HANDBOUND AT THE LN1\ ERSITY OF TORONTO PRESS .-<-?' The Medical Record. % ^m\-Mni\]\\] 3(ourn;il of ^IcMcuic (iiiii ^iinuri)'. (y EDITED BY GEORGE F. SHRADY, A.M., M.D. iJoluSu 7. MAECII 1, 1872— DECE:y:BEE 16, 1872. %^^ XEAV YORK: \vilil,ia:m ^vooD & compaxy, 27 GREAT JOXES STREET. n POOLE^ & MACLAUCHLAX, PRINTERS AND BOOK. HINDERS, 205-213 East \2ih St. INDEX TO VOLUME VII. Abdomen, impalement of, 198. Abortion, frequency of retained placentn in, .'520. Acid nitrate of mercury, in induration of womb, 151. Acne, remarks on, 54(5. 577. Aconite-poisoning, 3G ; test for root of, 515. ^tbylidenchloride, 275. After-pains, citric acid in, 108. Aiken, S. C. , a resort for invali Is, 43. Air- passages, death as a cause of disease of. 388. Air, compressed as a remedial agent. 31 ; on poisoned, 55!. Albuminuria, cathartics in, 30; during fertility, 442. Albuminuric retinitis, OG. Alcohol, action of, 346, 407 ; treatment of wounds by, 223. Alkaloids, comparative value of, 328. AUbutt, T. C, review of work by, 20. Althof, Dr. H.. canthoplasty, 34. Alumni Association of Collejje Physicians and Surgeons, 93 ; University of New York, 95 ; institutions, 399. American Medical Association, report of, 169, 201, 277, 426. American Ophthalmol ogical Society, review of transac- tions of, 19. American Otological Society, report of, 331. American Pharmaceutical Association, officers of, 527. American Public Health Association, 455, 523. Amherst College, Mass., notice of, 334. Ammonia, hydrochlorate of, 390. Amyloid disease, prevented by alkalies, 276. Anesthesia, discovery of, 187, 336 ; review of work on, 146. Anesthetic mixture, the, 299. Anjesthetics, administration of, 396. Anemia, progressive, 343. Aneurism, remarks on, 304, 347, 472, 540. Angioma caverncsum, case of, 120. Animalcula, poisonous effects of, 397. Animation, case of suspended. 46. Animals, a new hospital for, 96. Aniline colors, adulteration with sugar. 261. Ankle-joint, compound dislocation of. 251. Anus, imperforate, 312 ; nourishing by, 368. Aphonia, 390. Areolar, vascular tumor of labium, 303. Army News. 41, 92. 118, 166, 237. 250, 284, 310, 333, 359, 382, 403, 427, 455, 525, 550. Anny, the medical corps of the, 264. Arnold, Dr. E. S. F., letter from, 249. Arnott, Henry, notice of work by, 401. Arsenic in dyspepsia, 104. Arterioles, tonicity of, 511. Artery compressor (illustrated). 213. Artery constrictor, with cases. 52. Artesian wells propagating disease, 152. Ascites, a novel method for tapping, 36. Aspergillus, case of, 419. Aspirator, the, 473. Asthma, a cause of, 442 ; treatment of, 443. Astigmatism, determination of, 58, 347. Astragalus, cases of, disease of, o97. Atlee, Dr. W. L. , review of work by, 543. Atlo-axial disease. 510. Aural-catarrh, review of work on, 353 ; polypus, rapid development of. 418. Autopsies, neces.sity for, 536. B. Bailey, Dr. James S., death after child-birth, 385 ; snake- bites. 413 Baptisia tiuctoria in typhoid, 465. Barker, Dr. B. F.. puerperal thrombosis, 521. Bathing, directions for, 382 ; reduced to a science, 91. Battey, Dr. R., on cystotomy, 381. Beard and Rockwell, Drs., on electro-surgery, 292, 434. Beef essence, frozen, 300. Beef -tea, worthlessness of, 223 ; new method of making, 296, 323. Beer, adult-eration of, 551. Bell. Dr. A. N. , on quarantine, 66. Bell, Dr. John, of Philadelphia, death of, 432. Belladonna, antidotal preparations of, 159. Bellevue Hospital Medical College, 93 ; House Staff, 431. Bennett, Dr. E. P., dislocation of shoulder, 52. Bennett, Dr. J. H., review of work by, 203. Bennett, Dr. W. H. , dust as an exciting cause of disease, 388. Berberi, case of, 468. Bile, urea in, 346 ; detection of, 197. Biliary calculi, large, 360. Births, male and female in U. S. , 336. Bladder, cancer of, 276 ; puncture of, 289, 323 ; rup- ture of, 205, 356, 394, 457 ; impalement of by broom- stick, etc., 518. Black list, the physician's, 250. Blind, the,'^in Massachusetts, 288. Blindness, from cerebro- spinal meningitis, 341 , photopho- bia in, 56. Blood crystals, their physiological importance, 242. Blood, transfusion of, 58. Blotting-paper, incrusted, from nostril, 156. Bodenhamer, Dr. W., traumatic hemorrhage of rectum (illustrated), 361. Bones, notice of work on disease.=; of, 279. Booth, Hamlet of, psychologically considered, 287. Bougie-a-Boule, a new, 167. Bradley, Dr. E., letter from, 250. Brain, effects of removal of, 372 ; colloid degeneration of, 228 ; in uraemia. 579. Breath, organic matter in, 335. Briddon, Dr. Chas. K., elastic artery compressor {illus- trated), 213 ; surgery of male urethra, 217, 289 ; tubular aneurism, 472. Bright's disease, in children, 345 ; eye in, 84 ; work on, 23. Brigham Hall, report of, 428. Bromide of potassium, 328 ; notice of work on, 516. Bronchitis, muriate of ammonia and carbolic inhalation in, 274, 297. Bronsou, Dr. E. B. , syphilis corpuscle, 138. Brown-Sequard on epilepsy, 472, 517. ^ Buck, Dr. A. H. , on Ear Practice, 570. Buck, Dr. Gurdon, tracheotomy, 12; infra-auricular tumor, 517. i^S2 Index to I'ol. V'JI. Bulklty. Dr. H. D.. notice of denth of. 4.S. IJulkh-y, Dr. L. D.. cliniciil thernioiiu-tn-. UO. Bull. Dr. C. S. , atrophy of optic nerve, :!i:{. Biinistoud. Dr. F. J.. Lo8torfer'« corpuHcles, 1(14. 210. Bullet, rcniovul of ftoni cranium. t2(M). Bullets, l»(»(l practite of prubiug for in cavities, o25. Bunker. Dr. E. S , clay (ircMings in variola, 40. Burns, treatment of. 2'J(i. Burrall, Dr. F. A., oxton.sion of wrist (illimlnidd), 143; ua.s.al doucbe, (Jo ; carbolic acid internally, 52.'). Butler, Dr. S?. W., review of work by, 22. Byrne. Dr. J., on electric cautery in uterine surgery (illuiftrateci), 529, 55;i. Coesarean Foction. ;U2. lis. Calabar bean and chloral. 101 ; in constipation. 413. Calculi, 27; in the bladder, 230 ; chlorofonu in treatment of. 104. Camphor, monobromate in delirium tremens, 372 ; and bromine, lOo. Cancer, rcniarks on different characters, and treatment of, \',(K 22->. 2:)7, 21)1. :^7!J. 40. 512, 594. Cancruni oris, treatment of. 414. Cantharidatc of pota.y. 378. Dawson. Dr. B. F.. a new vaccinator {illustrated), 117. Dead bodifs. liquefying, 228. Deaf and Dumb, the uneducated, 336. Deafness, cured by electricity, 57 ; caused by cerebro- spinal meningiti.s. 341. Death, ap{)arent. remarkable case of. 335 ; test of, 574. Delaware State Medical Society, notice of, 312. Delirium tremens, chloral in, 197. Delivery, m.-xnual. in con\'ul8ion8, 82. De Marmou. Dr. P.. case of. 187, 349, 309. Denionomania and witchcraft, 96. Dental inegularity, treatment of, 153. Dentigerous cysts, 58. Dentists in the U. S. . 95. Department of safety, the proposed, 61. Derby. Dr. A. H , tenotomy in myopia, 64 Diabetes in India, 28 ; treatment of, 367. Diabetic nvine. new matter in. 251. Diarrhoea, infantile, treatment of, 228. Dickson. Prof. S. H.. death of, 163. Digitalis, an anaphrodisiac, 33. Diphtheria, recovery after tracheotomy for, 12 ; treat- ment of. 297. Diploma traffic, the. 117. 247, 514. Disinfectants, the best. 329. Dispensaries, first to suggest the idea of, 335. Dissecting wounds, treatment of, 197. Doctor's local quarrels, 301. Donnelly, Dr. M.. skin grafting, 573. Dowell. Dr. Greenville, new speculum (illuitrated), 402. Drowning, prevention of death from, 546. Drug-bill, remarks on. 17. Drunkenness, ])roposed law against, in France, 288. Dry earth a*; a surgical dressing. 420. Dubois, Dr. H. A., climate of San Rafael, 135. DufiBeld. Dr. Edward, baptisia tinctoria, 465. Dugorg oil, 382. Duncan, Dr. J. M., notice of work by, 304. Dunning, Dr. W. B. , death from ether, 411. Dust, as an exciting cause of disease in air-piissages, 388. Dwyer. Dr. John, cerebro -.spinal meningitis, 51. Dyspepsia, treatment of, 60, 104, 346. Dysentery, chlorate of potash in, 351. E. Ear, removal of bodies from, 395 ; review of work on, 19 ; the labyrinth of, 232 ; catarrh of, 444 ; unusual cases of disease of, 570. Earth in surgery, review of work on, 205. 1 Eczema, hesitation in curing, 43. Index to Vol. VII. 583 Editorial articles, 17, fil, >S5, 10!), 15:3, 15r), 201, 229, 277, :301, 82r), :349, P>78, 308, 421, 44"), 409, 518, 541, 575. Edson, Dr. B., on c.incer doctors, 879. Education, .sanitary aspects of, 898. Elbow, movement plan in fracture of, 418. Elbow -joint, excision of, 42. Electric cauter3' in uterine surgery, 529, 553. Electricity, review of works on, 110, 515. Electro-surgery, researches in, 202, 484. Electro-therapeutics, 189, 281, 540. Electrolysis in stricture of rectum, 209. Emnienagogue.s, 29(>. Empyema, latency of symptoms in, 86 ; cases of, 357. Eueuresis, nocturnal. 848, 458. Epidemic diseases, report of section of American Medi- cal Association on. 263. Epilepsy, character and treatment of, 198, 226, 276, 337, 472. Epulis, microscopic character of. 59. Erectile tumors, electrolysis in, 293. Erysipelas and surface thermometry, 1 94 ; abortive treat- ment of. 200. 442. Ether as a beverage, 168; death from, 408, 411 ; effects of iu labor, 416 ; the first insensibility from, 252 ; glue, 328. Eucalyptus, 298. Evolution, theories of, 396. Excisions, antiquity of, 549, 577. External iliac, ligation of, 105. Extra-uterine [regnancy, 467. Extraction operations. 848. Eye, syphilitic inflammation of, 58 ; relation of diseases of to other diseases, 337. Fabrics, to render non-inflammable, 222. Favus, treatment of, 56. Fecundation, artificial, 222. Fecundity, extraordinary, 264 ; a work on, 204. Fees in California, 287. Female, calculus in, 417. Female Dentists, 358. Female patients, our relations to our. 469. Female physician of the olden time, 403. Femur, cases of fracture of, 104, 198, 254 ; lengthening of in sj-philis, 368. Fermentation, remarks on, 511. Fever, mixture for. 59 ; lacto-phosphate of lime in, 226 ; and sewers, 227. Fibula, fracture of, treatment of, 41 8. Finnell, death from heart disease, 112 ; on whiskey drink- ing, 451 ; on aboi-tion, 520. Flint, Dr. A., aneurism and its relation to syphilis, 37. FUnt. Dr. A., Jr., notice of work by, 423. Fostal hypertrophy. :>47 ; remains, attachment of, 228. Forced Delivery, 107. Fork, swallowing of a. 46. Fortun, Dr. C. A., trismus nascentium, 343. Foundlings and foimdling institutions, 481. 513. Franciscan Hospital, quarterly report of, 286. Fra^er. Dr. William, death of, 'diS. Frisbie, Dr. C. W., on pessema, 308. G. Gall-stone, a large, 286. Galvanic current, therapeutic action of, 328. Galvanism, strictures, treatment by, 270. Galvano-caustic, amputation by, 516. Galvano- Puncture Needle (illustrated), 162,461. Gangrene of mouth, 462. Gant, Dr. F. J. , notice of work by, 302 ; Dr. James, notice of work by, 24. Gastric Tubuli. 372. Gastro-hysterotomy, 227. Gelsemium in irritable bladder, 57. German surgeons, annual congress of, 234. Gibbons, Dr. H. , letter from, 880. Gleet, an astringent for, 105. Glue bandage in fractures, 275. Goitre, treatment of, 847. •Gonorrhoea, remarks on character and treatment of, 199, 225, 299. 468. Good-Bll, Dr. William, membranous cast of vagina, 40. Gossypirtm as an anodyne. 108. Gouley, Dr. J. W. S., on rupture of bladder, 457; ure- thral fever, 409; retention of urine, curious case of, 483. Graduation of improper persons, 70, 153, 168, 258. Green, Dr. T. Henry, notice of work by, 88. Gross, Dr. S. D., notice of work by, 352. Grotto near Pistoie, curative properties of, 46. H. Habershon, Dr. S. 0., notice of work by, 424. Hachenberg, Dr. G. P., on tannin packing, 842. Hairs, changes in direction of, 574. Hare-lip, cases of, 540. Hemato-crystalline with irrespirable gases, 242. Hematoma, complicating internal urethrotomy, 291. Hematoxylin, 894. Hamilton. Dr. F. H., notice of work by, 423. Harle.y, Dr. G. . notice of work by, 802. Hay-fever, notice of work on, -878. Hayes, Dr. R. T., letter from Japan, 250. Health Board and Xuisances, 350. Health Council, a national, 180. Health Department and Committee of Safety, 61. Health Officer of the Port, 18. Heart, voluntary arrest of action of, 261, 268; anomalous malformation of. 111 ; .suppcsed cause of disease of, 58, 804 ; death from diseases of, 112 ; needle in the, 288, 416 ; nitrite of amyl in neuralgia of, 392 ; re- marks on disease of, 419 ; diseases of in pregnancy, 439 ; strain of, 444 ; vegetations in auricle of, 521 ; statistics of disease of, 420 ; calcareous infiltration of, 442. Hectic Fever, 296. Hematuria, malarial,- 418. Hemicrania. quinine and digitalis in, 105. Hemoptysis, remarks on, 60, 207. Hemorrhages, secondary, 120 ; post-partum, 443. Hemorrhoids, a new forceps for (illustrated), 26; treat- ment by galvani.sm, 881. Hemp-saw in excision of polypi, 149. Hemiplegia in syphilis, 297. Hermaphroditism, case of, 346. Hernia, novel methods of treatment for. 57, 105, 346, 414. Herpes zoster, collodion in, 371. Hewit, Dr. H. S., on Symes' amputation, 156. Hewson, Dr. A., review of work by, 205. Hiccough, management of. 276. Hip Disease, operation for, 2^9, 410. Homeopathy and Allopathy, 309, 383. Honolulu, climate of, 427. Horse, large intestinal calculus in, 335 ; influenza. 478. Hospital Appointments. 109, 211, 376. Hospital Report of a novel sort, 18. Hunter. Dr. W. C, on pepsin, 477. Hudson. Dr. E. D., on paraplegia (illustrated), 339. Humerus, luxatioa froin muscular contraction, 467. Hutchison, Dr. J. C, on syphilization, 305. Hutton. Dr. Allen C. on homeopathy, 309. Hydatid cysts passed per rec;um. 420. Hydrocele, new treatment of. 104. Hydrochlorate of aniorphia. 106. Hydromatous cysts, 897. Hydrophobia, remarks on. 200, 348, 419. Hydro-pneumothorax. 512. Hymen, persistence of after marriage. 335. Hysteria, fatal case of, 415 ; ischuria of, 57. niac artery, ligation of, 41 7. Illinois State Medical Society, notice of, 288. Impetigo and vaccinia. 371. Incontinence of urine in children, 417. 584 Index to Vol. VII. Increase in population. reinarkB on, 17. Indiana Stato Medical .Society, notica of, 884. Indipostion n-id its imn t^roraent, 348. Inebriety, horedit^rj-. 2;{J). Indican, origin of in nr.no. :M5. Infants, rare mode of djath in, 231 ; food for, :!91 ; work on. ;{77. Infantile paralysis, electricity in. 834. Infirmaries, first establish mont of, 48. Influenza among' horses, 47!). Infra-auricular tumor. .")17. In.!,'alls. Dr. E. F.. on cy.stotomy, 550. Insane, ophth.almoloffical examination of the, 152. Insanity, remarks on, 151, 275. 27G, 372. Intemperance, comic law of, 480. Interdental si)lint. :{72. Intermaniui^'c. remarLs on. 359. Intermittent fever, carbolic acid in, 224. Intestinal obstruction, 20S, Intus.susception. case of, 520. Iodine, tinct. of, bleached, 510. Iritis, atropine in syphilitic, 300. Iron, incompatibles. 00. Irreducible hernia, a case of, 151. Ischemia, case of. 339. Ischium, excision of, 198. J. Jackson. Prof. Samuel, death of , 118. Jacobi, Dr. A., letter from, 213 ; specimens by, 206 ; on foundling institutions, 481. Janeway. Dr. E. G. . pathological specimens by, 37, 205, 304, 305. 35() ; on post-mortems, 536. Jaw. the man with the " iron." 47 ; treatment of fracture of. 391. 4G0 ; excision of, 540, 579. Jeffries, Dr. B. Joy, notice of work by, 146 ; Jervina. experiments with, 130. Jewish mortality, 335. K. Kerosene oil in chronic rheumatism. 414. Kidney, effects of various liquors on, 30 ; notice of work on diseases of. 23 ; pathology of contracted, 395 ; remarivs on fatty, 60. Knapp. Dr. H. , on cerebro-spinal meningitis, 341 ; on the ear. 232. Knee-joint, amputation of. 32, 57 ; resection of, 235, 256 ; cartilage from. 300. Koumiss, preparation of, 408. Labor, cases in a private practice of thirty-nine years, 390 ; death after, 385. 439 ; electricity in, 347 ; force and version in, 151 ; manual force to uterus in, 108; not a painful process, 467; premature artifi- cial. 418. Laborde. Dr. J. V., notice of work by, 471. Lachrv'mal sac. catarrh of the, 510. Lactic acid as a remedial agent. 329. Laryngeal growths, causes of, 224. Laryngeal mirror-holder (illustrated), 358. Laryngoscopy. 199. Larvnv. svphilitic ulcerations of, 32; papilloma of, "411. Lead -poisoning from snuff, 56. Lee. Dr. B., notice of work by, 400. Lee. Dr. C. A. , notice of death of. 4. Leg. treatment of fractures of, 140. Leucin and tyrosin, 60. Leucocythjemia in a pig, 296. Leucocyte, the. 191. Leucaemia, a case of, 280. Leucorrhoe i. treatment of. 392. Lewis, Dr. Z., Edwards' folding saw, eta (illustrated), 161. Libraries of New York, 287. Lidell. Dr. J. A., carbolic inhalations in chronic bron- chitis. 27^. Light, blue, as a stimulant. 343. Lijfhtning, los.s of life by. 2S8. 428. Lime, phosphate as a remedy, 220 ; locto-phosphate of, 413. Lipoma, removal of an extensive, 251. Lips, chronic h^'purtrophy of, 59. Litbiasin. 395. Lithotomy and lithotrity, 150. 41fS, 430, 442 ; first case of in New York, 2f[4. Little. Dr. J L.. tumor of jaw. 520. Loring. Dr. E. G , operation for Ht.abismus. 97, Lostorfer's corpu.scles. 27, 138, 155, 104, 210. Lung, absence of. 108. Lupus of the extremities. 234. Lymphatic uiJema, 370. Liver, narrow escape of in paracentesis ; furrowed, a case of. 2S1, 357. Loomis, Dr. A. L. , on empyema, 357. M. Macdonald. Dr. A. E., small-pox statistics, 310, 305, 142. Iklacula lutea, di.stancG of from optic disc. 32. Magnetic and mineral springs of ALchigan, notice of work on, 425. Magnetic wells, 189. Maine Medical Association, notice of, 334. Malarial fever, hemorrhagic, 197, 396. Mammary tumor, 112. Manhattan Eye and Ear Hospital reports, 144 Mann, Dr. Ed. C. on skin di.seases, 412. Markoe, Dr. T. M., review of book by, 279. Marriage rp/s^.s celibacy, 41. Massachusetts Gen. Hospital. 384. Mason. Dr. E.. fajcal accumulations, 114. Ma.sturbation. a case of. 453. Mathewson. Dr. A., on criticism. 212. Meat, new method of preserving, 46 ; extract of, 415. Medical College commencements, 72, 85. Medical Library and Journal Association, reports of. 65. Medical diploma trade. 167. 380. Medical education, 176, 186 ; fees, 43 ; services, forced, 18. 171. Medical Register, notice of, 353; and the profession, 421, 445, 453, 525. Medical experts, 189. Medical literature, report on, 177. Medical and Surgical History of the War, 230. Medical schools, efficiency of, 541. Medical Society of West Virginia, notice of, 312. Medical Societv of County of New York, reports of, 33, 90, 231. 448. 523. Medical staff of U. S. Xavy, 432. Medical World, final notice of. 64. Medicine, history of, notice of. 471. Membrana tympani. anatomy of. 54 ; wounds of. 56. Menstniation, temperature during, 151 ; phenomena of, 512 Mephitis occidentalis, 466. Morcurv, injection in syphilis, 511. Methyline, bichloride of. 45, 369. Miller, Dr. M. N., on mydriasis, 387. Military Academy, West Point. 326. Milk, artificial. 45. Mind, influence of in therapeutics. 43. Miner, Dr. Julius F.. on ovariotomy. 13. Minnesota State Medical Society, officers of. 420. Microscopic sections of eyes, 58. Missouri Medical .\ssociation, notice of, 334. Mitchell, Dr. C. L. , heart disease in pregnancy, 439. Modem giants, 429. Morbus coxarius. case of, 303. Morphia, poisoning by. 47. 372. 391 ; hypodermic injec- tions of, 225 ; and chloroform. 252. Moore, Prof. E. 31., on vowel and consonant sounds, 49. Morris, Dr. Moreau, cerebro-spinal meningitis, 245. Index to Vol. VII. 585 Mortality of New York, extraordiuaiy, 332. Mother's Rcigister, notice of, 377. MoiTse's Ear, sensation in, 419. Munde, Dr. Paul, foreign letter from, 23G. Mud-baths, efficacy of, 3!)7. Murray, Dr. A, galvano-puncture needle (i'lustrrffcd)^ 102, 4')1 ; intrauterine pessary (UUistrate.i), 319. Mushroams, edibie and poisonous, 369. Mydriasis, case of, 387. Myopia, tenotomy in, 64. N. Naeviis, cured by vaccination, 261 ; an extensive, 150; cured by electrolysis, 2!)4. Nails, growth of, as a means of prognosis, 108. Narceine, hydrochlorate, in hypodermic injections, 200. Nares, new method of plugging, 84. Narium, sejitum, abscess of, 28. Nasal douches, 64. Naso-pharyngeal tumors, 395, 578. National Medical Library, 202. Neck, cystic tumor of the, 418. Negro mortality at the South, 429. Needle Forceps, a new (iZ/nstrateii), 26, Nerves, regeneration of, 511. Newman, Dr. R. , electrolysis, 209 ; treatment of stric - ture. 270. News and Items, 48, 72, 93, 118, 166, 237, 264, 311, 333, 359, 382, 408, 427, 478. New instruments, 117, 162, 213, 358, 402. New York Dispensaries, -statistics of, 431. New York Academy of Medicine, reports of, 6t), 115, 281 305, 328, 474, 521, 546, 577. New York Hospital, the late, 229. New York Medico-Legal Society, officers of, 479. New York Pathological Society, reports of, 36, 111, 15IJ, 295, 280, 30:5, 354, 451, 472, 517, 577. Nomenclature of diseases, report on, 179. Noyes, Dr. H. D. , relation of eye diseases with other dis- eases, 337. O. Obituary notices, 41, 162. Ob.stetric, report of section of American Medical Associa- tion, 189 ; report of practice, 390. Opium, use of the acute urasmia, 160 ; poisonous bella- donna in, 396 ; cultivation of in Tennessee, 526. Optic nerve, atrophy of, 313, 338 ; strychnia a stimvUus to, 32. Ophthalmia, purulent in new-born, 300. Ophthalmic arterj^ embolism of, 338. Ophthalmological congress, 383. Ophthalmology, notice of journal of, 327. Ophthalmoscope, review of work in uses of, 20. Ovariotomy, remarks on, 13, 189, 417, 430, 441, 512, M'i. Orbit, aneurism of, 419. Organic dynamics, 348. Os innominata, dislocation of, 105. Osteo-myelitis, cases of, 156. Otis, Dr. F. N., .sympathetic suppression of urine, 158. Otitis interna, division of, 151 ; media, 519. Otology, lectures on, 56. Our female brethren. 384. Ovary, cancer of, 394. Ovarian cyst, in a child aged eight years. 297; removal of during acute peritonitis, 512. Ovarian veins, thrombosis of, 305. Ozokerit in skin disease, 152. Oxygen in suffocation from coal gas, 419. Packard, Dr. C. W. , cerebo-spinal meningitis, 102. Pain, remarks on, 372. Painless parturition, 467. Painting, pathology of, 149. Pancreatic calculi, 356. Papilloma of larynx, 41 1. Palate, the, in health and disease, 359. Palpation in obstetrics, 416, 419. Paper dressing, 260. Paracentesis thoracis, 346. Paraffine, effects of on skin, 57. Paraplegia, mechanical treatment of {illustrated), 839. Parasites, review of work on, 146. Parisian hospitals. 383. Pathology, review of work on, 88. Pathological specimens, the keeping of, 526. Peasloe, Dr. E R., review of work by, 543. Peliosis rheumatica, 106. Pflvis, normal distortion of, 468. Peiisin, remarks on, 200. 329, 368, 477. Periuterine celluliiis, 393, 397. Perineum, supporting the. 391. 393. Peripheral placentitis, case of, 37. Peritonitis, acute in child, 281. Pessary, retained seventeen years, 45, 311 ; int ra-uterine galvanic, 319. Pessema, remarks on, 308, 403. Peters, Dr. J. C. , on quarantine, 68 ; perforation of pulmonary artery, 580. Peugnet, Dr. E., hypodermic injection of veratrum album, 114 ; on veratrum viride, 121. Pharmacy, Board of, 285. Pharmacy Bill, remarks on the, 17, 64. Pharyngitis, 393. Philadelphia, reminiscences of, 170. Phosphoric acid lemonade, 331. Phosphorus poisoning, turpentine in, 58 ; experiments with, 235. Phthisis, aneurism as a cause of, 305. Physic, Watson's practice, notice of, 351. Physicians, duration of life of, 162. Physiological section of American Medical Association, report of, 191. Physiology, review of work on, 86, 362, 423. Piles, suppository for, 296 ; new forceps for, 26. Pills, a new excipient for, 216. Plaster Paris splints, 140, 150. Plastic apparatus in surgery, 389. Pleurisy, early blistering in, 297. Pleuritic effusion treated by thirst, 30. Pneumonia, early blistering in, 297 ; aconite in, 390. Poisoning, by hydrochloric acid, 84 ; large draughts of water in, 108 ; medical jurispi-udence of, 399. Polypi, excision of by hemp-saw, 149. Polyuria, case of, 394. Pooley, Dr. J. H., letter from, 310. Popliteal cyst, case of, 303. Population, increase of, 17 ; of globe, 543. Porter. Prof. Noah, notice of work by, 26. Post, Dr. A. C, mammary tumor, 112; impalement of bladder, 518. Post-mortem examinations, necessity for, 449. Precocious development, 120. Pregnancy, spurious, feigned and concealed, 225 ; sur- gical proceedings during, 369. Prepuce, follicular ulceration of, 114. Presbyterian Hospital, New York, 480. Professions, mortality, statistics of the, 311. Progress Medical Science, 27, 56, 83, 104, 197, 122, 251, ^275, 296, 323, 343, 367, 389, 414, 441, 466, 540, 570, 574. Protoplasm, action of galvanic cuiTcnt on, 284. Prout, Dr. J. S.. a new needle forceps {ilituitrated), 26. Pruritus vulvae, 298, 444. Psammonea, a case of, 354. Psoas abscess, 251. Public schools, sanitary condition of, 898. Puerperal convulsions, statistics, 335 ; treatment of, 393, 466. Puerperal metritis, remarks on, 15. Puerperal thrombo.sis and embolism, 521. Pulmonary artery, perforation of, 580. Pulmonary consumption, 296. Purpura hemorrhagica, 451. Pus corpuscles, origin of, 252 ; uses of, 107. .586 Index to Vol. VII. Pntnam, Dr. Mnry C, on pyiomia. 7:1 ; scnrliitinous npphritiH, •\'}i; anomalous heart. 111 ; intestinal ob- struction, 2lW. Pvfrmia in Rdlovup Hoxpital, 87H ; remarks on, 7:5. Q. ','n ■ :i'.v ;ii.MinHt, 15.'). Qii:'.; tis. \. IN. ({(!. Oil ' . .- l:ir<^e (lijscs of, 223; in homicr.inia, li»-') ; tniniat« of, IIMI ; as parturient. I!i7, 27(i ; a >ubstituto for. 511 ; in uterine homorrhiif^e. oil. U. '■ • :.•-•», lOS. itLs. remarks on. 29, 200. ......us and ulna, dislocation backward, 297; double fraoture of. .jS. Ilectal .speculum (illustrated), 363. Rectum, plu','trinjf the, 224 ; polypus of, 347 ; speculum for. 402 ; stricture treated by electrolysis, 209 ; traumatic hemorrhage of (illustrated), 301. Red coipusclos, mountinj,' of. 324. Respirator}- diseases, chronic diseases of, 199. Reviews and notiees of books. 19. 8(5, 110, 14(i, 203, 279. 302. 327. 3") I. 377. 400. 423. Rhammis fraiigfular, value of. 329. Rheumatism, influence of on character, 345 ; treatment of. 414. Rhode Island Medical Society, notice of, 333. Rindfleisch. Dr. E . notice of work by. 88. Roberts. Dr. W. C, contagion of yellow fever, 474. Rodenstein, Dr. C. F.. cerebro-spinal meningitis. 71. Rogers. Dr. S., on a "/81. Schoeppe. acquittal of, 399. School, hygiene, 415. Sclerosis utari, remarks on. 15. Scorpion sting, treatment of. 413. Screaming fits, infantile, cause of, 208. Scrofulous anginae. diagnosis and treatment of. 30. Scrotum, instrument for amputation of (illustrated), 161. Scurvy, only in males. 105, 240. Sea- sickness, prevention of, 4.56. Sea-water in London, 288. Seguin, Dr. E., notice of work by, 25 ; surface ther- mometry, 194 Sewall. Dr. J. G.. cerebro-spinal meningitis, 265. Sewing-machines, use of. 59, 527. Sex of fcetus. prediction of. 417. Shoulder, new method for dislocation of, 52. Shrady, Dr. Geoi^e F., the drug-bill, etc.. 17, 18 ; the department of safety. 61 ; medical colleges. 85 ; hospital appointments, 109 ; graduation of improper person*. 153, 253 ; the Inw against quackery, 155 ; the late New York Hospital, 229 ; street cleaning, 301 ; medical leHson.s of Stokes' trial, 325 ; the hygiene of ruralizing. 349 ; American Medical Asso- ciation, 376 ; sanitiry condition of our jmblic schools, 398 ; the .Medicnl RogiHter and the profes- sion, 421. 445 ; our relations to our female patients, 4 ; the farmingout Hystem for foundlings, 513. Sick headache, a reniedy for. 252. '299. Simpson. Sir J. Y. . review of work by, 146, 327. Skene. Dr. J. C, sclerosis uteri. 15. •Skin. nbsor]ition through. 252; grafting of, 572. Skin diseases, treatment of. 225. 22f», 370, 412. Skull, compound fracture of, 2!l'^. Small-pox. chnractors and treatment of, 95, 118, 142, KJO. 198, 23(i. 310. 365. 40.8. 419. 426. 432. 444, 456. Smith. Dr. A. H.. laryngeal mirror in jiosition. 358. Smith. Dr. Gouvemcur .M , on lactic acid, 329. Smith, Dr. J. L., notice of work by. 377 ; pathological specimens by, 36, 39, 451 . • Smith, Dr. O. H. cerebro-spinal meningitis, 268. Smith. Dr. S. , notice of work by, 353. Snake-bites, treatment of, 413. Snell, Dr A B., on American Medical Association, 426. Snuff, lead poisoning from. 56. Soap, brown Windsor, atitute for santonine, 57. Tannin packing in prolapsus uteri, 342. Tape-worm, in child three years, 107. Tar, to remove, 415. Tarantula bite, treatment of, 413. Index to Vol. VII. 587 Temperauce in France, 428. Teetli, replantation of, 149, 3;")2 ; exercise of, 468. Tetanus, treatment of among Chinese, 228 ; treatment of by excision, and chloral, 108, 299. Tetanus cured by excision of nerve, 108. Thapsia as a rubefacient, 106. Theomania, 872. Thermometers, medical, the best, 380. Thermometry, clinical remarks on, 90, 359 ; notice of work on, 2;'). Thigh, amputation of, 234. Thomson, Dr. W. H. , on psammonea, 354. Thorax, impalement of, 198. Throat, notice of work on diseases of, 400. Thrombosis of tibial artery, 156; puerperal, 521. Tibia, reproduction of, 31(>. Tic-douloureux, 296 ; by galvanism, 442. Tonsillotomes, 2()1. Tonsils, hypertrophied, treatment of, 367. Tooth, fracture of, aud union of, 468. Tractea, stricture, a case of. 234. Tracheo- bronchitis, pseudo, 39. Tracheotomy, cases of, 12, 414. Transaotiens of American Ophthalmological Society, 19. Transfusion, cases of, 236, 324. Trephining over lateral sinus, 222 ; case of, 577. Triplets, case of, 428. Trismus nascentium, case of, 343. Trueheart. Dr. C W. , on conjunctivitis, 569. Turnbull, Dr. L., review of work on diseases of, 19. Tuberculosis following bronchial catarrh, 36. Tumors, injections for, 235. Tyndale, Dr. J. H. , vaccination during the fever stage of variola, 10. Typhoid fever, similarity with ovaritis, 106; treatment of, 199, 233,465, 444. Typhus, quarantine of, 8. U. Ulcers, sloughing, iodide of starch for, 105. Ulster County Medical Society, 333. Unscrupulous criticism. 212. United States Marine Hospital Service, 94, 185. University of Pacific Medical Department, 249. University of Pennsylvania, notice of, 383. Urajmia, acute, use of opium in, 160. Uranoplasty, 192. Urethra prolapsus, 299 ; rupture of, 290 ; surgery of the, 217; anatomy of, 235 ; hemorrhoids of, 381, 511. Urethral baths, 60. Urinary calculi in China, 44. Urinary diseases, review of work on, 302. Urine, diabetic, 351 ; indican in, 345 ; in malarial hemi- turia, 197; retention of, 149, 291, 433. Uteri, cervix, amputation of, 275. Uterine, cloth-tents, 57 ; hemorrhage, quinine in, 511 ; anomaly, 151 ; sound, 224, 352 ; tumor, 397. Uteru.q, sclerosis of, 15 ; double, 528 ; removal of inverted, 200 ; fibrous, hypodermically treated by ergot, 344 ; tannin packing in, 342 ; the surgery of, 344 ; foetal femur embedded in, 443 ; unique case of inversion of, 443; prolapsus of gravid, 444; inverted, 513; re- moval of, 510 ; cancer of, 512. V. Vaccine virus, 296. Vaccination during fever-stage of variola, 10 ; remarks on, 65, 11,7, 298, 396, 398, 444,467, 468. Vagina, membranous ca.st of, 40. Vaginal injections, warm, iise of, 100. Vanderpoel, Dr. S. Oakley, on yellow fever, 563. Vanilla ices, poisoning by, 149, 391. Varicocele, radical cure of, 416. Variola, character and treatment of, 10, 28, 40, 190, 326, 347, 371. Varix, injection of ergotin in, 236. Vaso motor physiology, 190. Venereal sores, cauterizing, 151. Veratroida, experiments with, 128. Veratrum al))um, hypodermic injection of, 114; proper- • ties of, 121. Veratrum viride, properties of, 121, 468. Vienna, Medical Department of University of, 44. Vol. VII. close of, 575. Vomiting of pregnancy. 93. Voridia, experiments with, 129. Vowel sounds, production of, 49. W. Walser, Dr. Theodore, on quarantine, 1. Warner, Dr. John W., a case of intussusception, 530. Washington delegates, the excluded, 182. Waterman, Dr S. , on blood crystals, 212. Water, vital importance of pure, 239. Watson, Sir Thomas, work by, 351. Webster, Dr. David, reports of Manhattan Eye and Ear Hospital, 144. Westchester County Medical Society, notice of, 333. Wharton trial, the, 360. Whitehead's, Dr. W. R., gag, 358, 403. Whithall, Dr, S. , cerebro- spinal meningitis, 200; medi- cal thermometry, 380. Whooping-cough, cause of, 298 ; a remedy for, 335, Williams, Dr. C. J. B., on pulmonary consumption, 23. Wisconsin State Medical Society, notice of, 288. Woman question, 174, 187 ; difference between man and woman, 382. Women's Medical College, 315. Women, notice of work on diseases of, 147, 327, 377. Worms, notice of work on, 471. Wounds, isolating dressing of, 336. Wood, Dr. H. C, Jr., notice of work by, 424. Wrist, dislocation of, 296, 408 ; extension in diseases of (ilhistrated), 143. Wunderlich, Dr. C. A., notice of work by, 25. Wymau, Dr. M. , notice of work by, 378. Xylol, remarks on, 20, 329, 347. Y. Tear Book of Therapeutics, notice of, 470. Yellow fever, quarantine of, 4; contagion of, 474; pa thology and treatment of, 38 ; history of, on JVuman- cia, 562. CONTRIBUTORS TO VOLUME VII. Bailey, Dr. James S., Aloany, N. Y. Baukkr, Dr. B. Fordyck, Prof. Clinical Obstetrics, Bellevue Hospital Medical College, New York. Battey, Dr. R., Rome, Georgia. Beach, Dr. Wooster, Jr., Deputy Coroner, New York- Beard, Dr. G. M., New York. Bell, Dr. A. N., Brooklyn, New York. Bennett, Dr. E. P., Danbury, Conn. Bennett, Dr. W. H., New York. Briddon, Dr. C. K., New York. Brockw.^y, Dr. A. Norton, Harlem, N. Y. Bronson, Dr. E. B., New York. Buck, Dr. Albert H., New York. Buck, Dr. Gurdon, Surgeon to New York and St. Luke's Hospitals, New York. Bull, Dr. Charles S., New York. Bumstead, Prof. Freeman J., New York. Bunker, Dr. E. S., Brooklyn, N. Y. Burrall, Dr. F. A., New York. Byrne, Dr. J., Brooklyn, N. Y. Caro, Dr. Salvatore, New York. Castle, Dr. F. A., New York. Chamberlain, Dr. W. M., New York. Clarke, Dr. H. K., Geneva, N. Y. Cohen, Dr. J. Solis, Philadelphia, Pa. Cruse, Dr. Thomas K., New York. De Marmon, Dr. Ph., King's Bridge, N. Y. Derby, Dr. H., New York. DoNNELY, Dr. M., N. Y. Dowell. Prof Greenville, M.D., Galveston, Texas. Dubois, Dr. H A., San Rafael, Cal. DuFFiELD, Dr. Edward, Hannibal, Mo. Dunning, Dr. W. B., Bellevue Hospital, N. Y. DwYER, Dr. John, Ward's Island Emigrant Hospital, N. Y. FixNELL, Dr. T. C, New York. Flint, Prof. Austin, New York. FoRTUN, Dr. C. A., Charity Hospital, N. Y. Frisbie, Dr. C. W., East Springfield, N. Y. GouLEY, Prof J. W. S., M.D., New York. Hamilton, Dr. Frank H., Prof Fractures and Disloca- tions, and Military Surgery, Bellevue Hospital Medical College, New York, etc. Hayes, Dr. R. T., Yokohama, Japan. Henry, Dr. M". H., Ed. Journal SypMhgraplxy and Der- matohgy^ New York. Hewit, Dr. H. S., New York. Hudson, Dr. E. D., New York. Hunter, Dr. W. C, New York. Hutchison, Dr. JosErn C, Brooklyn, N. Y. Jacobi, Dr. A., Prof Infantile Diseases, College of Phy- sicians and Surgeons, New York. Janeway, Dr. E. G., New York. Knapp, Prof H., M.D. flate of Heidelberg), New York. Leaming, Prof James R., iM.D., New York. Lewis, Dr. Z. Edwards, West Farms, N. Y. LiDELL, Dr. John A., New York. Lincoln, Dr. R. S., New York. Loomis, a. L., M.D., Prof of Theory and Practice of Medicine, New York University, New York. Loring, Dr. E. G., New York. Macdonald. Dr. A. E., Small-pox Hospital, New York. Mann, Dr. Edward C, Brooklyn, N. Y. Mason, Prof Erskine, M.D., New York. Mathewson, Dr. A., Brooklyn, N. Y. Miller, Dr. M. N., New York. Miner, Dr. Julius F., Buffalo, N. Y. Mitchell, Dr. C. L., Brooklyn, N. Y. Moore, Prof E. M., Rochester, N. Y. Morris, Dr. Moreau, San. Sup. Health Dept., New York. Munde, Dr. Paul, Florence, Mass. Murray, Dr. Alex., New York. Newman, Dr. Robert, New York. NoYES, Prof H. D., New York. Packard, Dr. C. W., New York. Pardee, Prof Charles Inslee, M.D., New York. Peters, Dr. John C, New York. Peugnet, Dr. E., New York. Pomeroy, Dr. 0. D., New York. PooLEY, Dr. J. H., Yonkers, N. Y. Post, Prof Alfred C, Beirut, Syria. Prout, Dr. J. S., Brooklyn, N. Y. Putnam, Dr. Mary C, New York. Roberts, Dr. W. C, New York. Rockwell, Dr. A. D., New York. Rogers, Dr. Stephen, New York. EossE, Dr. Irving C, U. S. Army. RussEL, Dr. Chas. P., Registrar Records, Health Dept., New York. Sands, Prof H. B., New York. Satterthwaite, Dr. Thomas E., New York. Seguin, Dr. E., New York. Sew ALL, Dr. J. G., New York. Skene, Dr. J. C, New York. Contributors to Vol. VII. Smith, Dr. OorvKnNKi'K M., New York. Smith, Prof. J. Lkwis, New York. Smith, Dr. T. Blajjch, Nyack, N. Y. Spkir, Dr. S. Flkkt, Hrooklyn, N. Y. Stiuson, L. a., P.iris, Frftiice. Sri-DLEY, Dr. Mahv J., Elizabeth, N. J. Thomas. Piof. T. rfAii.i.AiiD, M.D., New York. InnMrsos, Dr. ItHAPKoitn S., New York. TiUKMEAur, Dr. C. W., Gnlveaton, Texas. Ty.vdalk, Dr. J. II., German Ilospiial, New York. Van Geison, Dr. R. E., Greenpoinf, N. Y. VAXDERroEL, Dr. S. Oaki.ey, Quarantine, N. Y. "Walser, Dr. Theodore, SUten Islanil, X. Y. Watekma.n, Dr. S., New York. Webster, Dr. D., ^[anliattan Eye and Ear Ilospilal, Nl'W York, "West, Dr. II. S., Sivaa, Turkey. "White, Dr. Francis V., New York. WniTEHEAP, Dr. W. R., M.D., New York. WniTTAL, Dr. S. G., New York. WiNSLOw, Dr, John, New York. Societies and Institutions from which Rfports have been furnished. A.MKRICAN Medical Association. American Otoi-ooicai, Society. Beli.evue no.spiTAL, Nt-w York. Bellevue IIo.sriTAi, Medical College, New York. CiiAuiTY Hospital, Blackw(.ll'.s Island, N. Y. College Physicians and Surgeons, New York. German Hospital, New York. LoNQ Island College Hospital, Brooklyn, N. Y. Manhattan Eye and Ear Hospital, New York. Medical Library and Journal Association, New York. Medical Society, County of Kings, N. Y. Medical Society of the County of New York, Medical Society of the State of New York. New York Academy of Medicine, New Yorlc. New York Pathological Society. Presbyterian Hospital, New York. Roosevelt Hospital, New York. St. Mary's Hospital. Brooklyn, N. Y. St. Vincent's Hospital, N. Y. University Medical College. St. Vincents Hospital. New York. CO. E Medical Record 21 ^cnii-illoutljli) Journal of iUctiiciiic aiitr ^nt^cx^. Vol. VIL] New Yokk, Maticii 1, 1872. [No. 1. ©rigiital Communications. QUARANTINE REGULATIONS. By THEODORE WALSER, M.D., OF NEW BlilGHTON, STATEN ISLAND, N. Y. Read at a Stated Meeting of the New York Academy of Medicine, Febru- ary 1, 1872. In considering the quesdon of Quarantine, I am con- scious I am addressing the elite of the medical profes- sion — men familiar ^vith the literature, aetiology, and modus propagandi of every disease that comes under its provisions ; and I shall limit my observations, there- fore, to personal experience on a field which is compa- ratively foreign to the student of Hygiene, and in treat- ing the history of epidemics in New York City, merely refer to them as the causes Avhich prompted the fram- ing of new laws and the initiation of further quarantine restrictions. Tou will be pleased, therefore, to bear with me if I speak of these hws as an integral part of the question before us, and, in summing up the experi- ence of canturies, make this experience the basis on which to decide the claims of quarantine. Appalled by the gradual approach of the epidemics of yellow-fever, which had caused such fearful devasta- tion in Charleston and Norfolk during previous years, the first quarantine laws were enacted in the colony of New York by the Lieut.-Governor, Council, and General Assembly in 1758, enacting that " all trading-vessels, transports, and others, having small-pox, yellow-fever, or other contagious distempers on board ; and all per- sons, merchandise, and goods whatsoever, coming or imported in such vessels; and all vessels coming from any place infected with distempers, shall not come into any of the ports or harbors of this city, or nearer to it than the land commonly called Bedloe's Island, and shall be obliged to make quarantine there, or in such other place or places, for such time and in such manner as the Governor, or Commander-in-chief, by and with the advice of His Majesty's Council, shall deem proper and reasonable to direct and appoint ; and until such persons, goods, or merchandise shall have respectively performed, and be discharged from, such quarantine, no such per- sons, goods, or merchandise, or any of them, shall come, or be brought ashore, unloaded, go, or be put on board of any vessel within this colony, or the neigliboring colo- ny of New Jersey, unless they shall first be permitted and licensed by order of the Governor or Commander- in-Chief for the time being, by and with the consent of the Council ; " making the penalty of infiingement of this Unv £200, and £20 if any infected person Avas found on board of any vessel without due notice, or if any pilot refused or neglected to obey the provisions of this law. Whatever may have been the preventive course pur- sued, no epidemic or disease of any alarming character occurred in New York from this date, although Dr. Chisholm remarks, " that the smell from the ships was in the highest degree offensive, and the police at that time by no means efficient, and putrid substances of every description were accumulated in the siiips and every part of the city." In 1784 it was enacted in the Senate and Assembly, that all vessels having on board any persons infected with yellow-fever, or any other contagious distemper, or coming from any place infected with such conta- gious distemper, shall not come into the harbor or city lower than Bedloe's Island, and shall perform quaran- tine there for such time and in such a manner as tlie Governor, or, in his absence, the Mayor of the City, may direct ; and that during such quarantine no person, goods, or merchandise shall be permitted to leave the vessel without the permit of the Governor, or Mayor, of New York. The law further defines the duties of masters and pilots, applies the penalty exacted, as be- fore, for the benefit of the hf;hthouse at Sandy-liook, invests the Governor with the right of appointing a physician, and specifies his duties, privileges, and com- pensation. Yellow-fever prevailed in New York after this to a greater or less extent every year. Of the epidemics of 1791 and 1703 no further account is given than merely stating the number of its victims, and the lo- calities, streets, and wdiarves where it prevailed. Its origin in 1795 is, however, clearly traced to the brig Zephyr from the West Indies ; Dr. Treat, the examin- ing surgeon, being its first victim — as is supposed from making an autopsy of a death on board on the day of her arrival in port. Being permitted to go to the wharf, foot of Dover street, she hauled alongside the ship 117/- liarns from Liverpool, where the disease first appeared among the crew, and a few days later in White near Dover street, extending thence to the adjacent build- ings and streets. Every effort was made by Dr. BaiJy to contradict this statement ; using as the strength of his argument that no one of Dr. Treat's attendants and friends was taken sick, and hence it could not have been the yellow-fever. Indeed, the idea of personal infection had so overshadowed the intellect of the profession, that the most important facts were over- looked in the vain search of evidence for it. In the mean time the TIankey brought the disease from the coast of Africa to New Granada, arriving on the 18th of March. In the middle of April the disease as- sumed an epidemic form on the Island ; during June and July it swept over the entire Island. Erom New Granada it was carried to St. Domingo and Jamaica, and thence to Philadelphia, by clothes, and more es- pecially the woollen jackets, of diseased sailors. "Ves- sels from Philadelphia Avere now quarantined in New York. In 1796 the first Health Oflicer and seven Commis- sioners of Health were appointed, and their duties de- fined. All vessels wMth forty or more passengers from any foreign port were made subject to quarantine ; the Governor of the State was authorized to issue from time to time proclamations designating the ports from which vessels should be quarantined, and the Health Officer or Health Commissioners were authorized to bring vessels already at the wharf back to quarantine, and to TILE MEDICAL RECOKD. anchor wheresoever they might direct. £2,000 were nppropriatetl to orcct a Lazaretto on Governor's Island for the reception of infectious diseases, and placed under the charge of the Health Ofliccr, and a further sum of £2,000 was iipproj)riated for its maintenance. It was then maile oblii,'atory upon every practisin-,' physician to report I'ach case of infectious and contagious disease 10 the lleallli Commissioners. liy the laws enacted in 1798 the apppointment of Health Ollicer and Commissioners of Health, and their respective duties, were still further defined ; all vessels having or liaving had on board any case of lever, or coming from a port where such fever prevailed, being made subject to quaraniine, unless they had been pre- viously in any of our northern ports for a period exceed- ing ten days. Dr. I'nderhill gives the following account respecting the epidemic of yellow-fever which followed in the same year:— " Some time in July the ship Fame is said to have arrived from one of the West Indian islands, and come to the wliarf below New Slip, where she lay for some lime. About the tliird or fourth of August some people went to discharge her ballast and to pump her out. Among the ballast was a quantity of damaged coffee, extremely putrid, which, with the water discharged from the pump, was so oUensive to the smell tliat the neiglibors were induced to shut their windows, espe- cially while eating. About the sixth of the month, a party dined at the house of a Mr. Mead in the neighbor- hood, all of whom were taken sick in their respective residences, on the fifth day afterwards, of yellow-fever, and several of them died. The next house above was visited in the same way ; three of the inmates were t^ken sick at the same time, two of whom died. In the second and third houses the inmates shared the same fate." The number of deaths from yellow-fever during this epidemic exceeded 2,000; wbilein Philadelphia the ravages of the disease were still greater, and, as in New York iu the case of the ship Fame, were clearly to be traced to the Deborah and Mary from the Spanish Main. Ajipalled and now full}' conscious of the danger, and looking to an efficient quarantine as the only safeguard against its importation, in 1790 the healtli laws were so amended as to constitute the Health Officer Resi- dent Physician, and members of the Council the Com- missioners of Health, with the power to purchase a tract of land on Staien Island for a boarding station and marine hospital. The eastern shore was selected, and some of the buildings were occupied during the autumn. The list of ports from which ve.