marshes to
fall into neglect, until they were repaired by Augustus,
who constructed several new canals, especially a navigable
one skirted by the Appian way. It was on this canal, at
Forum Appii, that Horace embarked one evening, and at
the same spot St. Paul first met his countrymen from
Rome. Nerva and Trajan both contributed to the drain-
age of the Pontine Marshes, and left inscriptions, still ex-
tant, which testify to their great interest in the project
During the convulsions of the following centuries they
were overflowed anew, until in the reign of Theodosius
they were once more drained, with most beneficial effect,
by a public-spirited individual named Caecilius Decius.
We have no subsequent account of the condition of this
region until the end of the thirteenth century, when Pope
Boniface VIII constructed some works to drain it. Leo
| X employed the engineer Giovanni Scotti to repair and
enlarge the canal of Badino, the principal outlet of the
marshes, and Sixtus V. built a large lateral canal. The
| most important improvements, however, were effected by
| Pius VI, and a system of effectual drainage was almost
completed, when the low condition of the papal treasury
and the confusion attendant upon the French revolutionary
invasion completely arrested the undertaking, which up to
that time had involved an expense equal to $1,622,000.
No new works have since been attempted, although the
authorities endeavor to keep the canals clear and the
dikes in repair. The greater part of the plain is covered
with rich pastures; but, except the post-stations along the
highway, and some scattered huts of herdsmen, it has and
can have no permanent population.
Taking the United States census of 1870 as a guide for
our own country, we find malarial fevers forming a very
important feature of the mortality-tables. They are most
fatal in Florida, Louisiana and Texas. Next in order fol-

SELECT ED. 25
-*-
low Arkansas, Mississippi, Alabama, Georgia, Missouri,
Kansas and Nevada. In another group distinguished by a
somewhat less mortality we find New Mexico, the Caroli-
nas, Virginia, Tennessee, Kentucky, Illinois and Indiana.
Those states marked by the lowest mortality are the New
England and Middle States, Wisconsin and Minnesota.
In California there is a considerable ratio of mortality, di-
minishing easterly in Utah, and northerly in Oregon and
Washington Territory, while it augments largely toward
the south in New Mexico. Since the census was taken,
however, that is, since about 1869, there has been noticed
an evident extension of the subtile miasmatic agency over
regions previously exempt from it in the Middle and New
England states. The increase of mortality by this cause
in New York City has been notable, but can scarcely be
attributed entirely to local influences. In 1868 there
were registered in this city only 98 deaths from malarial
fevers. In 1869 they rose to 128; in 1870, to. 21.3; in
1871, to 291 ; and in 1872, to 348; an increase of 350 per
cent. in four years. Since then some diminution in their
fatality has occurred. They occasioned 282 deaths in
1873, 295 in 1874, and 275 in 1875.
Let us now consider under what circumstances malaria
may be produced. Although it cannot be denied that
there are peculiar localities where, with apparently every
presumed condition existing for the development of mala-
ria, that poison is entirely absent, yet the concurrence of
malarial emanations with such conditions in innumerable
places establishes beyond a question their direct relation."
The essential element in the production of malaria would
appear to be vegetable decomposition, and, in order that
this process shall ensue, the simultaneous operation of air,
moisture, and a certain high range of temperature, is abso-
lutely required, Localities, therefore, where such com-
bination occurs, are prolific of malaria. Of this character
are swamps and morasses, alluvial deposits, loose, porous,

26 - - SF I, ECTIED.
-ms- sº-
sandy, and argillaceous soils, loamy, marly lands under-
laid by impermeable strata affording capacity for the reten-
tion of moisture, regions exposed to periodical or occa-
sional inundation, places left bare by the subsidence of
| lakes or drying up of streams, and particularly areas sub-
; ject to the intermingling of salt and fresh water—as, salt-
| marshes into which fresh streams discharge, or regions
liable to tidal overflow and recession. -
The exhalations from marshy tracts are recognized by
their effects upon the human system throughout the
world; and the fact that marshes bear a causative relation
to malaria has been demonstrated in numerous instances
4. by the disappearance of fever after thorough drainage and
cultivation, and its reappearance upon their being allowed
to relapse into neglect. The favorable effect of drainage
and cultivation is owing both to the systematic removal of
water near the surface and most probably also to the ab-
sorption by the growing crops of the products of organic
decomposition. On the same principle Prof. Maury suc-
ceeded in antagonizing the noxious emanations from a
marsh surrounding the observatory at Washington by
planting it thickly with sunflowers, which seem to possess
an extraordinary absorbing power. Sebastian is inclined
to believe that the calamus aromaticus which grows in
some swamps has a similar neutralizing quality. Swamps
covered with water are not so dangerous as those partially
| dry, the layer of water serving as a protection against the
| actess of air and heat to the vegetable matter underneath.
A certain continuous range of temperature seems essen-
tial to the development of malaria, which is almost un-
known beyond 60° north and 57° south latitude, and dur-
ing the cold season in the temperate zone. According to
Hirsch, it prevails up to various degrees of latitude and
average annual temperature. It is the average summer
temperature, however, that is of account, and the northern
limit of this lies between the isotherms of 59° and 59.8°
-;||

:.
SEI, ECTED. 27
|
Fahr., giving a prolonged temperature sufficiently high to
insure vegetable decomposition.
The alluvial soil along the banks of rivers and at their
deltas, as those of the Ganges, Nile, Orinoco and Missis-
sippi, gives rise to fevers of a very malignant type. Their
banks are subject to overflow, and frequently have a clayey
subsoil, presenting an obstacle to percolation—thus upon
the river's receding into its ordinary channel its banks
remain damp below the surface, and disease is generated
by the Sun's agency. A like process annually takes place
in the extensive plains and table-lands formed of alluvium
washed down from naountain ranges during the lapse
of centuries, and having few actual marshes. Profuse
rains, succeeded by dry, hot seasons, render such regions
exceedingly insalubrious during certain periods of the
year. Somewhat similar in characteer are the oases of the
JDesert of Sahara, which abound in malaria. Hirsch
describes these spots as consisting of trough-like depres-
sions in a rocky or highly hygroscopic soil, the receptacle
of subterranean waters, and covered with a layer of allu-
vium, the surface of the oasis. In this the fierce heat of
the sun causes cracks and deep rifts in the earth, which
give free vent to the miasm evolved from beneath.
Sandy plains, especially when at the foot of tropical
hills and covered with vegetation, as the “Terai” at the
base of the Himalayan range, are often infested with ma-
laria. In other cases sandy plains at a distance from hills,
apparently dry and not subject to variations in the ground-
water, are equally sources of the poison. Such instances
as the latter might seem to militate against the generally
accepted theory, but actually do not. Some sands which
appear quite free from organic admixture are really the
reverse. Faure has pointed out that the sandy soil of the
Landes in southwestern France contains a large amount
of organic ingredient which is constantly decomposing
and gives rise to periodic fevers. Under such sands,
%

28 SELECTED,
moreover, there is frequently a subsoil of clay. Here,
then, assuming a continued high range of temperature,
we find all the conditions necessary for the production of
malaria.
Localities subject to the intermixture of salt and fresh
water are particularly prone to malaria. The Maremmas
of Italy afford examples of this on a large scale. The
Maremma of Lucca consists of three basins formerly
dotted over with ponds and pools. It had been for cen-
turies frequently overſiowed by the sea-tides which inter-
mingled with its fresh ponds. Malarial fevers ravaged it
and rendered it almost uninhabitable. To the wayfarer
who was so imprudent as to spend a night of August or
September within its desolate bounds, the penalty was al-
most certain death. A remedy for this deplorable condi-
tion of things was long sought. A proposition had been
made in 1714 by the engineer Rondelli to attempt the ex-
clusion of the sea. Renewed in 1730 by Muanfredi, and
Six years later by Zendrini, a mathematician of Bologna,
the idea was finally carried into execution in 1740. The
initial step was made upon the principal and most un-
healthful basin. A sluice was constructed at the entrance
of the canal of Burlamacca through which the waters of
the sea penetrated into the basin to its central pond, The
flood-gate was so arranged as to act like a valve, shutting
by the pressure of the rising tide and opening when it fell.
The success of this enterprise was so complete that in the
miasmatic diseases which had never failed to show them-
selves annually did not reappear, and the whole district
was rendered salubrious. It was at this period that the
village of Viarregio, previously abandoned and composed
only of a few fisher's huts grouped at the foot of an old
tower where galley-slaves were confined, became a place
of fashionable resort during the summer for the aristocra-
cy of Lucca. This fact of a region's being rendered
healthy by the exclusion of sea water is curious, but made
more decisive still by its counter-proof. In 1768-’69 fe-

SEI, ECTED. - 29
vers suddenly sprang up again as bad as ever in the same
territory. Upon the cause being investigated, it was found
that the sluice had become deranged and the mixture of
waters had been reestablished. Upon the flood-gate being
repaired, the malaria was again extinguished. The same
occurrence happened in 1784-'85. The sluice having been
neglected, there took place in 1784, out of a population of
I,900, the enormous number of 1,2OO cases of malarial
fever and 92 deaths. In the following year there occurred
IO3 deaths. The trouble was remedied in the same man-
ner as before. The other portions of the Maremma were
rendered healthy later by sluices successively established
at different points. Such a remarkable result necessarily
attracted public attention. Leopold II, Grand-duke of
Tuscany, was particularly impressed by it, and he con-
ceived the great idea of improving the whole Tuscan
Maremma in the same manner. It was an immense un-
dertaking which he contemplated—an actual transforma-
tion of a large part of his dominions—and it redounds to
his glory that he succeeded, in the face of almost insur-
mountable obstables, by the means described, and a prop-
erly directed system of canalization and field-culture, in
regenerating a very considerable portion of his territory.
It is not difficult to account for the generation of mala-
ria under such circumstances as those just mentioned.
The minute forms of vegetable life with which both fresh
and salt water teem require their own special element for
continued existence. The intermixture of salt with fresh
water introduces a new element with which the life main-
tained in each separately is incompatible. The surface of
the soil consequently after every invasion and retirement
of the tide exposes to the action of the heat a mass of de-
funct vegetable material spread out over an extensive area,
and in most favorable condition for speedy decomposition.
Besides the localities enumerated, malaria is apt to be
induced or intensified in a region wholly or comparatively
exempt from it before, during the disturbance of large ex-