-selswere sub- ject to quarantine embraced now all foreign and do- mestic ports south of Georgia, from the 31st of May to the 1st of October. In 1799, while the authorities were still groping in gutter;, and sinks for the origin of the disease, we find that seventy-four ca.ses of yellow-fever were sent from the city to the Marine Hospital, the dis- ease being confined to Old Slip and the vicinity of the East Iliver. In 1801 the Health Officer, Health Commissioners, and Resident Physician to the Marine Hospital were constituted the Board of Health of New York, and for the first time the introduction of cargoes and nifrchan- dise from infected vessels into the city of New York was prohibited. Cargoes from infected ports had to be discharged by lighters, and the vessel cleaned and fumigated before pratique could be granted. Over seven hundred cases of ship-fever were admitted dur- ing the same year, comprising among the number over one-third of the pa.ssengers of a brig from Sligo, arriv- ing at this port after a long passage, in a destitute and almost starvinsr condition. In 1803, out of 1,G00 cases GOO died of yellow-fever, commencing in coflTee-honse .slip and its vicinity. The source is not given l^y any existing record. Nor can the epidemic of 1805 be traced to positive infection and importation of any one vessel; and to attribute it to the landing of a quantity of rags from Leghorn is perhaps as eironcous as the as-sertion of the Health Officer, that it did not ari.se from any neglect at qua- rantine, or come through that channel. The law pa.?.sed in L'-'Ol, providing that no vessel from infected ports should approach nearer the city than three hundred yards, seems tiien to have been a dead letter. In 1811 the quarantine laws were revised, and vessels from Asia, Africa, and the Mediterranean, and from any port south of Georgia, the Bernuidas, Bahamas, and the West Indies, and all others having forty or more passengers on board, or having had sickness or death while in jiort or on the passage, were made subject to quarantine during the year; and all vessels from Am- erican ports south of Cape Henry were made subject to it from the 30th of May to the 1st of October. Ves- s.'ls with yellow-fever or any other pestilential disease onboard, or hailing from ports where yellow-fever pre- vailed, wore to be unloaded at quarantine, cleaned and whitewashed three times, and to remain at least thirty days in quarantine. No passenger or sailor was per- mitted to proceed to New York until twenty days after the occurrence of the la«t case of pestilential di.sease. Vessels from the West Indies, Africa, and South of Georgia were to remain but four days at quarantine 'to discharge tlieir cargoes by lighters, and under no cir- cumstances approach nearer the city than three hun- dred yards ; and crafs considered to be dangerous to be removed from the city to the quarantine grounds; car- goes of hides, wool, and cotton to be landed at the public stores at quarantine. New York remained exempt from the visitation of any contagious disease during the war Avith England and until 1819. when a few cases of yellow-fever occur- red near Old Slip; but by the vigorous exertions of the Board of Health and the blessing of divine Providence, its spread was averted. In July, 1822, the first case of yellow-fever occurred at the foot of Rector street, attributed to cargoes landed from the Sjjanish Soldier and the Eliza- Jane from Havana, although, as usual, its source was sought in churchyards, gutters, and sinks. A fact not to be overlooked is, however, that the same vessel which car- ried yellow-fever from Key West to St. Augustine, and was the prolific source of the epidemic in St. Augustine, was overhauled at the foot of Rector street, and two of the employes, and five who visited them, were among the first victims of the disease. Of five hundred who had the disease in this year, two hundred and fifty-five died. With this terminated the last of the yellow- fever epidemics, occurring during a period of more than half a century. The quarantine laws, as last amended, remained near- ly the same until 1830, when an act was passed, permitting healthy persons arriving in vessels from infected ports to proceed to the city, but without bag- gage. In August, 1831, the Board of Health were first con- vened to consider the quarantine of cholera, and a com- mission was appointed to confer with the President, and to memorialize Congress to institute a national quarantine, and aid the authorities of New York in protecting the public against the dreaded visitation of cholera. In response, a communication was received from the General Government, surrendering the use of Fort Lafayette as a depot for goods. A resolution was adopted to land all goods from Russia at the Fort. To THE MEDICAL RECORD. Ibis was added, at a later meeting, all merchandise from Hamburg and Smyrna. In January, 1832, tbe appointment of a sanitary com- mission under the auspices of the Greneral Government was solicited, whose duty it should be either to send some of their own members or other agents to the ports of Europe or Asin, where the disease prevailed, and to collect facts relating to the means of prevention, and remedies to be applied in cases of the disease. In April and June further preventive laws were enacted, and §500 were applied to the purchase of chloride of lime. On the 2d of July twelve cases were first reported to the Board of Health, and a proclamation was issued, assuring the public that the disease was not personally communicable. By the 18th of July the number of deaths from cholera exceeded six hundred. Tiie chole- ra epidemic of 1832 first appeared in Quebec. A law subjecting to quarantine regulations all vessels from ports of Upper and Lower Canada was passed in 1833, and has remained in force until the present day. In 1845 a commission was appointed to revise the quarantine laws, but without any special result. In 184S a number of infected vessels, government transports from New Orleans and ^lexico, were anchored oflF the old quarantine grounds. After an easterly wind, a quantity of refuse material from these vessels drifted ashore, lodging in Stapleton Basin. In less than a week following, two cases of yellow-fever oc- curred in the nearest dweUing, and then extended to the adjacent dwellings, and prevailed as an epidemic for half a mile along the shore. Visitors and nurses were attacked ; but returning to their own homes in the interior, the disease remained confined to themselves-, although surrounded by their families, and in localities much more favorable to the generation and develop- ment of miasmatic or contagious diseases than the place where they became infected. In 1849 §50,000 was appropriated, and a committee ap- pointed to efi'ect a removal of quarantine to Sandy Hook. In 1855, the year of the memorable epidemic of yellow-fever in Norfolk, Va., New York remained ex- empt from a visitation of the disease, and but few cases were admitted from shipboard. In 1856 the quarantine laAvs were again revised; new and special power was granted to the Health Offi- cer, and by an adroit transposition of the figure 3, the coastwise quarantine was extended from the 1st of April to the 31st of October, instead of from the 30th of April to the 1st of October; and after the different ports of the West Indies, Mediterranean, and coast of Africa, from which vessels were subject to quarantine, "all other ports" were sandwiched in, by which the Health Officer's income was increased from $6,000 to $10,000 per annum. The epidemic prevalence of yellow-fever at Fort Ham- ilton, on the shores of Staten Island, and on Governor's Island, during this year, has been so ably and recently described by Dr. Harris, that I need not refer to it. In 1858 the quarantine hospitals were destroyed, and then an entire change of quarantine regulations was initiated. The Commissioners of Emigration, the legal custodians of the quarantine hospitals, were super- seded by Quarantine Commissioners in 1859, and §50,000 were appropriated to defray their expenses. The "Floating Hospital," constructed from the hulk of an old ocean steamer, was anchored in the Lower Bay for the reception of yellow-fever patients, and as a boarding station for the c^uarantine of vessels from the West Indies, coast of Africa, and American ports south of Georgia. In 1861 an additional appropriation of §43,000 was made, and — In 18G3 the quarantine laws were so revised as to give the Health Otticer additional powers, even to the destruction of cargoes and the submersion of vessels. The employ6s, stevedores, and lightermen were to be selected by him, but their compensation was fixed by the Commissioners of Quarantine, who were also by this act constituted a Board of Appeal. In 1864 a further sum of §80,000 was appropriated. In 1865 the quarantine laws were again revised, but without making any material change; $49,000 ad- ditional were appropriated. In 1866 the Mayors of New York and Brooklyn, in conjunction with the Commissioners of Quarantine, Avere empowered to construct permanent quarantine buildings in the Lower Bay, and §400,000 appropriated fur that purpose. The sale of the old quarantine grounds, with the exception of a boarding station, was ordered, and, by concurrent resolutions, the general government petitioned for hulks and vessels for tem- porary quarantine purposes. In 1867, besides further appropriations of §132,000, temporary accommodations for the reception of passen- gers under quarantine were ordered to be made on " Barren Island," and the west end of Coney Island selected for a boarding station; but during the follow- ing session in '68 this law was again repealed, and no further enactments passed by which the quarantine reg- ulations were materially modified. Over §300,000 have sinc3 that time been appropriated for the maintenance of quarantine and the construction of buildings on the island in the Lower Bay. under the law of 1866 ; only the lower one is prepared to re- ceive patients, while the upper one remains unfinished, and may come "handy." but is certainly erected with- out special design or purpose. In reviewing the history of quarantine, and the various laws enacted to protect the community from the introduction and prevalence of contagious diseases, we find that every progressive measure was prompted , by a sense of the insufficiency and insecurity under ex- isting laws, and the modification and change of medi- cal opinion in regard to the mode of emanation and i propagation of the disease. The quarantine had been removed from Governor's and Bedloe's to Staten 1 Island, and each one in its turn abandoned. At first it was only intended to protect against yellow-fever I and small-pox. The swelhng tide of emigration, and the prevalence of typhus amongst the masses, intro- duced the last-named disease as the most prominent danger to be guarded against. Then cholera, appalling and tearful in its destructive march over the continent, called for new and energetic measures of self- protection. And so, patch upon patch was added, meeting each I contingency, and providing for ever}^ successive emer- gencies ; each disease in its turn engaging the attention I of law and medicine, as the danger from its ravage.? I appeared more imminent. The range of ports from ' which vessels were subject to quarantine was gradually ! extended, until it finally included all vessels from all foreign ports, and all coastwise vessels from domestic ports south of Cape Henlopen, from the 1st of April to the 31st of October. Before we consider the mode of propagation and the quarantine of each disease, permit me first to cast a glance upon the topography of port? from which ves- sels were subject to quarantine in the harbor of New York. I have already mentioned how strangely and surreptitiously " all other ports" have been smuggled in under the laws of 1856. What are the diseases which possibly can excuse a quarantine of merchant, vessels , from any of our northern ports ? Why are vessels from i Nova Scotia subject to sanitary restric; ions from which THE MEDICAL RECORD. Maine is exempt? and liow is it that vessels coming iliruufrh llu' sound ni;iy and do onlfr New York Harbor at all seasons, while vessels puissinp to llio east- ward of LoDfj Island are subject to visitation ? Are tliere any professional frrounds whatever justifying this restriction or infringement on conuneree? The same may be said of merchantmen from the west of Kuropc, whid), prior to this interlineation, were not subject to quarantine nnless having passengers on board. And yet only a slight, a very slight diancc exists of diseaSlatea, but is always the result nf impurt'ition from abroad. During the war the mo.'t ii;.«alubriou8 ports remained exempt from its visitation, and this less on account of an eflicienl quarantine, or inUjrmd sanitary regulations, but becau'^e commerce and intercourse with infected districts was partially or entirely cut off. II. If not indigenous, yellow-fever is necessarily a portable disease, and its portation must either be a, /'// jtersons laboring under the disease, and repro- ducing the morbific germ ; or, b. by things, f /miles, ship-s, merchandise, p<;rsonal effects, transmitting the germ in its maturity. a. liy persons. — The difficulty ofseparating effect from cause, and our inclination to draw our indications from the visible, perceptible, and tangible, have necessari- ly led tiie inquiring mind to look to the yellow-fever patient as the meansof portation and communication, and thus to overlook the most important facts connect- ed witii the transmission and development of the dis- ea.se. A clear interpretation of the experience of a century, and much negative evidence prove, however, beyond a doubt, that persons and their eliminations have 110 agency in tiie matter ; for not a single case can be traced beyond the source of infection, though thou- sands have fled during every epidemic from the stricken district, or tlic exposure to fomites, to be nursed and cared for where prior to their arrival no case of the discTse existed. From the opening of the Quarantine Ho.spitals in 1798 to their destruction in 1858, over 1,200 ca.ses of yellow-fever were treated, and not a single instance is on record in which the disease was communicated from the sick and their eliminations, to patients admitted with other diseases ; while the introduction of cholera was almost invariably followed by the development of similar cases among the other patients. Over 200 patients have since been treated in the Floating Hos- pital, and yet not one of the employes ever took the disease. Assuming, then, as an incontrovertible truth, that persons cannot be the carriers of yellow-tever viru.«, it necessarily devolves upon inanimate matter — vessels and fomites — as the only remaining media of transporta- tion from its original or acquired liabitat. I may cite as evidence in proof, the history of every yellow-fever epidemic, both on this continent and in Europe, in which the disease could be traced to these things alone, although local causes may have contributed to its incep- tion and development. b. By thinys. — That vessels may become infected, and the floating habitat of a local epidemic,' is corro- borated by the experience of every year, and the only questions before us are : Its source, or the condition of the port of clearance requisite for, and the condition of vessel and fomites favoring, the inception and infection by yellow-fever virus. Ports. — Yellow-fever may prevail as an epidemic, appalling and intense, or the occurrence of a few spora- dic c;iscs may simply indicate the presence of the virus ; although the former almost insure infection, the latter by no means excludes the possibility. The Alabama was infected by yellow-fever at Key West.where its pre- sence was not even known to the commander. The port may be land-locked, surrounded by swamps and decay- ing vegetable matter, as at Havana ; or an open road- stead, as Campeche, Tampico, and the probabilities of infection may be correspondingly less. Again, the vessel may be loaded by lighters, or at the wharf, the former not excluding, the latter certainly fovoring, the probabilities of infection. Vessels. — Old vessels are invariably more liable to infection than new ones, to whatever we may attribute THE MEDICAL RECORD. this predilection ; and that a local cause exists we may infer from the fact that we have vessels of bad repute, once the habitat of infection, and under ?iniilar circum- stances more than likely to be again, although others may escape. The James H. GHddev, Julin I/iilleck, and Susquch((H7ia, are instances ; in each yellow-fever had prevailed repeatedly. Repeated observations also show that human eflluvium favors the infection of vessels with tlie specific virus of this disease, as it does the occu- pants of crowded passenger ships and prisons with t}'- phoid. Yellow-fever occurs much more frequently on board of men-of-wnr than in any other class of vessels, notwithstanding the severe and constant attention to cleanhness and ventilation which the sanitary discipline imposes. The names of the Buzzard, Enterprise, 8us- (jiteluutnii, Ahhnna, and Tahoma stand pre-eminent in om- quai'antine records of yellow-fever. B}'' a pas- senger ship the disease was first introduced into the West Indies. Tlie ship Dehorah, aBritisli transport from St. Thomas, carried the disease in 179S to New York ; and the only infected vessels which arrived here during the summer of 1862 were Coolie vessels, which had dis- charged their living freight in Havana, while not one of the Havana packets or ordinnry traders appears to have suffered by the prevailing infection of the Port. Fomites. — Tlie portation of yellow-fever virus by fomites, by railroads and other conveyances than infect- ed shipping, cannot be the subject of quarantine regula- tions, and is of at least questionable occurrence. During the terrible epidemic in Norfolk, thousands came by rail to every city in the union, and I am not convinced of the occurrence of any case from persons or things brought thence. III. Mode of Infection. — Yellow-fever may extend from the infected vessel — 1. B]! contifiuitij, 2. Bij winds, 3. Bij fomites. 1. By contiguity. — To the law of contiguity we may attribute the prevalence of every yellow-fever epidemic in New York, commencing invariably in slip?, docks, and streets nearest to tlie focus of infection, until the approach of infected vessels was prohibited by laws, and in its efficient administration the introduction and prevalence of the disease prevented. What may still occur in the absence of such preventive measures we may infer from the history of St. Nazaire, in France, in 1861, when the Anne Marie arrived from Havana, having lost two of her crew by yellow-fever. On board of three vessels moored close to her the crew sick- ened in the order of their proximity not only, but while the vessel moored nearest to her lost four out of five, the third lost only one in seven other crew. 2. By winds. — Whatever may be tlie nature of yel- low-fever virus, its specific gravity is obviously greater than air, — as this alone can fix it to the vessel, — and vir- ulent in the degree of its density. The lower the stra- tum the more poisonous its influence. That by dis- charging and ventilating, the virus is dislodged and set free, we see in its effect upon the lightermen receiving cargo or ballast, and persons bathing in the immediate vicinity of discharging vessels. The extension of this virus so liberated, and by its specific gravity floating on the surface of the water, certainly cannot be limited, except by attenuation ; and if theformntive elements are found upon the water, or, drifted by wind and wave on shore, it finds the matter or formative element on shore, it will, under circumstances resembling its tropical habitat, necessarily generate and develop. The epi- demic on Staten Island in 1848, on Long Island and Staten Island in 1856 and 185S, each occurring after continued winds from the fleet of infected vessels, may be solely attributed to this mode of infection ; while the epidemics on Governor's Island, occurring in 1856, 1858, and 1870 in the same locality, the point nearest the Atlantic dock, where cargoes from vessels at qua- rantine were constantly received, was unquestion- ably due to the liberation of yellow-fever virus from these cargoes drifting on the surface, until it found on the shores of the island, or the df'biis floating near its shores, the requisite formative elements. This drifting, as snow in winter, may also account why a fence, a row of dwellings, an artificial barrier will arrest the progress of the disease ; and why tlie north side of llotten Row suffered while the south side remained exempt; on Staten Island the houses fronting the bay were infected, while others adjoining,fronting inland, remained exempt. By fomites. — These may be either materials Jloating NEAR, or the cnrgo, dunnage, and personal effects from the infected vessel. We have unquestionably in the floating material the most prolific source of infection. This may or may not be from the infected vessel, but debris, decompos- ing porous substances constituting the formative cle- ment for the floating virus, imder circumstances most closely resembling its tropical habitat. The straw taken from the Bay by the first victims on Fort Hamilton, the mattress at Gowanus, were such; though neither could be traced directly to an infected vessel. Cargoes. — To prove the infection by cargoes is ex- tremely difficult, because isolated cases are apt to be misunderstood, or hushed up under the apprehension ot public alarm, or reproach for ofBcial negligence. In 1822 the epidemic was attributed to a quantity of su- gar stored at the foot of Rector street. Custom-house ofticers were reported sick of yellow-fever while em- ployed at the Atlantic Dock, Brooklyn, in 1856; and Sleight, a custom-house officer not connected with quarantine, is said to have died of yeflow-fever in 1848. The law makes distinction in cargo and the charac- ter of "fomites" liable to carry disease, which is per- haps not wliolly based upon "facts. Rags, unwashed and from an infected port, may certainly be potent car- riers; and as the history of the J. II. Olidden teaches, a prolific source of infection, as also hides and animal remains. On the Chr. Martell seven out of twelve employes sickened, who had carried the partially de- cayed sheep-skins on deck. But few cases are known where general cargoes and the products of the tropics proved injurious, unless in a state of decomposition. Dunnage and Personal Effects. — That dunnage from the hold of an infected vessel may carry the virus we have the evidence in the Susquehanna. A Watch- man (?) slept in the folds of a sail removed from the hold of the ship the previous day ; he sickened in five days, and died of yellow-fever. That the virus may be carried a great distance by personal effects we have in evidence the well-known instance of the chest of clotliing carried from Martinique to New Haven, in 1794; the clothing of a dead sailor, washed in Lombardy St., in 1822, and infecting all pre- sent; the disease of the Sinclair family in Quarantine, in 1848, attributed to the clothing of stevedores sick with yellow-fever; and, more recently, the case of the mate of the Cravford, who went from a vessel, which subsequently proved infected, on board of another, out- ward-bound, the captain of which sickened three days after he slept in the bunk above the one containing the mate's clothing — in every instance the effects came from localities positively infected, without being opened and ventilated, and carried to localities favoring in- fection. THE MEDICAL KECORD. After careful considiTation of the natiiiv of yellow- fever, conclusively proving its exotic origin, nnd that it c.innot occur in our latitude unless carried by vessels and fviniiU'S, the condilions of infection of vessels abroad and the means of conveyance to our shores — the quarantine measures to prohibit the introduction and prevalence of the disease is the question of tliC great- est iinporlancc. The Quarantine of Yellow- Fever. — By law all vessels from any i)oint south of Georgia, the coast of Africa, and the ^lediterra'.lean are boarded from the hospital- ship, anchored about three miles below tin; Narrows. Upon examination of the bills of health, the sanitary record, and the present condition of pasoengers and crew, immediate prutiiue is (/ranted, or the vessels are detained to remain under observation, or perform quarantine. Inmiediato pratique is only granted if no ])retoxt wliatever exists to retain the vessels. I use the word pretext purposely ; fir as long as the Health Officer is the beneficiary of his own acts, and every vessel quarantined is a source of revenue, as during the past few years, it is scarcely to be presumed that he will lean towards the master of the vessel, anxious to end his cruise and join his home, who finds even a few days' quarantine very irksome. The quarantine of observation applies to all vessels coming from any port suspected of being infected, or at any time the seat of an epidemic, and implies a qua- rantine of from two to five days, opening of hatches, ventilation, and fumigation — provided the placing of half a dozen plates of black oxide of manganese, chlo- ride of sodium, and dilute sulphuric acid merits the name of fumigation. If the sanitary condition of the port of clearance is more questionable, or the cargoes of such a character that it belongs to the first class, as designated by law, the quarantine is extended from ten to fifteen days; and should the suspicion amount to positive evidence that sporadic cases occurred in the port of clearance, or any port where the vessel stopped on her homeward passage, the vessel is detained either with her own crew or with a crew of ship-keepers, for a period of from twenty to thirty days ; and only if all remain well, and later reports from the port of clearance show that yellow-fever is not epidemic, the vessel receives stream permit, or direction to discharge on an isolated dork or irarehouse. It will be remembered that by the laws of 1805 vessels suspected of being infected were prohibited from com- ing nearer the wharf of the city than 300 yards ; and the '■ stream perfliit " is unquestionably yet in obedi- ence to tliis ancient law, and certainly one of the best provisions whenever a question as to the sanitary condition of the vessel exists. " Isolated stores and warehouses " is of course a relative term ; the stores especially mentioned are, however, the west side of the Atlantic Stores, Brooklyn, which, surrounded by water and built of stone, and at least ha'f a mile from any dwelling, offers lacilities of isolation and compara- tive security which no other presents. Should Robin's Reef be built up by stone, as granted by tlie Legisla- la!ure, it would of course supersede the Atlantic bock for all quarantine restrictions. A vessel arriving from a port declared to be infected, by foul bills of health or private information, is suspect- ed of being infected, though all are well and have been during the passage. After a few days' quarantine she is discharged by licensed stevedores and lighters, and no pratique granted until sufficient time has elapsed to prove, by the continued good health of the employes, that she is not an infected vessel. By the discharge of vessels we have not only thor- ough ventilation, efficient means of disinfection of ves- sels and cargo, but, in the continued good healtii of a number of unacclimated employes, exposed lo tiie virus umler the most unfavoraljle circumstances, a number of negative evidences amounting lo positive assurance that the vessel is not an infected ves.sel. From the same port vessels may arrive, on board of which cases of yellow-fever may have occurred while in port or on tlie iiassa;^e, but no cases after the fifth day of her di-parture; ^he may be an infected vessel, but no positive evidence is adduced, since all her cases may be traced to the port of clearance ; she is treated in the same way, receiving jiratique only after every evidence manifests her sanitary condition. Another vessel arrives with new cases of yellow-fever occurring si.x and more days after leaving port, or even after her arrival in New York Bay ; she is quarantined in the Lower Bay for thirty days after the occurrence of the last case, then discharged by lighters, her cargo only receiving conditional pratique, .and the vessel only alter every evidence that she is no longer an infected vessel. When, however, this evidence confirms that she is and remains an infected vessel, she is quarantined till frost, her only solvation. A difficulty arises in the treatment of vessels in bal- last ; in this ca«e ship-keepers are placed on board, the vessel is cleansed, and the ballast moved by persons un- acclimated to the disease, and the vessel treated as others. Thanks to a manifest Providence, by this course not a single case of yellow-fever occurred in New York or harbor while Dr. Gunn was Health Officer, although over 500 vessels arrived from infected ports, and 10 vessels were declared positively infected, being refused pratique until after the middle of October. It willihus be seen that the percentage of infected vessels in vessels coming from infected ports is only a little over two per cent., or rather that the ordinary meth- od of disinfection by ventilation and fumigation suffices to eradicate the virus of the disease, or, by extreme at- tenuation, renders it harmless. It may appear strange that no provision should exist in our port for these positively infected vessels; but as frost alone exterminates the virus, and any other meth- od would necessarily entail loss of life, quarantine till frost is after all the only safe method, and more readily submitted to b}' masters and owners than exactions which they deem frivolous and unnecessary. Disinfection of vessels. — Frost alone can positively eradicate the disease, and to apply this so as to bring the temperature on board the vessels below the freez- ing point during the summer months is difficult, but by no means impossible, and only a few abortive trials have been made during the administration of Dr. Gunn. Ventilation of vessel and cargo may, and, as our experi- ence proves, will, fti a measure, disinfect vessels, for we know that by discharging of cargo or ballast the virus I is liberated, and vessels showing the most positive proofs of being infected on arrival, in the course of time give sufficient negative evidence to doubt longer that she is an infected vessel ; but neither white-wash- ing three times, as under former laws, nor fumigation, nor ventilation, nor even scuttling, will positively dis- infect an infected vessel. Fumigation. — The very method of fumigation as now employed in quarantine shows the utter contempt for this method of disinfection, and I doubt very much if a medical man can be found who believes that chlorine, to the amount used on board of these vessels, can have any effect whatsoever in the disintegration of the virus; and neither bromine nor carbolic acid, nor any other of THE MEDICAL KECORD. our disinfectants, can really prove more than mere aux- iliaries in llie disinfection of vessels. Tlie Upi^er and Loicer Bay as Quarantine Slations. — The detention of vessels at the Lower Quarantine, both while under observation and quarantined as suspected or infected vessels, commends itself so positively to our view of quarantine that it needs no argument in its fa- vor, and the discharge of suspected vessels at the Up- per Quarantine is excusable only by want of faeihties at the Lower Bay, and at no time should more than two or three vessels be discliarged at once, and at a suf- ficient distance from either shore, to insure immunity. Should stevedores or other employf-s sicken during the process, the vessel is to be returned to the Lower Bay and treated as an infected vessel. Ship-heepcrs. — The employment of ship-keepers to act as tests for the sanitary condition of the vessel may appear questionable; but as they fully understand their position, and are correspondingly paid, they voluntarilj^ assume the responsibility. Sievedorinc/. — The stevedores are the most important instruments in the hand of the Health Officer — his baro- meters, bjr which he judges the sanitary condition of the vessels ; yet as only suspected vessels are to be discharged, or in equity can be discharged, the steve- dores enjoy a certain security, although, of course, they are exposed to constant danger. Under the regime of Dr. Gunn they were mostly residents of Staten Island. Roll was called every morning, and any absentee im- mediatel}'' visited, and, if sick, taken to the hospital. The vessel where he contracted the disease being, of course, the one Avhere he labored five days — the univer- sally accepted time of incubation in yellow-fever — pre- vious to his illness, and such vessel then considered an in- fected vessel. At present a barge anchored in the Ba}^ answers for their residence, and, of course, places them still more under the vigilant eye of the Health Officer. Lightering. — Under the present law, vessels in quar- antine are lightered by persons and vessels licensed for that purpose by the Health Officer, and though their compensation is fixed by the Quarantine Commission- ers, the exactions under this monopoly are such that the lightering of cargo in quarantine is considered one of the most oppressive burdens of commerce. And when we consider that the vessels so licensed are daily at the wharves of the city, and used at the option of the owner for every other purpose, we must certainly question the ecfuity of law which grants such monopo- lies. It ia true that men on board are subject to infec- tion by yellow-fever, but this can only happen if the sanitary condition of a vessel has been improperly judged ; and if it should happen, no one behoves at the present day that a man sick with the yellow-fever could communicate the disease to others in his residence. The onl}^ thing necessary, then, and justifiable by reason or experience, is that the men employed in quarantine shall give bonds to the effect that any sickness occur- ring among their employes shall immediately be re- ported to the Health Officer. IN VARIOLA. An efficient quarantine is established by'prevcnting the intercourse of the community with variola, and the personal eliminations of the disease. Yariola did not' exist on this continent before the advent of the Caucasian race, and cannot originate de novo among the nations which have supplanted the ' Aborigines. It may, therefore, become absolutely extinct if we succeed in cutting off all intercourse with the per- sons diseased and their eliminations. The persons are either the patients already manifesting the presence of the disease in the particular eruption, or persons ex- posed to the virus, in which the disease has not yet made its appearance. The eliminations of the dis- ease are its products — the scab in its progress to ma- turity, and the more ethereal eliminations impregnating j the clothing and other personal effects of the diseased ! within a certain distance. What this distance may be, and the medium of its propagation, I am as unable to determine as I am to explain how far the odor of the patient may be cnrried, and by what means. We find, perhaps, in this a vague but approximate analogy. Certain it is that in no instance has the dis- ease been known to have been communicated from the Small-pox Hospital at Quarantine to the surround- ing village, a distance of some 300 feet. An interest- ing and rather amusing incident was related to me by the captain of a Coohe vessel, on which small-pox ap- peared soon after leaving port. He had a coop erected in the mizzen-top, where he placed his two patients ; not only did no new cases occur among the passengers, but the convalescents descended hale and hearty after spending three weeks there. Another captain quaran- tined a case of small-pox occurring among his crew, by placing him in a boat hung by a davit (rom the stern of his vessel ; the man recovered, and no new cases occurred. Small-pox patients are now carried to the hospitals on Ward's and Blackwell's Islands, and the only ques- tion is the propriety of the mode of transportation in boats used for other purposes? In the determina- tion of the quarantine of well passengers, exposed to the virus of small-pox, the extent and source of the disease, as well as the mode of isolation of the sick, must necessarily guide the Health-officer in granting pratique. If occurring as an isolated case, only trace- able to the port of clearance, vaccination of the pas- sengers and immediate pratique is all that is desir- able. When, however, a number of cases have occurred, the port of clearance not being the source of infection, but the sick on board of the vessel itself, thorough vaccination, and revaccination of all that have not taken the vaccination after four days' quarantine, are indispensable ; and as vaccination only rec[uires three days to manifest in its success entire and absolute immunity from the disease, pratique may then be granted, wiih the assurance that no new cases of variola will develop themselves. If not thoroughly vaccinated, new cases may occur, from seven to twenty- one days after the first case, or thirteen days after exposure and the maturity of the first case. For this reason I would commend the mode instituted by our lamented Dr. Gunn, who ordered the vaccination to be done with fresh lymph, by Dr. J. P. Loines, of the Eastern Dispensary, — almost invariably showing the desired result on the fourth day. The superiority of this plan over that of vaccinating from a scab, carried, perhaps for weeks, in the pocket of a police officer, appointed for the nurpose of vaccinating, can scarcely be a matter of doubt in the profession. I would sug- gest, as a sanitary measure, that all vaccination be done by the vnccinating dispensary which may offer the greatest facility of obtaining, at all times, sufficient fresh lymph. In this way, not onl}- would it be done thoroughly, but the Health Officer would be relieved of the suspicion of giving orders merely for his own pecuniary benefit. The disinfection of clothing, bedding, or personal effects, impregnated by the ehminations of small-pox patients, may be effected by a continued high tempera- ture, interment, or fumigation, or by over twenty-four hours' exposure and ventilation on a warm summer's day. Thirty minutes' exposure of the scab of the small-pox patient, — the most concentrated form of THE MEDICAL RECORD. porsoiml eliniiiiatioiis — to a toinpernturo of 130" and upwards, will di-slroy iLs virus as eflVctually iis three days' liiirial in dry clay — a process cniciont f-nouf^li, not only to render the virus perfectly inert, but also to exterminate the pediouii so ofleii infecting the clothing of small-jiox pa'ients. Simple washing and boiling •will disinfect — but this measure may l)e carrii'd ad ahsiinluin, if not oidy the effects of tlie patient, and tlie materials within the reach of the elinnnalions of the sick, but all the elTects of the passengers of a first- class steamer are also required to be so treated. The vessel itself recpiires no further quarantine than is required to wash and clean the rooms occupied by the sick, and by fumigation, entirely destroying the germ of future infection. A scab from a patient exposed to the fumes of nitrous a'id will oidy becDme inert after continued exposure; while chlorine will only jiroducc its etVect in its concentrated form. Fumigation in small-pox is, therefore, to say the least, a questionable expedient, and certainly much less reliable than high temperature. Having thus briefly spoken of the quarantine of small-pox, and recommended the immediate removal of the patient, vaccination of the well passengers, washing or burying their personal effects, and the cleansing of the vessel, let us proceed to the quarantine of typhus. The records of the quarantine hospital show that cases of t^'phus were admitted during almost every year, from its opening, in 1798, to the present day, almost invariably occurring after long passages on board of crowded vessels, with insufficient and unwholesome food. But it was not until after the Famine in Ireland, in 1847, that the disease really became epidemic. From that year until 1853 over twentv thousand cases were admitted and treated in the Marine Hospital, crowding the buildings to over- flowing, and necessitating the temporary occupation of the public stores for hospital purposes. These were four stories high, large and massively built, with ceil- ings not more than nine feet high. The mortality in these was, however, so fearful that they had to be abandoned, and temporary shanties erected, thereby diminishing the percentage of deaths to nearly one- half Since 1853 the number of cases has been steadily decreasing, until in the last few years comparatively few well-authenticated cases have occurred eitlier on ship-board or in the Emigrant Hospital. "With increased facilities of intercourse and commerce, of railroads and steamboats, famine has become well-nigh an impossi- bility, and typhus, the legitimate offspring of inade- quate nourishment and bad ventilation, has ceased its ravages in Ireland, its principal habitat. With the advent of ocean steamers and quick passages, it is scarcely possible that we shall evearhave any consider- able number of typhus patients to provide lor, or that there will be occasion for quarantine regulations to prevent its introduction. Typhus can originate as an epidemic only from ^rand national disasters, and, as already mentioned, it follows in the wake of famine and destitution, and is communicable, contagious, and infectious only by personal eliminations of the sick poisoning the immediate atmosphere, and rendering all within its precinct amenable to infection. The more concentrated the poison, by reason of the great number of the sick, and the less the number of cubic feet of air allowed to each sick individual, the more intense the poison, and the greater the danger — hence the terrible mortality in the public stores^ already men- tioned, where not merely fifty per cent, of its inmates, but also of the nurses and attendants who entered them, were among the victims. To the same cause may also be atiibuted the virulence of the disease on board of emigrant vcs'sels crowded with pa.ssengers, imperfectly fed, and witli less than the re(iui.site amount of air to sustain a healthy condition. l3r. Doanc, the lamented Health Officer, died after a single visit to the steerage of one of these ve.s.sels. As heated air ascends, so will the air impregnated with the virus of typhus ascend — in proof of which I may give my experience in one of tlie typhus wards, in which almost every patient in certain beds of the ward died, while others recovered. Upon examination it was found that a shaft communicating with the ward below opened directly under these beds. For the same rea- son we find that on board of emigrant vessels the disease is much more prevalent in the neighborhood of air- passages, communicating with the lower deck containing ca«es of this disea.se, than elsewhere. And while the morbific cause of the disease is so potent in the wards, it is a singular fact (hat a few feet beyond it, and by the interposition of a comparative narrow stratum of pure air, all danger ceases. There is not a single instance on record in which the disease was communi- cated to a distance greater than one hundred feet from the typhus ward, where every attendant sickened and many died. The quarantine of typhus, therefore, is simply isolation of the infected ; and the present provision at Ward's Island is probably as good as can be provided, as no possible danger could accrue to the city in their tran.s- portation, or to the other sick of the hospital, if any number of typhus patients should be provided for in isolated buildings on the island. Not oidy those sick of typhus, but all who have been exposed to, and there- fore subjl'ct to the disease within the ordinarily accepted period of incubation, should immediately be removed; and I know of no place better adapted for the reception of sucli passengers than the extensive fields of Ward's Island, where, during the winter season, they can be placed in well ventilated houses; but in summer, if possible, they should live in tents. An instance of a quarantine of this kind we had a few years since in Perth Aniboy, where the passengers of a badly infected vessel were disembarked, quarantined in open tents, and not a single case occurred after their disembaika- tion. Indeed, I hold the practice of retaining the pas- sengers on board of vessels on which typhus had pre- vailed as most reprehensible ; for although the sick may be removed, and every precaution taken to pre- vent the further progress of the disease, it cannot thus be arrested. In the instance of the Ctpiosure we have the most painful illustration of this. Not only did fur- ther cases occur after debarkation at Quarantine, but I valuable lives were lost, and the entire depot at Castle : Garden was endangered by this nefarious practice. The quarantine of vessels after the debarkation of the 1 sick and well is only requisite for the time necessary I to thoroughly cleanse and fumigate them ; and here the \ fumigation by chlorine gas, generated from a mixture of j the black oxide of manganese, salt, sulphuric acid, and water, is certainly the most efficacious. Merchandise . from vessels with typhus on board can never be the subject of quarantine ; for there is no instance on record in wliich it was, or could possibly have been, the mor- bific agent of the disease. CHOLERA. The literature of cholera is so voluminous, and the history of its Indian origin and prevalence, its migra- tion over the Continent of Europe before it reached America in 1832, is so familiar to all that I cannot pre- THE MEDICAL RECORD. sume to refer to it except in its relation to the subject before us — the quarantine of cholera. The verdict of the ablest wiiter is, " that all quarantine and sanitary cordons are useless." I admit at once the truth and equity of the verdict, unless all intercourse ■with the locality whore the disease prevails as an epi- demic, even in a limited form, is absolutely and entirely out off; for the researches of Pettenkofer, corroborated by our own experience, prove beyond a question, that though persons from an infected locality are invariably the pioneers of the disease, vi'hcrever it occurs, they may be apparently in p;ood health when they leave the source of infection, and unconsciously to themselves, or inappreciably to others, be the carriers of the disease. But while admitting this as truth in Europe, and on this continent if the disease has once taken a foothold, 1 make the assertion with as much assurance, that with a sanitary cordon of 2,000 miles in width, and a lapse necessary for its transit of ten daj'S or even move, an efficient quarantine ma}' prohibit and absolutely prevent the introduction of the disease into America. Before 1832 the records of quarantine exhibit, almost annually, deaths from " cholera morbus ; " but not until the lOtii of July of the year named have we any rec- ords of Asiatic cholera at the quarantine hospital. The disease had then already become epidemic in Quebec and Montreal. Whether it had been conveyed to this port by the Henry IV. from Havre, or whether it had been brought hither by the ship Carrick from Europe, arriving on the 1st of June, only a few weeks prior to the Henry IV., I will not undertake absolutely to decide. It is rather ominous that the first two cases Avere admitted from New York, and not from ship-board. A brig bound from New York to New Orleans was wrecked on Folly Island, and the passengers and crew, among whom cholera had prevailed previous to the disaster, were taken ashoi-e. The disease extended to the feAV negroes and wreckers living there ; physicians and nurses were sent from Charleston to attend the sick. In January, 1833, a man-of-war arrived at Havana with cholera on board. In February it became epi- demic in the town, carrying off" over 10,000 persons, or 10 per cent, of all its inhabitants. In 18-iS cholera prevailed in Bremen. Unal^le to procure the desired accommodation, a number of emi- grants went to Havre, and thence took passage on the New York sailing on the 9th of November. On the loth cholera first appeared among the passengers from Bremen. On her arrival here in New York, on December 6th, seven had died and eleven were landed sick. The remainder were landed at the public stores. Many were subsequently taken sick, and the disease extended to the hospitals and the surrounding build- ings — the first case occurring on the 6th of December in the building nearest to the ward where the female cholera patients from the Neio York had been placed ; and on the 8th of December another, in the ward con- tiguous to the cholera hospital for males; on the 10th of December several cases occurred in the building where patients from the same ship with other diseases had been placed. In all, over 100 were attacked. In the spring of 1819 a number of vessels arrived with cholera on board, the disease again extending to other patients, over 100 dying. But it was not until May that it made its appearance in New York. In Boston the Argyle arrived from Scotland, with cholera on board, on the 4th of June. 600 deaths occurred from the 11th of June to the 13th October. In New Orleans the first case of cholera came from the ship Swinton, arriving on the 2d of December from Havre ; and from the 11th of December until the 7th of February ov^er 1,200 died. The fatal consequences that have almost invariably followed the new introduction of cholera during the sub- sequent years, have not been so appalling as the above mentioned. But the books of the Marine Hospital prove that, in almost every instance when cholera was brought here from ship-board, the disease spread among the sick inmates nearest to the wards containing the patients, and more than once decimated the hospital in its fearful progress. In 1858 the quarantine hospitals on Staten Island were destroyed by a mob, and the port of New York remained exempt from a visitation of cholera until 1866, when the Atalanta arrived from Havre, reporting 60 cases and 15 deaths from cholera during the passage, and having 21 sick with cholera on board. These, and 23 other cases which occurred while the vessel and passengers were at quarantine, were sent to the Float- ing Hospital. Thirty days subsequent to her arrival, and ten days after the occurrence of the last case, the vessel received pratique, and no further cases were reported either among the passengers discharged or the employes of the hospital. About the same time cases of cholera occurred on vessels arriving from the same ports; but the disease again disappeared before they reached New York. It is, however, remarkable that the disease, on these vessels at least, could be traced to the same hotel in Havre ; all parties corroborating the statement that several persons died of cholera while the passengers who became the first victims on the different vessels boarded there. If, then, as cleaily proved by the facts before us, cho- lera never appeared here except when brought from abroad ; and persons were invariably the carriers of the disease, both to the vessel and from the vessel to the shore, the quarantine of cholera is a quarantine of per- sona, and the virus, reproducing the disease, is the personal elimination of the cholera patient, but differ- ing from the virus of small-pox and typhus — both eruptive diseases — in not being the eliminations of the skin but of the alimentary canal. The "Floating Hospital" used on the emergency of the arrival of the Atalanta' s passengers was, for the purpose, certainly preferable to the hospital on Staten Island ; for not only was their isolation more perfect, and the danger of communication to convalescents or sick of other diseases, especially typhoid, avoided, but the dejections of the cholera patients, incontrovcrtibly the principal receptacle of the morbific agent, and the generative principle of the disease, were cast into the sea, and with them all danger of infection and commu- nication was avoided. The buildings on West Bank, lately erected, may offer greater facilities and comforts, but scarcely as much security. The well passengers of cholera-infected vessels may be divided into two clas- ses : the first, where the disease already exists, but the patient suffers merely from a colliquative diarrhea, scarcely more than a matter of incouvenience to him, but equally morbific in its agency as the dejections of a cholera patient in a state of collapse ; the .second class, merely the subject of the incubation of the dis- ease, but in whom no development has as yet taken place, comprising, of course, all the pa=sengers exposed to the morbific agency of the disease. For this class, the buildings on West Bank are most admirably adapted. The time of quarantine may be fixed at 10 days after the occurrence of the last ca^e, being three days longer than the accepted period of incubation. Though this may seem long, we must not forget that a single case may be the cause of an epidemic, as clearly proved by Pettenkofer, in the history of cholera at Altrau, in 1865, when the disease Avas introduged by a lady direct and only five days from Odessa; in Thoyden Bois, in JO THE MEDICAL RECORD. Enpland, bv a pcntleman from London, and in our hos- pitals, by the arrival of a single cholera patient from Aspinwall, The cpiarantinc of merchandise may be safely re- duced to the quarantine of merchandise soiled by the tion» of cholera patients, and to personal effect*. Dr. Simpson relates a cai;e of the transmission of the disease by a chest of duthinfj fri)m a cholera patient, aideil perliaps b}' the use of unwhulesomo food con- tained in till) same chest. That the disease in the Marine Hospital almost invariably attacked others in t!ie same buildinp or in the adjacent ones, may be ex- plained by the fact that tlie soiled linen of cholera pa- tients was placed in a building attached to the water- closet, and allowed to remain there for days, these being only a few feet distant from the shanties used for the reception and treatment of the cholera patients. The disinfection of the clotliin2; and rags, the only merchandise which properly can be so|led by the de- jections, can be eOTected by ventilation, fumigation, and submerging in a sohuion of the sulphate of zinc, or, better still, of carbolic acid. How long sucli effects may retain the cholera virus is rather a matter of opinion than of positive demonstration, and if effects infected with tlie cholera virus may be disinfected by exposure and ventilation, and if cholera effects dis- infect;Hl in this way may c;iminat3 the morbific virus, through our own medium, the air. the most pertinent questiou is the distance to which such morbific agent may be carried. In answer I may cite the theory of Mr. Simon, that the cholera germ diminishes in ratio to the square of t'.ie distance from the point of emission. Certamly no case has come under my observation, where the gerui was carried more than 200 feet, and the hospital on West Bank oilers, therefore, t!ie desired seen ri ty. The quarantine of vessels, after the discharge of the passengers, and thorough fumigation and washing by a solution of carbolic acid, is scarcely necessary beyond the time required to do this; and the first instance has yet to be adduced where the infection could be traced to vessel or cargo. In speaking of the quarantine regrulations, I have treated the subject as my long experience and famili- arity with the practical workings of quarantine de- mand; and in presuming tj make suggestions before the Academy of Medicine, I invite their delibera- tions to questions which can only be decided by men of science, and thoroughly familiar with the mode of propagation of each disease. The community looks to the profession as its legitimate guardians, and the mer- chant for relief from exactions and impositions. VACCINATION DURING THE FEVER STAGE OF VARIOLA. By J. H. TYNDALE, M.D., HOUSE SUBGEON, GERMAN HOSPITAI., N. Y. Previous to the great discovery of Sir Edward Jenner, towards the close of the eighteenth century, the rate of mortality from small-pox was enormous, and is estimated to have reached fifty per cent. Moreover, the symptoms and course of the' disease were of a more aggravated character. No wonder then that efforts had been made from the earliest periods to mitigate the out- breaks of the epidemic by preventive measures, as well as by the administration of remedies. When and where inoculation originated is not known. From time immemorial the Chinese have practised a method of" sowing'or disseminating '" the disease, which consists in introducing the scales of the eruption into the nostrils. At a very remote period, in Hindostan, a tribe of Brahmins resorted to it as a religious ceremo- ny. A small incision was made, and cotton soaked in the virus applied to the wound. Oflerings were devot- ed to the goddess of spols to invoke her aid ; this divi- nity having first hinted at inoculation — " the thought being much above the reach of human wisdom and fore- j sight." But the merit of introducing the practice into England, from Turkey, is due to Lady Mary Woriley Montague. Writing from Adrianople, in April, 1717, she observed: "Every year thousands undergo this operation ; and the French Ambassador says pleasantly that they take the small-pox here by way of diversion, as they lake the waters in other countries. There is no exam|de of any one that has died in it; and you may believe I am very well satisfied of the safety of the experiment, since 1 intend to try it on my dear lit- tle son. I am patriot enough to take pains to bring this useful invention into fa.shion in England." (The Let- ters and Wurks of Lady Mary Wortley Montague, third edition, vol. i., p. .'509. London, 18G1.) The debt which our ancestors owed to this lady is not diminished by the fact that inoculation had been practised for very many years in South Wales, where it was known as " buying the small-pox ; " for this cir- cumstance only became generally recognized as Lady Montague's views engaged attention, and while she enjoyed the privilege of being the best-abused person in England." It has been calculated by the Ragistrar-General of England, that the average number of deaths aimually occurring from small-pox in London, during the years 1660-79, were 357 to every 100,000 inhabitants, where- as in 1859 they were A'l only lor the same proportion. Later statistics have reduced this proportion still further. But even the most palpable evidences of the bene- fits of vaccination have never sufficed to quell the oppo- sition to it. Statistics have been published, laws passed and enforced, and still the voice of opposition is as far from being stifled as it was nearly one hundred years ago. It is even at present so vehement that intelli- gent physicians have entered their protest against vac- cination as utterly inefTective. The press has also to some extent endeavored to establish the futility of the enforcement of the measure. To defeat this broad asser- tion nothing is needed but a reference to the statistics of au}' country, since the introduction of vaccination. Some of the objections urged seem at first glance to be quite reasonable; but on closer scrutiny it will be found that all are based upon false presumption?, and consequently woithless. It has been argued: 1st. That the prevention was wor.se than the disease; the dissemination of the poison throughout the body was paramount to an introduction of the disease itself, the consequences whereof could not be calculated. While it is true that the poison is intend- ed to be and is disseminated throughout the sj^stem, it must be remembered that the constitutional disturbance; caused by the introduction of the virus is of the mildest character, and never productive of evil results. On the other hand, the benefits derived from it are immunity from the disease for a period of from seven to ten years, and certain immunity at the time of an epidemic, as my experiments, to be spoken of hereafter, will conclu- sively prove. A second objection is the possibility of engrafting upon the constitution such diseases as syphilis, scrofula, etc., by means of virus taken from persons afflicted with these diseases. There can be no doubt that by the use of a foul lancet pyaemia has been caused, and abundant evidence exists of the fact of syphihs having been com- THE MEDICAL RECORD. 11 muiiicated by vaccination. The use of a dirty lancet can, of course, and ought to be avoided. As to the in- troduction of syphihs and other blood contaminations, Dr. Viennois, in an exhaustive paper upon the subject (Archives Generales de MCdecine, vol. i., p. G41 ; vol. ii., pp. 32, 297 ; Paris, ISGO), has come to the conclusion that if" the lympli from a vaccine vesicle alone be introduced, the cow-pox alone will be introduced; but if in addi- tion the blood of a person afilicted with syphilis be also inoculated, then sypliilis will likewise be commu- nicated. At the present period, lymph from the vesicle is almost universally employed, a fact to which I will refer again hereafter. Tlie third, and perhaps most plausible objection, is the uncertainty of a fixed period of immunity. The term of immunity is variously estimated at from seven to ten years, after which time the protection is sup- posed to have lost its power. Prof. Felix von Niemey- er, lately deceased, had instituted inquiry in that di- rection, and promised a treatise upon the subject at some future day. The work may have appeared lately, but has not come under my observation. Niemeyer feelsjustified in concluding in advance that vaccination is at all times necessary during an epidemic. Now in a city like New York, and all large places, small-pox never entirely disappears, and an epidemic is only spoken of when the cases are multiplied beyond the ordinary number. It is at such times that our health authori- ties, ever watchful of the welfare of their fellow-citi- zens, issue orders for the disinfection of affected neigh- borhoods, and urge the people to permit themselves to be vaccinated. Perhaps compulsion would be a better course. And then it is that the question arises, not only whether previous vaccinations will procure immunity, but whether the same now performed is to be consid- ered a perfect safeguard during the present epidemic. There is often doubt in the minds of persons, coming in contact with the small-pox, who have subsequently been successfully vaccinated, whether they would not have escaped the disease without being vaccinated. This is in a great measure encouraged by the assertions of those who have been, or imagined themselves to have been, in contact with it, and providentially escaped in- fection either without previous or present vaccination. The escape is generally credited to an abundance of moral courage. This induced me to ascertain whether, after a positively decided contagion has taken place, and, the period of incubation being passed, the fever sets in, it would then be of any avail to vaccinate. And the results more than fulfilled my expectations. An epidemic of small-pox, which broke out in the city of St. Louis, and continued for three or four months, furnished the necessary material. While I was acting in the capacity of public vaccinator, a young man pre- sented himself for admis.sion into the hospital, suffering from all the preliminary symptoms of variola. He stated that he had been nursing his brother, then lying sick Avith small-pox, for the past twelve days, relying for protection against the disease upon vaccination perform- ed in his childhood. For the past forty-eight hours he had high fever, with intense frontal headache, well- marked pain in the back, swollen tonsils, and, in short, every premonitory symptom of variola. I vaccinated him carefully, and sent him to tlie hospital to await the result. On the following day (expectant treatment having been followed) the fever, headache, and pain in the back had abated. An elevation at the point of vacci- nation and a slight redness indicated the success of the inoculation. The patient fth perfectly comfortable. The vesicle gradually dried up and ft^ll off about the eight- eenth day. No further symptoms were experienced by the patient. In order to fully satisfy myself of the truth of my patient's statement, I called on his brother and f jund him in a convalescent stage of variola, the pustules having mostly broken and formed scabs. The success of this case encouraged me to put my h3'potliesis to a still further lest. During the course of the epidemic, eight other cases of the same nature pre- sented themselves, the details of which are not necessary to describe. Suflice it to say that in each and every case the contagion was fully established. The result in each case was precisely the same as in the first case related above. In two cases the fever stage had lasted fully two days, as in the first case. In the others the fever had continued from twelve to thirty-six hours. In one case only, the result was unfavorable. The fever in this instance had continued for nearly three days, when the inoculation was performed. A few hours later the eruption made its appearance all over the body, and the case proved a discrete one. I can scared)' assume that vaccination exercised any modify- ing influence, f ince no vesicle was reported to have made its appearance (the patient being under the care of another physician), yet the possibihty of such an event cannot be denied. As regards the modus operandi of the virus at this stage, I cannot look upon it as different from that of an ordinary vaccination. A good absorbing surface being produced, and the virus introduced in a state fViVorable to absorption, it is readily carried into the circulation. Ca[)illary circulation being very active during the fever stage, as evidenced by the thermometer, seems to me to favor the absorption of the virus. This may in some measure account for the unusually rapid appearance of the vesicle. It is not my intention to speculate with regard to the action of the virus in the system. Whe- ther it acts as a ferment, or, in some manner unknown, attracts the poison within the system to that particular spot, are mere matters of speculation. It is a well- known fact that counter-irritation, as for instance the application of croton oil to some particular part of the body, as the chest, has the effect of determining the eruption to that neighborhood. If we choose to consider a local point of irritation a favorable spot for the eruption, the question will be solved as fur as speculation can solve it. The fact that at that point the skin has been removed and the corium exposed, will render the spot a "locus rainoris resis- tentise" for the eruption. I think that the results of these experiments will justify me in calling the attention of tlie profession to them. My excuse for presenting so limited a number of cases, lies in my inability to put it to a further test, owing to want of material. Nevertheless, I do not hesitate to affirm that vaccination, properly j)erformed, previous to the exacerbation of tltejfever on tlie third day, will cut short the disease, hy quickly relieving the general symptoms of small-pox, and causing a icell-marked erup- tion on the spot inoculated. It must be borne in mind that the fever accompany- ing variola is of a remittent type, and, like all remittent fevers, has its highest range of temperature in the even- ing. The third, and usually the last exacerbation, is also the most severe (marking the highest temperature), and quickly followed or rather accompanied by the eruption. Vaccine virus introduced during this last remission will scarcely have time to be absorbed, though it is possible that when absorbed it may mitigate the character of the eruption. Of this, however, no positive proof exists, and it is merely mentioned as a possibihty, if not a probability. In inviting the attention of my colleagues to this important matter, I cannot refrain from requesting a 12 THE MEDICAL RECORD. strict observation of llie ordinary cautions in further testiiip the results of vaccination during tlio fever stnpc of variijla. That the virus sliould be pure, unmixed with Mood, and not too old, need scarcely be mentioned. For my part I have loimd tiie recently dried scab, ex- clusive ol the inllammatory products on the perii)hory, rubbed up carefully with a drop of water or glycerine to a creamy consistence, to answer the purpose admira- bly. Various ages and various physicians have had their own peculiar method of introducing the virus, either by punctures of the skin or liy scraping away the cuticle. Punctures of the skin, whether performed by the lancet, a pin. or some instrument invented fi)r the purpose, are open to two objections. In the fust place, tlie [»uncture will close immediately upon the with- drawal of the instrument. Even when the virus is introduced with the pvmcturing instrument, the appli- cation is too .sudden to insure absorption. In the second place, it often occurs that, notwithstanding proper care is taken, blood will follow the puncture. Extravasated blood is verv slowly reab-orbod, and tlicrefore a hin- drance to absorption of the virus when the latter be- comes mixed with it. In my opinion, scraping of the cuticle with a dull lancet until the coriuin is exposed, i.s, although a more laborious, afar more certain method. The first appear- ance of moisture on the scraped spot is an indication of having reached the proper absorbing surface. It is well not to be too sparing in the application of the virus, but to spread it upon the absorbing surfaces (for there should be two) as thickly as possible. A CASE OF RECOVERY FROM DIPHTHE- RIA AFTER THE OPERATION OF TRACHEOTOMY. Reportkd by GURDON BUCK, M.D., NEW TOBK. Visited Ricliard, son of James H., pot. 10, residing No. 8 Dover st., at four o'clock p.m., Nov. 28, 1871, by request of Dr. C, his attending physician, and found him suffering from very urgent and increasing dyspnoea; his voice was reduced to a whisper ; cough was croupy ; pulse frequent but regular; surface perspiring freely from the labor of respiration. He had been frequently vomited by medicine the preceding night, but without relief; croupy symptoms had existed tor two or three days, and had become urgent within twenty -four hours. It was reported by his father that his physician had not found any exudation in the fauces. For some reason not explained, the attending physician did not appear at the hour appointed. After waiting a reasonable time I decided, in view of the extreme urgency of the symp- toms, to proceed to operate. Fortunately the attend- ance of Dr. A. J. Harrison, who had visited the patient once, was R?cured without much delay. A narrow table, covered with suitable bedding, answered the purpose of an operating table. Four sperm candles cut into halves, and bound with tape into two bundles, served as lights that could be conveniently held at any point where they were required. No anaesthetic was administered. The boy's father held his head, and kepthis neck on the streteh, while his godmother held the torchlights. The embarrassment of having only one medical assistant for the operation was felt at every step. The only feature of the operation to which the author would call atten- tion is the expedient employed to facilitate the opening into the trachea itself. Two accidents are liable to occur in this step of the operation. One is, the incision may deviate from lh3 median hne; the other, failing to penetrate into the interior of the trachea, the knife may pass either between the outer surface of the tra- chea and it.s coverings, or between its inner j-urface and lining membrane. The procedure was as follows: An ordinary pocket-ease tenaculum was thrust between the cricoid e.utilage and first tracheal ring, exa<"tly in the median line, .-ind made to hook up the cricoid, thus Serving to maintain a .'^ecure hold upon the trachea, and keep it at rest. While the tenaculum was held witli the left hand, a sharp-pointed knife, held in the right, was made to |)enetrate the trachea immediately below the entrance of the tenaculum, and an incision was car- ried downward through the four upper tracheal rings. The knife, without being withdrawn, was immediately carried back to the point of entrance, and a tran-sverse cut two lines in length was made on either side between the cricoid cartilage and first tracheal ring, giving the tracheal opening the shape of a letter T. A double tra- chea tube, previously armed with a piece from the blunt end of a gum-elastic catheter traversing it, and with its l)lunt point projecting a little bev'^ond llie inner end of the tube to serve as an obturator, was then inserted and secured with tapes passed around the neck. After the disturbance, always consequent upon the first introduction of a tube, had subsided, the res- piration became tranquil and the patient soon fell into a placid sleep. Instructions were given for the re- moval and replacing of the inner tube as often as it required cleansing. About three hours after the opera- tion the tube became obstructed by a coagulum, and the parents not succeeding in removing the inner tube, suffocation would have taken place had not Dr. Harri- son fortunately reached him in time to dislodge the inner tube, which he did by prying it out with a knife- blade. During the subsequent forty-eight hours the respira- tion continued easy, and his general condition satisfac- tory. At my visit in the afternoon of Nov. 30, how- ever, I found his respiration hurried and labored, and it had been so for two hours. The tube had been kept clean and free of obstruction. The outer tube was now removed for the first time to cleanse it and change the fastenings. This permitted a view of the wound, the surface of which was found coated with a layer of gray- ish tenacious exudation, not, however, pellicular. From this appearance the diphtheritic nature of the disea-e was obvious, and it was inferred that a similar exuda- tion was obstructing the air-passages and producing the dyspncea from which the patient was siiftering. After replacing the outer tube, and .supporting (he patient in a semi-sitting posture, a solution of common table salt, in the proportion of one teaspoonful to a teacupful of warm water, was poured into the trachea through the tube, one teaspoonful at a time, and at intervals which allowed the immediate disturbing effect of it to subside. A violent cough was immediately provoked by the en- trance of the fluid, accompanied by the expulsion of a quantity of the viscid secretion in a diluted state. Five or six teaspoonfuls were thus introduced in succession, when he became somewhat exhausted by his efforts in coughing. While supported in a half-sitting posture his breathing soon became easy and unobstructed, and continued so without any subsequent recurrence of dyspnoea. He continued to cough more or less, but a good night's sleep followed. The next day he was found doing well ; his pulse reduced to 100 ; his surface natural ; his countenance animated, and his spirits cheer- ful. Inspected the fauces, and found no diphtheritic exudation in sight. He craved solid food and enjoyed it. Ordered R. Sulph. quinine, sulph. ferri, 32 3 ss. ; acid sulph. aromatic. Ij.; syrup zingib. | vij. ; aquae cinnam. 5 ij. Dose, 3 j. ter in die. THE MEDICAL RECORD. 13 Dec. 2. Doing well. Removed and replaced the tube, and found the surface of the wound clean and liealthy ; appetite good. Dec. 3. An urgent message summoned me to visit him at iialf-past five o'cloc-k p.m. A hemorrhage from the wound, represented as very considerable, had taken place and alarmed the parents. His pale countenance and feeble pulse (SO per minute) showed the ellect of the loss of blood. A thorough examination of the wound, the surface of which was pale, could detect no vessel. Tlie occurrence of the hemorrhage Avas the more remarkable as. at the operation, the bleeding had not been considerable, and no vessels had required to be ligated. Dec. 4:. No recurrence of hemorrhage; doing well; respiration natural and easy ; appetite good. I)ec.. 7. Progress favorable. With the tube left out and the external wound closed by the fingers, patient could articulate some words in a natural tone of voice. I therefore substituted a fenestrated single tube for the double one, and closed the outer end with a cork, thus allowing him to use his voice and to breathe through the larynx, which he did without eflbit. Dec. 9. Patient passed the day without a tube. The lateral edges of the wound have come into contact with each other, so that the air no longer escapes through the wound; respiration is now pei'foi'med per vias na- turales. His voice has still further improved. His cough continuing troublesome at night, the following mixture is prescribed: — 1^. Ext. senekse fluid. ) -. , .. Tinct opii camph. ( ^' -* J- Spirit nitri dulc, 3 ss. Syrup balsam tolut., 3 ij. M. Dose, "j. pro re nata. The follow-ing preparation in the form of spray was freely used throughout the whole treatment alternately Avith hme water, and apparently with good efiect : — 5. Ammon. muriat. } -- _ •• Potas. chlorat. f '^'^ ^ ^^■ Tinct. seneka3, 3 j. Aquic ros8e, 5 iv. M. Jan. 11, 1872. Patient was visited, and found in all respects well. His voice had regained its full force. OVARIOTOMY. TREATI.VG THE PEDICLE WITHOUT CLAMP. LIGATURE, OR CAUTERY. Being a Taper read at the Meeting of tlie Medical Society of the State of New York, held Feb. 7, 1872. By JULIUS R MINER, M.D., * BUFFALO, N. Y. Gentlemen — During the past few years I have been led to make some observations as to the anatomical characters of ovarian disease, and to base upon those observations, and a few clinical facts which have come to my notice, the conviction that ovarian tumors — cystic disease of the ovary — can be removed by e/iuclea- tion, without ligature, clamp, or cautery. All other steps in ovariotomy have been pretty Avell settled; this one alone, of hoAV to treat the pedicle remaining subject to the caprice of the operator, directed by no well-defined rule or law. Without attempting to enu- merate the objections which may be fairly urged against all previous plans of procedure, allow me to describe a neio method, which, I am now led to believe. will in all, or nearly all, cases be found feasible, and if so, is in every respect satisfactory. My first observation and experience in this procedure occurred in April, 1809, and the case was reported in detail in the Jit(ffalo Medical and Sunjirul Journal for June of the same year. It was described as follows : — " A few months since I was invited to remove an im- mense ovarian tumor, occurring in the person of Mrs. Foster, of Cattaraugus County, N. Y. It was of a year's standing, had been repeatedly tapped, but at length the contents proved to be too thick to be drawn through the largest-size eanula; and the distress becom- ing too great for endurance, any operation which would end it, whatever might be the result, was gladly accepted. The tumor was inultilocular, very large, weighing, as near as could be determined, nearly one hundred pounds. It was attached throughout its en- tire circumference to the omentum, intestines, walls of the abdomen, and all other parts with which it came in contact. These attachments were not so firm but that they could be broken up, and with great care the tumor was separated from the surounding parts until the pedicle was reached. The process of enucleation had been carried on so successfully and so extensively that encouragement was afforded for continued trial : the pedicle was large, and extended over a wide surface, but by careful and patient effort it was separated fiom its entire attachment to the tumor, and tlje immense growth removed without (he ligation of a single vessel. The terminal branches of the vessels of the pedicle gave out no more blood than issued from the vessels of the attachment elsewhere, and there appeared no more occasion for ligature here than elsewhere. All hemor- rhage soon ceased, and the incision was closed by inter- rupted suture." The success of this procedure was complete, and the patient continued for more than two weeks to improve without an untoward symptom — so long that her re- covery seemed certain. She now commenced to lose her relish for food, grew weak and desponding, and died fiom exhaustion on the twenty-first day afier the operation. The fatal termination detracted nothing from the success of this mode of treating the pedicle ; indeed, so remarkable Avas the size and attachment of the tumor, tliat any attempt at recovery is surprising, and yet the feeble, emaciated, exhausted patient con- tinued to live long enough to show tliat the manner of treating the pedicle was, at least in her case, unobjec- tionable. My second opportunity to test the feasibility and safety of the plan I liad suggested presented itself in the Buffalo Greneral Hospital, in December of the same year, in a German woman sixty-six years old, of feeble and delicate appearance, and considerable emaciation. The operation was made iu presence of the students of the Buffalo Medical College, and I was assisted by my colleagues both of the College faculty and hospital staff. This tumor was found also extensively attached to the walls of the abdomen, and the process of separation Avas conducted as before, the bands of attachment being separated from the fibrous cj'st of the tumor, not torn or broken. On reaching the pedicle it was found large, its principal arteries throbbing distinctly. It Avas separated readily by enucleation, commencing at its central attachment, and folloAving out the fasciculi of vessels to their final termination upon the Avails of the tumor. Upon removal, it was found to Aveigh seventy-one pounds, and to be composed of numerous cysts. The bands of vessels composing the pedicle, when separated from the tumor, contracted so as to leave the pedicle appearing almost as if it had been divided Avith the knife. To the sui-prise of my asso- 14 THE MEDICAL RECORD. ciate-i, scarcely any homorrhnjre followed the separa- tion, much los^ than attended the separation of tlic bands of attachment cNewhere. This i)niient was nar- cotized hy ?nbcutaneous injection of morpliine given by my Hospital Assistant. She died eighteen hours after the operation. Post-mortem examination .showed no hemorrliage or other explanation, and we inferred that death was from overdose of n)orpliii)e. My friend and eclle.ngue Prof James P. Wiiite, of Buffalo, has since made succes-fid trial of tliis plan of operation — that is, successful sd far as removal by enn- cleation witliont hemorrhage is concerned. He in- forms me that there was less hemorrhage fron) the pedicle than from otlier places of attachment; and that, though he finally applied ligature, he did not do it from nece.