30 SELIECTEJO).
tents of soil, as in the construction of canals, roads, rail-
ways, fortifications, and dikes, rooting out of timber, prep-
aration of virgin land for cultivation, etc. Vegetable or-
ganisms previously hidden and protected underground are
thus brought to the surface and exposed to the agencies
of putrefaction. Laborers engaged in such works and the
neighboring inhabitants soon suffer. The “polders” of
Holland, those parts reclaimed from the sea by the erec-
tion of dikes, are of this character, and the workmen en-
gaged on them are attacked with malarial troubles of
great severity. In this country such instances are com-
mon. We have an example at our very doors in the in-
crease of malarial fevers which accompanied the opening
of the new boulevards, and the engineering excavations of
the Harlem railroad. After such works have been com-
pleted, however, it is not unusual for the vicinity to be
restored to healthfulness. It must be acknowledged that
occasionally miasmatic fevers appear and disappear with-
out there having occurred any perceptible changes in the
relations of the soil. Such circumstances were reported
to the Pennsylvania State Medical Society as having been
noticed in 1855 along the Juniata river. Reports to the
Connecticut State Medical Society also mention the ap-
pearance of Miasmatic disorders without any recognized
cause in portions of the state previously exempt from
them.
There would appear to be some connection between
such phenomenu and the fluctuating level of the subsoil-
water as affected either by rainfalls or subterranean forces.
According to Jilek's figures, in Pola, a noted malarious
district of Istria, between 1863 and I 868 the number of
persons attacked by fever varied from fourteen to fifty-one
in every one hundred inhabitants, in exact proportion as
the rainfall had varied from one to eighteen inches.
We know that the level of the ground-water is con-
stantly changing. It rises and falls more or less rapidly,
and at different rates in different places—in some only a

SELECTED. 31
*meºsºmsº
..few inches either way annually, but in many places several
feet. In Munich, its limit was found by Pettenkofer to be
about ten feet. In India the changes are greater. At
Saugor, in central India, the extremes are between a few
inches from the surface during the rains, to seventeen feet
in May. At Jubbulpore it varies from two to fifteen feet
from the surface. The causes of such changes are rain-
falls, pressure of water from seas or rivers, and obstruction
of outflow. The pressure of the Rhine has been observed
to affect the water in a well 1,670 feet distant from the
river. An impeded outflow which raises the level of the
ground-water has been productive of an immense spread
of paroxysmal fevers. Demster, Taylor and Ferguson
have reported such to have been the case in portions of
India. The severe and fatal fevers prevailing in Burdo-
wan, Lower Bengal, during the last fifteen or twenty
years, have been coincident with obstruction to the natural
drainage from mills and blockage of water-courses. The
same cause has doubtless operated to a great extent in
producing the fevers of Bloomingdale, Manhattanville,
Yorkville and Harlem. The establishment during the
past five years of extensive subsoil drains in those por-
tions of New York has had a visible tendency to diminish
the area of malaria. A similar result on a large scale has
been noticed in Lincolnshire and other parts of England,
where many malarious tracts have been rendered quite
healthy by similar measures, having for their object the
lowering of the subsoil water-level by an increased out-
ſlow.
I have thus far confined my observations to endemic
malaria. But, like other diseases dependent upon telluric
or organic emanations, miasmatic fevers occasionally as-
sume an epidemic character, and, breaking loose from
their native haunts, overspread a wide extent of territory.
Thus, as Hertz informs us, nearly the whole of Europe
was invaded by such epidemics in 1558—in 1678-79–
from 1718 to 1722—from 1824 to 1827—and from 1845

3.2 SELECTED,
to 1848. The cause of malaria being thus propagated is,
as mysterious as that of most epidemics. It is possible
that such an epidemic malarial influence has been prevail-
ing here; but we must not lose sight of the fact that
sporadic cases of malarial fever appearing in non-malarial
districts can frequently be traced to previous exposure in
an infected locality. -
Malaria, although having its ordinary habitat in low-
lying regions, may under conditions favorable for its pro-
duction exist at great elevations. On the Tuscan Apen-
nines it is found at a height of I, IOO feet above the sea;
on the Pyrenees and Mexican Cordilleras, 5,000 feet; on
the Himalayas, 6,400 feet; on the island of Ceylon, 6,500
feet, and on the Andes, I I,000 feet. Sometimes, however,
at considerable elevations it is unaccountably absent under
circumstances apparently supplying every condition for its
development. Thus, according to Jourdanet, close to the
City of Mexico lies the lake of Tuscudo, some twenty-five
square miles in extent, composed partly of fresh and part-
ly of brackish water, with a clayey bottom often laid bare
over large areas as the result of evaporation under a tem
perature of 122° Fahr., notwithstanding which, malarial
fevers seldom occur in its vicinity. At Puebla, Mexico,
on the other hand, is a very malarious marsh 5,000 feet
above the sea. Under ordinary circumstances, a certain
altitude affords immunity from malaria, although low ele-
vations of 200 or 300 feet above a miasmatic tract are
often more dangerous than the flat lands—the poison
seeming to float upward and become intensified. This
was long noticeable on the heights of Bergen Hill, West
Hoboken, and Weehawken, which overlook the Jersey
flats. At present, the elevation of entire security is not
positively determined, but it has been approximated as fol-
lows: In Italy, 400 to 500 feet; in California, 1,000 feet;
along the Appalachian chain of the United States, 3,000
feet; in the West Indies, 1,400 to 1,800 feet; in India,

SEI, EC 1. ED. 33
2,000 feet. In any of such regions, however, may drift up
ravines to an indefinite height. The agency of winds in
transporting malaria for considerable distances cannot be
questioned. Lancisi, author of the famous work “De
Noxiis Paludum Effluviis,” published in Rome in 1717,
attributes to such influence the fact of the Roman Cam-
pagna having become unhealthy after the removal of the
sacred groves exposed it to the currents of wind blowing
from the Pontine Marshes. In later years, Barat accounts
in the same manner for an epidemic of malarial disease
which arose in 1869 on the island of Reunion, believing
the poison to have been transported by the wind from
Mauritius, where such affections were then alarmingly
prevalent. In this instance none of the ordinary local
causes could account for the outbreak. In four months
over 4,000 cases occurred in a population of 23,OOO. Sal-
vagnoli and other observers affirm that malarial diseases
increase in intensity, and penetrate further inland on the
island of Sicily and in South Italy during the sirocco laden
with African miasm.
. With regard to the question, “Can drinking-water act as
a vehicle for the introduction of malaria into the animal
system?” a priori it seems reasonable to suppose that such
may be the case. If malaria, be it a gaseous substance or
an accumulation of minute organisms, cannot pollute
water, it differs essentially from other materials of similar
form with which we are better acquainted. But, in fact,
we have positive proof that malarial fevers may be due to
drinking impure water. Mr. Bettington, of the Madras
civil service, states that in that country it is notorious that
the water may produce miasmatic fever and affections of
the spleen. He mentions villages placed under similar
conditions as to marsh-air, in some of which fevers are
prevalent and in others not—the difference resulting from
the former drinking marsh-water and the latter pure
water. In one village there were two surces of supply—a
| tank fed by surface and marsh-water, and a pure spring ;

3
4.
SH, I, FC"l'Eſ).
*-* *-*
only those who used the tank-water contracted ſever. The
Celebrated instance related by Boudin is still more conclu-
sive on this point. In 1834 there returned to Marseilles
from Bona in the ship Argo I2O soldiers, of whom Iog
were seized with various forms of malarial fever after
drinking marsh-water taken on board at Bona. On the
other hand, the sailors of the same vessel, who had pure
water, and 780 men embarked on two other vessels, re-
mained well. The few soldiers on the Argo not attacked
had purchased their drinking-water from the sailors.
Against such positive evidence as this the statement of
Finke that in Hungaly and Holland marsh-water is drunk
without injury is of little value.
Now, a number of careful investigations have been made
of the constituents of miasmatic marshes in various parts
of the world, with the following results: They contain
from thirty to thiſ cy-five per cent. of vegetable organic
matter. This consists of humic, ulmic, cremic and apo-
cremic acids, all substances requiring renewed chemical
investigation. Various minute vegetable algoid forms are
revealed by microscopic examination—bacteria, vibriones,
and microzymes. But all these so-called impurities are
found in nearly every running stream and in many harm-
less well-waters, and to condemn water on account of their
presence would be really to reject all waters, even rain, in
which minute algoid vesicles (protococci) are often found.
Even distilled water may contain bacteria and vibriones.
Although, therefore, admitting that water may be contam-
inated by the presence of malaria, it by no means follows
that this poisonous ingredient has any relation to the
organic impurities mentioned, or that the latter are in any
way injurious, but we should none the less be cautious as
to the source of our drinking-water.
The stratum of air overlying typical malarial marshes
has also been examined with particular care. It has bcen
found to contain an excees of carbonic acid—watc1y va-
por in large quantity—often carburetted hydrogen, and

SELECTED. 35
occasionally free hydrogen, ammonia and phosphuretted
hydrogen. If the marsh contains sulphates, sulphuretted
hydrogen is present. Its organic matter blackens sul-
phuric acid—-gives a reddish color to nitrate of silver—
has a flocculent appearance, a peculiar odor, and affords
evidence of ammonia. The amount in Becchi's analysis
was .oOOI 18 grain in each cubic foot of air. Ozone had
no effect upon it. Besides this organic material, various
vegetable and animal matters are arrested when the marsh-
air is drawn through water or sulphuric acid—debris of
plants, infusoria, insects, and even small crustacea. Dr.
Balestra has described spores and sporangia of a little
algoid plant in the air of the Pontine Marshes. Lemaire
and Gratiolet, in 1864, found in the air of one of the most
unhealthy marshes of Sologne spherical, ovoid, and fusi-
| form spores and a large number of pale cells, products,
no doubt, of vegetable putrefaction. It has been supposed,
by Schonbein and others, that ozone is deficient in marsh-
air; that the quantity of ozone in the atmosphere and the
prevalence of malarial diseases have an inverse propor-
tion; and that ozone, by virtue of its supposed power of
destroying organic matters in the air, is an antidote to
miasm. There is, however, no evidence at all that ozone
and malaria are antagonistic, or bear to each other any
relation whatever. These various examinations, though
interesting, bring us no nearer to a solution of the ques-
tion, What is the nature of malaria 2 All of the many
substances and forms thus far observed in malarial local-
ities may be found equally in districts perfectly salubrious.
That it gains access to the system principally through
the respiratory organs is quite certain. What we really
do know of it has reference more particularly to its mode
| of action. It is most dangerous when the Sun is down,
and it seems almost inert during the day. It appears
providential that the sanne agency which is so potent in its
production should be the principle instrument of its de-
struction. It loves the ground, where in many regions it