«.sity, but rather from fear of its occurrence after reaction should take place. Other similar cases might be related, but I prefer to refer brictly to the experience of others, in confirmation of my own obser- vations. Richard H. Meade, Esq., Consulting Surgeon to the Bradford Infirmary, England, thus speaks upon the subject: — "The patient being under the influence of chloro- form, I made an incision about four inches long in the lower part of the linea alba, carefully opened tlie peri- tonreum, and evacuated nearly two gallons of ascitic fluid. On enlarging the opening in the peritonteum to the same extent as the external wound, the ovarian tumor at once came into view. I now' directed an assistant to compress the abdominal walls with his hands, one placed on each side, so as to compress the edges of the wound backwards, while I endeavored Avith my hands to draw the tumor partially through the opening. In doing tliis, the walls of several of the small cysts, of which the tumor was principally composed (being very thin), were ruptured by the pressure of my fingers, and a considerable quantity of thick, brown fluid, like dark-colored linseed tea, escaped. The edges of the Avound were so well compressed that none of this ovarian fluid was allowed to enter the peritoneal cavity. The tumor was now found to be firmly adherent to the free extremity of the great omentum ; these adhesions Avere carefully and slowly torn through, and the whole mass was then easily drawn through the wound. It was now found to contain a good deal of heav}', solid matter, and, on turning it over to examine its attachments, the pedicle, which was small and thin, to my dismay and annoyance at the time, gave way, and the tumor tore itself loose from its connections. Fearing hemor- rhage, I kept hold of the remains of the pedicle, but very little bleeding followed, and I could jBlnd no vessel requiring ligature. " It is difficult to account for the large quantity of ascitic fluid which was met with, unless there were some secondary deposits of cancerous matter on the peritonaeum, but the history of the case Avould hardly lead to that supposition. The pre=ence of a consider- able amount of serous eOusion in the peritoneal cavity has, however, one advantage in cases of ovariotomy — it seems to render the membrane less likely to take on acute inflammation, its delicate secreting surface having undergone some change, and after the removal of the ovarian disease it does not seem to be re-secreted. " In some of the medical journals a case of ovariot- omy has be?n reported (extracted from an American periodical), in which Dr. Julius F. Miner removed a very large ovarian tumor by enucleation, without either clamp, ligature, or cautery, and without hemorrhage. When I commenced the above operation I iiad no idea of imitating his proceeding, but when the tumor (to my horror at the time) enuclea:ed itself, and there appeared to be no bleeding from the pedicle, I deter- mined to follow his example, and leave the torn surface unsecured, thinking that the ri>k from hemor- rhage was less than that from inflammation from the presence of a foreign l)ody in the peritoneal cavity. My ca.se turned out successfully, and I think I .should venture to repeat the proceeding in .some special cases — for instance, Avhere the pedicle does not appear to be vascular — when the attempt might be made to tear the tumor gently from its connections fin the same way as adhesions are generally separated), but a firm hold should be kept of the pedicle, so that it might easily be secured in case of bleeding." — liritish JfedicalJour- nal. — limithiraile's Retrospect for July, 1871. Upon these fact-* I based the conclusion that the pedicle in ovariotomy can be safely separated from the cyst, and left without ligature, clamp, or cautery, thus avoiding many dangers attending it. At first this proposition Avill appear startling to surgeons who have tied large vessels in the operation, or have witnessed the fearful hemorrhage which sometimes takes place from slipping of clamp or ligature; these will regard it with incredulity, and, perhaps, Avithout trial look upon it as wholly impracticable. I should myself, probably, be among this number, had I not had opportunity to demotistrate to my own mind, certainly, its entire feasibility. The ovarian tumor is composed of a firm, dense fibrous cyst, containing fluid of varied color and composition. It may, and it may not, have a solid portion, but usu- ally it docs haA'e more or less of a body, the remnant of an enlarged or degenerated gland. Upon the surface of this smooth, dense fibrous cyst are spread out the vascular and cellular tissues which compose the pedicle, but only the terminal branches of the vessels enter this cyst; the vessels may be quite large at their origin, but soon they are numerously divided, and enter the cyst, if at all, of capillary size. The attachment of the pedicle to the cyst is more easily broken than any one Avould mistrust who has not attempted its separation in the manner described, and I am confident that the same efforts Avhich are made to break up the adhesions to the peritonaeum, omentum, and other parts, if ex- tended to the pedicle, anmII be equally successful. The finger should be gently introduced under the centra! portion of the pedicle, and followed out along the fasci- culi of A'essels as they extend over the sides of the cyst; nothing can be more easy of execution or more readily accomplished. If this method can be adopted without hemorrhage or other difficulty, its advantages are apparent. The pedicle can then be returned into the abdominal caA'ity Avithout any of the objections which have been urged against this procedure. There is no ligature to be discharged by the ulcerative process, or to become encysted, or to induce inflammation. There are no purulent or inflammatory products to be in any way removed or provided for ; the pedicle is wholly a living tissue, and h.TS no irritative qualities which render its return to the abdominal cavity objectionable. This cannot be said of it when treated by any other knoAvn method. My object will be fully answered, provided the feasi- bility of enucleation in OA-ariotomy is shown with suffi- cient clearness to obtain trial by surgeons. It is now believed that all or nearly all cases will admit of it, or of this general plan at least, perhaps varied to suit cir- cumstances ; and that, Avhere practicable, it is the least objectionable of all known methods. Prof. E. M. Moore, my colleague, has suggested that if alter separation, as described, there is any slight or troublesome hemor- rhage, the different fasciculi, or the various parts which THE MEDICAL RECORD. 15 have extended over the walls of the cyst, may be braid- ed, causing in that manner arrest of hemorrhage upon the principle of acupressure. Again, provided this meth- od in any case should fail, the plan of arresting hemor- rhage by acupressure or torsion, or separate ligation of any vessel which might seem to require it, witli thread, silver Avire, or other material, may yet be tried, may indeed be adopted as aid to the operation by enucleation. The advantages of this procedure are sulficiently obvious to all surgeons of experience in this operation; and the feasibility of the method being granted, little else need be said to insure its universal adoption. (Driijinnl Cccturcs. SCLEROSIS UTERI: ONE OF THE SEQUELS OF PUERPERAL METRI- TIS. A CLINICAL LECTUKE, By Prof. ALEXANDER J. C. SKENE, M.D., AT THE LONG ISLAND COLLEGE HOSPITAL. BROOKLYN, N. Y. (Reported by K. S. Bunker, M.D.) Gentlemen: You will readily call to mind the patient who had endometritis, giving rise to monorrhagia, and I trust you also remember the clinical fact, then so strenuously insisted upon, namely, that menorrhagia, not accounted lor by any other conditions, is a common and most valuable symptom of endometritis. In direct and striking contrast with that case, I present you one to-day, not of such frequent occur- rence as the former, but presenting, nevertheless, points of extreme interest in its pathology and clinical history. This patient informs us that she is 35 years old, has been pregnant five times, and has given birth to four living children. While j^regnant at the seventh month, with her fourth child, she received an injury which caused her to give birth to a dead foetus a few days afterwards. During her fifth pregnancy, four years ago, she received a shock from seeing a friend in a convulsion ; labor came on immediately, and she was delivered of a seven months' child. Soon after her confinement she complained of pain and tenderness in the region of the uterus, followed by fever and delirium. These sjanptoms extended over a ))eriod of three weeks, and there can be little doubt, from the history given, that she had acute puerperal metritis, which lelt her health permanently impaired. Since that time her menses have been irregular, scanty, and attended with pain. At times she has a menstrual molimen, but no catamenial flow. During the last year she has menstruated only twice, the last time three njonths ago. So much for the previous history of the case. She now suffers from extreme debility and anaemia, as you can see by her general appearance, and com- plains of ill-de6ned aching pains throughout the pelvis, but more especially in the sacral region ; and occasion- ally she has very slight leucorrhoea. Her digestive organs are also very much deranged, and her nervous system, from the joint action of disease and drugs, is a miserable wreck. By physical exploration I find that the uterus is en- larged, being an inch larger than normal. The body and cervix are tender to the touch, and the sound, carried into the cavity, gives extreme pain. The cer- vix is indurated and smooth, and the os is smaller and more circular than is usually found in those who have borne children. Exploring the cavity with the sound, I find that while the long diameter is considerably increased, the antero-posterior and lateral diameters are relatively, indeed absolutely, shortened. The uterine walls ap- pear to lie in close contiguity, so that it is impossible to turn the sound far in any direction. These signs obtained by the probe are of vast impor- tance, for they indicate clearly that the enlargement of the uterus is due to an actual increase in the loalls of the organ, and not a mere expansion of its cavity, as in the case of endometritis, which I showed you the other day. In other words, the growth is concentric, not eccentric. The cervix, as seen through the speculum, is notably pale; the os is small, with its lips curved inward. This retraction, or drawing inwards of the os, is confirmatory of the opinion that the Avails of the cervix are enlarged more than the mucous membrane of the cavity. When the mucous membrane of the cervix is swollen, and the walls remain normal, the lips are enlarged or pouting. Briefly, then, the physical signs indicate that there exists a condition of unusual hardness and enlargement of the uterine Avails, while the relative or even actual size of the cavity is lessened. The uterus is also anaemic, as you knoAV from a glance at the cervix. And, before closing the history, let me attract your attention to the fact that our patient has amenorrhoea — a condition that is much more common among the young than Avith those AAdio have borne children. NoAV you cannot fail to have observed that this case presents many points of resemblance to that of endo- metritis, AA'hich occupied your attention at our last lecture. It is on account of these resemblances that I present you this case to-day. By placing them in juxtaposition, as it Avere, AA'hen the subject is still fresh in your memory, you Avill be better prepared to study the points of dif- ference; for both the past history and the present con- dition shoAV that the cases are essentially different. This patient's trouble began Avith acute inflammation of the uterus; the other's did not. This one had amenorrhoea; the other had menorrhagia. In the case before us the uterine Avails are enlarged and the cavity diminished, the reverse almost of Avhat obtained in the the other. The uterus, in this case, is indurated and anajmic ; in the other it Avas relaxed and highly con- gested. These are plain outline distinctions, easily recognized at the bedside, and characteristic of almost opposite pathological conditions. Excluding, then, the only uterine disease that might lead us into error, and basing our opinion on the clinical history and physical signs, Ave are compelled to pro- nounce this a case of Avhat is usually knoAvn and described as " cJtronic metritis." But I fear the term "metritis" will lead you astray. It certainly does not give you a true idea of the patho- logy of the disease — at least, if you recognize inflamma- tion only by the presence of hyperemia, the exudation of lymph, suppuration, etc. In this case Ave have no such evidence of the inflammatory process; the present condition is not that of an inflammatory disease. It bears no more resemblance to ordinary inflammation than the stricture of the male urethra does to an acute gonorrhoea. Nor is the condition that of induration the result of the inflammatory process. That usually results in the contraction as well as hardening of the tissue in Avhich fibrin is effused. Noav, in the case before us, you Avill observe tAVO conditions not often associated except in malignant disease, namely, hard- ening with increased size of tissue. Clinically considered, this condition is not unfrequently obser\-ed associated Avith a history and symptoms such as Ave gather from this patient, and in the absence of any name to indicate 16 THE MEDICAL liECOliD. the condition. I venture to suggest that of HclfrusU — a term nlroaily fiuniliar to you aMlesi'^niiting morbid con ditions of other organs similarly allectfd. I conii'ss to you my dislike to introducing new terms into tlie literature of gyna3cology, and certainly would not if I did not think the one usually eni|iloyed, namely, ''chron c metritis," gives no true idea of the nature of the lesion. The term sclerosis simply moans hardening, and when applied to the inter-cellular connective tissue, it includes also thickenitig or growth of this structure. It resL-mbles the condition described by Virchow as ''nutritive irri tation of connective tissue." Your knowledge of anatomy will enable you to estimate the relations of this tis-ue to the varied structures of the body. In its normal stale it is an exceedingly delicate structure, and is e.vteiisively difl'used in all parts of t!ie body. It is the bond of union to the framework of the body as the plaster is to the bricks; it is the delicate curtain upon which the minute capillaries are spread ; and it follows, of course, that the increased growth of this connective tiisue takes place at the expense of the fibro-muscular tissue of the uterus, a condition of local anieinia is pro- duced b}' pressure on the capillary vessels, and I need scarcely add that function and force are correspondingly destroyed. This lesion has been specially studied of late as it occurs in nerve-centres. Hypertrophy of the " neuroglia," or connective tis.sue in patches, gives rise to a condition resembling locomotor ataxia. Now the result of this same proliferation of the con- nective tissue cells, from some previous spur of excite- ment, is precisely what we find in this uterus. We have the '* nutritive irritation" of Virchow, all'ecting the connective tissue cells at the expense of the other structures of the part, and not simple induration from previous inflammation. The organ is rendered ab- normal in size, dense in structure, brittle in quality, and is anaemic or bloodless. In tlie older pathology we have no word that repre- sents this condition. We can scarcely believe that the process is merely one of exudation of lymph into the tissues of the uterus, for that is usually followed by more or loss contraction ; nor can we for a moment believe that there is excessive cell-growth from mahg- nant tendency. Thanks to our German brethren, they have pointed out and accurately described the lesion, and applied to it the name of "sclerosis." And no other term, in my judgment, so perfectly represents a certain class of uterine diseases, a typical case of which is now before you. I would not be understood, however, as denying that there is inflammatory exudation. On the contrary, there is every reason to suppose, from the natural his- torj' of the disease, that there is more or less effusion of inflammatory lymph into the tissues of the uterus. But the hypertrophy of the cellular tissue, and conse- quent enlargement of the organ, are so much more prominent characteristics of the disease, that I have selected the term .sclerosis, rather than metritis, to describe it. It would be interestiu:? in this conned ion to study how the lesions of sclerosis uteri are developed in their natural order of sequence; but time will not permit at present. Let me refer you for information on this point to a most admirable article on " Chronic Metritis in its Relaiiuns to Malignant Diseases of the Uterus," by Dr. Xoeggerath, of Xew York. You will find it in the American Journal of Obstetrics for Novem- ber, 1869. I will read you a brief extract : — '• The disease in question is the combined result of sub-involution of the uterus, and a process of exudation which takes place in the tissues of the uterus immedi- ately after delivery, in consequence of puerperal fever. This int'Trui)tion of retrogressive metamorpho.-is takes place whenever the natural involution of the uterus is interfered with by some injurious influences, so tha! the absorption of the exuded mass depof-iied between the muscular elements cannot be properly accomplished. This results in the development and permanent deposit of cellular tis-iue within thj walls of the utern.«." Just here there comes up a question to which I can give but a single remark at jiresent: Doe^ .'■clerosis uteri arise exclusively from puerperal metritis? Or may it be developed from other morbid influences ? Dr. Noeggerath sa^'s he has never seen the disease occur a.s a sequel of any other afifection. My own experience accords with his. We should naturally suppose, how- ever, that long-continued hyporaemia and nervous irrita- tion might favor the proliferation of the connective tissue cells in tlie uterine walls, as well as elsewhere; but we have no proof as yet that sclerosis uteri is de- veloped in that way. Finally, sclerosis uteri is a permanent lesion. There is no tendency to restoration of normal tissue; on the contrary, there is lowered vitality of the part, and con- sequent tendency to still further degeneration. The afiection exemplifies the general pathological law, to which there is no exception, that whenever the tissues of an organ are changed from their normal type, that change is towards degeneration, decay, and death. Hence the practical fact that these cases of ."Jclerosis are peculiarly prone to such diseases as epithelioma, cauli- Jlower excrescence of the cervix, etc., etc. Malignant disease of the uterus can often be traced back through a natural history such as I have pointed out in this case; and that the tendency to malignant action is hastened in such cases by the injudicious use of caustics, I have no doubt. It is important, there- fore, that we shall early recognize the difficulty and avoid a course of treatment that must end, sooner or later, disastrously to the patient. Trusting that you comprehend the pathology of scle- rosis uteri and its relation to other morbid states, I will now briefly recapitulate some of the leading points in the diagnosis of this affection. 1. A clinical history indicating that the patient has previously had puerperal metritis, followed by an im- paired sUite of health. 2. Constitutional symptoms such as occur in chronic forms of uterine disease. 3. Derangement of function: usually irregular, scanty, and painful menstruation. The pain continues, as a rule, through the whole period of menstruation, and may be likened to an exaggeration of the ill feelings of an ordinary menstruation. By these peculiarities it may be distinguished from the dysmenorrhoea caused by flexion of the uterus. In this latter afifection the pain is that of intense uterine colic, and is usually limited to the beginning of menstruation, decreasing or disappearing when the flow begins. 4. Enlargement and induration of the uterine wall?. 5. Increased length of the uterine cavity, without increase of the lateral and antero-posterior diameters. 6. Ansemia of the uterus, indicated by the amenor- rhoea, and the pale appearance of the cervix. 7. Absence of cervical disease, such as occurs in hy- peraemic and inflammatory aflfections. 8. The slight retraction of the lips of the os, and the small diameter of the cervical canal in proportion to the increased size of the cervix. THE MEDICAL RECORD. 17 The Medical Record: A SEMI-MONTULY JOURNAL OF MEDICINE AND SURGERY. GEORGE F. SHRADY A.M., M.D., Editor. Published on the Isl and \^lh of each Month by WOT. WOOD & CO., 27 Great Jones Street, N. Y. ]SreAV ^^ork, INIarcli 1, 187; THE RELATIVE mOREASE OF POPULATION. ALTHOUGn the subject of the relative increase of popu- lation among the higher and lower orders of society is one of vast importance, yet it has been terribly neg- lected. While men are discussing the great question of the rise and fall of nations, they seem to ignore the one great fact, where the men of which nations are made are to come from. Dr. Nathan Allen, of Lowell, is one of the few who have given the subject a scientific and patient attention. He has studied the subject as it ought to be studied, statislically ; and he has discovered th'at the average number of children to American families in New Eng- land is but three, or three and a half, against an average of eight to families of a corresponding social scale a century ago. Population can hardly be kept up among the cultivated classes, unless an average of more than three children are born to a family. This, then, is the great problem of the future ; it is a problem which no nation and which no government has yet solved. Historians have long debated the question, what was the reason for the decline of Greece and Rome. Prof. Seelye, the eloquent author of Ecce Homo, has answered this question : " Rome died for want of men." " The human harvest was bad." Dr. Allen, in a very suggestive paper, based on Prof. Seelye's essay on ^^ Roman Imperialism," has shown by quotations from standard authorities that, in all proba- bility, Greece died for the same cause as Rome. The nation died because the individuals that composed it died, and there were none to fill their places. The most pertinent fact concerning these statistics is, that they are in the main true (for Dr. Allen's opponents have made no headway against him), and they are con- firmed by common observation. Practitioners in New York and vicinity tell us that they find not more than an average of three children in a family. Among the higher classes, very few families have more than five children, very many have but one, and altogether too many have none. We should be glad to hear from practitioners in the country their views on this matter. A nation can do without high culture; it can do witliout extensive ter- ritory; it can do for a lime without religion; it can. like China, do without a pure morality, but human beings it must have. Questions of science, of education, of gov- ernment, of religion, of morality, etc., are trifles com- pared with this one great question of population. Un- less we are greatly in error, the population in distant country-places increases among the higher classes much more slowly than it did one hundred years ago. The time must come when the labors of Dr. Allen and the few interested in this matter will be appreciated, when their errors, if they have made any, will be corrected, and the whole subject will be scientifically investigated. The time must come when physicians will evince a dis- position to employ a portion of their leisure in studying the great laws of population. THE PROPOSED DRUG EILL. The Drug Bill now before the Legislature has been modified in several important particulars which will, we doubt not, render it even more acceptable to the pharmacists of our city. Instead of the several grades already mentioned we have now but two, viz., graduates in pharmacy and licentiates of pharmacy. The former grade comprises all those Avho hold diplo- mas from recognized colleges of pharmacy, and the latter includes such as have not enjoyed the privileges of these educational institutions, but who have obtained a license from the present board, or who shall pass the examination before the proposed new board appoint- ed by the members of the New York College of Phar- macy. The other grades are, so to speak, abolished, and in their stead simple assistants are named who are only responsible through their principals. It is also provided that these so-called apprentices shall have served with some practical pharmacist four years be- fore they shall be eligible for examination as licentiates. The provision for an annual registration is also abolished, as it has been objected to by many of the leading apo- thecaries as an unnecessary measure and an irksome obligation. Senator Weismann, Chairman of the Com- mittee of Health, is understood to favor these modifica- tions, as being best calculated to simplify the opera- tions of the proposed board, and do away with the ob- jections urged against the passage of the bill. The pharmacists may rest assured that no effort will be wanting on his part to jealously guard their interest, despite the pressure brought to bear upon different members of the legislature by members of the present Commission. The saving for the coming year of seven- teen thousand dollars to the city should of itself be a conclusive argument in favor of the repeal of the pres- ent law, irrespective of the principle of placing a 18 THE MEDICAL RECORD. premium upon lopitimale education, wliicli is one of the main and truly commendable features of tlie proposed new law. We sympathize with the pharmacists in their struggle for their rights, and sincerely hope that they may triumph over all opposition. TUK QIKSTION OF QCARANTINE. The question of Quarantine has of late commanded more than ordinary attention. The medical profession have had the matter under serious discussion, and some valuable papers bearing upon the contagiousness of yel- low-fever, cholera, typhus fever, and variola have been read before the New York Academy of Medicine, with the result of placing upon record many important and interesting facts. The paper by Dr. Theodore "Walser, in the present number of the Record, is a contribution to the subject of more than ordinary value at this time, detailing, as it does, the experience of one who has so long and so conscientiously served the Quarantine De- partment. "We take occasion to commend his sugges- tions to the serious attention of our legislator?, who have it in their power to modify the laws governing that department. A MODEL HOSPITAL REPORT. The Report of the Imperial Rudolph Hospital, of Vi- enna, for the year 1870, which we have just received, is truly a model of its sort, and we take this occasion to commend it to the attention of the large number of gentlemen who appear to think that the possession of hospital appointments for Ufe, to the exclusion of oth- ers, entails upon them no responsibility towards the less fortunate members of the profession. In this report the usual tables of statistics are supplemented by a careful working up of each class of disease treated in the institution during the year, and by reports of all cases which hive any features of interest. Throughout the volume there is an entire lack of that self-glorifica- tion which eliaracterizes some of the so-called "hospi- tal reports " -which have appeared in our own large cit- ies, and which, instead of being what the term would indicate — a report of all the work done in the institu- tions during the time specified — are little more than a collection of monographs upon difi'erent subjects, by •several gentlemen, some of whom may never have had any connection with the institutions whatever. FORCED MEDICAL SERVICES. Toe /n^encfawf of Valparaiso, by a decree of date Octo- ber 11th, requires all the doctors of the city to submit to a weekly " turn,"' when they are to hold themselves in readiness to serve the pubhc, whenever called on, from 12 P.M. to 7 a.m., for an entire week, and this without any remuneration whatever, in case of the applicants being unable to pay them. They are also required to take turns in attendance at a public dispen- sary, also without remuneration. Two of the sixteen doctors of the city suspended all work for several days, but resumed practice again, witli the understand- ing that the " turn " should not be enforced, and the authorities are endeavoring to get physicians from abroad to remove to Valparaiso, on a contract to give their professional services for a term of years, under such laws, decrees, and ordinances as regulate the exercise of the medical profession in that country, and are to receive free pa.=sage to Valparaiso, and two hundred dollars per month, for the first three months. Before being permitted to practice they will (the cor- respondent of the Medical Times and (j'azette writes) be required to pass a medical examination in Spanish. On its face this is a very unjust and arbitrary law, and it is not to be wondered at that the profession as a body rebel. But aside from this, there are some modi- fying circumstances to be taken into account, which do not ordinarily obtain in medical communities. In the first place, the practice of medicine seems to be monopo- lized by sixteen gentlemen, the provisions of the law regulating said practice being sufficiently stringent to prevent the ingress of any ambitious outsiders. The queition is certainly a suggestive one, whether these gentlemen should not be willing, in lieu of such a monopoly, to give some of their services gratuitously to the State. The law supports their interests on the one hand, and it would appear to be nothing more than a just return for them, even at the risk of personal in- convenience, to conform with a law which has the ostensible object of protecting the commonwealth. Again, it would seem to be a reflection upon the pro- fession of that place that any law should be deemed necessary to compel their members to attend the poor ; but we are disposed to take a charitable view of the case by assuming that a law based on such grounds is really uncalled for. In spite of all this, it would seem that our brethren of Valparaiso are not so alive to their purely professional interest as their protest would lead us to expect, else the obnoxious decree would not com- pel them to assemble at least twice in each year for the purpose of discussing matters of medical interest to themselves and to the State. THE HEALTH OFFICER OF OCR PORT. The power of the Health Officer of this Port to quaran- tine vessels at his discretion has been very much abused, and besides opening wide the door for bribery in every conceivable shape, it has been conducive to much shameful oppression to our merchants. This, it seems, from facts brought to light by the recent inves- tigations of the Quarantine Sub-Committee of the Le- gislature, is particularly the case with the present incumbent. The system of hghterage, as now enforced under his direct patronage, is an abomination, and calls loudly for a remedy. The practice of fumigation, as carried on by him, is also deserving of the serious atten- tion of such as have it now in their power of remedying the impositions connected with it. At present vessels THE MEDICAL RECOKD. 19 are kept unnecessarily long in quarantine, and fumiga- tion is practised when there is no otlier apparent reason for the same tlian the mere object of increasing the emoluments of the officer by exorbitant charges. When we add to this the fact as brought out in the investigations of the Sub-Committee of the Lcgisla- lature, that vessels held in quarantine are not uniVe- quently released on the payment of a sum of money, eveiy unprejudiced person has a right to suspect that there is very good reason for the almost universal out- cry among the merchants, of corruption and fraud. In view of these charges, the profession owe it to themselves to enter their solemn protest against the course of the Health Officer of this port, and deny to him the right to represent them as a faithful protector of the health of the people on the one hand, and the rights of the commercial community on the other. Although, in a political sense, appointed as a representa- tive medical gentleman, he long ago forfeited his right to be so considered. His appointment to the responsi- ble office was viewed by the respectable portion of the profession of this city as an insult to their dignity. The recent developments of corruption in his depart- ment have in no way tended to alter professional opinion concerning him ; and we speak the sentiments of our medical brethren, when we say that his removal will be one of the first of the important steps taken towards remedying many of the existing abuses of the quaran- tine. The profession as a body have a right to a voice in this matter, and now seems to be the time when its wishes should be heeded by the Executive. {Since writing the above, and on the eve of going to press, tue learn that Dr. S. Oakley Vanderpoel, of Albany, has been nominated by the Governor, and confirmed by the Senate, to take the place of Dr. Carnochan. The profession have reason to congratulate themselves on the change, and to express themselves as perfectly satisfied luith the choice. Dr. Vanderpoel has held many offices of trust, and to this, the most important of all, he ivill bring a i-epntation for professional ability, and an unques- tioned integrity of character.) vol. VII. to end with the year. It has been deemed advisable by the Editor and Publishers of the Record to end the present volume with the year. In order to do this to the best of advantage to our readers, we have concluded to is- sue four double numbers during the year. We give the first of these with the present issue. EetJtntJs antr notices of HJoolis. A CLmiCAL Manual op the Diseases of the Ear. By Lawrence Turnbull, M.D. The general practitioner stands very much in need of all the information he can obtain upon diseases of the ear, provided it be real information, founded on the actual experience of some accurate observer. A book. professing to treat of diseases of the ear. should do so in detail, and should not be a mere compilation of what has been written upon the subject by other authors, and this is all that the work under consideration is, though it (.laiiiis to be more. Dr. Tuinbull is mistaken in thinking that the day has passed fir medical men to allirm that they " know but httle of the anatomy and physiology of the ear, and nothing about its diseases." Most of the general practitioners are lamentably igno- rant of the subject; and if they do not all confess their ignorance, do what is worse by concealing it, and do their patients a great deal of harm. The " scientific reformation " mentioned by Dr. Turnbull has not, un- fortunately, extended as far into tlie rank;: of the gen- eral profession as he imagines. The author's manner of expressing himself is generally obscure, and some- times almost incomprehensible ; e. lo chaiiges. The first, called nrieiiiic amaurosis, may exist alone, or may precede or complicate the second or retinitic amaurosis. It may precede any symptoms of renal disorder, and cannot be demonstrated by the oplithalmo?cope. The changes of the second form are in the retina, are partly I'atty, partly a sclerosed action, and involve the nerve-tissue as well as the connective-tissue framework of the retina and the adventitia of the vessels. Speaking of leuctemic retinitis, the author thinks that the hypothesis of adenoid tumors in the retina of leucfe- mia must be abandoned, as not based upon sufficient evi- dence, and that we must fiill back upon the belief that leucivmic. like albuminuric retinitis, is a combination of hemorrhagic with irritative events; but that in both diseases we are as yet in want of further evidence as to the mode and causation of the latter. As regards the form of retinitis associated witii syphilis, the author is strongly inclined to coincide with Mr. Oglesby in at- tributing to it peculiar destructive appearances. We do not agree with him on this point, but think the retinitis to be similar in appearance to other forms of simple retinal inflammation, and that a diagnosis of a specific cause can only be made from coincident general symptoms, though we are aware that many good observers, particularly among our German con- temporaries, agree with Mr. Oglesby. The chapter on toxic amaurosis is very interesting. Speaking of alcohol poi^oninir, tlie author very justly says: "As in ur&imia, so in this, there is an amblyopia potatorum with ophthalmoscopic sign^ and an ambly- opia without them. Tlie latter defect is not rare, and may be due to congestion of the choroid, with conse- quent pressure upon the layer of rods and cones of the retina. The other kind of amblyopia seems to depend on this same congestion, witli consequent tissue-degen- eration of the optic nerve. Dr. AUbutt passes over the subject of tobacco-amaurosis very lightly, regarding it as not yet satisfactorily proven. In lead poisoning he thinks that the atrophy of the optic nerve some- times met with is occasionally preceded by a stage of subacute irritation. In the article on hypnosis and narcosis. Dr. Allbutt speaks of two kinds of sleep, viz. : Sleep, artificial or natural, due to anaemia; and sleep, artificial or natural, due to venous congestion of the capillaries; and he thinks it probable that narcotics produce their effect j by venous hyperaemia of the brain. In conclusion, we wouLl most cordially recommend Dr. Allbutt's book to the perusal of every practitioner, as a very valuable contribution to medical science. | TiiK PiivsiriAN'H Daily PorKicT RKfonn : Comprising a Visiting List, etc. By S. W. IJi ti.kh, M.D. Phila- delphia, 1(S71. Tme objectionabl(! feature of this book is the amount of printed matter which it contains. A memorandum with its pocket full of cards, prescription blanks, etc., is at best an awkward burden to have always in one's coat-pocket, and is a sullicient reason for leaving out such matter as tables and directions for urinary analysis — which can only be undertaken in a physician's office — and lists of remedies and doses other than such as re- quire .special care in their use. If a list of new reme- dies is added, it should only include such as are yet on trial, and regarding whose merits the majority of phy- sicians are imdecided. Such a list, with doses and the- rapeutical indications as far as known, might aid in ad- vancing greatly our knowledge of such remedies ; but we can hardly think it necessary to put into such a category the bromide of potassium, as regards iLs influ- ence in epilepsy, pumpkin seed as an anthelmintic, ipecacuanha for dysentery, M ousel's salt as a styptic, or carbolic acid as a disinfectant. Whereas, we would expect to see something said about chloralum and ni- trite of amyl, which we do not in the present instance. That])ortion of the book devoted to the visitinglist, re- cord of obstetrical cases, vaccinations, deaths, etc., is very commendable, the visiting list especially so, as it can be used for any year, from any date, and for any number of patients, without waste of room. The use of springs in the cover to keep the book closed, thus doing away with the need of an elastic band or tuck, is a very great convenience. PuT.MONARY CoNSUMPTiox ; its Nature, Varieties, and Treatment, with an Analysis of One Thousand Cases to exempHfyits Duration. By C. J. B. Williams, M.D., and Charles Theodore Williams, M.D. Philadel- phia: Henry C. Lea, 1873. 8vo, pp. 315. This volume, containing as it does a summary view of the opinions of a gentleman whose "experience in dis- eases of the chest in private practice during the last forty years has probably not lieen exceeded by that of any other physician," complemented by statistics of 1,000 cases selected from his note-books during a period of twenty-tAvo years, its practical value to the medical practitioner is very great, independently of any appro- val or disapproval of the author's theory of consump- tion. This tlieory, which tlie senior author has ad- vanced for more than forty years, and which receives support from modern pathological research, is, " that the tuberculous and kindred lesions whicli cause consump- tion of the lungs, arise from a degradation of the plas- ma or nutritive material by which old textures are re- newed and new ones formed." "This material, or pro- toplasm, is seen in an inflamed part of a living animal in the form oi sarcophytes or bioplasts^ multiplying and clinging to the insides of the blood-vessels, penetrating their walls, and emigrating by a movement of their own into the adjoining tissues. Like other forms of animal and vegetable protoplasm, these sarcophytes have vital endowments of motion, growth, power of ab- sorbing and digesting various matters from without, and of multiplying by division, and probably also by gemmation and endogenous proliferation." These sarcophytes or pale corpuscles exist naturally in very small numbers in the blood, but in greater abundance in the lymphatic system, and they may multiply and decay independently of inflammation, constituting a true scrofula; Avhen overcrowded and hardened from loss of their plastic and self-sustaining power, they become the gray tubercles, obstructing the THE MEDICAL RECORD. 23 adjoining tissues, and irritating them, and in them- selves prone to decay. The causes of consumption are classed as follows: — 1. General causes, -vvliicli by their weakening in- fluence on the constitution generally predispose to con- sumption. Such are family predisposition, want of pure air and good food, continued fever, scarlatina, measles, cessation of discharges, miscarriages, bad con- finements ; and over-lactation, mental depression, damp- ness of habitation. 2. Local causes, the effects of which are limited at first to the lungs, but may at a later date extend to the system. Tliese are: attacks of bronchitis, hooping- cough, and croup; attacks of pleurisy and pneumonia; attacks of asthma; trades and occupations giving rise to a dusty or gritt}^ atmosphere ; injuries. Tlie 1,000 cases selected for statistical purposes are taken from notes of about 25,600 cases, accumulated during some thirty years, representing all the cases of any gravity in which the author has been consulted in private practice. The average duration of the 1,000 cases was nearly eight years. Tliey are divided into two groups; phthisis of inflammation, and phthisis of constitutional origin. The first group includes varieties designated as fibroid, suiDpurative, chronic pneumonic, scrofulous pneumonic, catarrhal, albuminous, hemor- rhagic, and others more or less mixed, and in their course assuming more or less of the form of constitutional phthisis. The second group includes acute tuberculosis, chronic tuberculosis, and scrofulous consumption. These are represented as varieties of one common disease, varieties not always distinct and easily passing into one another. With regard to the treatment of consumption, our author, on taking a retrospect of an experience of forty years, can trace a remarkable improvement in its suc- cess. This is due, in great measure, to the use of cod- liver oil, in connection with the liberal use of nutritious food, and the administration of tonics. The tonics on which most reliance is placed are quinine and iron, but they are not deemed useful as long as there exists any inflammation, active or intercurrent. Under these cir- cumstances ealumba, cascarilla, and chiretta are pre- ferred. The oil recommended is the pure pale oil. The best time for its administration is immediately after a solid meal, or at or before the meal, for those who pre- fer it so. It thus forms part of the chymous mass, less apt to rise by eructation, and less apt to disorder the stomach. It is given with an aromatic bitter, acidu- lated with a mineral acid, and, where a tonic is given, it is added to the dose of oil, the dose of which should rarely exceed a tablespoonful twice or thrice a day. With regard to climate, it is advisable that the patient should breathe as pure an air as possible, and that its beneficial influence should be increased by such gentle and varied exercise in it as his strength and the conditions of his organs will permit. The separate points of special forms of phthisis and their management are treated of fully and in sufficient detail. Consumption is such a fearful destroyer of human life, that every valuable communication concerning it de- mands the serious attention of the physician. He will find much to admire, and much to follow, in this useful summary of a well-known aud distinguished author. A Practical Treatise on Brigiit's Diseases op THE Kidneys. By T. Gr.\inger Stew.\rt, M.D., F.R S.E. Second edition. New York : William Wood & Co. 1871. We welcome this work as a model of what a second edition should be. The revision of the first edition, which appeared in 18G8, has been very thorough. The size of the volume has been nearly doubled, the addi- tions consisting mostly of reports of cases which are of great interest, and strongly enforce the views of the au- thor on certain disputed points in the pathology of Bright's Diseases. A supplementary chapter has been added on " The Complications of the Different Forms of Bright's Disease," and two new lithographs have been introduced. But, besides these improvements, the work bears evidence of careful attention to the minuter details of revision. Sentences are reconstruct- ed, positive statements qualified, new modes of treat- ment suggested ; in a word, the author gives us the re- sults of three years' additional study of these " well- known but little understood diseases." To review this book as its merits deserve would require more time and space than we can command, but it may be of in- terest to notice a few points in pathology in which the author differs from the views expressed by Dr. Dickin- son in his work on Albuminuria. Dickinson adopts the classification of Virchow, according to which the differ- ent forms of Bright's Disease are distinguished by the tissue primarily and principally affected. When the renal tubules are the principal seat of the morbid pro- cess, we find the large red or the large white kidney the result of an acute or of a chronic tubal nephritis; when the affection starts with and is chiefly confined to the intertubular matrix of the organ, we have the contracted, granular or cirrhotic kidney; thirdly, the amyloid or " depurative" disease, which primarily affects the walls of the smallest arteries, especially the convo- lutions composing the Malpighian tufts, but subsequent- ly extends, by exudation of the amyloid material, to the intertubular s{)aces, and may ultimately lead to di- minution in the size of the organ through contraction of the exudation. Stewart's classification is widely dif- ferent from this, but is, Ave are convinced, more in ac- cordance with recent pathological views. His division is as follows : — " 1st. The wflammatory fo7-m, of which there are three stages. a. That of inflammation. b. " " fatty transformation. c. " <' atrophy. 2. The waxy or amyloid form, of which also there are three stages. a. That of degeneration of vessels. b. '■ " secoiidary changes in the tubes. c. " '• atrophy. 3. The cirrhotic, contracting or goidy form ." According to the author, an atrophied kidney may belong to any of these three divisions; Dickinson would exclude it from his first division, tubal nephritis. Stewart thus expresses his views in regard to the rela- tion between tubular inflammation and atrophy of the kidney. " The first stage is that of inflammation, in which exudation is poured out, and a destruction of the epithelium takes place. This exudation, affecting a large number of tubules, leads to enlargement of the organ, and also to fatty degeneration of the epithelium ; its absorption or removal leads to ultimate atrophy." The granular or " uneven surface is due to the irregular affection of the tubules, some being involved and under- going atrophy while others escape, . . . and not to the contraction or outgrowth of connective tissue." Dickinson dissents emphatically from the view that a granulated contracted condition of the kidney may result from a tubal nephritis. " If," he says, " in sim- ple tubal nephritis, the loss of the contents of the tubes ever suffices to reduce the once enlarged kidney below the natural bulk, such a result must be of rare occur- rence, since no unequivocal instance has fallen under 2i TilE MEDICAL RECORD. the observation of the author." Case No. XIX. in the present work bears directly upon this point. Wc have not the sjiace to quole it, but any one interested in renal i)ath'ilogy would be amply repaid by carefully studying,' Dr. Stewart's commentaries upon it. That thi.s furm of atropliy is not of fretpient occurrence is doubtle.-s duo to the f.ict lliat patients with this variety of Brighl's Disease j^encrally recover or die before this stage of degeneration is readied. The microi^cope will generally show, in a kidney thus contracted, a relative excess of connective tissue, but this degeneration may be distinguished from a true cirrhosis by noticing the considenvble amount of disease in the tubes not yet ob- literated, and the absence of the characteristic broad masses of connective tissue found near the surface of a cirrhotic kidney. Our autlior vigorously combats Dr. Dickinson's views as to the pathology of the amyloiil disease. He agrees with him that the amyloid material consists of an al- buminoid sub.-^tance probably delicient in alkah, but he denies tliat it has any necessary or constant relation to the suppurative process as indicated by Dickinson's unfortunate term " depurative disease." In 18 cases coming under the author's observation, only C> were found, after careful examination, to have suffered from a past suppuration. ]Ie maintains, moreover, that the disease is essentially a degeneration of tissue, and in no sense an infiltration by any ingredient of the blood. '"That it is not an infiltration." he says, "will become apparent if we consider the parts it affects. We have seen that it affects the cells of the liver. This might well be a result of infiltration, for we constantly see the same structures loaded with fat which has been poured out from the blood. But far more generally through- out the body it affects small arteries. How is this to be explained on the infiltration theory ? How can it happen that the small arteries — nay, the small arteries of certain organs— nay, the middle coat of the small ar- teries — should be the chosen seat of deposit of a ma- terial poured out from the blood ? If it be poured out from the blood, why does it so generally confine itself to the walls of arteries and unstriped muscular fibre ? Why does it not infiltrate the parenchyma of organs? Why does it, in the intestine, as it flows from the blood, confine itself to the walls of small vessels, to the muscles of Briicke, to the epithelium ? Why does it not pass out among the cellular tissue of the villi, and become deposited there ? These questions can scarcely be answered by those who hold the infiltration theory. On the other hand, how exactly the characters corre- spond to those of degeneration, — certain tissues always primarily aflfected, those tissues presenting every de- gree of alteration from the slightest to the most dis- tinct, the surrounding parts remaining unaffected. The closest analogy exisis between what is seen in this and in the atheromatous and calcareous degenerations, the former affecting the inner coat of arteries, and es- pecially the deeper layer.«, the latter, when primary, af- fecting the middle coat. Both are independent diseases originating in the tissues, not even secondary results of infiltration." By the cirrhotic kidney our author understands " an hypertrnphij of the connective tissue, and a consequent atrophy of all the other structures." He objects to the term granular kidney because the same condition is found in the third stage of the inflammatory and amy- lOid diseases; to the term gouty kidney because the dis- ease often occurs independently of gout ; to the term contracting kidney because contraction is not peculiar to this variety; and to " intertubular or interstitial nephri- tis" because there is no evidence of inflammation. He ho'ds to the non-inflammatory nature of the morbid process, and denies that there is any evidence that an inflammatory exudation takes place into the intertubu- lar spaces. Further investigations are needed in regard to the essential jihenomena of inflammation before this question can bo discussed in an entirely satisfactory manner. Wc congratulate the publishers on the creditable style in which the work is is.sued. The cloth binding has the American merit of being firm and substantial. Why is it that our English bretliren persist in so fast- ening their cloth bindings that they fall to pieces after the book has been used half a dozen titucs? The paper, letter-press, and lithographs, plain and colored, are excellent, and we lieartily rejoice that the time has come when a physician can gratify his taste for hand- some books in his medical as well as in his literary li- brary. The Science and Practice op Suugery. Illu.strated by four hundred and seventy wood engravings. By Fkedeiuck James Gant, F.R.C.8., Surgeon to the Royal Free Ho.spital ; formerly Surgeon to Her Majes- ty's Jlilitary Hospitals, Crimea and Scutari. Philadel- phia : Lindsay ic IJlakiston. 1871. In the preface of this work, wc are told that now many years have elapsed since a new systematic work repre- senting the science and practice of surgery has ap- peared in his country, and that it is the aim of the writer to give a full but condensed embodiment of all those changes in the pathology and treatment of inju- I ries and diseases which the progress of surgery has established. Evidently the intention of Mr. Gant has been to make a big book, and certainly in appearance it is very pretentious, to say the least. By gleaning largely from the writings of English surgeons, and per- haps chiefly from the articles contained in Holmes' System of Surgery, the book has grown to one of con- siderable size. Indeed, we nmst look upon it pretty much in the light of an epitome of the more recent English authors, and as such it must be regarded as a work of no little value. In a book of this kind, however, we think its value would have been greatly enhanced, if the writings of Continental as well as American authors had been a little more consulted. Had this been the case, in our judgment both the pathology and the treatment advocated in many affections would have been more in keeping with the progress of science than we find to be the case in many parts of this work. Full and due credit has been given to all the sources whence information lins been derived, and through- out the work the author's own surgical experience and pathological observations have been freely inter- spersed. The subject of inflammation is considered entirely in accordance with the views which have been adopted by most English writers, and differs but little, if at all, from what was taught many years ago. We were no little surprised that in this field the labors of the Ger- man pathologists were hardly noticed. No reference is even made to the researches in this direction by Strieker, Recklinghausen, or Cohnheim. Should our author even dissent from these views, he should, at least, have acquainted the reader with the more modern views on this important subject. Tumors we find classified into those that arc localized (not infiltrating), which includes some of the recurring varieties, and into the infiltrating growths, as the varie- ties of cancer. The whole subject of these grov/ths is but briefly referred to, with the exception of that of cancer, which is more fully and much more satisfac- torily treated. While reading the chapter on tumors, it is with difficulty that one can persuade himself that THE MEDICAL RECORD. 25 he is not turning over the pages of Mr. Paget or Mr. Moore's excellent treatises on this subject, as found in Holmes' Suigery. Were we to criticise the cbapter on syphilis as we believe it deserve?, we should tuke up more space than can be allotted for a notice of the whole work. Did we desire to thoronghly confuse a student on the sub- ject of syphilis, we could not succeed better than ask him to read this chapter. Mr. Gant states his views incline to the opinion '• that while the indurated chan- cre possesses the greater power of producing constitu- tional syphilis, and is thence the most freciuent cause; yet that so/if chancres may also occasionally have this causative relation. Hence, they also may be regarded as forms of primary syphilis." We were no little sur- prised to fmd the statement here made that a chancre on the glans penis never acquires induration. Suffice it to say, that this article savors more as if it came from the pen of one whose information had been derived from reading, rather than from actual experience in the study of this disease. While speaking upon the subject of the treatment of erysipelas, especially in those cases where the skin is tinged with a yellow hue, even when " verging on jaundice," we must dissent from the view here ex- pressed that this condition is best overcome by the re- peated (italics our own) administration of calomel or blue pill, to restore the secretion of bile. Cases present- ing these symptoms which have passed under our ob- servation Avould have exhibited a very unpleasant result from such treatment. Pycemia is treated not in accordance with the more recent views that pathologists have advanced, and the same is to be said in reference to phlebitis. When describing the symptoms of pyaemia, no mention is made as to the rapid rise of temperature, as indicated by the thermometer just before and during the period of chills, (fee. ; nor are the diseases which the student might mistake it for mentioned, nor is he told the usual duration of the disease. The chapter on gunshot wounds is very meagre, and certainly not such as we would have expected to have emanated from one who has been a military surgeon. Had some reference been made to the experience gained in our late war in regard to these wounds, it would have considerably enhanced the value of this portion of the work — at least to the American reader. Injuries and diseases of the nerves are very unsatis- factorily treated, and in no way is it a creditable chap- ter to its author, not being up to the requirements of a Avork of this kind. Little or nothing is said in regard to wounds of nerves, and the various operations that of late years have been performed for the relief of neu- ralgic affections are not even alluded to. The succeeding chapter, however, on aneurism, is very well written. While referring to ligature of the innominate artery, we find the statement made that it has been tried in eleven cases, and that they were all fatal. No reference is made to Dr. Smyth's successful case, which we believe makes the twelfth reported case of ligature of this vessel. Here, as in very many portions of the work, Mr. Gant appears to have been utterly ignorant of what has been accomplished in sur- gery on this side of the water. The chapter on fractures gives us a good description of tliese lesions, and is well illustrated by the time- honored woodcut?. The treatment, however, recom- mended in this work must strike American surgeons in many cases as somewhat antic|uated. For fractures of the femur "we find that Liston's long straight splint will be found most effectual in all fractures of this bone, and extension is to be made by confining the foot to the splint by a figure-of-eight bandage ! What has been said in regard to fractures applies also to dislocations. The principal obstacle in reduc- tion our author attributes to the muscles, and but little reference is made to the ligaments, which we believe at the present day are regarded by many as offering the chief obstacles to reduction. No reference is made, while speaking of dislocations of the hip, to Dr. Bige- low's work on this subject, and only brief reference is made to reduction by manipulation. With regard to the chapter on diseases of the eye, it may be considered as a slight improvement upon the manner Avhich we find these diseases treated upon in the majority of text-books on surgery. Had Mr. Gant followed some other ophthalmologist than Mr. Dixon, we have no doubt the chapter on diseases of the eye Avould have been more in accordance with the present state of ophthalmology. Though this work is faulty in many respects and in- vites criticism, there is much to be found in its pages which will be very valuable either to the student or practising surgeon. Under this head Ave would espe- cially refer to the articles on resection of the joints, inju- ries of the brain and spinal cord, together Avith the subject of curvature of the spine, and the chapter on the diseases of the genito-urinary organs. Mkdical Thermoaietry, and Human Temperature. By C. A. Wunderlicii, M.D., and Eda\^\rd Seguin, M.D. New York : Wm. Wood & Co. 1871. Within the past five years much attention has been paid to the use of the thermometer as a means of in- vestigation in clinical medicine and diagnosis ; and though A'ery man}^ practitioners Avere convinced of its value and utility, it has not as yet come into such ex- tensive use as it undoubtedly Avill hereafter, as Ave noAV have a concise manual on the subject to serve as a guide in the study of its use. The observations pub- lished in the Avork of Dr. Aitken Avere the first, we think, of any importance to call the attention of the profession to the real value of the instrument ; and though, from time to time, we have had more or less elaborate articles upon its use in various disea-es, we Avere AvhoUy in Avant of a hand-book treating of the AA'hole subject. Consequently, though the thermome- ter is quite largely used here, it may be said, Ave think Avith truth, that its use is nearly confined to thoscAvho have had opportunities for the study of its applicabilit y in the various large hospitals. Within a year Ave have had a translation ot the encyclopaidic treatise of Wunder- lich, which, besides being inaccessible to those Avho are not subscribers to the publications of the Sydenham Society of London, is objectionable on account of its great length and detail, and will be consequently of no reaf value to the majority of practitioners. To render this Avork available to American practitioners. Dr. Seguin has with great industry and care abridged it very materially, and at the same time has enriched it with a resume of his own extensive observations, and the result is a A'cry convenient and comprehensiA-e hand-book, Avhich is especially adapted to the Avants of the busy practitioner. The Avork is divided into two portions: first, the abridgment of Dr. Wimderlich's treatise; and second, the supplementary chapters by Dr. Seguin. We find in the opening chapters a concise and brief history of the instrument; followed by a consideration of the fundamental principles and of the art of medical thermometry, Avhich contain facts Avhich, Ave think, should be "thoroughly mastered. The observations upon local alterations of temperature in disease will no 26 THE MEDICAL KECORD. doubt bo novel lo mnny, and should be rosul in connec- tion with ihe ri-nmrks nia. Tinct. rad. aconiti, Tinct. opii, il a 3 ss. M. One liaif hour afterwards he was .seized with dizziness, nausea, dimness of sight, cephalalgia, pain in back, with sensation of coldness running along tlie spine, etc. One hour after the ap- plication, the usual results from an overdose of aconite internally were exhibited. On examination, no abra- sions were discovered on face, but the index finger of right hand had a slight wound. The patient, male, aged forty-five, of good constitution, was treated with ammonia and cldoroform, and at the end of forty-eight hours the symptoms subsided. C.\Tn.\RTics IN' Albuminuria — Dr. Moore, of Pioches- ter, X. Y. (Med. and A^urfj. Reporter), read a paper before the Central Xew York Medical Society, in which the idea was enforced that albuminuria might remain as an organic disease for a considerable length of time; and during that time there was a remedy in sulphate of magnesia. A case was presented, in which the con- dition of albuminuria was removed by the cathartic treatment. Drs. Benedict and Campbell gave histories of cases which had been managed according to Dr. Moore's plan, which afforded relief. In answer to Dr. Mowris, whether the saline treat- ment had been successful after scarlet fever. Dr. Moore replied affirmatively. Large Pleuritic Effusion Treated by Thirst. — A case in winch this mode of treatment was pursued by Dr. Moxon, in Guy's Hospital, is reported in the Medical Times and Gazett'' of January 6th. At the commencement of the treatment the right pleural cavity were filled with liquid.- The drinks of the patient were Umited to ten fluid ounces per diem, and five grains each of iodide of potassium and muriate of ammonia were given three times daily. By the middle of the third week of treatment dulness on the affected side had disappeared. Presence of Bacteria in the Blood during Ery- sipelas. — Dr. Nepveau reports, in the Gazette Mtdicale de Paris, four observations, made with a No. immer- ' sion of Ilartnack's make, on blood taken from patients suffering with this disease, and says: — 1. Bacteria exist in considerable numbers in blood drawn by puncture from a surface affected with ery- sipelas; three to five, and sometimes as many as seven, having been at one time in the field of the microscope. 2. Bacteria exist as well in blood drawn from other fiorlions of the body than those affected witli erysipe- atoiis inflaminalion ; they are not so numerous as in blood drawn from the disea.sed surface, but can almost always be found in any drop of blood submitted to examination. 3. In all the ca.ses examined the bacterium punctum of Ehrenberg was the one observed. 4. They ajipcar t) be present in ca.ses of .so-called idiopathic as well as in tho.*^ of traumatic erysipelas; but it remains to be established whether or not this is constantly the fact. Xylol is the name of a new hydrocarbon lately in- troduced to the materia inedica in Germany. Wiien pure it is colorless and has a faint odor, somewhat like benzole. Its specific gravity is 80G, ano, in their cases, to interf(,>re with the development of the Graafian vesicles ; the propagation of species being thus doubly retarded. Freqcenct of Laryngeal Ulceijatioxs in Syphilis is the subject of a valuable article in the Wiener Med. Press, from which the following figures are taken : — Out of 100 post-mortem examinations of patients affected with secondary syphilis, performed at Prague, Kiihle saw ulcerations of the larynx 15 times; whilst Alten- hofer met only 25 cases among 1,200 living patients. Gerhardtand Roth, on the other hand, found it IS times | in 54 syphilitic patients — viz., 11 times with 44 second- I ary patients, and 7 times with 12 tertiary ones. Out i of 1,000 syphilitic patient?', Lewin found 44 presenting | an a5"ection of the larynx and more or less hoarseness. , Engeftted counted 25 laryngeal cases among 521 patients suffering from syphilis — viz., 14 cases among i 292 men, and 11 ca=e3 in 292 women. Doctor Som- j merbrodt (the writer of the article) himself collected ; cases for nine months at the AUerheiligen Ho.spital; i and, out of 84 patients with constitutional sypliilis, 15 i presented ulcerations of the larynx in different periods, ' and 14 had catarrlial affections with hypertrophy of | the mucous membrane. These lesions seem, therefore, I rather frequent, as already stated by Tiirck in his j manu.ll. Among 2.38 cases of persons sufi'ering from i various laryngeal affections, says the author, 45 were syphihtic. Laryngeal syphilitic symptoms may occur in j all the stages of the disease. Tiirck observed them in a I patient who had had primary lesions thirty years he- lore ; and Krankel has s(>en such ulcerations in a child I two months old, with whom the first .signs of syphilis had appeared one month after birth. The earliest time alter primary lesions ha", in Tiirck's experience, ' been six months; in Somiiierbrodt'.s, five months; and "j in Lewin's, from two to three month.s. The seat of the I lesions is indicated in the following table in 92 cases: — Epiglottis 21 timo.s. ( both, True vocal cords ■ right 4 ^ /left ( both False vocal cords < right (loft Interior of larynx } '^T'-"""!-' in r •^ / Anteriorly 10 ( Aryteno-epiglottic folds. . . . I'pper opening Right pyriform sinus Lower portion of the larynx 9/ 34 It will therefore be seen that the vocal cords are the partsmost frequently attacked, especially the l>/t. This circumstance sliould be recollected, as, in Rhimer's experience, tubercular ulcers are mostly situated in the right, and this peculiarity has a diagnostic value. It is, in fact, towards the upper part of the larynx that the syphilitic ulcerations are formed. Strychnia a Retinal ano Optic Nerve Stlmclus. — Dr. Juliauj^J. Chisolm, Clinical Prof, of Eye and Ear Diseases in the Univ. ot' Maryland (Am. Journal of Mecf. Sciences), advocates the hypodermic use of strychnia in cases of optic nerve atrophy, and reports cases in which the effects seemed nearly instantaneous upon the injec- tion of the fluid under the skin. In nearly every instance'the patient experienced the brightening of the light in less than a half minute. Prof. Nagel, of Tiibin- gen, Germany, injects, in his cases, the temple, near the seat of the eye disease. As the strychnia has first to be absorbed, and only acts upon the nerve centres through the circulation, he sees no advantage in thi^ location over the arm, and hence uses this distant but more convenient portion of the body. He commences usually with the one-sixtieih of a grain, which is grad- ually increased to one-thirtieth, twice a day, in no case exceeding this last amount. This treatment has been tried in many cases, doing harm to none, and benefiting all more or less. In functional disturbances the relief is prompt; in organic troubles of the retina and optic nerve results show themselves more slowly. So far, his experience in the h3'poderniic use of strychnia enables him to indorse the statement of the wonderful effects secured by Prof. Nagel, of Tubingen, and he can recommend to the profession strychnia, hypoder- mically used, as a most valuable remedy in many cases of nerve-blindness. Amputation at the Knee-joint. — Two successful crises of this amputation are recorded by Dr. G. M. Staples, Dubuque, Iowa (Am. Journ. Med. Sciences). In regard to the length of the anterior flap, he states that the incision extended but a trifle more than an inch below the tubercle, and, as is seen, the cicatrices remain in the hollow behind the condyles, with non- retraction of the patella. If it is a matter of some im- portance to retain the patella at the end of the .stump, he asks, may not as short an anterior flap as is practi- cable and safe, with flexion of the thigh ujion the pelvis until union is effected, contribute to this result? THE MEDICAL RECORD. 33 Ueports Df Societies. MEDICAL SOCIETY OF THE COUNTY OF NEW YORK. Stated Meeting, January 22, 1872. Dr. Abraham Jacobi, President, in the Chair. TiTK following physicians wero reported from the Co- miiia Jilinora as recommended for membership, and, by vote of the Society, they were admitted, viz. : Alex- ander Perry, Charles M. FairbroLher, Nicholas L. Camp- bell, Julius H. Tyndale, Gustavus Treskatis, Herman Loewenthal, and L. De Forrest Woodruff. Tlie President announced the death of Dr. Henry D. Bulkley and of Dr. Alexander N. Gunn. On mo- tion, Drs. D. C. Carr, D. A. Hedges, and S. W. Roof were appointed a committee to draft appropriate reso- lutions in the case of Dr. Gunn. Resolutions on Dr. Bulkley's death had been adopted at the Special Meeting which we have already recorded. DISEASES OF THE PAST YEAR. The report of the Committee on Diseases was read by its chairman, as follows : — The Committee on Diseases has the honor to present the following report upon the mortality and prevailing diseases of the past year : The total mortahty of this city for 1871 amounted to 26,976 — a decrease of 199 from the previous year. It was equivalent to a death-rate of 28.6 in each thousand inhabitants. Zymotic diseases destroyed in the aggregate 8,365 lives — being 31 per cent, ot the total mortality — a slight increase upon 1870. The most prominent epidemic of the year was that of small-pox. This disease had pre- vailed to an unusual extent in 1870, having produced 293 deaths, but it had so subsided in the autumn of that year, that in the three months ending December 31st, 1870. it occasioned but 12 deaths. In the early part of January, 1871, it broke out afresh with extra- ordinary vigor, and rapidly increased during the en- suing six months. It caused 208 deaths in the first quarter of the year, and 304 in the second quarter. In the summer it began slowly to decline, its mortality being 164 for the quarter, and but 23 for the month of September. Up to that time the work of vaccination had been so energetically pursued by the vaccinating corps of the Health Department, that they had vacci- nated 100,000 persons in nine months. At the very time, however, when the prospect was most favorable for entirely arresting the disease, the Board of Health was obliged, on account of the failure of its pecuniary resources, to dispense with its extra inspectors for some two months. The result was soon apparent in the extension of the epidemic, as, although only 23 deaths were due to small-pox in October, it occasioned 36 in November, and 70 in December. On November 21th the work of vaccination Avas resumed, but the disease had acquired too nmch new force to be readily overcome. Its total mortality for the year amounted to 805, its greatest yearly niortality recorded in this city during the present century, the next largest number of deaths, 681, having occurred in 1853. During the year 2,085 cases were reported to the Bureau of Sani- tary Inspection. According to these figures its mor- tality reached 39 per cent. About 47 per cent, of the deaths were among children of 5 years old or less. The greatest number of deaths according to locality were as follows: 17tli Ward, 41; 22d Ward, 37; 2()th Ward, 26; 21st Ward, 23. The Small-Pox Hcs- j)ital furnished 572. Its severity here during the past year, although remarkable for New York, was insigni- ficant as compared with its ravages in many other places throughout the world. We may simply mention, for example, among foreign cities the Hague and Lon- don. In the former (whose inhabitants have always evinced a peculiar antipathy towards vaccination) the mortality from small-pox during the first quarter of 1871 was enormous, reaching the extraordinary annual death late of 48 in the thousand inhabitants — a rate which would have pioduced in New York 7,500 deaths from smnll-pox in three months. In London there were registered during the year 7,876 deaths from small-pox in a total from all causes of 80,332. In a single week the fatal cases amounted to 288. The same death-rate here would have given us 2,300 deaths instead of 805. The most remarkable epidemic of small-pox upon this side of the Atlantic has devastated the city of Philadelfihia. Nearly 2,000 fatal cases were registered during the past year, of which 1,^12 oc- curred in the three months ending December 31st. 233 were recorded in a single week. The next zymotic disease which displayed ati un- usual activity here during the past year was whooping- cough. It carried ofi" 465 victims, being the greatest number of lives destroyed by this disease in any year of the present century, the next largest number having been 377 in 1855. 01' the 465 deaths, 196 were males and 269 females. The large preponderance of females over males is curious, but, as the death records of former years show, is quite characteristic of this aftec- tion. As far as we are aware it is unaccountable. Remittent fever during the year caused 165 deaths; intermittent, 110; and typho-malarial, 12. These fe- vers were never so fatal belore. They prevailed most extensively in the upper wards of the city. There is little of interest to record in regard to the other zymotic afiections. The following statement presents the mortality of the principal ones for the yearg 1870 and 1871: 1870. 1871. Scarlatina 975 791 Measles 298 409 Diphtheria and croup 729 704 Typhus fever 96 65 Typhoid fever 422 239 Diarrhceal diseases 3,956 3,653 The principal feature of the above statement is a considerable falling ofi' during 1871 in the mortality from typhus and typhoid fevers and diarrhoeal com- plaints. 6 deaths were ascribed to cholera ; 6 to re- lapsing fever; 2 to yellow fever; 142 to sypliilis; 7 to hydrophobia, and 220 to intemperance. Typhus and tvphoid fevers Avere most prevalent and fatal in the l"7th Ward. The following cases of contagious disease y^ie re- ported to the Bureau of Sanitary Inspection during the year : Typhus fever, 126; typhoid fever, 492; scarlatina, 2,850; relapsing fever, 80; measles, 1,626; diphtheria, 408; small-pox, 2,085. Constitutional diseases produced 6,263 deaths, about 23 per cent, of the whole, against 6,329 in 1870. Of these rheumatism caused 103 ; cancer, 339 ; marasmus and scrofula, 757 ; hydrocephalus and tubercular men- ingitis, 755; and phthisis pulmonalis, 4,186. The mortality fiom phthisis was equivalent to 15i per cent, of the total, and was both positively and relatively large as compared with that of late years. In 1866 it 34 THE MEDICAL RECORD. wa3 equal to 12.2 percent.; in 1867 to 14.4; in 1868 to 13.7; in 1869 to 1:3.3; in 1870 to 14.8; and in 1871 to 15.'). We thiKS [KTceive tliat tliis formidable disease has been constantly increa.sinf,' in falJilily during the past six Vi^'.^. About one-(iuait(T of its deatlis tooi< jdace in "hospitals, and a lar<,'e majority among the tcnomfnt-liouse population. The migratory character of that ela.ss of our inhabitants rcndersit almost impo.s- sible to observe and localize those regional causes -which may inlluence consumption in this city. Local diseases, or aflections of special organs, occa- sioned 9.282 deaths; 34 per cent, of the whole, a decrease of G17 from the previous year. Of these there were due to diseases of the nervous system, 2,G77 deaths ; circulatory system, 894 ; respiratory system, 3,*J48; digestive system, 1,0')2 ; urinary sys- tem, 1,103; generative system, 54; locomotory and osseous system, 120 ; and integumentary, 74. Among these theVe was little worthy of extended mention. There were 904 deaths from bronchitis, and 1,834 from pneumonia, against 855 and 1,830 respectively in the preceding year. Urinary diseases were uncom- monly fatal, and they appear to have been becoming more" and more so during the past few years. Thus the deaths by Bright's disease within four years have been as follows?, commencing Avith 1808: 534; 557; 787, and 947 — an increase of 77 per cent, during tlie period mentioned. Developmental diseases (or those arising from ab- normal action of the formative, reproductive, or nutri- tive processes) produced 1,703 deaths, or Oi per cent, of the whole. 888 were in infants newly bom ; 312 in women ; 333 were due to senile decay ; and 230 to atrophy and asthenia. These figures were somewhat in excess over the previous year. Finally, the deaths from violent causes amounted to 1,303, or 5 per cent, of the whole, against 1,000 in the jirevious year. " The increase was owing principally to the July riot, which caused 53 deaths, and the West- field explosion, 82. 1,070 deaths were ascribed to accident and negligence ; 05 to homicide; 114 to sui- cide ; and one was a judicial execution. Of the total number of deaths, 7,994 occurred among infants less than one year old ; 10,700 among those less than two years old ; and 12,970 among children less than five years old ; the last being 40 per cent. 9f the total mortality. In 1870, the deaths among such children were equal to 49 per cent, of the whole; in 1809 to 51 per cent. ; in 1808 to 52i percent. ; and in 1867 to 53 per cent. Altogether, therefore, between 1867 and 1871, there has been a gain among children less than 5 years old of 13 per cent, upon the total mortality. There Avere 1,290 deaths among persons 70 years old and upwards, a gain of 74 upon the previous year. 14 were reputed to have been 100 years old or more, of whom 3 were males and 11 female?. KespectfuUy submitted, Chas. p. Russel, M.D., Chairman Com. on Diseases. C.VNTUOPLASTY IX CONJUNCTIVAL AND CORNKAL AFFEC- TIONS. Dr. H. Althof read a paper entitled Clinical Notes on Diseases of Conjunctiva and Cornea. Its main object was to call attention to an important element, hitherto rather neglected in the therapeutics of these affections, viz. : the diminishing of the pressure of the lids upon the globe. After a review of the present methods of treating the more serious forms of conjunctival disorder — granular lids, diphtheria, blennorrho^a, etc. — all of them only partially under the control of the physician, Dr. A. entered more directly upon its special subject. Thus far, three diflferent procedures had been occa- sionally followed for the purpose of relieving the ball of the eye from excessive pressure, viz. : incisions or excisions of chcmotic conjunctiva; removal of a trian- gular piece of skin (down to the niu.scle) from the up- per lid ; and splitting of the outer angle. This last method undoubtedly suited best, but its gooa in its most acute and destructive forms lost most of its dangers. Dr.H. D. Notes agreed Avith Dr. Althof in his high estimate of the operation of canthoplasty. It had be- come as much a sine qva non in the treatment of tracho- ma as had iridectomy in that of glaucoma and diseases of the iris. The remarks upon diphtheritic conjunctivitis had especially interested him, from the fact that he had within three weeks had in his practice four cases of the affection, one them very severe, involving the ocular as well as the palpebral conjunctiva. Up to six months ago his experience had furnished him Avith but feAV examples of this disease. Since that time he had had perhaps a dozen ; and he believed the occurrence of these cases in such close succession was coincident Avith an unusual prevalence of scarlet-fcA'er and of croupous afiections generally. As to the therapeutics of conjunctival disorders, there was less need of discovering new means of treatment than of learning precision in the application of those now known ; for their number was already bewilder- ing. Dr. Agnew's experience had confirmed his belief in the bold use of canthoplasty. He had been led to modify the operation by division of the edge of the ex- ternal tarsal ligament of the upper lid only, as exposed in the Avound. It Avas the pressure of the tarsal carti- lage of the upper lid Avhich caused the chief trouble ; and the incision of skin and mucous membrane alone would not always make such pressure harmless. He felt confident that since the introduction of iridectomy no other addition so important as canthoplasty had been made to the resources of ophthalmic therapeutics. Dr. Edward Curtis could testify to the value of the procedure in phlyctenular conjunctivitis, the prompt- ness of its eflect seeming at times almost magical. He related a case, attended Avith great photophobia, cured by its means in a couple of days. Dr. E. H. Derby thought the advantage of the ope- THE MEDICAL RECORD. 35 ration lay, perhap?, as much in its enabling the surgeon to reach the retro-tarsal fold with his applications as in the relief from pressure it afforded. Von Graefe ob- jected to its employment in diphtheritic conjunctivitis, from the danger that any wound in such a case might itself become the seat of diphtheritic deposit. Dr. ALxnorhad had only seventeen cases of diphthe- ritic conjunctivitis in five years, up to September last, though since then he had seen at least twenty. He would not set his own slight experience against Ton Graefe's; but although he had always found the diphtheritic deposit infiltrating the incision, as it does wounds of other pai-ts, yet he regarded this as of slight consequence, when compared witii the great ad- vantage conferred by the operation. By the time the diphtheritic trouble was cured, the wound was well healed, and no harm had come of it. Dr. Koosa had never seen any grave consequences from the operation as performed by Dr. Althof, though he had several times seen ectropion of the lower lid follow, as a result, perhaps, of the incision having been made not horizon tall}'' outwards, but obliquely down- wards. He had known, however, one or two instances of serious injury from the operation, where the dissec- tion of the conjunctiva was made very thorough, and carried into the orbital tissue. In one case the eve was lost. Four years ago he had had a dispensary case of phlyctenular keratitis, relieved most remarkably, in twelve hours, by the operation. He was not aware at the time that it had been previously performed for this form of disease. Dr. Lorixg had been anticipated by the last speaker in most of what he was about to say. He had ob- served some half a dozen cases of ectropion due to the operation, and had several times seen trouble from too free a dissection of the parts. He thought the division of the external tarsal ligament, suggested by Dr. Agnew, should be limited to those cases in which trachoma had progressed to the extent of converting the inner surface of the lid into a hard, cicatricial tissue, which by its con- traction had warped the tarsal cartilnge, increasing its natural curvature, so as to bring its sharp edge against the cornea. He had himself formerly employed the method, originally proposed by Pagenstecher, of dissect- ing up the conjunctiva so as to make a considerable flap, the sides of which were so stitched to the skin near the outer extremity of the horizontal incision as to convert this into a wound, with its long diameter verti- cal. But this produced much greater deformity than the method followed by Dr. Althof; and moreover, as before remarked, the liberal incision into the orbit was by no means free from danger. He had seen two in- stances of severe inflammation from it, one of them be- ing that referred to by Dr. Roosa, in which the eye was destroyed. He had therefore abandoned the jilan in favor of the simple operation recommended in the paper. In this, as there stated, the stitch at the angle was the main point upon which success would de- pend. Dr. Agnew did not mean to say that he would cut the tarsal hgament in every case, or that he would ever cut it in the lower lid. But he would incise it oftener than recommended by Dr. Loring, on account of the danger of relapse when this was omitted. Indeed, he had more than once been obliged to divide the ligament by a secondary operation, where the ordinary horizon- tal incision, previously made by another surgeon, had proved insufficient. There was no difficult dissection required, and no danger of orbital cellulitis. It usually sufficed to make the incision through the edge of the ligament, near its insertion into the periosteum of the orbital rim. It need not be cut in such simple cases as those of phlyctenular ophthalmia with photophobia. CEREBRO-SPI>fAL MENINGITIS. Dr. RrssEL said that, within three days, seven cases of cerebro-spinal meningitis had occurred in the city, three of which had proved fatal. At the suggestion of Dr. Peters, he read the report of an interesting case furnished by Dr. C. E. Simmons. The Health Board were anxious to study the disease, and asked, as a matter of favor, an early report of any cases which might be discovered. The Presidext had seen two cases on the east side of the city, near Dr. Simmons' case, one of them in the Hebrew Orphan Asylum at Third avenue and Seventy- seventh street. He had also, by the invitation of Dr. Eodenstein, been three times to see the cases under his charge at the Catholic Protectory in Westchester. There were some twenty of them ; and five or six had ended fatally. The speaker pointed to the presence of stagnant water between Second and Third Avenues, in the upper part of the town, as connected with the prevalence of endemic diseases in that neighborhood. criminal abortion. On motion of Dr. S. Rogers, the Society Risolvech That the Medical Society of the Cotmty of Xew York indorses the Amendment to the Law of 1869, relative to criminal abortion, proposed by the Xew York Medico-Legal Society. Adjourned. Special Meetiny. January 29, 1872. Dr. a. Jacobi, President, in the Chair. OBITCARIES. The meeting was called to hear memorial notices of some deceased members, which had been prepared, under authority of the Comitia Minora, for transmission to the State Society. Dr. Fordyce Barker, to whom had been committed the notice of Dr. George T. EUiot. was unavoidably absent. Dr. Ellsworth Eliot gave an account of the life and labors of Dr. Wm. B. Bibbins ; and Dr. Wm. C. Roberts reviewed the career of Dr. Henry D. Bulkley. The leading points of these memo- rials have already appeared in our columns. Dr. David C. Carr recounted the professional and other services of Dr. Alexander N. Grunn, dwelling especially upon the assistance he had always been ready to profi'er to young men. As chairman of the committee on resolu- tions. Dr. Carr reported the following, which were adopted : — ^yhereas, It has pleased an aU-^-ise Providence to re- move from his earthly labors Dr. Alexander X. Guxx, a beloved associate, and an honored member of the 3Iedi- cal Society of the County of Xew York ; Revolted, That in his death all have lost a valued friend and counsellor. 