36 SELECTED. .
-**-
is so concentrated and deadly as to destroy the incautious
sleeper on the earth almost as quickly as the most noxious
gas. Hence it is generally regarded as having specific |
gravity heavier than that of air, but this is by no means
certain. It is doubtless rendered heavy by combining with
night-fogs and dews, but upon their being dissipated by
the Sun it rises into the air and probably becomes innocu-
ous by wide diffusion and dilution. It is intercepted by |
impediments, such as walls and groves of leavy trees,
which obstruct the winds that bear it. Perhaps the latter
also neutralize it by absorption. It is likewise neutralized
and probably absorbed in passing over a considerable
body of water—especially salt-water. The distance neces-
sary to effect this result naturally varies with circum-
stances—force of winds, concentration, intensity, and
abundance of the poison itself. According to Blane, in
the channel between Beveland and Walcheren, 3,000 feet
of water rendered it inert. In china, three-quarters of a
mile, and in the West Indies, one mile, have been required
to be effectual,
Recognizing the facts mentioned, the precautions to be
observed against malaria are quite obvious. In built-up
cities we are protected by pavements and sewers to a great
extent, and probably also by the character of the atmos.
phere, which is artificially warmed by radiation at night,
and impregnated with gas which, though injurious in other
ways, are antagonistic to malarial emanations. But in
malarial suburban and country districts it is otherwise.
There certain precautions are necessary. If possible, ele-
vation of a dwelling-place, at east 500 feet above the
source of the miasm, is to be recommended in temperate
climates, and from 1,500 to 2,000 feet in the tropics. If
this be not practicable, thorough subsoil drainage, filling
up of low and moist grounds, covering the earth with
closely cut herbage, belts of umbrageous trees interposed
between the dwelling and the point of danger, but at a
| sufficient distance to permit free ventilation, and the access

SELECTED. 37
gººmsºmºsºmºsºsºms
of sunlight; doors and windows opening principally away
from the malarial quarter; the house, if possible, to be
raised on pillars or arches a few feet above the ground,
otherwise a sub-cellar thoroughly cemented—all these are
measures of primary importance. The sleeping apart-
ments should not be below the Second story, and should
be provided with open fireplaces in which on damp or
chilly nights a little fire may be kindled. Exposure to the
open air after sunset, or until several hours after sunrise,
should be avoided. As whatever tends to lower the vital
powers predisposes the individual to malarial invasion, per-
sonal hygiene is indispensable. It should of course be
dictated by common sense, with the object of establishing
and maintaing, in the words of the old maxim of the sani-
tarian, mens sana in corpore Sano.
SUMMER CoM PLAINT s of CHILDREN.—BY J. M. A. LLEN, M.
D., LIBERTY, M. O.
The wide range, under this heading, which authors,
especially the older ones, have taken, is such that to un-
dertake to go over all the ground from this standpoint,
would require an immense deal of labor, and would not
be acceptable in an essay before this learned body. Be-
sides, all the older, and many of the recent writers on this
subject, make many different diseases under the name of
summer complaints of children, such as simple diarrhoea,
inflammatory diarrhoea, cholera infantum, etc.; and all, too,
expressing a condition dependent on the same or on sim-
ilar causes, and attended with the same pathological re-
sults.

38 SEI, ECTED,
All admit that dentition, follicular change in the gastro
intestinal canal, and high temperatures, are the three prin-
cipal factors as operating causes. . . -
Recent post-mortem examinations establish the fact,
that in a large majority of cases, the cause of death was
entero-colitis. Indeed, where the assigned cause of death
is collapse or convulsions, &c., there is more or less of
this condition present. Meigs and Pepper, in their valua-
ble work on children's diseases, state that the yearly rate
of mortality in Philadelphia from this disease is very
large, and it is rare not to find entero-colitis. Smith and
West, of London, record, as a result of their investigations
of the cause of death of children from this disease, the
same pathological condition. -
It is true that a large number of cases recover, and in
them there may or may not have been gastro-enteritis, and
the opinion of many is based on this doubt. But the ther-
mometer comes to our assistance, and in my hands has
nearly universally indicated inflammation, as it has in the
hands of others. I do not wish to be understood that
there are no cases of this disease without inflammation,
for such is not the fact. But I do think, and I believe you
will bear me out in the assertion, that they are very rare,
and are so mild as not to require Inedical treatment unless
from reflex phenomina, If I am correct in this, that the
cause of the disease, under these different headings is the
same, and the pathological results the same, why should
there be so many terms used to express the same thing,
in substance P Does it not lead to confusion? Is it not
often the case that the cause of diseases is the same but
the effect different; the result of difference in the individ-
uals and in the surroundings P. Yet we do not change the
name of the disease, but prefix adjectives to indicate its
degree. We will, therefore, regard the disease under con-
sideration as gastro-intestinal irritation, with or without
inflammation. The period of childhood will include den-
tition.

SELECTIED. 39
Doctor Jackson, in his essay of advice to young physi-
cians, not inaptly regards the periods of dentition and
puberty as two of the most important epochs of human
existence so far as the development of disease is con-
cerned. Because of the rapid changes which are going
on in the structures of the body, therefore the great dan-
ger of disaster, which might result from nature's being
thwarted in her purposes by the many influences that sur-
round each individual. In children the most prominent
change is follicular in the gastro-intestinal canal, added
to this is their natural excitability.
IDoctor Smith, of London, in his work on the Wasting
Diseases of Children, asserts that excitability in children
is an indication of perfect health, and its absence denotes
disease. Together we may say that they are the founda-
tion of nearly all those most troublesome diseases which
attend this period of life, because they are easily effected
in their mutual relation by the slightest cause, and at once
wholly or partially effect secretion and nutrition, produc-
ing at first hyper-excitability, which may be followed by
convulsibility. If this condition continues long enough
to produce much waste of tissue the tendency to convulsi-
bility passes off because of anaemia of the nervous cen-
ters, and peripheral irritation no longer produces active
congestion of the nervous centers, when we may have con-
gestion from states of blood, especially of the brain, a
danger much to be dreaded in the latter stage of this dis-
ease, if there has been much waste of tissue.
In studying the cause of the summer complaints of
children we find four principal factors: Follicular change
in the gastro intestinal canal, dentition, high temperature,
and improper food.
Strictly in the first we cannot recognize a cause, only a
condition, highly susceptible and easily perverted from its
natural course, owing to the active structural changes
necessitating an increased supply of blood to the part,
together with the excitability of the nervous system.

40 SELECTEI),
Secondly, Dentition. The older writers lost sight of the
first “follicular change” in the gastro-intestinal canal, and
ascribed to dentition the great source of causes of the dis-
eases of children. Recent authors have gone as far astray
in the opposite direction, ignoring the influence of denti-
tion to a great extent as a cause of the disease. In this,
in my opinion, they are wrong. We will see what the
facts furnish in evidence of my views on this point. If we
remember the rapid structural change which is going on
in the gastro-intestinal canal at this period of life, and the
necessary increased vascular circulation, we can under-
derstand how easy it may be changed by any influence
which would effect the circulation of the blood in the
part, and thereby effect secretion and nutrition. Brown-
Sequard, in the tenth lecture of his work on Physiology
and Pathology of the Nervous Centers, states that the
supply of blood to a part may be, and often is, effected by
reflex irritation, and further that nutrition and Secretion
may be hindered and indeed wholly suspended from the
same cause. He still further insists that this alone is suffi-
cient to explain the cause of many inflammations, in Sup-
port of which he gives many cases both under his own
and the observation of others of equal standing. If reflex
irritation is sufficient to induce the above change, we may
reasonably conclude that digestion would be affected, and
from this point we recognize an important factor in the
production of this disease, to say nothing of the strong
probability of its producing entero-colitis, which patholo-
gists insist is found in a large majority of cases dying of
this disease. Besides, it is within the observation of all
how rapidly most of the cases improve after the tooth or,
teeth have made their appearance through the gums. The
patient soon regains usual strength and health, and re
mains so until the approach of another tooth,
Coupled with the two preceding causes we have im-
proper food, alone not sufficient to produce the disease,
In the majority of cases mothers have sufficient intelli-

SELECT Eſ). 41
;
}.t
º
gence to understand how to feed children, and in the
country they can always procure food of good quality.
Lastly, we recognize high temperature, with its results,
as the great sine gua non of crtcrual influences, and with-
out this factor the disease rarely exists. As evidence, we
have as many children undergoing the changes connected
with dentition in the winter months as in the Summer, yet
we rarely see more than the effect of reflex irritation with
but little functional derangement, and very rarely struct-
ural change of the alimentary canal, though we find in-
creased bronchial inflammation if the child has a tendency
in that direction from colds or otherwise.
While we place heat as the most prominent factor, and
as has been shown the disease rarely exists without it, we
do not wish to be understood as considering it per se the
cause, but, that it favors vegetable and animal decomposi-
tion, and the rapid development of certain forms of organ-
ism, which float through the atmosphere either as carriers
or producers of disease, just which, science has not yet
determined. - *
My reasons for the opinion that heat is not a factor per
se, are these: It has been abundantly proved that heat
alone will not produce the bowel diseases which some-
times prevail as epidemics. Hubner——Ziemssen's cyclo-
poedia—states that while bowel affections are more fre-
quent in tropical countries than elsewhere, yet there are
many places in the tropics where these diseases are un-
known, although the mean temperature and the surround-
ings are the same. I have witnessed as doubtless others
have, epidemics of dysentery in mid-winter. If high tem-
perature alone is sufficient to cause these diseases, why do
we not have them annually as epidemics, for their is no
great difference in our annual temperatures.
It is a fact, which we have all observed, that bowel affec-
tions are much oftener prevalent, both in adults and chil-
dren, in some seasons than in others, although the mean
emperature is the same. Again, bowel affections, both in

42 - SEILECTED.
|
adults and children, seem to manifest themselves more in
some localities than in others, and not in the same locality
each year, although the temperature, inhabitants, soil, and
its vegetable growth, and, in fact, all the surroundings, re-
main the same. It is the observation of every physician
that when there is an epidemic of bowel affections in
adults, we find a large number of summer complaints of
children less amenable to treatment than ordinarily. It
seems evident that the cause of this disease, so far as high
temperature is concerned, is the same as that which would
produce gastro-intestinal irritation, or inflammation in the
adult, plus follicular change and dentition, Again, it is
sure to be more frequent and more fatal where families are
crowded together in filthy houses or narrow and filthy
streets of cities, and indeed just where we would expect the
rapid development of the lower form of organism. While
I do not consider these forms of life as primarily the cause
of the disease, yet I do believe that when they are absent
the disease is very mild, and only the effect produced from
reflex irritation. Its range of symptoms are so wide that
I shall only mention some of the more prominent.
In the Inild cases there is only slight reflex irritation,
producing fretfulness for a few days, with an exacerbation
of fever during evenings, which lasts only a few hours, at-
tended with increased circulation of blood, excitability,
slight nausea, and two or three actions daily from the
bowels. These symptoms pass off in a few days, if proper
treatment is used. In the more severe we have the above
symptoms increased in intensity, with early manifestations
of entero-colitis, manifested by hot skin, rapid pulse, and
with or without nausea. Bowels acting every three or
four hours, and oftener if thc rectum becomes involved,
which is the case frequently. During the existence of the
active state there is more or less delirium, and often con-
vulsions. If the mucous membrane of the stomach be-
comes involved, we have nausea, which also may exist
merely from reflex irritation, It is often the case the at-

SELECTED, 43
tack is more insidious, the child being able to run about
for several weeks (only suffering from the effect of reflex
irritation) until it becomes exhausted to a degree that it
has not strength enough to walk; then the waste of tissue
is very evident, because of failure to digest enough food
to replace the waste caused by the exhausting discharges
which are increased by undigested food undergoing fer-
mentation in the alimentary canal, the symptoms gradually
grow worse, wintil the most extreme exhaustion is pro-
| duced. -
| These are often the most rebellious cases to treat, if not
| taken early, and it is rarely the physician is consulted
early enough to render the aid he wishes; it is my opinion
that many similar cases could be rendered very mild if ||
properly treated at the beginning. The tongue is a very -
valuable indication as to the stage, and as to the effect
produced by the inflammation. In the early stage it is
covered with a whitish Coat, but if the disease lasts long
enough to produce ulceration of the bowels, it becomes
red and pointed. The heart action, which is strong at
first, becomes very feeble and rapid in the latter stage,
often its beats cannot be counted, this is the cause of that
very fatal condition—anaemia of the nervous centers, fol.
lowed by congestion, the result of stasis of the blood. If
this state of the circulation is not relieved, and the patient
lasts long enough, it is apt to be followed by inflammation
of the brain. -
We have a condition in childhood that is in no wise
different from cholera morbus in the adult, and should be
so considered. It has the same train of symptoms, but it
is more fatal in childhood because children have not the:
strength to support the exhausting discharges, and in them
is readily produced collapse.
I have stated that the evidence is positive that the pa
thology of the disease is gastro-intestinal inflammation,
more frequently affecting the ilium, coecum, colon and rec-
tum. In many of the protracted cases ulceration of the
wº

44 - SELECTIED,
bowels is present, and often enlargement of the mesenteric
glands; in other cases the lymphatic glands become in-
volved in the latter stage of the disease. In the manage-
ment of this disease much depends on cleanliness and
pure air. The child must be kept perfectly clean, and the
discharge from the bowels removed from the house at
once, as they may become foci for development of organ-
isms. Pure air, night and day, is indispensable, the want
of this alone is sufficient to explain the greater mortality
in cities than in the country. -
Where there is a predisposition to this disease, and
especially if the child be feverish toward the close of the
day, I have found much benefit from having the child.
bathed several times during the evening, in warm weather,
in water at a temperature of four or five degrees lower
than the temperature of the child. The child's food
should be from its mother's breast, if not contraindicated.
In the absence of this our effort should be to furnish it as
nearly like that in composition as possible.
In the use of medicine I will mention them in the order
in which I rate their value.
We have shown that reflex irritation is sufficient to ar-
rest secretion and nutrition, by controlling the amount of
blood furnished a part, also sufficient of itself to produce
inflammation. In my opinion reflex irritation is the cause,
in a large majority of cases, of arrest of follicular change,
thereby affecting nutrition and Secretion, and laying the
foundation of the disease. If this is true the course we
should pursue is plain. That is to control the reflex irri-
tation. To do this we resort to those remedies that have
known power in this direction. My experience has taught
me that opium, in some of its forms, possesses this to a
larger degree than any other remedy, when the phenom-
ena are from peripheral irritation. I therefore begin the
treatment with opium, and prefer either the simple tinct. or
the camphorated. The amount given is just sufficient to
keep the patient comfortably under its influence, repeating
/

SEI, ECTED. 45
the dose every three or four hours, and, as the irritability
subsides, gradually lengthening the interval and lessening
the quantity. I am prepared to hear you say that it would
increase the tendency to convulsion where there was much
febrile excitement; but such is not the result. You very
much lessen this tendency by controlling its cause. In
the middle stage of the disease, if there has been much
waste of tissue, I give it for its tonic effect on the nervous
system, and to give tonicity to the blood vessels, and
thereby lessen the tendency to coma from this source,
After an experience of several years in the use of opium
in this condition, I have not had a single case of coma
from stasis of blood in the brain. Besides, the use of
opium lessens glandular irritation, and thereby lessens the
tendency to the production of white corpuscles in the
blood, so much to be dreaded in the latter stages.
In connection with opium in the first stage, bicarb,
potass, given in Carminative water, also large doses of qui-
nine during the remission of fever, which occurs during
the morning. If the disease is protracted, I continue the
quinine in smaller doses (occasionally intermitting for a
few days.)
In this remedy we have a good general tonic (and par-
ticularly to the heart) in addition to its recognized influ-
ences in Septic diseases.
Astringents I never use in the first stage, unless the ac-
tions are very serious and large, but think they are of
much benefit later in the disease. My preference is for
plumbi acetas, or tannin, in Suitable doses. I also use in
the latter stage dilute sulphuric acid with opium, and re-
gard it as very valuable. Where there is much exhaus-
tion, and the tongue is not red, and the stomach will bear
it, I have found much benefit from Ferri et quin, cit, given
in port wine. A valuable tonic may also be found, in the
latter stage, in acid, hydrochlr. dil. with pot. chl. In the
latter stage, where the patient is much reduced, I have
found benefit from cod liver oil rubbed on the skin. Where

46 SELECTED.
sºs ºssºmsº *
ulcerations of the bowels are present, I find much benefit
from ol. terebinth. with opium. I also have used with
decided benefit, creosote in the latter stages, especially if
there was ulceration present; also angenti nitras.
In all stages of the disease, when you are using opium
freely, it is indispensible to give a dose of castor oil every
36 or 48 hours to remove undigested food and vitiated
secretion, mucus, etc., from the alimentary canal, to pre-
vent their becoming a source of irritation and blood
poisoning. If the rectum becomes involved much benefit
may be expected by using emeulcient and astringent in-
jections, and if the inflammation is great, cold water injec-
tions, given frequently, are of decided benefit. In the lat-
ter stage, especially if there is evidence of ulceration, I
use injection of solut. arg. nit. gr. xx—xl twice daily.
Alcoholic stimulants should be given as soon as there is
evidence of the failing strength of the child, and used
freely. I feel sure many cases are lost by neglecting to
begin stimulants early enough, and to give them in large
enough quantities. -
Other remedies are mentioned by authors, but I consider
them only adjuvant to what I have mentioned. The line
of treatment indicated is consonant with my views of the
disease, and has been more eminently successful than that
practiced years ago, sic calomel, blisters, etc.—Medical
Association of the State of Missouri, 1877.
SALICINE IN THE TREATMENT of THEtſ MIATISM.
Mr. A. D. L. Napier, in a short article on the action of
salicine, contributed to the Practitioner (June, 1876), thus
*—3*. *º-º-º: & –44–1 Aº-ºº: **-*A------

SELECTED. 47
speaks of his experience with this drug in rheumatism :
The form of rheumatic disease for which I have most
frequently ordered salicine is the arthritic, and in these
cases relief was almost invariably experienced. In one
case of severe arthritis of the left finger, wrist, and ankle-
joints, decided benefit attended the exhibition of a fifteen-
grain dose, and, though the disease was of six days'
standing, complete relief from pain was experienced after
three other doses. In such cases I have repeatedly seen
reduction of pain, redness, heat, and swelling about an
hour and a half after the administration of a twenty-grain
dose.
The salicylate of soda, in addition to its general action
in lessening arterial tension, acts frequently as a powerful
diaphoretic, producing increased perspiration, large flow of
urine, and in some cases an increased quantity of Saliva.
These latter effects seem to be more often caused by
the soda salt than by the acid. Although swelling fre-
quently is materially decreased in a short time by salicine,
yet in some cases this is not so; I have a patient at pres-
ent who suffered from rheumatic arthritis of the wrist joint,
was treated by salicylate of soda, and relieved of all acute
pain, more than a month ago, whose joint is still greatly
swollen, and useless for all active exertion; he is now rap-
idly improving under galvanism.
Symptoms exactly similar to cinchonism may follow the
prolonged use of salicine. An old gentleman, who was
under my care suffering from rheumatic affection of the
wrist and ankle joints, was ordered twenty grains of sali-
cylate of soda every two or three hours; a few doses
speedily cured him. He ceased taking the drug, and was
again similarly affected, about ten days after his first at-
tack; the drug was resumed, and he was recommended to
continue it for a fortnight, in ten-grain doses twice daily,
after all symptoms had disappeared. He only used it,
however, for two or three days. Within a short time he
again became ill, and having experienced the decidedly
\
R-
–A–

48 - RECORDS.
beneficial action of his former medicine, resumed taking it
without sending for medical advice. On this occasion,
evidently desiring to make assurance doubly sure, he per-
severed in taking twenty grains every three hours for more
than a week, although the pain had almost ceased after
two or three doses. IHe then became very deaf, had ring-
ing noises in the ears, experienced severe headache, thirst,
loss of appetite, and felt dull and heavy. The medicine
was discontinued, and the unpleasant symptoms shortly
vanished. It is necessary for the perfect action of salicine
that the drug should be used in reduced doses for some
time after acute symptoms are dispelled; I have often seen
a relapse from a too early cessation of the medicine.
In muscular rheumatism, salicine affords some relief,
but its action in such cases has given uncertain results in
my hands. In neuralgic affections, I have seen good from
salicylic acid, more especially in mixed cases of neuralgia
and rheumatism ; one case of neuralgia of the brachial
plexus was undoubtedly cured in a very short time. From
its greater solubility, and from its being more easily taken
by the majority of patients, I have found Salicylate of soda
preferable to the salicylic acid. With the exception of
the greater diaphoretic action of the former, I have been
unable to discriminute between their therapeutic action.
REcoRDs of THE LINToN DISTRICT MEDICAL SocIETY.
MonTGOMERY CITY, Mo., April 4, 1877.
The sixth annual session of the Linton IDistrict Medical
Society convened in the Masonic Hall in Montgomery
|