'and this Society one of its brightest orna- ments, distinguished alike for his eminent social qualities, his Christian virtues, and his professional ability. Rosohed, That while we bow in submission to the di- -N-ine will, we deplore the loss of an active worker in the profession to which he was an honor ; of a man who by his genial, snnshiny nature won not only the hearts of his patients, but the confidence and esteem of all who knew him. Resolved, That a copy of these resolutions be preserved in the archives of the Society, and also that a copy, signed by the President and Secretary, be sent to the family of the deceased. The meeting adjourned. 36 THE MEDICAL RECORD. A Special Meeting called for February 3d, " to con- Kiik'r, and t.iko suiUiblc action upon, llio bill recently intro lutrd into the Assembly by Mr. Klaiiuncr, enii- tli'il. An Act to Protect the People against Quackery and Crime," was very thinly attended, and adjourned with- out action. NEW YORK PATHOLOGICAL SOCIETY. Stated Meeting, January 10, 1872. Dr. a. L. Looms, President, in the Cliair. LATENCY OF STMPTO.MS IN EMPYEMA. Dr. Lewi.s Smith presented specimens of lunjrs remov- ed from infants dyinp in the Infant's and Child's Hos- pital of this Ciiy. The first specimen was taken from a little patient that died at the age of five months and twenty-eight days. Although in charge of one of the best nurses of the institution, nothing unusual was noticed about the child, except a slight hacking cough for two or three day.*, and some acceleration of the res- piration, until it was found dying. On post-mortem examination tlie right lung was found covered with a thick sero-fibrinous exudation. The serum, which was very considerable in amount, was confined altogether in the meshes of the fibrinous material. The case was of interest as showing the latency of the symptom.*. There wns no evidence to the naked eye of pus in the effu- sion, although it was probable that pus-globules could be found by the microscope. Dr. Smith was of the opinion that, in cases of pleurisy among foundlings in an hospital, pleurisy as a rule degenerated into empyema. tubercclosis following bronchial catarrh. The second specimen of lungs was removed from an infant aged four months and ten days. It had suffered I'rom cough for seven weeks, during -which time the physical signs of bronchitis bad been developed. Dur- ing the last week of life, in addition to the symptoms referred to, there was an expiratory moan, and this, with other phenomena, led to the diagnosis of cheesy pneumonia. Two or three days before death, evidences of a dilated bronchial tube or a cavity were very dis- tinctly made out. On making the post-mortem examination, the left lung was found healthy, with the exception of a col- lection of small miliary tubercles. These masses were also discovered scattered throughout the right lung, in which latter organ also was found a cavity the size of a filbert, and nearly filled with cheesy matter. This cavity was so near the surface that a local pleurltis was excited, which accounted for the respiratory moan heard during life. This cavity was lined by a pyogenic membrane. In addition, small tubercles, some scarcely visible, were found in the spleen, liver, and in the coats of the large intestine. The other organs were healthy, with the exception of some of the bronchial and mesenteric glands, which were slightly enlarged and contained cheesy deposits. The interest in this case centred in the regular gradation of pathological changes, commenc- ing in ordinary bronchitis and ending in miliary tuber- culosis. The third specimen was removed from a child that died at the age of three months. The patient was sup- po.sed to be doing well until eighteen hours before his death, when he began to breathe rapidly, the pulse became accelerated, the temperature elevated, and death finally occurred as the result of what was sup- posed to be capillary bronchitis. At the autopsy, both lungs were found studded with tubercles in process of formation, and around them were to be teen zones of vascular injection. Small tubercles were also found in spleen, liver, ami in other organs. The mc.M;ntcric glands appeared to be healthy, but the bronchial glands had ui;dergone cheesy de- generation. In answer to a question from Dr. Loomis, he stated that in his opinion empyema was more apt to follow pleurisy in foundlings tiian in adults. Dr. Loomis remarked that he had seen cases of acute pleuri.sy in adults, that were cases of empyema from the bcfiinning, and he had also .seen cases of empyema the natural residt, apparently, of ordinary pleun.sy in a pa- tient otherwise in good condition. The Society then went into Executive Session. Stated Meeting, Jan. 24, 1872. Dr. a. L. Loomis, President, in the Chair. uterine tumors and ascites. A NOVEL METHOD OF TAPPING. Dr. Caro presented a specimen of the above with the following remarks: Mrs. H , thirty-nine years old, married twenty years, had no children. She complained, November, 18G4, of dy.smenorrhoea. On ex- amination, a polypus the size of a cherry was found protruding from the internal os uteri. I evulsed it with a pair of long forceps, and cauterized the pedicle with nitrate of silver. No hemorrhage followed ; men- struation returned regularly until September, 18G8, when it disappeared. Supposing herself pregnant, she did not inform me of the loss of her catamenia un- til November of the same year. Examining the uterus, I found she was mistaken as to pregnancy, although her breasts gave evident signs of it. I advised no interference, but to wait for further developments. January 20th, 1869, called in consultation the late Prof 0. T. Elliott. We concluded she was not preg- nant, but could not decide upon what -prevented her monthly returns, or caused the abdominal enlargement, unless it was simple tympanitis. Nourishing diet was prescribed, and an occasional dose of cream tartar and Epsom salts to regulate the bowels. In February men- struation returned, and continued regular until death ; but the abdominal enlargement continued, giving signs of ascites. June 4th, 1869, had her examined in the presence of other physicians, at Dr. Emmet's hospital. As previously done, sound was passed into the womb, two and a half inches. Arrived at the conclusion that she had a fibrous tumor adhering to the womb, and ascites produced by subacute peritonitis. Elaterium and cream tartar were prescribed, also tapping. June 30th, in presence of Prof O. T. Elliott, I per- formed paracentesis, selecting the median line between umbilicus and pubes; — sixteen quarts of fluid were drawn. Microscopical analysis of the fluid was made by Dr. Stephen Rogers, who reports : " The fluid was highl}-- albuminous, contained many blood-globules, and amorphous colored constituents in the form of various-sized dark-brownish masses. There are also a few granular, cell-like objects, containing one or more nuclei, in fact exudation corpuscles." Suspecting them to proceed from a cystic cavity, I changed my treat- ment and prescribed: — Spiritus mindereri § iv. Acidum aceticum 3j. Tr. ferri ehloridi 3 ij. A tablespoon ful three times a day. THE Medical record. 37 This remedy increased the flow of urine, but did not arrest the ascites. She was tapped every second month as follows : August 30th, 1809, second tappinj?, twenty-one quarts were drawn ; October 26th, 18G9, third tappiiip-, twenty-three quarts were drawn; Janu- ary 4th, 1S70, fourth tapping, twenty-five quarts were drawn; March 19th, 1870, fifth tapping, twenty-four quarls w^ere drawn ; May 11th, 1870, sixth tapping, twenty-eight quarts were drawn ; July 9th, 1870, seventh tapping, twenty-eight quarts were drawn ; August 29tl), 1870, eighth tapping, twenty-seven quarts were drawn ; November 1st, 187U,ninth tapping, thirty- one quarts were drawn; December 15th, 1870, tenth tapping, thirty-two quarts were drawn ; February 10th, 1871, eleventh tapping, thirty-six quarts were drawn; March 30th, 1871, twelfth tapping, at Emmet's hospi- tal, thirty-six quarts were drawn; May 27th, 1871, thirteenth tapping, twenty-six quarts were drawn. Left canula permanentl}', with a iaucet, so she might draw the fluid herself, but during tint night it came out. July 11th, 1871, fourteenth tapping, twenty- eight quarts v-^ere drawn, and canula lell in situ until December 10th, when it was removed to be repaired. After removal the flow of fluid stopped, and abdominal pains commenced. January 10th, 1872, she died of peritonitis. On post-mortem examination, a vast amount of fatty degeneration was found around the womb ; to the left fundus of the uterus, two ovarian cysts, about the size of a pine-apple, adhering to one another; and above them a tumor of calcareous nature, adhering firmly to the diaphragm, the abdominal vaults firmly adhering to the cysts and tumor, and the peri- ton£Eum to the intestines infiltrated with a serous fluid. The fluid from the cysts and the tumor were ex- amined by Dr. S. Rogers, who reports as follows : " The hard masses found in the substance of the speci- men are composed of irregularly spherical bodies, car- bonate of lime, adhering to each other very firn)h^ It is henc-i ca^.careous, not osseous. The tumor is a some- what degenerate fibroid growth. The fluid from an adjacent cyst is of a brownish color, and abounds in crystals of cholcsterine, fatty granules, and globules. It is therefore not improbable that the cyst represents a degenerate and liquefied fibroid tumor." The amount of fluid by paracentesis was 381 quarts, and drawing at an average one pint a day from July 11 to December 10th, was seventy-six quarts, total 457 quarts. Of the mixture, as above prescribed, 244 oz. was used. Dr. Hart referred to the possibiliiy of the tumor being cancerous, as, according to Prof. Thoma^^, the persistent accumulation of serum in the abdominal cavity was almost pathognom.onic of that disease. Dr. Loomis remembered one case where tapping was performed twenty-eight times. The patient, a lady, had been tapped twenty times by the late Prof Simp- son, of Edinburgh. The intervals of tapping grew longer, and the last operation was performed as long ago as four years. ANEURISM AND ITS RELATION TO SYPHILIS. Dr. Flint exhibited a specimen of aneurism of the abdominal aorta. The history of the case was very in- complete, the patient being received in the hospital only a few houis before his death, and then in a state of almost complete exhaustion. It Avas ascertained, however, that he had had syphilis fourteen years be- fore, followed by certain constitutional symptoms, af- fection of the throat, eruptions, etc. During last sum- mer he had complained of pain in the back and abdo- men. After his admission he rallied somewhat on tne use of stimulants, so that the facts above narrated were obtained. The hou.se physician ascertained the pre- sence of a tumor which he found to be pulsating, but he discovered neither thrill nor murmur. Shortly after his temporary improvement he raised up in bed, when he complained of feeling faint, was laid back, and ex- pired almost immediately. The abdominal aorta, just above the renal arteries, showed a large circular opening, perhaps an inch and a half in diameter, which communicated with an aneuris- mal sac the size of a small orange. There was a per- foration in the sac large enough to admit the end of the little finger. There was some blood infiltrated in the areolar tissue beneath the artery, and the peritoneal cavity contained a large quantity of blood. The speci- men was of no particular interest except the fact that it occurred in a patient who had syphilis, and that, in all probability, there was a certain amount of hemorrhage from rupture before he was admitted into the hospital, and that the hemorrhage was arrested by temporary coagulation. The internal coat of the artery was lined with atheromatous deposits. The patient was 37 years of age. SYPHILIS AND VALVULAR DISEASE. Dr. Janeway believed that syphilis was not only a very common cause of aneurism, but a'so of valvular disease. He had met with two cases of thickening of the valves which could be explained in no other way. Dr. Flint had not had his attention drawn particu- larly to syphilis as a cause of valvular disease, but thought that it might explain many of the cases of the latter le.sion, in which none of the usual causes were made out. Dr. Mason had seen several cases of aneurism which appeared to be the direct result of constitutional syphi- lis. He referred to one case in point, occurring in a man aged 33. Dr. Loomis alluded to a long list of cases published within the last two years in the Lancet, in which all under the age of forty gave a syphilitic history. Dr. Rogers was reminded of a case presented to the Society ten years ago, of very extensive aortic disease, in a young man 28 years of age, who had contracted syphilis only eighteen months before his death. The patient eventually died of extensive aortic disease. In that case no other cause for the arterial and cardiac le- sions was assigned than syphilis. PERIPHERAL PLACENTITIS. Dr. Rogers presented a foetus, with the following re- marks : — About a month ago I presented a specimen of placental disease that has been ranked as comparatively rare. Its history was. that a lady, at about the begin- ning of the fifth month, or a Httle after, began to sutler from the escape of blood from the vagina, with uterine contractions which were regarded, by every one who saw her, as threatening abortion. The bloody charac- ter of the discharge subsided little by little; but at va- rious intervals she had very large discharges of colored fluid, in such abundance as to saturate six or eight nap- kins in a single evening. In that case there were also, within a period of twomouths, after frequent threaten- ings of abortion, contractions of the uterus, with the es- cape of more or less bloody fluid. So marked were these contractions that the lady herself would call at- tention to it. There was a good deal of interest at- tached to the case, and some of the leading obstetri- cians were called in to see it. It was regarded as a case of cystic degeneration of the ovum. However, from time' to time, besides bloody fluid there Avas a discharge of such a material as is seen in this vial. [A vial ex- hibited, containing blood-stained shreddy material, 38 THE MEDICAL Re);ORD. lloatinp in a bloody fluid.] Sometimes a plug of this material, as large as the little finger, would come away. Notwitlistaiidinjr the ca^e was (liaprnoslicatrtl as a cys- tic degeiuration of the chorion, tliere w.is evidently a live fcetus in the womb. It went on growing', and continued active up to the last. It was early in the fourtli iiioiilh that the t^ymploms commenced. Towards the end of the fifth month labor came on, and when I arrived I found the caput succedaneum protnidinp, and soon delivered the woman of a child which breathed an hour after birth. The placenta was found diseased ; its whole periphe- ry was blackened and slircddy. In some portions of the organ it had gone on to an extent of llirec-fourths to an indi in dc|)th. It was a striking example of a dis- ease of the whole peripliery of the placenta. It struck me at onre as a case of peripheral disease the like of which I had never .seen. I recited the appearances to Dr. Noepgerath, and he made the remark that the case was one of peripheral placentitis. I present another specimen very similar to the one just described. This case had advanced to the sixth month. The mother received a sliock, caused by one of her children running again&t her abdomen. Scon after she was taken ■with a discharge of blood from tlie vagi- na. There were no uterine contractions nor pain. All that was noticed for a few days was a little bloody dis- charge, when it became less blood}'. But at vari('US intervals she would have these large discharges blood- stained, which would saturate half a dozen napkins at a time. She went on for two whole months, and when labor set in the child was evidently alive. The presen- tation was a breech one, and the head of the child was detained so long that life was destroyed — at least such was the belief of the attendant. At all events, the child was alive two hours before labor set in. The placenta presentij a little different appearance from the first; it is much smaller, and its whole structure is lobulated. When this specimen was first "brought to me I found evidences over more tlian three-fourths of its periphery of this same kind of inflammation — peri- pheral placentitis. At two or three points there were little clots of blood, but the marked feature was a layer of fibrinous material — thicker at some places than others — all aroimd the edge of the placenta. Dr. Jacobi was disposed to look upon the fibrinous clots as the residue of the hemorrhages. That may be so, but in the case which I presented, during one period of more than two weeks, there was scarcely any hemorrhage; it was almost pure water, and on some occasions there were those extra fibrinous clot«, and during that period she had more discharge of those fibrinous shreds than she had immediately after, or about the time when there had been mo.st hemorrhage. They ran through a period of more than a month. I have since asked some questions of persons versed in the literature of the subject with reference to the frequency of this kind of placental disease, and I am precisely where I was a month ago, viz., that there is not very much written or said about it in that form. Dr. Noeggerath said then that the only paper written on this suViject was by Braun, of Vienna, several years ago. The first case, presented a month ago, has had no untoward symf.tom, and is perfectly well. The first .ady was delivered two years ago of a child that re- mained in utero a month after it died. The child was Killed at the eighth month by metro-peritonitis, which interrupted the foetal circulation. The mother in a measure recovered, and went on to full term. She had metritis after delivery, and a little pelvic cellulitis. She therefore had the antecedent of uterine inflamma- tion estabhshed, which this person has not. Dr. Jankwat thought that there might have been a partial deiachmoiitof the placenta in this la.st case, at- tended first with a disiharg'Mjf bl()0ossibility of nublishinn the true clinical record of his sicknes.s, as if ine disease sliould behave differently in a Prince than in a simple hospital patient. This courtly idea offers the only extenuation for tiie unscientific character of these bulletin?, but is far from finding its justification even in courtly habits and traditions. For these tra- ditions and habits have always been, in case of sick- ness of a Queen. King, or Crown -Prince, to issue bul- letins as complete as the science of the time could afford, and to keep the royal patient constantly in view of .some of the high officers of State. And why that publicity of sickness and death; why cannot a king agonize quietly ; Avhy must peoples prey upon his decomposing form by minute reports and by de visii proxies ? Evidently because a prince — whatever could otherwise be his individual worth — is a cipher, wliose social value is borrowed from the millions standing by him, millions who have never been denied the right to know what becomes of the zero. Therefore we do not hesitate to affirm that, if the physicians of the Prince of Wales in issuing their bulletins hare literally conformed them.selves to courtly traditions, in avoiding or neglecting to stamp these bulletins with the seal of modern positivism, they have forfeited the confidence of the English nation; they have left the door of their council-chamber open to imtrue but deserved .suspicions; they have neglected a solemn occasion of impressing the people with the precision of the methods of observation which have been substituted for guessing at the bedside ; and thereby these eminent physicians have, in no small degree, lowered, or at least prevented the legitimate rise of, the standard of physic in public estimation. On the contrary, let us for an instant suppose that these eminent men. improving the opportunity actu- ally offered to them by the tradition of all the courts of Europe, would have clothed their bulletins in the scientific form adopted by the medical institutions of London, Pari?, Vienna, Berlin. New York ; these daily or hourly reports would have been written in a few figures, and summed up every septenary. They could also have been accompanied by a few commentaries, such as escape from the lips of a medical man looking at the table of vital signs appended to the bed of an ordi- nary subject of typhoid fever. In the supposition tliat these popular and progres- sive views had prevailed in the judgment of the physi- cians in charge at Sandringham, the world would have assisted to a novel and dramatic spectacle. We do not mean the spectacle of the pitiable youth slowly eaten up, then let go by the ulceration of his Peyer's glands — we mean the narration, by telegrams, of the phases of an almost typical case of complicated typhoid fever. Never before would nations have listened to such a tale, rna'nly told in advance, like a prophecy, by the thermometer ; never such interest would have been attached to predictions of better or worse, fore- shadowed on the stem of the instrument, and to the degrees of vitality infused in the patient by tonics or food, and written in tlie pulse-wave of the sphygmo- graj)h. Such a medical problem would never before have been solved to a larger or more interested audience: no better opportunity <'ould have been found to prove to the civilized world huw much of a science medicine has cume to be. If this mode of bulletins had been adopted — and we firmly believe that Aitken, Sydney Ringer, Wunder- lich, or Jaccoud would have carried it . The head-master at Eton has a salary of £6,680; of Harrow, £6,280; of Rugby, £2,960. Philadelphia Medical Times. — Dr. James Tyson, of Philadelphia, has retired from the position of assistant editor of this journal, in consequence of the demands made upon his time by professional engagements. The U. S. Army Medical Museum. — Fifteen hundred and sixteen new specimens were added to this Mu- seum during the year ending June 30, 1871. The total number is 15,018. During the year, 15,000 persons visited it. A Western Monthly Medical Journal Changes its Name. — The name of CinciJinaii Medical Hepertori/, with the opening of the year, has been changed to Cincinnati Medircd Keics. The editor is J. A. Thacker, M.D., assisted by the following associate editors: Drs. R. C. S. Reed, A. J. Miles, and D. D. Bramble. The Agency of the Mind in Etiology, Prophylaxis, AND Therapeutics. — Prof. Austin Fhnt, New York (Am. Pracdtioner)^ in a practical paper on this subject, re- marks : That the proper exercise of all the faculties of the mind, the sentiments as well as those belonging to the intellect, is the great requisite fur mental health, and consequently for happiness. Mental disorders not amounting to insanity, it seems to him, are not sufficiently considered by medical wri- ters, and their importance is apt to be underestimated b}^ practitioners of medicine. These disorders not in- frequently precede and lead to insanity ; and there are grounds for the belief that timely attention to the for- mer, on the part of the physician, would often prevent the latter. Those who give exclusive or special atten- tion to the treatment of cases of insanity, do not, as a rule, see patients until after they have become insane. The treatment of mental maladies, which precede and lead to insanity, must devolve upon the general prac- titionei-. In so far as bodily health and vigor afford protection against disease, the exercise of these sentiments is pro- phyhvciic. The state of the mind of a patient enters in many cases more or less largely into the prognosis. To develop and maintain this, hope and conlidence siiould enter, within proper limits, into the aims of the physician. In regard to the success in treating diseases and obtaining practice, the mental temperament of the practitioner has much to do in this matter. Some pliy- sicians are prone to look always on the dark ^ide of cases. Others are distinguished for always taking the most hopeful view of cases; they look ever on the bright side. The efiect is often more powerful than medication. There is an injudicious extreme in the latter direction, and between this extreme and the op- posite there is a golden mean ; but if there must be a deviation from this mean, it is desirable that it should incline to hopefulness rather than despondency. Aiken, South Carolina, as a Resort for Invalids. — This town is situated in the northwestern portion of the State, 120 miles from Charleston, and 17 miles from Augusta, Georgia. It is 600 feet above tide Avater at Charleston, and 400 feet above the Savannah river at Augusta. The South Carolina railroad passes through the centre of the town, making direct connection with the Charleston steamers from New York and other northern ports. The township contains 4 square miles, situated on a nearly level plateau. The streets are all 150 feet wide, crossing each other at right angles. The building lots or squares contain 4 acres each, with one, two, or more houses. The streets are all well shaded with a great variety of the original forest trees ; such as oak (five or six varieties), pines, China, wild orange, mulberry, and black walnut. The soil is a white sand, with an under-lay of red clay. The sand varies in depth from 12 inches to as many or more feet. The wells and numerous springs furnish an abundant supply of pure, sweet, and limpid water. The welis vary from 80 to 125 feet in depth. From the nature of the soil and the elevated location of the town, the climate is dry and moderately bracing in winter, rendering it a favorite place of resort for invalids from the North, especially those afflicted with pulmonary disease, from the slight cases of bronchitis to those of a more grave nature, and chronic affections of the nervous system. The climate in winter is delightful. Invalids can exer- cise in the open air from morning until evening without any unpleasant effect ; seldom needing an overcoat in the middle of the day. The dense pme woods, Avith their agreeable odor, furnish delightful drives and lides over the hard, level sand. This climate possesses more tonic properties than the milder but more debilitating climates of Florida or any of the West India islands. It is also entirely free from the moisture of those places situated near or surrounded by salt water. Those who visit Aiken as invalids are frequently injunjd by not taking timely advice, either of their physician at home or of some one resident in this place, as to exercise, diet, and general hygienic management while here. They come here for the benefit of the pure, fresh, and invigorating air; and are apt to think they cannot liave too much of it. Or else they may arrive when we are experiencing one of our cold, windy "spells of weather," and shut themselves in their rooms, stuff all the cracks with cotton, and with a rousing fire of Black Jack and light wood deceive themselves into the belief that they are doing the best they can to receive the full benefit of the climate ; or else heap curses and maledictions on the climate and those whose advice they followed in 44 THE MEDICAL RECORD. coming here. A little advice from an intelligent phy- sician, who imdor-itniula llic climate and it;' effects, woulil save all this; and in many ca«e.s the life of the patient would be prolonged if a permanent cure was not effected. The accommodations for inva'ids are for the most pari first-class. With the hotel, the Sanitarium, and private hoarding-houses, there arc aocommoJations for about 400. Most of the private boarding liouses are situated either in tlie centre of the town, or near enough to bo of easy nccoss. Prof Saml. Henry Dickson, M.D., of Jefferson Medi- cal College, Pliiladiliiliia, a former resident of Charles- ton, says: " I have long regarded the town of Aiken, or rather the country immediately surrounding it, as among the most agreeable arid healthy loc:ditie3 in our Atlantic States, so far as climate and topographical conditions are concerned. A sandy soil, and an at- mosphere fragrant witli tlie pleasant smell of the pines which form the prevailing growth for miles about, a genial, sunshiny sky, pure air, and limpid, sweet water constitute a sjt of circumstances highly favorable to the preservation of health to the sound, and its resto- ration to tlie invalid. The region is especially adapted as a winter and spring residence to those generally who suffer from affections of the respiratory organs from the most serious cases of consumption to the lighter but often tenacious attack of chronic catarrh and bronchitis. I have often been called on to give advice to pati?nts laboring under these maladies and chronic affections as well of the digestive organ, and have found them in a majority of instances to be benefited by a residence in and near Aiken, both in winter and summer. '• Dr. Percival. a resident of Aiken, presented to the American Medical Association, at its meeting at Wash- ington two years since, an account of this place of re- sort for Northern invalids which, however wrong it may seem, is really entirel}' truthful and without exag- geration." From an experience of one season at Aiken, I can bear witness to the truth of all this, although the last winter was one of unusual severity not only in Aiken but throughout the States, Florida not even excepted. This may and probably will not occur again in a number of years. Even last winter, the benefit received by those w-ho were advised to be prudent, more than overbalanced the evil to the oppo- site class. A great variety of vegetables are raised here in abundance, and can be procured fresh nearly the year through. The best of beef and mutton, from East Tennessee, can be procured, with but little trouble, at the markets in Augusta. Poultry and game are abundant. A great variety of fish can be had from Charleston and Augusta. Oranges from Florida. Ap- ples from the North and West. Canned fruits are as cheap as in New York, and can be had in every va- riety. The material for food is abundant. There is no necessity for any one to go hungry or contract dj'spep- sia if he only hits upon the right place to indulge his gastronomic propensities. " Fem.vle Pills" .\s Abortifaciexts. — The sum paid for these quack remedies in the United States is estimated by investigators at about one million of dol- lars. Dr. Ely Van De Warker, Syracuse, N. Y. {Jour. Gyncpcological Society) believes the crime of abortion is more common in Protes'ant countries than in Catholic. Among the Roman Catholics the indi.screet maiden re- ceives the crown of motherhood. She has been taught from childhood to bow before the reality of an unborn soul. To the Protestant woman of many sects such a reality cannot exist. The belief finds no place in her heart, that the embryo of coming manhood within her has roused pulses of love not unmarked in heaven. UiiinXhv Calcilus in CniNA. — According to J. G. Kerr, of Canton, (.'hina (iV. V. Med. Journal), stone in the bladder is confined almost entirely to the province of Canton; it is a remarkable fact that the disease is not known to exist only in tlie Southern portion of the Chinese Empire. Why the disen.se should be so common in the South of China, on latitude 2'.\Y, and entirely absent in the central or northern parts, is a curious question, not easy to be answered satisfactorily. The first operation for stone in the bladder pcrlbrmed in China was in 1844, by the Rev. P. Parker, M.D., the ibunder of the Medical Mi.ssionary Society, and now a resident of Washington, D.C. From that time ti; 1853 about 37 cases were operated on by him. Since the year 18-")(J lithotomy has been performed 187 times, with 19 deaths; the cases of lithotrity for the same period amount to 30, with 3 deaths. The ordinary lateral operation with the s?alpel has been performed iu most of the lithotomy cases. Generally the incision was not extensive, and reliance was placed on dilatation. In one or two cases the median ojieration was resorted to. Sir Henry Thompson's lithotrltc, made by Wei^, was used in most of tlie lithotiity cases, and seemed to be as nearly perfect in its adaptations to the purpose re- quired as it is possible for any instrument to be. Thirty-seven of the lithotomy cases were operated on by Dr. F. Wong, a Chinese physician educated in Boston,'' Mass., and in Edinburgh. He is the only Chinese who has performed the operation. Maltine. — This substance, called diastase, first re- ported by Payen and Persoz in 1833, is recommended in dyspepsia, either with or without pepsine, by Prof. De Renzi. The subjoined formula is laid down in La Kuova Ligiiria Medicah : R. Maltine, centigr. xv. F. pil. No. 3. One pill before each meal. K. Maltine, centigr. v. to x.; Pepsine, centigr., c. to cl. F. doses No. 2. Stramonium ax Axtidote to Opium Poisoxing. — In two cases, Dr. D. B. Putnam, of Boston, Mass. {Boston Med. and Surrj. Journal), has used stramonium as an antidote to poisoning by opium, and from the prompt- ness and certainty of effect manifested in these cases, he would suggest to others a trial of its virtues in cases of this character. Medical Department of the Universitt of Vienna. — This institution was founded in 1787, by the Emperor J'rancis Joseph II. It is of brick, two and a half stories high, and covers an area of ten acres or more. The number of wards is 110, and they contain 2,500 beds. There are 28 civil and 52 medical officers ; all of whom receive pay. About 20,000 patients are admitted annually, besides tliose in the lying-in wards. From eight to ten thousand children are born in the obstetrical wards during the year. Bilroth and Du- meicher are the surgeons, Braun and Spiit the obste- tricians and gynaecologists, and Hebra and Neumann hold the chairs of dermatology. Sigmund and Zeisel lecture on syphilis, Jiiger on the eye, and Rokitansky on |)atliological anatomy. Excellent as is the faculty and splendid the clinics, it is from the assistants that the most practical le?sons are obtained. They teach everything. Pro*'. Braun is about fifty years of age, has a pleasing face, and is thoroughly German in ap- pearance, lie delivers his lectures sitting; speaks very slowly and distinctly, but with little animation, offering in this respect a striking contrast to the fiery THE MEDICAL RECORD. 45 style of his nssistant, Rokitansky, Jr., wliobkls fiiir in his chosen field to rival the reputation of his illustrious sire. — Vienna Corresp. Am, Practitioner. Retention of a Wooden Pessary Skventekn Years. — Dr. J. J. Kenipe, of Milwaukee {NortluL-esteni Med. and Surg. Journ.), recently removed a ring-shaped pessary from a German woman, which was forcibly in- troduced, 17 years ago, by a physician in Germany for complete prolapsus uteri. The pessary, made of a wood similar to our hard maple, measured three and one- eighth inches in diameter, and the outer border was one-half inch in thickness. The instrument originally was covered with leather, which came away about eighteen months after introduction. The patient had sought to obtain partial relief from her suffering by repeated and long-continued traction upon the pessary, and in this way an urethro-vaginal fistula was originated— by pressure of the tissues between the arch of the pubes and the outer border of the ring. Bichloride of Methylene. — Samuel Theobald, M.D., of Baltimore, Md., London correspondent of the Bait. Med. Journ., writes that the advantages of bichloride of methylene as an anaesthetic, have been largely tested at Moorfields Hospital, London. No dangerous or un- pleasant symptoms caused by its administration have been noticed there. The advantages which it possesses over chloroform are, that it produces its effect much more rapidly, and is more evanescent in its action. These properties recommend it more especially for ope- rations of short duration. In its administi-ation, it should be diluted with a much smaller percentage of air than chloroform. To an adult from one or two drachms may be administered at once, and this will generally prove sufficient if the operation is of short duration. If desired, however, it may be repeated (four or five times), in drachm doses, as soon as its influence begins to pass off. The Sphygmograph. — This is the title of a beauti- fully printed monograph of thirty pages, published by Wm. Wood (fc Co., and written by Edgar Holden, M.D., of Newark, N. J., in which the subjoined instru- ments devised to carry on his observa'.ions are particu- larly referred to, viz. : the sphygmograph already described in the Medical Rkcord. an artificial heart and capillary apparatus made of rubber ; a large sphyg- mograph two feet in length, adapted to record its workings. The author announces that this essay, originally read before the Medical Society of New Jer.sey, is prepara- tory to a larger work on the practical value of the sphygmograph and the physiology of the circulation. The writer, after referring chiefly to tracings of the pulse in connection with cardiac pathology, says in closing: " With a new principle and a simpler and less costly instrument within reach, sphygmography will rise into a definite and useful science. Certain it is that by it, even now in its immaturity, we may detect deviations from perfect health not discernible by any other means, and consequently in at least one, and a growing interest in this country, namely, the estima- tion of possible longevity, it will be invaluable." The attention and perusal of all interested in the workings of the sphygmograph is called to this useful book, which presents, in a form convenient for reference, the results of his own experience. Transactions of the Medical Society of the State OF North Carolina. — This pamphlet, containing the minutes of the eighteenth annual meeting of this Soci- ety, held at Raleigh, N. C, May, 1871, also exhibits creditable papers by the following gentlemen : " Report of a case of Scleroderma atid two of Empyema," by Robert J. Hicks, M.D. ; "Operation for Traumatic Aneurism of the Superficial Palmar Arch," " Cranio- tomy and Operation for Vesico- vaginal Fistula," by E. Burke Haywood, M.D., Raleigh. Dr. R. L. Payne, of Lexington, gives an interesting address on "Some of the duties of the Avorthy i)hysician, and some of the obligations due the worthy physician by the commu- nity." The following officers were elected lor the en- suing year: Premlent, Di-. William G. Hill. Raleigh, N. C. ; Vice-Presidents, Drs. H. W. Faison, R. J. Hicks, (iid. H. Macon, and W. A. B. Norcum ; Treasurer, Dr. J. W. Jones, of Farborough ; Secretary, Dr. James McKee, of Raleigh. Artificial Milk. — Among the melancholy records of the siege of Paris may be counted those on the utilization of strange materials for food ; not the least in- teresting of these being the researches of M. Boillott, M. Dubrunfant, and M. Charles Fua on " Alimentary Fats." "Alimentary Fats" is a wide expression, including some rather unsavory hydrocarbons and very curious refuse materials. The main object of these iiivestiga- tions was to determine how such substances may be " usefully employed in alimentation," or, in plain, un- sophisticated English, how to make butter from candle ends, dirty drippings, colza oil, fish oils, the refuse of slaughter-houses, the restored greasa of the wool- dresser, etc. The general result has proved that the "frying process" is triumphant over its rivals; that by simply raising the temperature of the fat to 140° or 150" centigrade, and in the mean time cautiously sprin- kling it with water, the cellular tissue, the volatile oils, the rancidity, offensive odors, and all other non-senti- mental impediments to "alimentation " are removable. This frying process has already effected something like a revolution in the industry of soap-boilers, some of whom have changed their trades to that of butter- fryers. M. Dubrunfant is not content with superseding the cow in the matter of butter, but has made similar at- temps upon milk. He contends that milk is simply an emulsion of neutral fatty matter in a slightly alkaline liquid, such as can be artifically imitated ; and that the process of churning consists in hastening the lactic fer- mentation, thereby acidifying the serum of the milk, and at the same time agglomerating the fatty matter which the acidity sets free from its emulsion. He fur- ther controverts the cellular theory by showing that fat-globules of milk do not display any double refrac- tion, as do all organized membranous tissues. Having thus examined the theoretical constitution of milk, he proceeds to the practical method of imitat- ing it, and gives the following directions: Add to half a litre of water forty or fifty grammes of saccharine material (cane sugar, glucose, or sugar of milk), twenty or thirty grammes of dry albumen (made from white of egg), and one or two grammes of sub-car- bonate of soda. These are to be agitated with fifty or sixty grammes of olive oil, or other comestible fatty matter, until they form an emulsion. This may be done with either warm or cold water, but the tempera- ture of 50° to 00° C. is recommended. Tlie result is a pasty liquid, which, hy further admixture with its own bulk of water, assumes the consistency and general ap- pearance of milk. Luxuriously- minded people, who prefer rich cream to ordinary milk, can obtain it by doubling the quantity of fatty matter, and substituting two or three grammes of gelatine for the dry albumen. The researches of Dumas and Fremy having reinstated gelatine among the nitre- 46 THE MEDICAL RECORD. genmis nlimentftry matoriala, M. Dubniiifniit profers it to albumon ; it is rlioai)or, more easily obtaiiicil, and tlio sliglit viscidity wliicli it (ifivis to tlie litjuid, materi- ally assists the formation and maintenanie oftlie emul- sion, liy sulislitulinp vegetable idbuinen for the white of cpg or pelatine the vegetarian may prepare for liim- BeU a milk that will satisfy his uttermost aspirations. — Nature. A New Qlautkrly lias made its appearance in Eng- land, called ' T/ir (rermnii Qiiarlerli/ Mdijazine: a Series of Popular Es.«ays on Science, History, and Art.'' The first number contains three papers : — " The Cranial AfTmiiics of ^[an and the Ajyo," by Rudolpli Virchow ; " Sight anil the Visual Organs,'' by A. von Graefo ; and " Tlie circulation of the Waters on the Surface of the Earth," by II. W. Dove. Conjoint Examinino Board. — It is stated that all of the English Universities have accepted tlie draft scheme as proposed by the College of Physicians and the College ot Surgeons, for a Conjoint Examination Board. Tliere appears to be every probability of its soon being put into effect. Loris KosscTii communicates to the Neue Freie Presse of Vienna the remarkable curative qualities pos- sessed by a grotto near Pistoies, in the Valley of Luc-» ques and Pisa, the virtues of which consist in radically curing the gout. The treatment is easily followed, and lasts from eight to fifteen days. The patient descends into the grotto, which is well lighted, covered with a bathing-gown. There he has only to sit and admire the stalactites, or converse with his friends. After ten minutes he sweats profusely, but not disagreeably. After an hour he is taken out. wrapped in a flannel covering, and after reposing a little, subjected to a cold shower-bath. The curative principle of the grotto is, however, an enigma. In the warmest parts of the grotto the air does not show more than thirty-two to thirty-four degrees (cen- tigrades), and is less oppressive than the air outside; the water is still colder, but it is heated by the air, the chemical composition of which resembles that of atmos- pheric air ; the only difference being a slight addition of azote. Ko.-suth attributes the remarkable qualities of the grotto to electro-magnetic agents. The subterraneous grotto in question was discovered some years ago by a number of quarrymen engaged in excavating stone. An E.xtremely Curious Pathological Fact, in the highest degree interesting to the scientific world, was signalled this week in Paris. On the 6lh of February M. Roux, sluice-keeper at the station on the Seine, opposite the mint, withdrew from the river the evidently lifeless form of a woman who had thrown herself in two hours previously, but who in spite of the most active measures, could not be discovered sooner. The body laid upon the quai was cold and rigid, the face livid, the pulse of the poor woman had ceased to beat, and so sure were the bystanders she was dead that not the slightest effort was made to restore her to consciousness. On the arrival of the ))olice commissary Dr. JuRien thought he still perceived some feeble in- dications of life in the apparently inanimate body. On minute examination he found that, notwithstand- ing her long submersion beneath the Seine, the functions of life had not completely ceased. Dr. Jullieii in turn tried fumigations, friction.'', and the breathing of air into her lungs. The beatiiij^ of the heart, feeble and uncertain at first, gradually became stronger and more regular, until she finally became conscious, and could with safety be transported to the nearest hospital. In falling into the Seine .she had been seized with a syncope, which during the two hours of her immer.sion in the river had completely suspended the functions of life. Her name is Jeanne Duboi.s, and adilre.ss, 52 Rue de Seine. Monsieur Tei.lier ha.s di'^covered a new method of preserving meat for an indefinite period of time, by submitting it to the action of melhylic ether. When once it is proven that meat thus treated, pos- sessing intact its qualities of freshnes.s, may be trans- ported to Europe at little cost, in a frozen state, from Australia, South America, and the west and south of United States, the welfare of the mas.se3 in overstocked Europe will be greatly advanced ; with the boundless resources of the New World at their disposal on easy terms, a new era will be opened to the working classes. Swallowing a Fork. — An individual in Florence named Hegisto Cipriano, while imitating the tricks of Japane.se jugglers, was seized with a fit of coughing, and had the misfortune to swallow the metal fork with which he was experimenting. Conveyed to the hospital, the most experienced physicians there endeavored by every possible means to extract the fork from tlie stomach, but without suc- cess. As he is able to eat and drink with the greatest freedom-, and enjoys general good health, the medical men attending him are in hopes that the fork will be gradually digested, and that ti)e result of the accident will not be fatal. Home for Incurables, West Farms, X. Y. — The Fifth Annual Report of this Institution gives the fol- lowing exhibit: — Whole number of patients under the care of C. F. Rodenstein, M.D., the attending physician. during the year ending June 1st, 1871, 57; number in house at last report, 35 ; admitted during the year, 22 ; died, 9 ; removed, 5 ; now under treatment, 43. Clas- sification of diseases. — Hemiplegia, 13 cases ; debility, 6 ; dementia, 4 ; epilep.sy, 5 ; progressive locomotor ataxy, 3 ; phthisis pulmonalis, 4 ; paraplegia, 2 ; rheu- matic gout, 4 ; and softening of the brain, 2. The remaining 12 cases represent as many different diseases. The annual meeting of the Society was held at Asso- ciation Hall, New York City, June 12, 1871, and appropriate addresses were made bv Chancellor Crosbv, Rev. Noah H. Schenck, D.D., Rev. S. H. Tyng, Jr., and Hon. Erastus Brooks. Contributions are sohcited, which may be sent to J. D. Vermilye, Treasurer, Mer- chants' National Bank, 42 Wall street, N. Y, City. The Photometer. — A newly-invented photometer proves that light penetrates 100 fathoms below the .surface of the sea — 70 fathoms more than hitherto sup- posed. A Centenarian. — The most remarkable centenarian alive is probably Thomas Fitzgerald, of Rhinebeck, N. Y.. who is one hundred and eight years old. He lives with one son, while his wife, one hundred years old, lives with another at Rondout and keeps house for him. Mr. Fitzgerald u.ses tobacco, but has always been strictly temperate. He is very deaf, but his eye- sight is good, and he can thread a needle at arm's length. He strops his razor, shaves himself, dresses and THE MEDICAL RECORD. 47 undresses, nnd Avithin the year hns chopped and put up six cords of wood. His occnpation has been that of a fisherman and laborer. He is a native of Irehind, and was thirty-four years of age at the time of the Irish rebellion in 1798. Berardius Aruxxii. — A unique specimen of the rare animal, lierardius Arunxii, of Dnverney, 30 feet in length, has been recently given to the Hunterian Museum, by Mr. Erasn.us Wilson. Only four of these creatures have been discovered, all on the coasts of New Zealand. De.vtii from Hypodermic Injection of Morphia. — Dr. Stanton, of New Brighton ,Pa., relative of the late Secretary Stanton, and Auditor-G-eneral of the State of Pennsylvania, lately died from the effects of an hvpodermic injection of morphi;), administered by him- self to produce sleep, in tlie inner part of the arm near its junction with the shoulder. The dose was about one grain. Death occurred six hours after its admin- istration. In the opinion of those physicians Avho witnessed the death scene, his death was caused by the unusually prompt and complete absorption of the morphia, prostrating a system already struggling with cadaveric poisoning. Scarlet Fever in Great Britain. — During the last sixteen years the losses i'rom scarlet fever in Great Britain were not less than 100,000 lives. Chloride of Sodium. — In the year 1871 nine million bushels of common salt Avere manufactured in the neighborhood of Syracuse, New York. Analysis of Milk. — Dr. P. Schweitzer, of the School of Mines in Columbia College, New York (Journ. A])- 2ilied Chemistry), in his examination of the milk fur- nished to the inhabitants of this city, reports that in no samples were any injurious ingredients found, tiieonly adulteration being water. The specific gravity of pure milk adopted by the English is 1.029; it should contain from 12i to 13 per cent, solid constituents, the rest being water. The solid portions are made up of Ordinary Milk. Condensed Milk. Ash 0.70 2.60 Butter 3.80 13.12 Casein 4.10 14.44 Sugar 4.20 16.30 12.80 46.46 New York State Lunatic Asylum, Utica. — In a voluminous paper on "Materialism in its Relations to the Causes, Conditions, and Treatment of Insanity," read before the Association of Superintendents of Insane Asylums, at Toronto, by II. B. Wilbur, M.D., Sup't of the New York Asylum for Idiots (Journ. of Psyc/wlo- f/ical Medicine), the statistics of the Utica Asylum for 27 years ending Nov. 30, 1869, are cited to show that the percentage of recoveries, during the later years, has not been an increasing one. He would not be under- stood as presenting them to prove that they are less favorable than in the case of other institutions during the same period, but as showing that the modern system of treatment, based upon the exclusively " physi- cal basis" theory of insanity, is no more successful than in former times, though it must be conceded that the resources in the way of remedial agencies have been greatly enlarged. The partial statistics of three Massachusetts institu- tions, he believes, indicate that the medical treatment, when pushed, is no more successful than when less vigorous medication is employed. According to this author, in the last six years, the average annual cost of medicines, for each patient, at the Utica Asylum, has been $7.94. In the six years of Dr. Brigham's administration, Avhen the moral treat- ment was made very prominent, he states that the average annual cost of medicine and medical supplies for each patient was $1.15. The Man with the Iron Jaw. — Mons. D'Atalie, or, a.s he is commonly known, " The Man with the Iron Jaw," was presented recently at the surgical clinic of Pro- fessor Mears, in the Penn. College of Dental Surgery, for an examination of his maxillary apparatus. From early life he has been engaged in a gymnasium. His first efibrt to raise weights, grasped by his teeth, was made tiiree years ago, when he made an attempt to lift a heavy table. This effort was successful, and now he is able to raise seven hundred pounds. His maxillary apparatus does not present any extraordinary develop- ment; on the contrary, there seems to be an absence of any very full development of the various parts which enter into its formation. Mons. D'Atalie holds heavy weights by placing the part seized between both the anterior and postei-ior teeth, so as to employ all the elevators of the jaw. His power does not reside alone in the muscles of the jaw — those of the neck and body play an equally im- portant part in all of his feats of strength. — Denial Times. Proceedings of the State Medical Association of Arkansas. — The second annual session of this Society was held at Little Rock, Arkansas, November 5th and 6th, 1871. The annual address was delivered by the President, Dr. P. 0. Hooper. Interesting communica- tions were read by Drs. R. G. Jennings, W. H. Haw- kins, E. R. Du Val, and Geo. W. Lawrence. Nine local medical societies, representing fifty members, compose the parent society. The following officers were elected for 1872: President, J. M. Holcombe, of Pine Blufi"; Vice-Presidents, Drs. O. A. Hobson, J. F. Davies, and W. "W. Bailey ; Recording Secretaries, Drs. E. V, Deuell and Ed. Cross, of Little Rock ; Correspondimj Secretary^ Dr. Claiborne Watkins, of Little Rock; Treasurer, Dr. J. B. Bond, of Little Rock. Chinese Surgery. — John G. Kerr, M.D., Chief-Sur- geon of the Canton (China) Hospital {Cin. Lancet and Observer), writes that the department of surgery in this empire can scarcely be said to exist, beyond the appli- cation of caustics and plasters to tumors and ulcers, and of poultices to broken bones. They are entirely help- less. There is no native doctor in all China who can give aid in any case of accident or disease which re- quires manual or instrumental interference. The ines- timable benefits of operative surgery in all its branches are unknown to them, except so far as they have been derived from a few foreign physicians and the pupils instructed by them. They are entirely without surgi- cal instruments, and all the apparatus which modern in- genuity has applied to the relief of injuries, deformities, and disease. In the instruction of students there, by foreign medical men, there is a want of suitable text- books in the Chinese language. A beginning was made in this department some years ago by Dr. Hobson, of the London Missionary Society, who published the out- lines of several branches of medicine in four volumes. He inquires : Are there not many of those who are aspiring to the honors of the medical profession, who will be ambitious thus to benefit so large a portion of the human family ? 4B THE MEDICAL RECORD. The Drco Trade or Chicago and thk Fiiik.— Of the 100 r.'tftilers of driips in Chicago, upwanls of (ifiy, or more than cne-thiid of the whole niinibor, lost their all ill tlie wide-spread desolation. The sinn-total did not fall <-iiort oC JJIUO.OUO. before llic fiie, the gross sales of the icadinjr wliolesalc diugf:ists amounted to $'),(iOO,OOt) annually. Of the six wholesale druppists wlio were entirely burned out, five have re--umcd busi- ness and are transacting business with their usual de- spatch. A Vkuv Old Man.— Harvey Thncker, who died recently in California, was one hundred and twenty- eight years old at the (iate of death. He was tlic son- in-law" of the famous Daniel Boone, the first settler in Kentucky. A Gift to the Kentucky Puhlic Librarv. — Dr. Christopher Graham, one of the oldest and most es- teemed citizens of Kentucky, lias presented to the public library of that State his collection of minerals, fossils, and geological specimens, valued at $30,000, the work of fifty years. TiiK Laugest Consulting Practice in the Would. — Dr. Gull, of Guy's Hospital, London, is said to have the largest consulting practice of any phy.^ician in the world —worth not less than £25,000 a year ($ll>5,000j. LoNGEViTV OF FARMERS. — According to Dr. Nathan Allen, of Mass., in his registration report of dcatlus in that State for thirty years, tlie cultivators of the earth stand as a class at the head, reaching, on an average, the age of nearly G5 years. Value of Salt. — In Africa the liigh-caste children suck rock-salt as if it were suga", aUhougli the poorer classes of natives cannot indulge their palates. Hence the expression in vogue amongst them, " He eats salt with his victuals," signifying that the person alluded to is an opulent man. In those countries where mineral salt is not procurable, and where tlie inhabitants are far removed from the sea, a kind of saline powder is prepared from certain vegetable products to serve in its stead. Indeed, so highly is salt valued in some places, that from its very scarcity it is employed as asubstitute for money.— Food Journal. Nationalities Relieved in Chicago, III. — "We learn from the First Special Report of the Chicago Relief and Aid Society, that the sufferers by the fire were of all nationalities; and of 18,478 families who needed suc- cor, 1,985 only were of native birth. The number of Irish families' was 5,512; German, 7,280; Scandina- vian, 2,104; English, 599; Scotch, 195; French, 185; Italian, 112; Bohemian, 208; African, 241; Canadian, 94 ; Polish, 90. Ten other nationalities were represent- ed. Up to Nov. 30, 1871, only one death occurred among a population of 5,000 in barracks. The Treasurer, Geo. M. Pullman, reports the receipt of $2,485,884.55 up to November 18th, inclusive — of which $493,4G0.3G had been judiciously distributed, leaving a balance in sixteen different banks of $1,190,424.19, drawing five per cent, interest. The officers of this Society, incorporated February IG, 1857, are men of high standing, and are entitledto the confidence of the cora-nunity. Since this Report was written avc learn that the aaiount received up to January Gth, was $3- 335,700. The balance on February 3d was $1,314,G29. The Roosevelt Hospital, New York. — The Trustees of this new Institution have published the learned ad- dress by Thomas E. Vermilye, D.D., LL.D., made at its opening, Nov. 2, 1871 — with opening address by Edward Delafield, M.I)., the President. Interesting sta- tistics are given, in which he mentions that physicians and surgeons were first established in Infirmaries in 1437. The Knights of St. John opened a lio.spital for sick pilgrims at Jerusalem in 1048, and were styled Kniglits Hospitallers. There were hospitals for the sick at Constantinople in the eleventh century. They sprang then from the bosom of Christianity. Death of Dr. Bulklev. — Resolved, That in the death of Dr. Henry D. Bnlkley, the Medical Board of the Nursery and Child's Hospital have to deplore the loss of one of the earliest officers of the institution — a member of its consulting staff since its organization. Resolved, That the clo.se of his long life of usefiil- ness is covered with honor, and that his memory will be cherished by his former colleagues in this Board, in common with all who were associated with him, know- ing the inestimable worth of his private life, and the eminent skill and spotless integrity of his professional career. Resolved, That a copy of these resolutions be sent to the family of the deceased, to whom we tender our warmest sympathy, and that they be published in the medical journals of this city. T. M. Markoe, M.D., > ^ _ ... T T TT ^r V^ r Committee. J. J. Hull, M.D., ( S.MALL-i'OX. — The cases of small-pox in this city average the same — from seventy-five to eighty weekly. In Philadelphia the number is somewhat decreased, as is also the case in Boston and Chicago. The large towns throughout the State are beginning to develop the disease. Especially is this the case along the lines of our railroads. Academy of Medicine of Paris. — On account of the deaths of Drs. Poiseville, Fabret, Dan3'an, Leblanc, and Blache, five vacancies exist in the various sections of the Paris Academy of Medicine. Professor Huxley. — This distinguished savant will absent himself from England for the next two or three months — his health having given way. He will reside during this time in Egypt. King's College, London. — Dr. Priestley, of this Lon- don medical college, has resigned the professorship of obstetric medicine and physician for diseases of women. He has lectured on widwifery for the last fifteen years in this institution. Deaths of London Practitioners. — Robert Wade, F.R.C.S., who has left important papers and works on stricture of the urethra, recently was seized with a fit of paralysis, and died .shortly afterwards. Dr. J. Charles Hunter, L.R.C.P., formerly an in- spector of vaccinators to the National Vaccine Institu- tion, died December 19, 1871, act. 72. Rush ^Medical College, Chicago. — At the twenty- ninth annual commencement of this college — held January 17, 1872 — there were seventy-seven graduates. A New Monthly Medical Journal, called L' Union MidicaJe du Canada, has made its appearance in Mon- treal, edited by J. P. Rottot, M.D., with A. Dagenais, M.D., and L. J. P. Desrosiers, M.D., as assistants, and contains about fifty pages of the matter usually found in journals of that size; the principal article in the first number being devoted to a discussion of " The New Medical Bill," and of the question of " Medical Reform." THE MEDICAL RECORD. 49 ©rigtital Communications. TWO CASES, ILLUSTRATING THE PRO- DUCTION OF VOWEL AND CONSONANT SOUNDS. By Pkof. E. M. MOORE, M.D., ROCHESTER, N. Y. The function of voice has always been a theme of inter- est to a wider circle of men than pliysicians. The most profound students of language, those who push their inquiries into the phonetic forms of the dim past, seek- ing to unravel the net of histor}"- in the twilight of the race, are perhaps more interested than any other class, except the ]iure physiologist. The students of San- skrit have brought forward elaborate and excellent treatises upon phonation, written more than three thousand years ago, pushing the inquiry as far and as accurately as mere observation could go. Since the discovery of the lar3'ngoscope tlie whole subject has undergone and is now undergoing a complete revision by the practice of auto-laryngoscopy, and we shall undoubtedly have the whole topic vastly advanced. Indeed it may be so far as to enable us successfully to initiate an inquiry into an anatomical explanation of certain phonetic laws which some profound German scholars have propounded, and also lead to the discov- ery of others. Tliese men look to the physiologists, in hopes that a law of anatomical and physiological rela- tion to sounds may be discovered, upon whii.'h to rest a solid foundation for the expansion of ethnology and L'omparative philology. The unanimity of opinion among physiologists, who have given their attention to the function of the larynx in the production of the voice, has led me to note two cases of striking interest, and so conclusive in their character that I think they will be regarded as an off- set to the experiments and observations that have heretofore been made, and upon Avhich opinion has rested. They have the merit of substituting fact for inference, and, indeed, fact bearing the potency of an experimentum crucis. In order, however, to the full understanding of the question, I will take Carpenter as the authority for the standard opinions, and recite his view on the subject at the point I propos3 to eluci- date. The doctrine of the reed-sound in the production of the larjmgeal voice, it seems to me, is firmly settled and universally admitted; the proof resting not only upon the form of the organ, but on the production of sound from the artificial larynx. Here at the vocal chords, the body of sound known as the sonant voice, in contradistinction to the whisper, is undoubtedly made. But the especial point to which this paper is directed is not this, but to the correction of opinion with reference to the production of vowel-sounds. These are asseverated to result from the passage of air along the mouth, and to be the effect of its modifica- tion, including, of course, the pharynx and nose as fac- tors. In proof of this I quote Carpenter. "The vowel-sounds are continuous tones modified by the form of the aperture through which they pass out; while in sounding consonants the breath suffers a more or less complete interruption in its passage through parts anterior to the larynx. Hence the really simple vowel-sounds are capable of prolongation during any time that breath can sustain them. This is not the case, however, with the real diphthongal sounds (of which it will presently appear that the English i is one). whilst it is true of some consonants. It seems to have been forgotten by many who have written on this sub- ject, that the laryngeal voice is not essential to the formation of either vowels or consonants; for all may be sounded in a whisper. It is evident, therefore, that the larynx is not primarily concerned in their produc- tion, and this has been fully established." Again he says: "That the vowel-sounds are pro- duced by simple modifications in the form of the exter- nal passages is easily proved, both by observation and imitative experiment. When the mouth is opened wide, the tongue depressed, and the velum palati elevat- ed, so as to give the freest pO:sible exit to the voice, the vowel a in its broadest form (ah) is sounded. On the other hand, if the oral aperture be contracted, the tongue being still depressed, the sound oo, the continen- tal M, is produced. If attention be paid to the state of the buccal cavity during the pronunciation of the dif- ferent vowel-sounds, it will be found to undergo a great variety of modifications, arising from varieties of posi- tion of the tongue, the cheeks, the lips, and the velum palati. The position of the tongue is, indeed, one of the primary conditions of the variation of the sounds, for it may be easily ascertained that, by peculiar inflec- tions of this organ, a great diversity of vowel-sounds may be produced ; the other parts remaining the same. Still there is a certain position of all the parts which is most favorable to the formation of each of these sounds; but this could not be expressed without a lengthened description. The following table, slightly altered from that of Kempelen, expresses the relative dimensions of the buccal cavity and of the oral orifice^ for some of the principal of these — the number 5 ex- pressing the largest size, and the others in like propor- tion : — Size of Yuwel sounds. Oral opening. Buccal cavity. a as in ah 5 5 a " name 4 2 e " theme 3 1 " cold 2 4 00 " cool 1 5 " These are the sounds of the five vowels, a, e, i, o, ?/, in most continental languages ; and it cannot but be admitted that the arrangement is a much more natural one than that of our own vowel-series." Having made this quotation, I proceed at once to give the first case, bearing directly on this point : — Edward Larkin, tet. 50, born in Ireland, April 14, 1871, attempted suicide with a razor. A cut was made immediately above the thj'roid cartilage, extending an inch each side of the median line horizontally, and shaving off the epiglottis at its base. The muscles be- low and above, by their tonic power, soon made an oval opening, two inches by | of an inch. Swallow- ing became impossible. On the fourth day he was brought to St. Mary's Hospital, having taken no food. No attempt was made to bring the edges together, trust- ing to the granulating process. A tube, introduced through the opening into the oesophagus, conveyed food to the stomach. This process was continued for about five weeks, when swallowing became possible, although the opening, which had become nearly circu- lar, was about half an inch in diameter. At the present time (June 10, 1871) he swallows solid food, but part of the liquid food will run out of tlie opening. At any time he was able to talk by bending his head forward and temporarily closing the opening. When the head was thrown back, he immediately lost this power. The experiment of enunciation of the alphabetical sounds, with the head thrown back, was made with the vowels first. The four sounds of a as in all^ arm, age, 50 THE MEDECAL RECORD. at, were at once disi inctly rendered. F, next attempted, alwnys resulted in n as in uije. (This, I tliink, must be jmt to the ni'counl of tlio llibeniian larynx.) y is a (liphthong, and was ck-arly reniltTod. O, botii long and sliort, was well brought out as in note and not. The short u as in cut, and represented by nearly all the other vowels, was also well pronounced. }' as /. The diphthongs were more difficult, and some could not be uttered ; 01/ as in onr was pretty well pronounced ; 00, a pure vowel, was uniformly rendered as o in note. Oi, as in noise, could scarcely bo distinguished. The alphabet, taken in order, resulted in the enun- ciation of the vowel element. Thus our letter Ji was pronounced a, as also C and A There was absolutely no consonant uttered. The breathing, which is repre- sented by the letter //, was perfectly rendered. It was clear and smooth, and when joined to a vowel was spoken loudly and clearly. Thus, J/a and other sounds of(f, III and IIo, tilso Jin short, -wove i)ronounced with ease. A' and O' arc considered guttural aspirates. Any attempt to produce them resulted in the pure aspirate. These experiments were repeated on two difierent occasions, a few days apart, and with the same results. But on the second trial it was suggested that some air might pass into the mouth, and a curtain of buckskin was iitted to the upper part of the aperture, thus cut- ting off all the air that might reach the mouth. The result was the same. As regards the finish of the tones called vowels, there was clearly a defect. This might be due to the thickening of the mucous membrane, incident to the in- flammation in its immediate neighborhood — a good and quite sufficient cause. Or it might be explained by the absence of the modification by the mouth, tongue, and other parts, which have been supposed to create the sounds, but which, as is here shown, can only polisii and comj)lete what has been begun. But a little prac- tice will enable one to hold the parts above the larynx perfectly quiet, and still produce the vowel-sound. This case is so pathognomonic, if I can apply such a term, that it must reverse and settle opinion upon the seat of certain vowe'-30unds. The number of sounds that Larkin was able to enun- ciate is limited ; but I will now cite another case that, from its peculiar character, supplements the one just detailed, and by its results confirms the belief that Larkin's ability to enunciate as described would exist in all others, tims placing the seat of such vocalization as normal in all. During the year 1856 I Avas called into Orleans Co. to see Edward Matthews, wlio was suflfering from ur- gent dyspnoea. I arrived at his house in the night, and at once opened the crico-thyroid space. The relief was sufficient, and I did not see him again for a long time. Two years after, as I am informed, a piece of bone was removed from the opening, which had been kept free by a tube. This seemed to be lodged in the larynx somewhere, but the statement is too indelmite to be thoroughly understood. Nevertheless, there was a great abatement of unpleasant symptoms from soreness and dy,«pnoca. But slowly and gradually the glottis became closed, and for more than ten years a cicatrix has cut off the air from the trachea into the mouth, the closure being at the base of the larynx and absolute, not the least air passing through. Mr. Matthews, who is now forty-four years of age, is a man of intelligence, and has made great and constant efforts to enunciate clearly, and has improved much of latter years. Of course, every sound is a whisper, and also short, for the air ii driven by the buccinators and the muscles of the tongue and the supply of air is small. From this man we would expect to hear the consonnnis, if ho could speak at all, and this is essentially true. II and L he cannot jironounce, as they rc(iuirc a con- tinuous tone, and are interested in a quiescent state of tiie buccinators, wliich arc the chief means of forcing the air out. JJut even these sounds can be faintly traced in combination with others, in the con.vtruction of a word. Tlie pure breathing represented liy the let- ler II cannot be made at all, or in any combination. The single vowel-sounds of a, as in arm, uf, all, and aye, cannot be rendered at all. A blowing sound was the result of the effort, and when the finger was placed over the aperture in the trachea there was nb.solute silence. The cerebral command was obviou.sIy to the larynx. O was also silent, or resulting in 00, as in ooze. /, as in isle, was also silent when the aperture was closed, or a mere blowing sound if opened. 7i clearly enunciated, and this vowel is made in the front part of the mouth, by throwing the tip of the tonpue against the lower incisors and curling it upwards. While fixed, the continuous tone -f results. The nameless vowel represented by u as in nut, e as in err, i as in sir, and as in honor, sometimes styled the nnvocal, could not be uttered except in connection with consonants. Short o as in not, " e " net, " i " nit, could be rendered in conjunction with consonants, but, with the exception of short e, could not be rendered individually. The diphthongs were much more success- fully pronounced than by Larkin. Thus the soft u as in fjratitnde is a diphthong com- posed of e w (00) and was rendered beautifully. Oo'is really a very pure vowel, perhaps the most of any, if we except e, but it is not so placed in our cata- logues, and I can hardly understand why, unless it happens to be represented by a double character. This is made at the lips exclusively, as in ooze, and was ren- dered with great perfection. Oi as in noise, and ou as in our, both failed. As might be expected, the consonants are generally pronounced, most of them individually, but some only in connection with voweL^. B, C, D, F, G, K, P, T, X, Z, and V, pronounced as words and pure. But H not all. L and R very faint, when combined with e long. M and N in connection with vowels only. The consonants, P and T, made in the front part of the mouth, were more easily managed than the others. Accordingly the vowels within his capacity were sure to be brought out best between them. Thus: — Pet 1 Pretty well. Pit " " Pot " " Put " " Peet Admirably. Pout Not at nil". Pent Beautifully. . Pat as Put or Pot. Pate, not at all, or as Peet. Th, as in Thing and With Well. Ch, as in Church, and Sh, as in Shall. . .Well. Nt, as in Se7it Well. The conclusions that I arrive at from these two striking cases are these : — 1st. That the larynx is not only the generator of voice (so called), but the actual seat of vocalization for the vowels a, in all its forms, i long, long, and the pure aspirate. Also the short vowels, which are also explosive, as i in sit, in not, and nameless one or unvocal. THE MEDICAL RECORD. 51 2el. That these sounds receive a finisli in the pha- rynx, nose, and mouth ; with the exception of tlie pure breathing and the short vowels. 3d. The consonants are all made above the larynx. 4th. The vowel e long is made purely in the front part of the mouth, also the vowel oo and the diphthong e«, which is composed of these two elements. 5th. The short vowels (e in met) (i in sit) (u in nut) (o in not) can be made in the front part of the mouth. 6th. The unvocal can probably be made in several places from the larynx to the front of the mouth. These propositions are nearly all mere statements of facts, but some are inferences. The observations on Edward Larkin were made in the presence of my colleagues Drs. Casey and Carroll of Sr. Mary's Hospital, and also of Prof Lattimore of the Rochester University. They were repeated on two occasions, a few days apart, but became afier a short time impossible from closure. Those on Mr. Matthews have been repeated on three occasion?, within the last three months: on cne in the presence of my colleagues in the Buffalo Medical Col- lege and several physicians and students of medicine, and on another, in the presence of Prof Mixer of the Rochester University, and Prof Palmer of the Normal School at Brockport — two gentlemen whose inteivst in the case arose from the fact that they were the teachers of languages in their respective institutions. Doubtful sounds have been carefully excluded, and I feel sure that no observations have been retained which are not clear and decided beyond cavil. CASES OF CEREBRO-SPINAL MENIN- GITIS. By JOHN DWYER, M.D., RESIDENT SCnGEON NEW YORK STATE EMIGRANTS' HOSPITAL, WARD'S ISLAND, N. Y. The following notes of six cases, typical of thirty cases of cerebro-spinal meningitis, treated in the Emigrants' Hospital during the years 1870 and 1871, may be of interest in connection with an inquiry made at a late meeting of the County Medical Society, "Whether any member had at present a case of cerebro-spinal menin- gitis under observation ? " Case 1. — Mary McG., aged IG, previously a strong healthy girl, living in a private residence on the Island, was rather suddenly attacked on 9th February, 1871, with a chill and headache which increased during the night; first saw her at 11 a.m. on the 10th, and found her shivering, complaining of acute pain in right frontal region, also in the lumbar region ; she was vomiting freely a yellowish-white matter. At 6 p.m. she was visibly worse, although vomiting had ceased and a solu- tion of quinine was retained in her stomach ; complained of intense pain in forehead and occiput, neck arched backwards, surface and extremities cold. She was screaming out for relief, had a wild look in the eyes, and she rolled restlessly about the bed, striking her head against the pillow. She was partly delirious. At 8 P.M. tiie right pupil was insensible to Hght, right foot and hand slightly convulsed. She suddenly began to sink, and died comatose a little after midnight, about thirty six hours from the attack. No post-mortem could be obtained. Case 2. — Peter Samelsen, aged 32, engaged in out- door work, suddenly attacked on 13th February, four days after case No. 1, with chills, prostration, and in- tense headache; did not speak after admission to hos- pital, moaned heavily, head and neck bent stiffly back- wards, vomited freely ; died comatose 36 hours after admission. Post-mortem revealed acute meningitis and profuse serous effusion of the arachnoid on the upper anterior surface of the right hemisphere of the enceph- alon. The lungs were oodematous and the spleen en- larged. Case 3. — Pelagius Cremer, aged 39, engaged in out- door work, attacked on same day and in same manner as preceding case ; died in thirty hours. Post-mortem — acute general meningitis, not marked in one locality as in case No. 2 ; otlicr organs healthy, except a very much enlarged spleen. It was reported that this man had repeatedly suffered from intermittent fever. Case 4. — Charles Grevcr, aged 24, in hospital with periostitis of tibia, suddenly attacked with chills and headache on 12th March, 1871 ; vomited freely yel- lowish matters; skin cold, pulse not extraordinary. Quinine Avas given which was retained, and seemed to restrain the vomiting. Under the influence of chloral he dozed through the night, occasionally waking up, moaning and tossing about restlessly in bed. On the 13th he was worse, complained of terrible pain in fore- head, neck, and back ; the muscles of abdomen became rigidly tetanic, and opisthotonos set in. The skin was mottled darkly, and there was an indistinctly marked purpuric appearance; he had a slight convulsion, and passed urine and fteces in bed ; he slept occasionally, raved and breathed stertorously, frothing at the mouth. Commenced to sink early on the 14th, and died forty- seven hours from attack. Post-mortem : Calvarium unusually thin, dura mater much congested ; on de- taching dura mater the whole surface of encephalon was bathed in bloody serum floating small jelly-like particles of lymph ; the pons varolii and medulla ob- longata were profusely charged with serous effusion ; other organs healthy. Case 6. — Recover3^ Patrick S., aged 10, residing in a detached house near the farm. Deep excavations for buildings have been going on in tiie immediate vicinity. He Avas suddenly attacked, on February 12, 1871, with headache, chills, and vomiting, as in preceding cases. On the 13th his breast and face mottled darkly, but not spotted; abdominal muscles rigid, neck and spine bent backwards, herpetic eruption on face and lips ; this child suffered great pain and was delirious at intervals, rolling about uneasily in bed, and stretching out his arms ri- gidly. About the tenth day the right eye became in- flamed, and an opaque effusion appeared in the anterior chamber. The pupil was kept well diluted with atro- pine, but seemed insensible to light ; he was also a little deaf The eflfusion daily became more opaque and solid ; the boy suffered severely, continually complaining of his head ; but fighting through all the phases of the disease, he began to improve about the sixth week, but was unable to leave his bed before the expiration of the ninth week. The herpetic eruption and the effusion in sheath of the optic nerve left no doubt of this being a true case of cerebro-spinal meningitis. He still resides on the island, and his condition at present, one year since his sickness, is as follows : Right eye atrophic, vision completely lost, anterior synechia, pupillary space contracted, and filled up with a lymphic white deposit; partial but apparently perma- nent paralysis of right side, throws out the right foot and hand with an uncertain motion ; occasionally com- plains of headache; hearing not good. Case 6. — Recovery. Teresa S., aged 4, sister of case No. 5, attacked on Feb. 23, eleven days after, and in the same manner as her brother ; opisthotonos ex- isted to a degree, swallowed with difficulty ; suffered severely with headache, and moaned incessantly ; shrieked when her neck or occiput was touched ; when lifted by her mother she continued rigidly bent back- THE MEDICAL RECORD. wards ; the tongue always kept dry and chippy ; the Hps and face also spotted with herpes; she was for some time deaf while sick, but the eye did not suffer. Althoufjh ihis child wa^ an aggravated case, she re- covered three weeks before her brother, and she now siiows no evidence of any cerebral lesion, being ap- parenily quite heallhy. During 1870 only four cases of cerebro-spinal me- ningitis occurred in the hospital, all resulting in death. Shiirtest duration of disease three days. During 1871 there were 26 cases treated, of which li died: 1 died in eighteen hours from attack; 5 died within two d.iys, 3 within ten days, 1 within thirteen days, and 4 exceeded this up to eight weeks, the re- maining 12 becoming clironic, made a protracted re- covery. In the month of January, 1872, already two fatal cas;;s have occurred: one died in twenty-two hours, and the other in eight days. There was no peculiarity to be observed in the ages of those attacked; the majority were adults, four were under ten years of age. Of the whole, only four were females. Winter or summer did not seem to make any diflerence, the cases in each season being about equally divided, except that in February, 1871, five cases occurred wiihin a few days of each other. With the exception of cases 5 and 6, there was little or no communication between the parties attacked, the cases were scattered through the different buildings of the institution. Strict attention is paid to the sanitary condition of the whole institution, Hospital and Refuge, and no local cause could be discovered as the exciting one, unless the turning up of fresh ground for the buildings i 1 progress might indicate its malarious character. men had been exerted to their utmost. Now for my plan: I place the patient upon a common chair. I pass around his body, below the arms, a bmad strong towel, the ends of wliich I give to a stout assistant. The next step, ami tlie most important of all, is to fiindy fix the scapula. Without tins precaution you will Ijc pretty sure to fail, pull as hard and as long as you plea.se. To fix the scapula I direct one intelligent a'-si-tant to place the ball of the hand firmly against the acromion process. I then tie a handkerchief around the arm direc'ly above tlie condyles, and make in it a loop for my right hand, then, with the arm hanging down closely to the body, I pull gently and steadily directly downward:*, and, with my lelt hand in the axilla, the bone slips ea-ily and quickly into place. Now in this dislocation the head of the bone lies under and in contact with the neck of the scapula, and if by any means you can depress the head of the bone to the extent of one-eighth of an inch, or even less, there is nothing to prevent your glidini; the bone easily into place, and that, too, without injur- ing any of the joint structures. I have said that I claim this method as exclusively my own. If it has ever been practised or recommended by others, I have failed to see it. THE "ARTERY CONSTRICTOR," WITH CASES. By S. FLEET SPEIR, M.D., BKOOKLYN, N. T. (Rcml before the Medical Library and Journal Assuciation, N. Y.) A NEW METHOD OF REDUCING A DISLO- CATION OF THE HU:\IERUS INTO THE AXILLA, WITH REFERENCE TO THE ANATOMY OF THE SHOULDER-JOINT. Bt E. p. BENNETT, M.D., DAXBUBT, CON'S. Ix the early part of my professional life, being often called upon to reduce this very common dislocation, I often experienced great difficulty in accomplishing my object, and when I did succeed I often found irrepara- ble injury had been done to the structure of the joint, and the patient more or less crippled. I carefully studied all my surgical works, and carefully examined and tried all of the various methods by them advised for the reduction of this injury, and finally came to the conclusion that they were all radically defective, as they did not take into consideration the anatomical structure of the joint. It is needless for me to detail these various methods, as they are famihar to all, and, as I said before, they are all unscientific and defective. It does seem as if in most of them the efforts of the sur- geon and of his assistants were designed more to tear the scapula from its attachments to the chest, and the muscles from their attachments to the humerus, than to replace the displaced bone. Since I have adopted my method, which I call the anatomical method, and which, egotistic as it may appear, I claim as exclusively my own, I have never failed in a single instance of re- ducing this dislocation by the tractive force of one hand, and this after all the other methods had been tried and failed, and when the united strength of ten or twelve ' CONS'TRICTION' OF THE ASTERIOR TIBIAL AND INTERNAL PLANTAR ARTERIES. Case I. This is the only case in which there has been any accident after the application of the artery con- strictor, under my observation; and as a faithful record requires the whole truth to be told, I am glad I have nothing worse to report. On tlie 28th of December, 1870, at the Brooklyn City Hospital, Dr. D. E. Kissam, performed amputa- tion at the ankle-joint, on a woman aged 30 years, for extensive disease of the bones of the foot. The patient was etherized, and Pirigoff's operation perform- ed. At the invitation of Dr. Kissam, I closed the ante- rior tibial artery with the constrictor. This was the onl)' arter}' which bled at the time of the operation, and it was supposed that the other arteries had been closed by the previous disease and inflammation ; however, tl:e internal plantar artery looking larger than usual, it was thought best to apply the constrictor to it also; which was done before closing the wound. In coaptating the flaps, it was found tiiat considerable force was neces- sary to overcome the resistance of the muscle, and adjust the portion of the os calcis (which is left, in this operation), to the ends of the tibia and fibula. In doing this, Dr. Kissam jiressed very violently upon the anterior tibial artery, at the point where it had just been constricted, and repeated this pressure several times before he was able to adjust the bones. Not- withstanding which, there was no bleeding from the artery. I was in some doubt as to the propriety of leaving the vessel in this condition without reapplying the constrictor, in order to replace the invagination of the internal and middle coats, which it seemed to me must have been turned back, and perhaps the clot dis- lodged by this violence ; however, as there was no bleeding from the vessel, and all present appearing satisfied with the security of the artery, it was left as THE MEDICAL RECORD. 