JR ECO RI) S. 49
City, Mo., on Wednesday, April 4, 1877, at 3 p.m.
The house was called to order by the President, Dr. W.
T. Lenoir, of Columbia, Mo., and exercises opened with
prayer by the Rev. Dr. Vincil, of Mexico, Mo.
The President then congratulated the Scoiety on its past
success and its ſuture prospects, after which Dr. H. W.
Pocoke, of Montgomery City, in a brief speech, welcomed
the members of the Linton District Medical Society to
that city, and tendered them the hospitalities of its citi-
Zen S.
On motion of Dr. Rothwell, members of the press were
invited to attend during the meeting.
The minutes of last meeting were then read and
adopted. The roll was called, and the following gentle-
men answered to their names:
Drs. W. Dickinson, St. Louis; A. S. Loving, Wright City; M. T.
Warren, Middleton ; — — Goodrich, Wentzville ; M. Yates, Fulton ; S. J.
Burch, Warrenton ; A. W. Graham, Warren county; W. B. Adams, Dan-
ville; J. F. Hanna, Ashley; S. Overall, C. M. Johnson and J. R. Mudd,
St. Charles ; G. W. Broome, Moberly ; C. G. Hubbell, Rocheport; J. I.
Bodine, H. W. Pocoke and — Caldwell, Montgomery City; W. F. Hum-
phreys, Concord ; J. M. Foreman and E. A. Ball, Jonesburg; S. N. ltus-
sell, P. French, W. Humphrey, W. W. Macfarlane amd J. P. Rothwell,
Mexico; W. T. Lenoir, A. W. McAlester, J. N. Garnett and J. H. Dun-
can, Columbia.
On motion of Dr. Broome, the President filled facancies
on standing committees as follows:
(1.) On Scientific Communications—Drs. Overall, Humphreys and
IIulyl)ell.
(2.) On Credentials—Drs. Mudd, Pocoke and Macfarlane.
(3.) On Medical Ethics—Drs. McAlester, Broome and Rothwell.
(4.) On Medical Eulucation—Drs. Humphrey, Foreman and Broome.
The committee on credentials presented the names of
the following gentlemen for membership, who were unani-
mously elected :
Dr. Martin Yates, Fulton.
l)r. S. J. Burch, Warrenton.
Dr. A. W. Graham, Hopwell Academy,
Dr. McAlester, chairman of committee on medical eth-
ics, Dr. Pocoke, on arrangements, and Dr. Duncan, on
publications, made their reports, which were accepted and
committees discharged. The committee on scientific com-

50 REcoRDs.
munications reported only one paper presented to them.
The committee on medical education then made the
following report: “That in surveying the field of medical
education, one of the most pleasing features. that presents
itself is the high standard our own University is taking in
the standing required of her graduates. Abandoning the
idea entirely that a certain length of time with the pay-
ment of the requisite fees entitle the student to his diplo-
ma, graduation now depends upon the evidence given not
only of proficiency but also of high attainments, as evinced
by a class standing and Standing on examination, even
higher than that required by the University of Virginia,
which has gained for itself a deservedly high reputation,
not only at home but in Europe. This fact is highly grat-
ifying, and we hope to see our University in this respect
and all others primus inter pares.”
This report was unanimously adopted.
The Treasurer made his report, showing collected dur-
ing past year, $64.00; paid out, $72. I4; leaving $8. I4
still due. The Treasurer, however, reports that the yearly
dues to be collected at present meeting will liquidate the
debt and leave in treasury at least $2O.OO. The report was
received,
On motion of Dr. Overall, the Secretary was instructed
to write to Dr. Pitman in regard to funds in treasury at
the time that gentleman vacated the office.
The election of officers for the ensuing year was next
in order. The following was the result:
President—Dr. W. B. Adams, Danville.
1st Vice-President—Dr. W. F. Humphrey, Concord.
2d Vice-President—Dr. J. R. Bodine, Montgomery City.
Treasurer—Dr. S. N. Russell, Mexico.
Recorder—Dr. W. W. Macfarlane, Mexico.
Secretary–Dr. J. H. Duncan, Columbia.
On motion of Dr. Rothwelſ, the reports of special com-
mittees were heard. º
Under this head Drs. W. W. Macfarlane and J. R. Mudd
read very elaborate and excellent reports on Topography
of Audrain and St. Charles counties. The gentlemen ap-

RECO 13 DS. 51
pointed on the Topography of the other counties either
being absent or having only verbal reports, were, on motion
of Dr. Macfarlane, continued to the next meeting and in-
structed to have written reports, and they be placed in the
hands of the publication committee.
The society then adjourned to meet at 7% p.m., April
4, 1877.
Society met at the appointed hour, Dr. Lenoir, Presi-
dent in the chair. -
Dr. Russell, of Mexico, Mo., chairman of a committee
appointed by the president at the last meeting to consider
the feasibility and practicability of publishing a Medical
Journal in connection with the Society, announced his
readiness to report. The report was made, and, after a
long discussion in regard to publishing the Journal, Dr.
Macfarlane moved to defer the further consideration of the
matter until to-morrow morning, and Dr. Duncan be added
to the committee. Carried.
The reading and discussion of papers now being in
order, the Secretary read a communication from Dr. Jack-
man, of Rocheport, Mo., on the “Therapeutic Properties
of Ammonium Carbonate.” The essay showed research
and study on the part of the author and elicited the com-
mendations of all present. The value of this agent in
| pneumonitis was urged, and in all diseases in which there
is an excess of fibrine. Its modus operandi in the treat-
ment of these diseases is its property of maintaining the
fluidity of the blocq. The paper was discussed by Drs.
Adams, Rothwell, Humphreys and Garnett.
The next subject for discussion was “Hysteria.” Dr.
A. P. Spence, the gentleman appointed to open this dis-
cussion, being absent, the Society devoted one hour to its
consideration, Dr. Macfarlane thought it common to both
sexes and all ages; that it is a nervous disease due to
physical disorders, and that every case of Hysteria is a
case of insanity. The last view, expressed by the Doctor
brought forth a discussion of some length, participated in
-
1–

52 JR ECO RIDS,
*
by Drs. Rothwell, Adams, Humphreys, Pocoke, Foreman
and Russell.
On motion of Dr. Garnett, Society adjourned to meet at
8 a. m., April 5, 1877.
Society met at appointed hour, President in the chair,
Dr. Russell, chairman of committee on Medical Journal,
made the following report, which was accepted :
GENTLEMEN:—In addition to former report, we submit
that, as it is the expressed wish of the Society to establish
a Medical Journal, and as it is the opinion of some that
the funds for printing the same should be first secured by
advanced payments from subscribers, thereby neeessitating
much delay and the use of some money for other publica-
tions, circulars, etc., and as such a plan would embarrass
those having it in charge—in asking payment for a Jour-
nal not yet in existence—we are inclined to discourage
this plan and recommend the following: The cost of
printing two issues of the proposed work, as ascertained
will be $85.00. After paying present indebtedness of the
Society $30.OO will remain in the hands of the Treasurer,
leaving $50.OO or $55.CO to be obtained. Could 30 names
be secured who would pay as soon as the work was done
or in advance, the required amount would be raised and
the enterprise could be inaugurated, with the exception of
the editor's pay. To provide for that we have the certain
prospect of, we think, $50.OO now in the hands of the
former Treasurer, with the fair prospect of at least 50 addi-
tional subscribers, amounting to a very probable $150.OO
as editor's pay. We recommend: First, That an imme-
| diate call be made for 25 guaranteed subscribers. Second,
That two editors be now appointed to take charge of the
work, under such instructions and limitations as the Soci-
ety may direct.
Respectfully submitted. S. N. RUSSELL.
t W. F. HUMPHREYs.
It was then moved by Dr. McAlester that this Society
have a Medical Journal to be published semi-annually, and

RECORDS. 53.
* gººmsº
that a committee of three be appointed by the President
to retire and select two editors for this Journal and report
immediately. Adopted.
The following committee was appointed: Drs. Fore-
man, Rothwell and Mudd, to which was added the Rev.
Dr. Vincil. The committee retired and after a few mo-
ments returned and presented to the Society the names of
Dr. S. N. Russell, of Mexico, and Dr. J. H. Duncan, of
Columbia, as editors of the Journal, who were unani-
mously elected. On motion of Dr. Rothwell, it was de-
cided to issue the Journal under the title of “The Linton
District Medical Journal.”
A motion was made and carried that members who have
heretofore read communications be requested to send them
to the editors. On motion of Dr. Russell, a recess of ten
minutes was taken.
Society met, Dr. Lenoir, President, in thc chair.
The gentleman appointed at last meeting to read an
essay upon “Epilepsy” being absent, the subject was
taken up and discussed by the Society.
Dr. Foreman thought it due to a molecular change in
the nervous matter, and that there is a retrograde process
in the nerve tissue going on. The blood vessels of the
brain dilated and congested cause the paroxyms. The
Bromides act by contracting the vessels.
The subject was discussed by Drs. Humphreys, Macfar-
| lane and Hanna. The treatment in such cases is Bromides
and Valerian ; Oxide of Zinc is sometimes beneficial.
The next subject for discussion was “Leucocythemia,”
to be opened by LJr. Pearson, of Louisiana, Mo, He was
| absent, and Dr. Macfarlane, of Mexico, made a few re-
marks upon it, after which the Society took up the dis-
cussion of “Puerperal Fever.” The discussion was opened
by JDr. McAlester, of Columbia, who advocated the view
that there is a fever occurring during the Puerperal state
which can only be called Puerperal Fever. The Doctor

54 RECORDs.
:-º-º: **-*. - ºf
ably advocated his view, presenting it in the strongest
possible manner. -
Dr. Garnett, of Columbia, read a very ably written ar-
ticle upon the subject opposing the views of the above
gentleman.
Dr. Rothwell, of Mexico, advocated the views of and
agreed with the first gentleman. - -
On motion of Dr. Russell, the further discussion of the
paper was postponed until 2 p. m. - . . .
Society then adjourned to meet at 2 p.m., April 5, 1877.
Society me at the appointed hour, Dr. Lenoir, Presi-
dent, in the chair. .
The discussion of Puerperal being resumed, Dr. J. H.
Duncan, of Columbia, made a few remarks, advocating the
view of the relationship between Puerperal Fever, so-
called, and Puerperal Septicaemia and Pyaamia. He re-
garded it as a septic disease, not distinct from other fevers
occurring during Puerperal state ; in fact, the name was a
misnomer. -
Dr. Loving, of Wright City, considered it a septic dis-
ease, and not a specific fever, and clearly showed the rela-
tion between Erysipelas and Puerperal Fever, so-called.
The next subject for discussion was “Breech Presenta-
tions,” which was opened by Dr. Garnett in an excellent
speech pointing out the danger in such cases and advocat-
ing the use of Traction, after the manner of Dr. Penrose.
The Doctor dwelt specially upon the fact that most chil-
dren may be saved if the requisite amount of force is used
in traction, to take the place of the propelling power of
the womb which is now lost to the child; also the im-
portance of bringing the face under the Pubic Arch in-
stead of in the hollow of the Sacrum; in this position not
only is traction more easily made, but death from suction
of liquid in the air passages is prevented.
The subject was discussed by several gentlemen, all of
whom were pleased with the views of Dr. Garnett.
Dr. French made a few remarks upon “Cholera In-
w-r-
Records. 55
fantum,” showing its dangers, treatment, &c. He gave
Calomel, good food and fresh air. *
Dr. Humphrey, of Mexico, thought it a frightful dis-
ease from the beginning, eliminating from the blood large
quantities of Serum, and occurring oftener in hot weather.
Diaphoretics should be used and purge the skin and thus
carry off a great deal of poisonous matter; during the
evacuating stage control the bowels with opium. Use
stimulants in stage of collapse ; give cold water.
The subject was also discussed by Drs. Loving, Mac-
farlane and Garnett.
Dr. McAlester then spoke upon “Hemorrhoids,” giving
the Patholgy, Etiology and Treatment of External and
Internal piles. He used. Carbolic Acid to deaden thc sen-
sibility of the Tumor, and if it is external simply cut it
open; if internal, either ligate, transfix or clamp. He al-
ways tried local applications first. •
Dr. Duncan agreed as to the treatment of Piles; had
never used the clamp but treated by local applications and
ligature.
On motion of Dr. Russell, there was a recess of ten
minutes.
Society met, Dr. Lenoir, President, in the chair.
Dr. McAlester read the following biographical sketch of
the late Dr. Chandler, which was received, ordered spread
upon the record and a copy sent to his family:
“Dr. C. Q. Chandler was born in Louisa county, Va.,
January 26, 1826. His father moved to Cooper county,
Mo., in 1836. He went back to Virginia at the age of 14
to finish his education, and study his profession under his
uncle, Dr. Charles Quarles. He attended his first course
of lectures in Richmond, Va., in 1846-7 at Hampden-
Sidney College. He graduated at the University of Penn-
sylvania April 8, 1848. He was 22 years old when he
graduated. His preceptor thought he was too young to
begin practice by himself (successfully) and urged him to
remain in Virginia and practice with him a year, which he
*—

56 - IRIECORDS.
did. He returned to Missouri in 1849 and practiced at
Conner's Mill, Cooper county, until August, 1853, when
he removed to Rocheport, where he continued the practice
for 22 years. He died of rheumatism of the heart, Feb-
ruary 2, 1875. What more can be said of him than as a
man, a citizen and as a physician he was faithfully tried
and found to be true. He left us with a full assurance of
a happy hereafter.”
Dr. W. Dickinson, of St. Louis, presented to the Society
a communication upon “Lesion of the 3rd Pair of Cranial
Nerves.” He presented a case illustrating his subject
showing the causes, effects and treatment of paralysis of ||
this nerve. He gave origin, distribution and function of
the nerve. He also showed that when both eyes are
effected the lesion is at the base of the brain. The prog-
nosis depends upon the cause. If the cause is reflex,
rheumatic or syphilitic and of short duration it is favorable.
Best treated by continued galvanic current for 9% to I min-
ute at a sitting; also Iodide of Potassium, Protiodide of
Mercury and Cathartics. The paper was one of great merit
and the Society presented their thanks to the gentleman
for this voluntary Scientific communication.
On motion of Dr. Russell, Mexico, Mo., was selected
as the next place of meeting.
The society then adjourned to meet at the college
chapel at 7% p.m., April 5, 1877.
Society met at the appointed hour, Dr. Lenoir, Presi-
dent, in the chair. -
Under motions and resolutions, Dr. Humphreys offered
the following amendment to Section 5, Article I, of By-
Laws:
Insert after “annual meeting,” in parenthesis (“or during
the following year,”), the section will then read as follows:
“Any Physician, after having been admitted as a member
of this Society, shall retain his membership by the pay-
ment of an annual fee of $2.OO at each annual meeting (or
during the following year) as long as he is in good stand-

RECORDS. - 57
ing in his profession.” This was adopted.
Dr. Rothwell, of Mexico, offered the following resolu-
tion, which was adopted :
Jºesolved, That a vote of thanks lyc tendered the ploysicians and citi-
zens of Montgomery City for their courtesy and hospitality to the mem-
bers of this Society during their present meeting.
The President then appointed Drs. Garnett and Hanna
to conduct the newly elected President, Dr. W. B. Adams,
of Danville, to the chair.
The President elect thanked the Society for the honor
conferred, after which the retiring President, Dr. W. T.
Lenoir, of Columbia, delivered the annual address; sub-
ject, “Professional Jealousy,” -
On motion of Dr. Garnett, delegates were appointed to
the meeting of the State Mcdical Society, which convenes
in Kansas City, April I7, 1877. The President appointed
the following:
Dr. W. H. Lee, Audrain county; Dr. A. W. McAlester, Boone; Dr.
W. S. Hutt, Lincoln; Dr. Jno. S. Pearson, Pike; Dr. H. H. Middelkamp,
Warren ; Dr. J. R. Mudd, St. Charles; Dr. E. M. Kerr, Callaway; Dr.
G. W. Broome, Randolph ; Dr. M. Y. Warren, Mlontgomery.
Un motion, the President, Dr. Adams, of Danville, and
Secretary, Dr. Duncan, of Columbia, were also appointed
delegates; Also Dr. T. Allen Arnold, of Columbia.
On motion, the President appointed the following dele-
gates to the National Society which meets in Chicago, Ill.,
in May, 1877: Dr. W. Humphrey, of Mexico, and Dr. J.
M. Foreman, of Jonesburg.
The following standing committees for the ensuing year
were appointed:
(1.) On Scientific Communications—Drs. Humphreys, Lee and Fore-
Il) &lll .
(2.) On Credentials—Drs. Loving, Rothwell and Lenoir.
(3.) On Medical Ethics—Drs. Hanna, Mudd and Maupin.
(4.) On Publications—Drs. Garnett, Macfarlane and Middelkamp.
(5.) On Medical Education—Drs. French, Broome and Bodine.
(6.) On Arrangements—Drs. It oth well, Humphrey and Russell.
The following gentlemen were appointed to read essays
at the next meeting of the Society, in November, 1877,
upon subjects opposite their names:
(1.) Dysentery–Dr. Samuel Overall, St. Charkes,

58 - R. ECO RIDS,
*
(2.) Modus Operandi of Chloroform— Dr. P. French, Mexico.
(8.) Skin Grafting in Syphilitic Ulcers—Dr. A. S. Loving, Wright
City. -
(4.) Treatment of Urethral Stricture—Dr. T. Allen Arnold, Colum-
bia. - -
(5.) New Remedies—Dr. J. A. Mathews, Ashley.
(6.) Electricity—Dr. H. H. Middelkamp, Warrenton.
(7.) Diphtheria—Dr. W. F. Humphreys, Copcord.
(8.) Fractures and Dislocations in and near the Ankle Joint—Dr. W.
W. Moss, Columbia.
(9.) Menopause—Dr. J. N. Garnett, Columbia. g
(10.) Treatment of Fractures of the Femur—Dr. J. N. Foreman,
Jonesburg.
Dr. Humphreys, of Concord, presented the Society the
picture of a child born, at term dead, with no development
of hips; umbilicus too far to the right side, but all parts
from there upward natural. Instead of two legs they fused
into one, so as to form something resembling the tail of a
fish, There were no openings for the discharge of feces
and urine. - -
On motion of Dr. Garnett, Dr. Humphreys was in-
structed to obtain a wood cut of this monster and prepare
an article concerning it, for publication in the Linton Dis-
trict Medical Journal. -
Dr. Hubbell, of Rocheport, reported a case of a growth
of hair, eight inches long, from anterior wall of Rectum,
The Doctor removed it, cauterized the part with Chromic
Acid, and thus far there is no return of it.
Dr. Macfarlane, of Mexico, was called to a lady in con-
finement; child born with a Tumor extending from the
centre of the Sternum under the arm and to the spinal
column. The Tumor was eight inches long and four
inches wide. On it were cicatricis. It was movable.
Child now doing well. He thinks it a Twin Pregnancy.
On motion of Dr. S. N. Russell, Society adjourned to
meet in Mexico on Tuesday, the 6th day of November,
I877, at 3 o'clock, p. m. -
- W. B. ADAMS, M. D., President,
J. H. DUNCAN, M. D., Secretary, JDanville, Mo.
& Columbia, Mo.

ANNU A L A D D]3. ESS. 59
º|:
ANNUA I, ADDRESS OF THE IR&T'ſ RING PR EsłD ENT, W. T
LENo1 R, M. D., CoLUMBIA, Mo.
Gentlemen of the Linton District Medical Society:
It is the imperative duty of every true Physician to
labor earnestly and persistingly to promote the interests
and honor, and to defend the good name and integrity of
our noble Profession. We can draw sweet consolation
and, in the fact, see an earnest of better things, that in all
the reputable Medical Schools the standard of scholarship
has been raised, and with almost universal disposition and
practice to still demand higher and increasing proficiency
and capabilities in the aspirants for such distinguished
honor. This is right, and we most truly and sincerely
indorse it. Then, too, we aren ourished and strengthened
through the benign and up-building influence and potency
of County, District, State and National Medical Associa-
tions, besides a brilliant host of active, earnest co-laborers
all over the country, aggregating a stupendous and invin-
cible army which is achieving glorious victories for Sci-
ence, and dispelling the superstitions and crudities of less
enlightened ages, throwing a halo of brightness on the
present, and justifying larger hopes for the near future.
While all this is true, let us not be deceived, for we
should know and can only possibly fail to recognize the
fact that there are instrumentalities at work—materies 1/zor-
ôi–which have touched corruptably our ranks, whose
legimate and necessary tendency and effect are to enervate
and destroy our capabilities for good and to bring reproach
on the name, Doctor.
I have not the leisure or disposition at present to discuss
all these dishonoring and destructive evils, for it would
unduly extend this paper. I will direct, then, your earnest
attention to one of the most despicable and potent:
PROFESSIONAL JEALOUSY.
There is a peculiar attribute belonging to many words
in the English language, by virtue of which they possess
a weight and significance of meaning that can not be
- - - ** - - - - *** *...* . . ." - - º :* -

(50 ANNUAL ADDRESS.
expressed in terms. This attribute is understood and felt
by some innate power of intellect, which itself can
not be fully described. When we undertake to define such
words we generalize. Thus, who can define the word
conscience so as to convey to the mind of him who has not
learned its meaning, all that we recognize and feel the
thing to be?" In such cases, the word furnishes a sort of
point-d'appui for reflection and investigation,
How complicated and labyrinthian are the difficulties
suggested when we introduce a modifying term, or under-
take to specifically circumscribe and apply a given word 1.
Now there is not a hidden, but an indefinable meaning in
the word jealousy; and when we limit it in the combina-
tion “Professional Jealousy,” the very restriction intensifies
its meaning, so that we no longer can depict the hideousness
of our conception of the enormity, nor artist's brush por-
tray to the eye outlines of a deformity so disgusting. A
concentration of the meaning of all its synonyms, a com-
bination of all the figures that have been used to illustrate
it, still leaves something which we appreciate, but can not
embody in a definition.
Of all the definitions given of jealously, we select that
one of Webster which describes it as a “painful appre-
hension of rivalship in cases nearly affecting one's happi-
ness,” as the one which, itself amplified, most nearly con-
veys our idea of the passion—aye, passion ; for it is a suf-
fering, a disease of mind which, among the possibilities at
least, can induce a faulty physiological action—disease of
mind which is contageous to the moral faculties; disease
which corrupts; disease which enervates intellectual and
moral forces, perverts legitimate instrumentalities of men-
tal growth, and destroys the nobler impulses of the human
heart.
As there is no class of society to which the finer ele-
ments of a noble manhood are more essential to the conn-
plete success of its profession than practitioners of medi-
cine, so to none is jealousy such a hinderance and curse.

ANNUAL AIDDRESS. - 61
i. - xx - ſt *4.
I hold it to be a truth, universal and incontrovertable, that
no man who is constitutionally of a jealous habit, nor one
who has perverted the natural bent of an otherwise amia-
ble disposition into this channel, can do his duty as a
physician, nor develope the full measure of his capabilities
and powers of usefulness. Such a disposition is not only
an evil in a community, but is debasing to its possessor, a
reproach to the profession, and an incubus which impedes
its progress to a place in the esteem and veneration of cul-
tivated and enlightened society—a place to which it is en-
titled and should assume and hold. If these are truths,
our profession owes it to its own dignity, to its own self-
respect, and to its own highest aims to correct this, a
wide-spread evil, in its ranks. We must find an antidote
for this virulent poison.
But, is our position on this question an extreme one P
Is the view exaggerated, or the picture over-drawn P Let
uS SCe,
The science of medicine is not only a growth and a de-
velopment, but it is at present, and always will be, a pro-
gressing development. It is a well understood and univer-
sally acknowledged fact, even whether true or false, that
the types of diseases are constantly changing, or new dis-
eases are brought to light, or developed, yet the physi-
cian must keep himself thoroughly posted in the written
and unwritten experience of the profession. He mnst ap-
ply all the energies of his mind to the theories advanced
by and to an analysis of the real or reputed discoveries
and experiences of his brethren, or he falls behind and is
overtaken by the credulity and crudities of quacks and
absurd old grannies. No man who neglects to study, who
fails to investigate, can make a first-class physician. But
the jealous man, puffed up in his own vain conceit, com-
pletely reversing the order of the golden maxim “search
others for their virtues, thyself for thy vices,” contemptu-
ously rejects everything that his supposed rival happens
first to discover. Thus, grand truths which are potent to

62. A NN U AI, A DI) RESS.
-*--ºs-
relieve pain and banish disease, are frequently rejected, and
error is nursed. The true man—and a good physician is
necessarily a true man—has a mind for impressions, and
not a will to mould principles and prune truths to suit his
own changeful convenience. - -
It is a moral impossibility for the natural talents or ac-
quired ability of the jealous physician to have full play or
free growth. He becomes cynical, skeptical and obstinate.
He is ill at ease with his brethren, and broods over the pro- ||
geny of his own self-communings. Thus, he is unfitted to
understand the grandest truths of nature, or to grapple
with the difficulties he is called to remove. He is con-
stantly perverting nature, and fretting himself into ill hu-
mor. One of earth's true nobility—whose massive genius
and facile pen have depicted the Secret springs and revealed
the inmost recesses and mysterious impulses of human na-
ture as no one else has ever done, declares, that no man
can do anything to advantage in a life of constant turmoil,
disappointment and worry. But the physician, to be suc-
cessful and to protect himself against the possibility of vio-
lating his sacred trust, must be always at himself and have
under control all the powers of mind and heart with which
nature has endowed him. -
It is a self-evident truth, that no man should possess the
virtues of patience, forbearance, gentleness, generosity and
self-denial to a greater degree than the physician. They
are a part of his profession. It is his highest duty to exer-
cise them without stint. But they cannot grow in the same
soil at the same time with the vicious exotic-jealousy.
How can a man be tolerant of the whims of a petulent
invalid, who cannot brook the independent course of his
brother physician P. How can he maintain courage under
inevitable failure, when another's greater professional or
business success, and consequently his own comparative
failure, destroys his temper and his peace P - . .
In a thousand ways jealousy hurls its poisoned arrows
at a struggling, rising and worthy opponent. By a con-
--—-a--- —x------------it-- * - -

A NNUAL ADD HESS. 63
temptuous curl of the lip—by inuendo, by flat-footed lying,
by misrepresentation, by sneering at glorious triumphs and
brilliant successes, and by a cherished and successful plan,
failing to defend and exonerate a brother from unjust and
baseless accusations prefered by wickedness or malice.
With the uninitiated and vulgar, which compose the larger
class of mankind, such cowardly efforts degrade the profes-
sion; but with the gifted few, who can disrobe the monster of
his vestment of blackness and slime, and read his real status
and motives, such blows demolish nothing, but Scoop-out
a niche in the temple of Fame for the sure preservation
of the Faithful.
Whoever then wages or sympathizes with such a fratri-
cidal warfare, whether he be the ambitious Tyro, just en-
tering the vestibule of the rich store-house of medical truth
and honor, or the hoary-headed hypocritical worshipper
who has long lingered and desecrated the sanctuary by his
ministrations, let him be ejected beyond the pale of recog-
nition, let him be kicked without the camp, and baptized
seventy times seven in the righteous, indignant frowns of
an insulted and injured Brotherhood.
Ours is a Profession which demands the noblest minds,
the noblest hearts and the noblest lives. Let us, then, dis-
countenance every tendency to narrowness, bigotry and
Selfishness on all occasions, and thus elevate the standard
of Professional honor by improving ourselves, correcting
this grievous and wide spread evil in others, and contribu-
ting directly, through a broader and more liberal spirit, to
the welfare of those who entrust so much to our judgment
and skill.

THE LINTON DISTRICT MEDICAL JOURNAL.
*
COLUMBIA, MISSOURI, 1877,
A NTRODUCTORY
To the Patrons of the journal.-
GENTLEMEN:—In offering to you, this our first issue of
the Linton District Medical Journal, we are sensible to
some extent, of the responsibility we have assumed, as well
as of our inability to meet the demands and expectations
of the Society whose organ we are to control.
Yet relying upon your assurance of confidence in plac-
ing us in this untried position, with the promise of patience
and forbearance with our shortcomings, until experience
shall have made us more competent, we venture to present
you with this, though very imperfect, as the best we could
do.
As to the taste or style manifested in the mechanical
execution of the book we anticipate entire Satisfaction ; as
good at least, as the price paid should lead us to expect.
In regard to the subject matter presented, while controlled
by our discretion, it is by agreement, to a large extent,
yours, not ours. The respective merits of which your
judgment will determine, while you will appreciate its
scientific worth. The plan of arrangement of the volume
is no doubt open to objections, it being entirely our own.
But where perspicuity and convenience are attempted,
rather than established form, we ask that your criticism be
lenient, promising improvement in the future, where faults
21°C Sée Il.
A peculiar circumstance connected with this undertaking
which gives to it a novelty almost without a parallel in
journalism is, that it is not an individual or private enter-
|

F. DITOIR. I. A ſ,. 65
===ºsºsº assºssmsºs
prise. While to us is assigned the editorial duties of the work,
they are to be performed without pecuniary remuneration,
and this is here mentioned, only for the purpose of illustra-
ting the relation of individual mennbers of the Society to
the Journal, and their duties growing out of that relation.
This is the journal of the medical men of this district, es-
tablished, and to be sustained (if sustained) by them alone,
Consequently, they are to be responsible for its character,
including its editorial management.
Therefore if the papers presented at our semi-annual
meetings and the discussions thereon shall furnish records
of scientific worth, then that department of our Journal will
be valuable to that extent. To do which, members appointed
to prepare such papers must not shrink from the duty they
assume. And in the character of their productions they must
endeavor to do justice to themselves—to the Society their ar-
ticles represent——and worthy the perusal of the Profession
at large. Again this Journal, depending as it does, upon
the voluntary contributions of district members, will be lean
or robust just as the pabulum is furnished from which its
strength and vigor are to be derived. The success then
of our Journal depending on individual members, to so
large an extent, each should understand and respond to his
individual duty. Not only to contribute to its pages occa-
sionally, to the best of his ability, but also to furnish for
publication all peculiar and anomalous cases, results in the
use of new remedies, any new departure in medical or
Surgical practice; thereby contributing his mite for the ag-
gregate progress to which we aim. Thus, this Jour-
nal may become not only the exponent of the medical abil-
ity of the Linton District, but also the repository of the
best experience of the day of its existence.
The main object in establishing and maintaining a med-
ical journal in connection with this Society is the same as
thc objects of the Society itself. Those objects being “To
constitute a representative body of the regular Medical
Profession of the District which may advance the interests

66 ED ITO RIA II.
and encourage the unity and harmonious action of the en-
tire Profession throughout the District; to suppress empir-
icism as much as possible ; to restrict the practice of medi-
cine to regularly qualified graduates; to develop talent,
stimulate medical inventions and discovery, and to main-
tain our rights and immunities as medical men.” The
Journal then becomes the auxiliary to the objects of our
organization. We seek by organized action to accomplish
for the profession what cannot be done by isolated indi-
vidual effort.
The above being the conditions—the resources, and the
objects of our Journal, we shall expect and welcome com-
munications in harmony with the same, while all matters
foreign to these objects will be excluded.
The principles of the practice of medicine are every-
where the same. Our field, embracing nine counties, is a
|| fair representation of the diseases of the west, wherein is
contained, we honestly believe, a Medical Profession of
average learning, ability and skill. We thus possess all the
elements of Professional progress and success. It is with
us then as a Profession, whether we plod along the awk-
ward imitators of the more skilled, or availing ourselves of
the advantages we possess we shall stand abreast with
those the most advanced.
The age demands this at our hands. We must be more
than our pioneer predecessors. And as the Linton District
Medical Society was the first district organization in the
State, and its Journal the first enterprise of the kind under
the auspices of a district society, let the unswerving pur-
| pose of our membership be to make our Society first in
character and our Journal first in literary worth.
The Linton District Medical Society meets in Mexico,
Mo., on Tuesday, November 6, 1877, at 3 p.m.
|
i
EDITOR.I.A.L. 67 |
i
We cannot refrain from calling the attention of the
members of this Society to the importance of preparation
for our November meeting. Remember, brethren, it is
your duty to attend. Let no trivial excuse prevent your at-
tendance. The success of the Society depends upon you
as an individual as much as upon any other. You need
the relaxation. The meeting needs your presence. Come
and let us make our next session the largest, most inter-
esting and profitable of any preceding one. Your duty is
not only to attend, but come prepared to work. Let com-
mittees, both standing and special, be ready with their re-
ports; and especially would we urge those appointed to
read papers on assigned subjects to respond. Nothing so
mars the interest and distracts the order of business as
those failures in the programme of work. Also come
prepared to discuss the subjects presented. Progress in
medicine can be attained only so far as its representatives
become acquainted with its facts. The idea of our organ-
ization is to obtain at each meeting an exhibit of the
knowledge, the experience and the opinions of the Pro-
fession upon the subjects there presented ; and these
opinions, as expressed in the discussion of subjects will be
valuable in proportion to the thought or preparation these
subjects have received at home.
Gentlemen, we contemplate a profitable meeting next
November. Shall we have it?


EDITORIAL ABSTRACTS AND SELECTIONS.
CoLD APPLICATIONS IN CROUP –W. H. Lanman, M.D., ||
Mount Holly Springs, Cumberland county, Penn., directs ||
attention to cold applications to the neck in cases of croup.
He wraps a cold towel around the neck and renews as
often as it gets warm. This has been his practice during
the last eight years with uniform good results. He suc-
ceeded in removing the false membrane with
Pot. Iodide; 20 grs.
Senegae Syrup, 3 dra.
Aquae Distill., J3 oz.
Small teaspoonful every three hours.-9 ouſ nal Med. Mat.
CASTRATION FOR THE CURE OF SPERMATORRHCEA.—Dr.
Spaulding has brought before the Detroit Academy of ||
Medicine a case in which, from a boy fourteen years old,
he removed both.testicles. The boy was rapidly becoming
an imbecile from masturbation. Before resorting to so
desperate a measure, Dr. S. consulted with several eminent
medical men who deemed the operation justifiable. The
result is satisfactory; the youth is acquiring good business
habits.--The Doctor.
FIVE CHILDREN AT A BIRTH.-James F. Pierce, of Mars ||
Bluff, S. C., reports a case of a negro woman giving birth
on the I Ith of last September to five children. The labor
was premature by one and a half months. The children
were small but perfectly developed, ten and three-quarter
inches long. The estimated weight of each was two and
a half pounds. One female was attached to a seperate
placenta. One female and three male children attached
by seperate cords to the same placenta. Mother did well.
Four of the children died immediately; one lived several
hours.-Med. News and Ziórary, Wov. 1876, and Pacif.
Med. & Surg. journal, Dec. 1876, and The Cincinnati
Lancet & Observer, March, 1877.

EDITORIAL AIBSTRACTS. 69
OvARIOTOMY IN AN OLD WOMAN.—Dr. C. Richards, of
Joliet, Ill., operated for ovarion tumor in April, 1876, upon
a woman sixty-five years old, resulting in complete re-
covery.—Chicago Medical %urnal & Examiner, Sept. 1876.
DR. H. HARTSHORNE'S CHOLERA REMEDY :—
Chloroformi, Tinct. Opii, Spirit Camphorae, Ammoniae Aromatic, each
1} fluid drs. .
Creasoti, 8 drops.
Olei Cinnamomi, 8 drops,
Spiriit Vini Gallici, 2 drs.
Mix. Dilute a teaspoonful with a wine-glass of water
and give two teaspoonsful every five minutes, followed by
a lump of ice.—New Remedies.
DEATH FROM NITROUS Ox1DE.—The late case in which a
surgeon perished under the influence of the gas has been
discussed at the Odontological Society and elsewhere.
The dentist is exonerated by the fact that the deceased, a
qualified. Surgeon, insisted on taking the gas and Adirecting
it to be given till he had “a good snore.” It is idle to de-
ny that the gas was the cause of death, and the case
should be a warning as to the danger attending all anaes-
thetics, journal Mat. Med., June 2 I.
ExcESSIVE SWEATING.—Anhydrotics.--Anhydrotics are
remedies which are of use in checking excessive sweating
from disease. The sweats of phthisis especially call for
these remedies. Phosphoric acid, Sulphate of copper, tan-
nic and gallic acids are of some use as anhydrotics. The
most potent of all anhydrotics, in my experience, is un-
questionably belladonna. We are indebted to Dr. Sydney
Ringer for our knowledge of this property of belladonna;
and the debt we owe to him can only be sufficiently esti-
mated by those who have an extensive experience of phth-
isis, and who give the drug a fair trial. I have no hesi-
tancy in Saying that the use of this agent completely
changes the aspect of many cases of pulmonary phthisis.
For the arrest of the exhausting night-perspirations of
phthisis, belladonna is as potent as digitalis is in giving
tone to a feeble heart. It is quite true that neither is very

70 EDITORIAL ABSTRACTS.
effective in the last and final stages of disease, for indeed
nothing is very potent then ; but in the early stages the ac-
tion of each is very pronounced. In the night-sweats of
spreading caseous pneumonia, the administration of bella-
donna is followed in almost all cases by a decided arrest of
the flux; and in many cases the arrest of this flux is ac-
companied be immediate improvement. To produce these
effects it is necessary, however, to use larger doses than
those spoken of by Dr. Ringer. He speaks of from
I-2OOth to I-IOOth of a grain of atropine given hypoder-
mically; but as to the dose given by the mouth, I us-
ually commence with I-75th of a grain, and up to I-25th;
the latter dose rarely failing.—%. Milner, Fothergill.
PAIN.—Outward Application of Hydrate of Chloral,—Hy-
drate of chloral is capable of cutaneous absorption, and
acts in this way as a local anaesthetic. I have tried it with
great success in neuralgic pains and in cancer of the breast,
in cases in which other sedatives and narcotics have failed
to give relief. The mode of application is by the satura-
tion of folds of lint of the size of the part to which it is
used, brought into close contact, then covered with three
or four layers of lint, covered with oil-silk or spongio-pi-
line wrung out of hot water. The application to raw sur-
faces, of course, requires some care in manipulation. The
strength of the solution is about four drachms to sixteen
ounces of water. The addition of a small quantity of gly-
cerine is advantageous.—Dr. W. B. Kasteven, Lancet.
WHooping-COUGH.—Croton-Chloral,—I do not know if
the administration of croton-chloral in whooping-cough
has any originality; but, after a somewhat extended trial, I
regard it as almost a specific. I have given it in gradually
increasing doses, commencing with one grain twice or
thrice a day, and almost without exception there has been a
very marked reduction both in the violence and the fre-
quency of the attacks,—Dr. Wm. Paulson, Lancet.
New Antiseptic and Astringent Letion.—Salicylate of

E I) IT' () [? I / J , A £35T IRA (T.S. 71
Iron.—Salicylic acid and its compounds are excellent anti- ||
Septic applications to wounds after operations, but like car-
bolic acid they are not astringent, and therefore allow free
capillary bleeding. A solution of salicylate of iron is both
astringent and antiseptic.—Dr. Robert Kirk.
SURGIcAL LIGATURES.–Carbolised Ligatures versus Tor-
sion.—Of the vexed question of ligature or torsion. We
have ceased at this hospital to use acu-pressure, because,
after a satisfactory trial, we thought it decidedly inferior to
the old plan of the silk ligature, and some of my col-
leagues still use the latter. I have, as a general rule,
abandoned it for the carbolized cat gut ligatures, which I
have found equally efficient against primary and second-
ary hemorrhage, and which offer (I am again speaking
only generally) no obstacle to the rapid union of the
wound. You saw this illustrated in the case of the little
child whose thigh was amputated. The wound was healed
almost entirely, and the patient out of bed, on the four-
teenth day after the amputation, no trace of the ligatures
having been seen. I prefer this plan to torsion (though
quite admitting the efficacy and safety of torsion in skilful
hands), inasmuch as it is very much easier to apply, and
involves much less handling and contusion of the parts.
In an amputation in which torsion is used, though the
larger and more obvious vessels may be easily and quickly
secured, we often see much difficulty in dealing with those
which come less distinctly into view; and this difficulty is
greater if the tissues are unhealthy. In such cases either
the parts are left long exposed and are much handled—
which cannot but retard union—or the smaller vessels are
left to bleed; and even if this bleeding ceases without any
serious damage to the patient, yet the blood must distend
the flaps, some of it must remain as clot, even in spite of
drainage, and it must in that way again retard union. |
With the carbolised ligature each vessel can be perma-
nently secured in a moment; and the small knots of gut

72 EDITORIA L AIBSTRACTIS.
left in the wound do not seem in any way to affect the
rapidity of its union. It is for these reasons that I prefer
this form of ligature in amputation.—Mr. T. Holmes.
Post-PARTUM HEMORRHAGE.-In post-partum hemor-
rhage a drachm of laudanum will rally the exhausted
strength, restore consciousness, rouse the uterus to action;
and arrest the bleeding when six times ten minims in water
would allow the patient to bleed to death. In syncope a
tablespoonful of undiluted brandy will have an effect which
twice the quantity drowned in water would fail to produce.
We defeat a paroxysm of ague and cut short the disease,
or suppress neuralgia, by a single large dose of quinine,
when repeated doses of average amount have entirely
failed,—Dr. W. H. Broadbent, Practitioner.