53 it was, and the wound was closed by silver sutures, one of which was passed, as it seemed to me, right through the anterior tibial artery (an accident which might very easily occur, as there was no guide to the artery), and my anxiety for the integrity of the vessel was again aroused; slill, no bleeding following, the stump was bandaged, and (he patient put to bed. At 8 P.M. the same night there was bleeding from the stump. Dr. Hamilton, the House Surgeon, found it necessary, in order to nri-est the hemorrhage, to open the wound. He found the anterior tibial, which had been constricted, bleeding; he tied this vessel back of the constriction. This, however, did not arrest the bleeding, and the external plantar artery was sought and tied; this checked the bleeding sufficiently to leave it for the night, and Dr. Kissam was notified. I went with him to see the patient the next morning. We found that there were yet several small vessels which continued to bleed. Their texture was such that a ligature applied to them cut completely through them, and came off at once, — so that it was very difficult to check the hemonhage, but by great care we finally arrested it. The internal plantar artery, which had been closed by the constrictor was sought, and it was found to be perfectly closed with a firm clot, no bleed- ing having occurred from it. In fact, it was about the only vessel in the wound which did not bleed. POPLITEAL ANEURISM TREATED BY THE APPLICATION OF THE " ARTERY CONSTRICTOR " TO THE FEMORAL ARTERY. Wm. L , a cachectic mulatto, aged 50 years, was admitted to the Brooklyn City Hospital, August 4, 1871, under care of Dr. D. E. Kissam. In March last, while descending a flight of stairs, the patient slip- ped and wrenched his left leg, which gave him at the time some pain about the knee. The following day the pain was so great that he could not bend his knee. In a short time the pain diminished, and he could walk pretty well. Early in June he noticed a tumor in the popliteal region, and at that time he had pain in his foot, and a feeling of numbness in his leg and foot. Since the first of July, he has had sharp darting pains in the tumor. The following is the history as taken by Dr. Balch (Resident) : On admission he can extend his leg perfectly, but he cannot flex it com- pletely ; there is a tumor the size of an orange situated in the popliteal space ; palpation gives distinct pulsa- tion in the tumor, and a decided thrill ; auscultation gives a well-marked " bruit." Pressure on the femoral artery stops the pulsation, and the tumor is then easily emptied ; stop the pressure, and it immediately refills. Auf/unt bth. — Treatment was commenced by the ap- plication of Dupuytren's Pad to the femoral arterj' ; at the same time flexing the leg on the thigh, a bandage was applied from the toes up to the knee. This ap- paratus remained on till August 17th, at which time the tumor was considerabl}^ harder, but the patient would not submit to the apparatus any longer, as he said it gave him too much pain. The leg was then kept flexed on the thigh till August 2Gth, when, no further progress being made towards a cure, Dr. Kis- sam invited me to apply the artery constrictor to the femoral artery. Dr. Kissam made an incision about 14- inches long in Scarpa's space, and found the artery very superficial. The sheatli of the artery was opened, and I applied the artery constrictor to the vessel, and immediately all pulsation in the tumor ceased. The wound was closed with silver sutures and adhesive straps, and picked lint, dipped in a weak solution of carbolic acid, placed over all, and the leg enveloped in cotton wadding, and the patient put to bed. In the evening the temperature of the foot and leg was higher than that of the sound limb ; there was verj'' little pain ; pulse 92. AiKjTist 21th. — Rested pretty well last night; wound looks healthy; no pain ; no numbness. Aiirjvst 2Sth. — Wound begins to suppurate ; pulse 84 ; some fever; complains of numbness; temperature of foot good. August 2dth. — No fever; pulse 80 ; tongue a little coated ; sutures removed, and wound dressed with weak solution of carbolic acid, and adhesive plaster ; some suppuration. Avgust 30tJi. — Wound suppurating freely ; no union by first intention. September 3d. — Not so much suppuration ; Temperature of foot normal. Srpiemher Blh. — Wound begins to heal ; removed wad- ding from the leg; temperature of the leg normal; aneurism smaller. September Wth. — Wound nearly healed ; patient looking well ; no pain or numbness. September '?.hth . — Wound entirely healed ; patient can nearly straighten his leg, can flex and extend his foot without any trouble. October 5tJi. — Discharged from Hospital, cured. The immediate relief from pain which followed the application of the constrictor was in marked contrast with the great distress and pain attending the treat- ment by compression and flexion. AMPUTATION OF THE FOREARM WITH APPLICATION OF THE " ARTERY CONSTRICTOR." Christian S , set. 39, admitted to th.e Brooklyn City Hospital August 7, 1871. This patient, while at work in his shop, had his wrist caught between two wheels, producing a badly-lacerated wound of the dor- sal aspect of the liand, compound dislocation of lower end of radius, compound fracture of the styloid process of ulna, and crushing of the carpal bones. The parts above the wrist were uninjured. I saw the patient at one P.M. He was then etherized, and I amputated the forearm at its lower third, by dorsal and palmar flaps. The artery constrictor was applied to the ulnar artery, the radial and interosseous arteiies were secured by silk ligatures, the flaps broughtjtogether by Avire sutures, and dressed with lint soaked in a solution of carb(»lic acid and water ; patient put to bed, arm at rest and elevated upon a pillow, and an opiate at night. Sth. Patient feels very weak (probably due to loss of blood before operation) ; pulse 120 ; has pain in stump ; ordered an opiate ; vomited after breakfast to-day. dtJi. Pulse 110 ; stump looks well ; suppurating where the ligatures were applied, no .mppiiration on side where the constrictor was used. 10!"/;. Pulee 105, suppuration con- fined to the radial side. i2fJi. Feels better ; pulse 100 ; sat up in bed to day. 15;!/?. Removed sutures. The flaps on the ulnar side of arm have entirely, healed by first intention; on radial side suppuration continues. 17^/;. One of the ligatures came away to-day. 20th. Patient went out on pass to day, still suppurating at point of radial hgature. This ligature remained in the stump until September 29th. October 12fh. The wound has entirely healed, and the patient is discharged from the hospital, well. AMPUTATION OF THE LEG WITH APPLICATION OF THE ARTERY CONSTRICTOR. Thomas T , fet. 40, was admitted to the Brooklyn City Hospital August 17, 1871; service of Dr. D. E. Kissam. The Ibllowing history is furnished by Dr. Rushmore (Resident): While at work on the East River Bridge, the patient's ankle was caught by a coil of rope in motion. He was knocked doAvn and his leg severely injured. He was brought to the Hospital im- mediately, and there was found a lacerated wound on the inner side of the tibia, at the lower end. The inter- 54 THE MEDICAL RECORD. nnl malleolus nl^o fractured. The foot was everted, the plantar aspect being parallel with the outer aspect of llio iofr. The posttTJor tibial arlory was uninjured; no laceration of soft parts above the wound; but little loss of Mood. The accident happened about 7 a.m.; at 10.30 A.M. the patient was anaesthetized, the malleoli dis- eected ouf. and the di.slooation reduced by Dr. Ki?8am, with a view to save the foot, if possible. The edges of the wound were drawn together by wire suture.'*, except at the most depending part, where there was left an open- ing for the disc!iar;jes. On the 10th the patient's gen- eral condition was i)ad ; pulse 13'2, skin hot, foot cold; sensation in the foot pood, no di.scharpe from wound; inner side of leg and tliigh red, painful, and hot. At 2.30 P.M., after consultation, it was decided to amputate. The patient was etherized, and Dr. Kissam anij)utatcd below the knee by anterior and posterior flaps. The soft parts on the inner side of leg at the point of ampu- tation looked and smell unhealiliy. At the request of Dr. Kissam 1 applied the "constrictor" to the anterior t.bial and the posterior tibial arteries, which were the vessels bleeding, and a!l hemorrhage was immediately controlled. The stump wa.s united by wire sutures and carbolic-acid dressing applied, patient put to bed and ordered supporting and stimulating diet, and opiate at night. Pyaemia set in on the 21st; he was delirious during tiie night and part of the day. The integument on the inner side of the thigh inflamed high up as the groin. The stump very unhealtliy, had very little sup- puration, which was thin and bad-smelling. Sloughing .^pots formed, one over the tubercle of the tibia and ano- tiier on external aspect of the thigh. 23d. The flaps sloughed, especially on the inner side and in front. 25th. Patient died to-day. The stump was examined, and the main artery was found closed at the point of constriction. A few drops of pinkish, thick, bad-smelling matter were found in the vessel, but no clot. To the outer side of the larger artery was a smaller one, lying close to the main artery. This was constricted at a point corresponding to that in the larger vessel, aud upon its invaginaled inner coats was a clot which perfectly occluded the vessel. There had been no hemorrhage from either vessel after the operation. The absence of a clot in the larger ves- sel seems to show that the invaginaled inner coats of the artery were sufficient to perfectly close the ves- sel From the rough manner in which some of the "con- strictors" that I have seen have come from the hands of the instrument-makt?rs, it would appear that they do not all understand the design of the instrument ; and I wish to call attention to the fact that the constrictor is not intended to have the effect of an ecraseur, but, on the contrary, a blunt and smooth-linished surface is very necessary. I would recommend to any one who wi.shes to obtain the best result from the use of this instrument, to pay special attention to this poiat: every part of the surfiice which comes in cont.ict with the artery must be polished, and great attention should be paid to the edges of the sheath, to see that they are ,well rounded and smooth, — this is necessary to secure the integrity of the external coat, more particularly so when it is to be used in the treatment of aneurism. Each constrictor should be tried on a piece of chamois- skin or a fold of soft paper, or better still, an artery from the " subject." If this is done, it can at once be determined when the instrument is perfect. Every instrument which " cuts through " should be discarded, and only those should be accepted which constrict and draw the paper, chamois-skin, or the artery, whichever one is used, into the sheath, and allows of its being pushed out again without breaking or cutting it. At the same lime it must permit of a considerable degree of constriction, and must not fit too loosely. The size of the instrument used um.it be, to a certain extent, adapted to the size of the artery to be closed. In taking up small arteries in section, as in general oj)eration.s, a very small constrictor should be used ; and I have found that in such cases it is not nece.s.sary to i-olate the vessel from the surrounding tissues before constricting it, but they may be taken up with a tenac- ulum or forceps, and constricted en masse. In constrict- ing large arteries it is best to separa'.e the vessel some- wliMt from the other ti-sues. The length of time usually required in the application of the artery constrictor for completing the clo.sure of a vessel varies with the size of the vessel and the j)erfec- tion of tlie particular constrictor used. In my own cases it has varied from a single minute to several min- utes. I usually leave it on the vessel only long enough to thoroughly invaginate the inner coats, and then re- move it, which would require for the whole operation not more than one or two minutes. The work of the constrictor may be considered done the moment a complete invagination is accomplished. In the case of aneurism it may be well to leave it on the vessel a little longer, to secure a firm clot in the vessel before remov- ing it, or even to control the circulation above the point of application. No constrictor should be used in an operation until it has been tried upon a dead artery or on a piece of chamois-skin or fold of soft paper, and its size and peculiarities determined by actual trial; any imperfec- tion will then be seen, and may be remedied by poUsh- ing or filing down, as the case may require. As soon as the instrument-makers learn exactly what is required of the constrictor, they will, no doubt, be able to furnish constrictors which will be perfect in every respect when they leave the shop, and then these precautionary measures will no longer be necessary. Mr. Pfarre, of Tiemann & Co., has a thorough knowl- edge of what is wanted in the instrument, and makes some very good ones, and Avhen requested, will take pains to adapt the constrictor to any sized artery de- sired, or he will furnish them in sets of three or four instruments of different sizes. (DriaimU Cccturcs. LECTURES ON OTOLOGY. DELIVERED AT THE COLLEGE OF PHYSICIANS AND 30RGE0NS, NEW YORK. By Prof. H. KNAPP, M.D. Repokted by Charles S. Turxbull, m.d., AS.SISTAST TO THE NEW YORK OPHTHALMIC AND ACBAL INSTITUTE. THE ANATOMY OF THE MEMBRAN.^ TYMPANI. Toe memb}-ana ti/wpani, or drum-head, separates the external meatus from the tympanic cavity. It is set in a groove upon a ridge at the tympanal termination of the bony meatus. It is situated obliquely, its outer surface being directed downward and forward. Upon viewing the membrane, Ave distinguish the fol- lowing details:* — In the centre of the upper portion a white pointed elevation is conspicuous, — this is caused by the short process of the hammer bone; from this a ^* The lecture was illustrated by drawings on the blackboard, anatomi- cal specimens, and microscopic preparations. THE MEDICAL KECOED. 55 ridge, formed by tlie manubrium mallei, runs downward and slitjhtly backward, terminating in a navel-like depression called the lonho membraniv hjmpani. The area of the drum-head is best divided, according to Sir Wilham Wilde, into an inferior, superior, anterior, and posterior segments. The inferior segment is defined by lines running at right angles from tlie umbo forward and backward to the periphery. The superior segment presents itself as a purse-like, flabby projection, the inferior boundary of which runs horizontally from behind forward, with the short pro- cess lying a little before its centre. On account of its flabby pnd folded appearance, the superior segment of the membrane is called the flaccid portion, or " 7nem- hraiia flaccida ShrapnelUi." As the folds are directed from the short process partly backward and partly for- Avard, they are distinguished as posterior, and anterior folds. That part of the membrana tympani lying in front of the manubrium mallei, between the anterior-superior fold and inferior segment, is called the anterior seg- ment, and is generally somewhat depressed. In a similar way the p)osterior segment lies between the handle of the malleus and the posterior portions of the upper and lower segments. At the junction of the anterior and inferior segments a bright triangular speck, pointing towards the umbo, is conspicuous on inspection with the mirror, and is pro- duced by tlie pecuUar curvature of the membrane being convex from the umbo to the periphery. Tlic membrana tympani is of a pearly-gray color, somewhat yellowish in the centre, on account of the sur- face of the promontory shining through the translucent membrane, the centre of which lies much nearer the promontoiy than the periphery. It is winter at the peri- phery, because there the circular fibres and the connec- tive tissue continued from the neighboring parts to tire membrane are more abundant than in any other part. Upon considering the structure of the membrana tym- pani we find it composed of tliree layers, divided as fol- lows : first, the cutaneous, containing the dermoid and sub-dermoid layers; second, the./?/j/-o».s layer, consisting of radiating and circulating fibres; and third, the raucous layer, containing the epithelial and sub-epithe- lial layers. The fibrous layer is found devoid of both blood-vessels and nerves, whilst the two others, being continuations externally from the epidermis of the meatus, and, internally from the lining mucous mem- brane of the tympanum, are supplied with nerves, ves- sels, connective tissue, and epithelium. The thinnest portions of the membrane are about midway between the end of the handle downward and forward in the anterior portion, and downward and backward in the posterior portion ; and it is in one or other of these po- sitions that we generally find a perforation, whether caused bj' accident or disease (Wilde). The cutaneous layer is composed of all the essential elements of the cutis, except glandy, and is made up of several layers of epithelium, connective and elastic - tissue, well supplied wiih vessels and nerves. The sub-dermoid connective tissue is intimately connected with the fibrous, and is densest at the periphery of the membrane and along the manubrium. A band of parallel fibres, two lines in breadth at its origin, descends from above downward, and surrounds the manubrium, and in it and the peripheral increase of connective tissue the vascularity is greatest. The fibrous layer is comiposed a) oi a radiating slra.lum of fine fibrilte, with connective-tissue corpuscles between them, which are spindle-shaped in their longitudinal section, and round, with three or more offsets, in the transverse section, being a nucleated system of nutiitive canals, like that of the corneal substance; b) the tendi- nous ring, which is situated near the insertion of the membrane into the groove of the tympanic ring, consists of irregularly interwoven fibres of connective tissue, and belongs to both the radiating and circular strata; c) the circular stratum, which, however, does not commence in the immediate vicinity of the tympanic ring, is thickest near the tendinous ring, and becomes thinner as it ap- proaches the manubrium. Gruber has described fibres descending like those of the sub-dermoid layer. The mucous layer on the inner surface of the mem- brana tympani is a part of the mucous membrane lining the tympanic cavity, and is abundantly supplied with vessels, but scantily with nerves. Its epithelium consists of one layer of polygonal cells, which are not ciliated. Gruber describes a dendritic, or dendroid fibrous formation, Avhich begins in the fibrous layer, with a broad base at the lower and posterior part of the periphery, running obliquely upward toward the handle, and lying with its upper offsets near the sub-mucous layer. It is identic with the fibrous layer, which lies between the circular fibres and the epithelium of the inner side, described more recently, in Strieker's Histol- ogy, by J. Kessel. It is densest in the centre of the membrane around the handle, and divides into numerous branches which communicate with one another, and in- sert themselves finally into the tendinous ring at the periphery. Some of these branches penetrate the layer of circular fibres, and either terminate there or return in their further cour.se on the posterior surface of the fibrous stratum. This membrane, of a more or less trabeculated appearance, constitutes the sub-mucous stratum. On the inner surface of the mucous membrane, and especially upon the trabeculse of the sub-mucous stratum, are found numerous villi, which have the structure of the mucous membrane, and contain in their axes a loop of a blood-vessel, and so constitute vascular papillae. Gruber represents the connection between the handle and membrane as joint- like, and asserts that in many specimens the handle shows at this place a thin layer of cartilage upon its surfiice. Facing the handle and short process, a cartilaginous formation is imbedded in the substance of the membrana tympani, connected with the handle very loosely on its surface by delicate fibres, but more densely by a kind of capsule on its edges. The manubrium is, however, more densely con- nected with the cartilage, and he asserts that he has found epithelial cells on the opposing surfaces of the short process and cartilage, and that a synovia-like fluid is found between the bones and the described for- mation of cartilage (page 63 of his monograph on the membrana tympani). Moos, Prussak, and others deny this joint-like union between the membrana tympani and the hammer bone, the fibres of the membrane proper inserting themselves directly into the periosteum or perichondrium. The blood-vessels of tliC membrana tympani are de- rived externally from the arteriaauricularis profunda — a little branch of the internal maxillary. In its course it descends from the upper wall, runs along the manu- brium, and divides into radiating branches, which anastomose with those of the tympanic ring at its periphery. The capillaries collect into two venous branches, which run alongside of the artery. Prussak and J. Kessel described two venous plexuses which re- ceive the blood from the outer layer of the membrana tympani, the one running along the handle, and the other in a circular direction around the periphery. The internal vessels are derived from those of the 56 THE MEDICAL RECORD. mucous membrane of the tympanum, " artoria tympnn- ioa," till" ramifications of whicli arc numerous, forming a den^e net-work of capillaries. The fibrous layer, or , membrana propria, was formerly considered as having neither ve^si.ds nor nerve?, but J. Kessel says that it is pervaded by a net-work of capillaries connecting the blood-vessela of the outer layer wilii those of the the inner layer. The capillaries of thn membrana tym- pani have an arrangement similar to tliat of tlie blood- vessels: three strata, the one belonging to tlio cuta- neous, the next to the mucous layer of the membrane, and a third connecting the two witli each other by capillaries running through the membrana propria (J. Kessel). The nerves of the membrana lympani are supplied externally from the tympanic nerve — a branch of thfi " tempero-auricular," derived from the third branch of the trigeminus. It descend sfrom the roof of the meatus and courses brandling in the same direction as the artery. According to Kessel, there are branches running from the outer layer into the fibrous layer, in which a part of them remain, dividing into more mi- nute branches or twig-:; while another })art pass tlirough it and communicate with the nerves of the mucou> lay- er. Those found internally are scanty, and are trans- parent, without medullar}' sheaths. WOUNDS AND INJURIES OK THE MEMBn.\NA TYMl'ANI. The causes tending to injure this delicate membrane are quite numerous — penetrating instruments and foreign bodies, by external force or violence, such as fracture of the temporal bone, blows upon the side of the head, falls, etc.; sudden concussions of air, as in pertussis, loud, sharp reports from heavy pieces of artillery. Gruber says that the membrana tympani bears verv high degrees of pressure (from four to five atmosplicres) Without bursting. He thinks that only in membranes previously diseased a rupture is liable to occur by sud- den increase of atmospheric pressure. The bleedino' in pertussis and other diseases is not always a symptom of rupture of the membrane, as also the blood-vessels of the conjunctiva and other membranes are very apt to burst in this disease. The si/)))p'oms are : — Pain, mostly of an inter.se character, at the moment of the rupture. Sometimes, however, no pain is felt. Fainting, which may be repeated during the next twtnty-four hours. Convulsion.'} are very rare. A loud noi.'ie or crash at the moment of the rupture, caused by the fearing of tb.e fibres or the sudden pres- sure upon tlie labyrinth. The noise persists for some days, in most cases, but gradually dmiinishing in in- tensity. The hearing is impaired in ©very case where the mem- brana tympani was normal before the accident, but it may be improved in cases of diseased membrana tym- pani, for then the membrane is no longer a septum barring the entrance to the waves of sound, the latter having immediate access to the stapes, and the mem- brana tympani secundaria. Jlyperacusis, or Sonophohia, in rare cases: some noises or tones being very disagreeable. Los>i of the faculty of determining the direction of sound. Tliis symptom is not constant, and soon disappears. Extravasation, covering the rent in an otherwise nor- mal membrane. A rent orjissure of oval or linear shape; at times the dermoid and radiating layers retract more than the inner layers, and a wound with terraced edges is produced. The prognosis of wounds and injuries to the mem- brane is generally favorable. Wilde, however, ob- serves : — '' It is remarkable that, while we experience the greatest difficulty in keeping open a perforation made with a surgical instrument, accidental openings seldom close." This serves as an argviment in favor of Gruber's statement, that the memi)rane was gen- erally diseased before the perforation occurred. The treatment is simple and can be readily given : Do not syringe, but let the ear alone. Cleanse the meatus with cotton, and insert into it a light plug of cotton or wool to protect the membrane. The healing in most ca~es takes place rapidly and without inflammation. If the latter ensues, the symp- toms are those of myringitis. profircso of iHctilcal Science. PnoTOPnoBiA IN Sightless Eyes. — A writer in the Br. Med. Journal cites three or four cases in which marked j'hotophobia remained after destruction of the eyeball, following injuries, in which favorable prognos- tications had been given by physicians in attendance ; their opinions that sight would remain after inflamma- tion had been subdued having been wrongly based upon such persistent sensitiveness to light. Lead Poisoning from Snuff. — Dr. Garrod reports an interesting case of this nature, which had been caused by snuflT which had been packed in lead, and refers to several other cases of similar character. It appears that when moist snuflF is enclosed in leaden cases, and especially when subjected to the action of heat in tropical' climates, it becomes intensely poisonous from impregnation with the metal. He explains this as fol- lows: — Tlie moisture of the snufl', containing its solu- ble salts, is evaporated and condensed on the sides of the leaden case, upon which it slowly acts ; and the lead salts, thus brought into solution, gradually impreg- nate the mass. Albuminuric Retinitis. — Mr. Swauzy, speaking of this aflFection, says {Med. Press and Circular) : '' Every one who has busied himself specially with diseases of the eye must have had frequent occasion to diagnos- ticate Bright's disease by the opthalmoscopic appear- ances, while, as yet, there were no other prominent symptoms ;" the disturbance of the function of the eye being the first thing which would lead the patient to seek medical advice. He thinks the physician who takes the trouble to learn the use of this instrument will be abundantly paid, during his first five years' prac- tice, in his ability to use it as a means of diagnosis in this afl*ection alone. He says that " as a general rule, in those cases where the eye gives the first indication of the presence of Bright's disease, the progress of the latter is fiom that time very rapid. From three to six or eight weeks is commonly long enough to biing the case to a fatal termination, and it is rare for these patients to live for three or lour months after the sight has become aflfected." Treatjient of Favus avithout EriLAXiON. — Prof. Enrico de Renzi has undertaken to treat this affection without removal of the hairs, by the following method : First, the nature of the disease having been determined by the aid of the microscope, the hair is cut closely and the head rubbed with an ointment consisting of one- tenth part of phenate of soda. After a very short course of treatment the parasitic growth is seen to lose its transparency, become granular, and at last is 1 THE MEDICAL RECORD. 57 detected, by aid of a magnifying glass, reduced to frag- ments around the roots of the hairs. Under the con- tinuance of this treatment it completely disappears, never to return except as a result of a new engrafting of tlie parasite. — Lyon Medical. Gelsemium in Irritable Bladder. — Dr. W. Scott Hill, of Augusta, Maine {Am. Jouru. Med. Sciences) re- lates five cases of irritable bladder wliicli were relieved by the administration of Tilden's fluid extract of gel- semium. Electrotherapy. — J. W. Holland, M.D., Prof. Chem., Univ. Louisville (.1???. Practitioner), speaks of a case of " nervous deafness," due to a sudden but enduring apathy of the auditory oerve, in a patient aged forty- one, which was considerably improved by the feeblest current from a volta-faradic coil, after a sitting of five minutes' length. The revival of the auditory nerves gained fresh force from each electrical sitting, and he presumes that, as five applications have accomplished so much, by continued excitation the torpor may even- tually be entirely removed. Uterine Cloth Tents. — In a reprint from the Atlan- ta Medical and Surgical Journal, Dr. V. H. Taliaferro, of Columbus, Georgia, gives some practical observations upon medication by the use of uterine cloth tents in diseases of the body and cavity of the uterus, with ac- companying wood-cuts. They are designed as a safe, read}', and thorough means of intra-uterine medication, dilatation in uterine cervical structures, and of prepara- tion of the uterus for intra-uterine injections. That they accomplish these objects witli greater safety and thoroughness than any means heretofore employed he is fully convinced. Knee-joint Amputations. — Dr. W. H. Hawkins, of Rocky Comfort, Arkansas (Proceedings Arh. Med. As- soc), presents two successful cases of this amputation, and notes the excellent treatises upon this subject by Drs. Markoe and J. H. Brinton. In general, he be- lieves that knee-joint amputations compare favorably with amputations of the leg at any point above the knee, and as economy in preserving as much of a dis- eased or injured member as possible is always desira- ble, this operation possesses decidedly the advantage in this particular. In these two cases the antero-posterior flap, with retention of the patella, was adopted, though the con- dyles were shaved off. The shaving off of the condyles he regards as an unnecessary proceeding, and, in future operations, he will follow Dr. Stephen Smith's method, as detailed in the Am. Journ. Med. Sciences, 1870. It admits of a more thorough drainage, and places the cicatrix in a position least liable to be pressed by an artificial limb. A Plan for Facilitating the Reduction of Stran- gulated Inguinal Hernia by Taxis. — A correspond- ent of the British Med. Jour, calls attention to a method recommended by Baron Sentin to be followed in this operation. The patient is to be placed on the back, with the hips well raised, and in case the hernial tumor is not reducible by the ordinary manipulation, the surgeon is to pass his index finger up into the ring, if possible to the outer side of the gut. After crowding the point of the finger past the column of the ring, strong and constant pressure is made, until the fibres of the ligament give way, or the opening is perceptibly enlarged, when it will be found that the intestine can be returned easily to the abdomen by the usual effort. The conditions which contraindicate a resort to this procedure are : — 1. The fact of the hernia being old and irreducible. 2. The presence of the constriction at the inner ring — the external ring being too small, and the canal too long, to admit the finger. 3. The existence of general symptoms of grangrene of the intestine. Tanacetic Acid as a Substitute for Santonine. — This acid is prepai-ed by distillation of ihe heads of common tansy {tanacetum vulgare). The filtered resi- due is evaporated to the consistency of honey, treated with lime and animal charcoal, dried, and then dis- solved in water acidulated with hydrochloric and acetic acids. Tiie tanacetic acid is deposited in colored crystals, which are purified by repeated washings with distilled water. It has a sharp, bitter taste, and is in- soluble in water, but soluble in alcohol and ether. Nearly all its salts are crystallizable. As a vermifuge, it operates in tlie same doses as santonine. — Med. Press and Circular. Hysterical Ischuria. — M. Charcot reported to the Societe de Biologic (Lyon Mcdicale) a curious case (if true — Ed.) of this affection occurring in a woman 43 years old, who had suftered for several years with hemiplegia with contractured limbs, and who had an almost complete supi>ression of urine supplemented by constant vomiting. The total quantity of urine col- lected with great care by aid of a catheter was, from the 8th to the 14th of July, but 4G grammes; from the 16th to the 22d of July, 33 grammes; and from the 24th to the 30th of the same month, 21 grammes. The vomited matter, analyzed by M. Grehaut, fur- nished urea in quantities very nearly proportionate to the amount which should have been normally dis- charged by the urinary passages. Effects of Crude Paraffine on the Skin. — An af- fection of the hair-follicles is described by Dr. Alex. Ogston in the Edinburgh Med. Journal (Dec), which is caused by prolonged exposure of the skin to the action of the oily matter contained in this substance: the result being an eruption of nodules and pimples on the skin so exposed, speedily breaking out on those who are for the first time engaged in handhng it, lasting for a few weeks or months, and then generally diminishing or disappearing. In the few cases in which it becomes chronic a change of employment is a necessity. The mark of difference between the acute and chronic forms is the presence of inflammatory action in the former. A minute examination of the skin in the former variety shows bright-red nodules which are hard to the touch, tender onpressure, vaiying little in size,which is about equal to that of a grain of barley, are of a rounded form, and consist eacli of a single hair-fohicle with the surrounding parts red and inflamed. A hair emerges from the summit of one of these follicles, the orifice of which is enlarged to the size of a pinhole in a card. This dilatation extends to the deeper part of the follicle, which is filled with a dry and friable mass of epithelial scales and dirt. In the chronic form the hairs have been atrophied and destroyed by pressure, and the skin affected presents the open mouths of these distended follicles, sometimes large enough to admit the end of a probe, the skin including those raised patches of erup- tion being of natural color. The modus operandi of the crude paraffine in pro- ducing this eruption seem.s to be that the oily matters in the shale called "blae oil," is irritating to the skin; and, coming continually in contact with the epidermis, soaks into the hair-follicles, where it causes an increased growth of epithelium, which is not counterbalanced by increased expulsion of the scales, owing to the fatty 58 THE MEDICAL RECORD. matter from the sebaceous glands being dissolved out and rohioved liy tlic "blae oil," tlius leaviiif,' tlio brittle mass of fpitholiuin to plug "P tlic follicles. I'arts of the skin not supplied witli hair-foUiclos are not aflocted. A suprosKn Cause of Heart Disease. — Dr. Moinet (Kdinbiirgk Mtd. Jour.) offers the theory that ili-ease of the heart and aorta are produced in some instances by the weiglit of the heart wlien the subject is in the erect posture, producing lle.xion of tlie arch of the aorttn, rendering its curve more acute, and thus oQcring an increased resistance to the current of blood; corre- sponding hy[)ertrophy of the heart being tlie first no- t:ceable result. This bending of the aorta tends also, he thinks, to weaken its coats, thus laying (he founda- tion for aneurism at the commencement of its arch, where it is so often found. He thinks also that soldiers, on account of the confinement of their chests by their acoutrements and uniform, and the active and prolonged exercise of their upper extremities ■while tliey are so confined, are particularly liable to disease of the lieart arising from this cause. Spirits of Turpentine in Phosphorous Poisoning. — The Bulletin of Hie Royal Acad, of Med. of Bekjium (No. 9) contains a long article by M. Rommelaere on this subject, in the course of which numbers of suc- cessfully treated cases are detailed, the amount of tur- pentine taken averaging about a drachm daily. Cutting Microscopic Sections of Eyks. — Edward Curtis, M.D., of New York (Tra?is. Am. Ophthal. Sac), devised an apparatus for cutting microscopic sections, when needed, of an entire eye. In preparing the tissue and cutting the sections there are one or two points which it is necessary to observe iu order to get the best results. Supposing the object to be a morbid eye, this must, immediately after enucleation, be put into Muller's fluid — bichromate of jjotash, 75 grains; sul- phate of soda, 25 grains ; water, 6 fluid ounces — and there left for at least three weeks. It is then cut open with a sharp knife or razor, and the halves soaked in water to remove the bichromate. Such portion as is intended for cutting in the section-cutter is then to be further hardened in alcohol. When ready for cutting, the piece is transferred to light-colored oil of cloves, where it is allowed to stay froirf half an hour to several hours — until thoroughly impregnated with the oil. The piece is then to be imbedded for cutting. For this purpose the following menstruum is recommended : one part of oil of turpentine or benzine to twelve or sixteen of parafline. The section-cutters and accessories can be obtained of the makers, Hawkins and Wale, of the Stevens Institute of Technology, Hoboken, New Jersey. General Syphilitic Inflammation of the Eye. — Dr. Francis Delafield, of New York ( Trans. Am. Ophih. Sac.), says that the iris and choroid are the portions of the eye which are most frequently attacked after the intro- duction of the syphilitic virus in the system. In rare cases, however, the inflammation becomes general; iris, choroid, ciliary bod}^, retina, sclera, , and cornea are involved, and the produclion of new cells is so great that staphylomatous tumors of large size are formed. The literature of such cases is scanty. Arlt describes two cases of anterior staphyloma produced by syphilitic new growths from the edge of the iris and ciliary body; but no anatomical examination of the eyes was made. Von Hippel gives a full description of a case in which the iris, choroid, sclera, cornea, and retina were involved, and a large staphyloma formed. Two cases of this character have come under the observation of Dr. Delafield, which are published. Functional Trouble of the Eye. — Dr. Henry D. Noycs, of New York (Trans. Am. Ophthal. Sac), gives a scheme to aid in examining and recording cases of functional trouble of the eye. This printed form he has used for .several months past, and finds very useful to insure regularity and completeness in llie examina- tion, and for convenience in preserving notes. At the date of report lie had kept notes of one hundred cases by this method. Tliis author, in another article, also exhibited an ingenious apparatus for testing the perception of color. The Determination of Astigmatism. — An additional method for the determination of astigmatism is record- ed by Dr. George Strawbridge, of Philadelphia (I'rans. Am. OpJiilial. Soc), which has* these advantages: — 1st. Simplicity. 2d. Accuracy, which results from the ex- treme delicacy of the test formed by illuminated bar. 3d. The great saving of time. 4th. This method allows of examination being made entirely independent of daylight, and so obviating any inconvenience arising from defective illumination found in cloudy weather, etc. Dentigerous Cysts. — In an essay to which was awarded the first prize of the Boylston Medical So- ciety for 1871. by W. P. Bolles, M.D. (Boston Med. and Surg. Joicrmd). it seems that the sexes are nearly equally liable. Of 23 cases, 11 were males, and 12 females. The number of upper and lower leeth af- fected is also equal. The majority of the cases oc- curred between the ages of 10 and 40; 1 to 10, one case ; 10 to 20, nine ; 20 to 30, nine ; 30 to 40, three ; 40 to 50, none ; 50 to 70, three. Contrary to the usual statement, but as might be expected from their posi- tion in the jaw, the lower third molars are the teeth most frequently encysted, and second to these come the upper canines. In the appendix, the writer gives a synopsis of all the accessible cases (29), with the sources whence obtained. CoLLEs' Fracture simultaneous in both Arms. — A case of this character is published by T. Curtis Smith, M.D., Middleport, Ohio, in the Cin. Lancet and Observer. The radius of the right arm was fractured at three-fourths of an inch above the wrist-joint, that of the left at one inch above the joint. These fractures were successfully treated by two pistol-shaped sphnts applied to each arm, after removing the deformity by extension. At the date of publication the union was firm, and no deformity can be observed in either arm. The patient was a boy, aged 10 years, who, while climbing, was precipitated from a height of fourteen feet to the ground ; his weight was received on the palms of the extended hands. In this case motion is as complete as before the oc- currence of the accident. Dr. Smith affirms that if due care is used, deformity will not often follow the treatment by use of two pistol-shaped splints (!). Transfusion of Blood. — Carl Proegler, M.D., of Au- rora, Illinois, late Surgeon German Army (Chicago • Med. Journal), records four successful cases of transfu- sion of blood. The patients were French soldiers, who were wounded in the streets and before Paris. The indications for transfusion in these cases were : — 1st. Where amputation had been delayed for some reason, with but little chance for the patient, but where the latter insisted upon an operation. 2d. Re-amputation or resection on account of pyaemia or extreme hemor- I rhage, either on account of dangerous after-bleeding, J general debility, or a hemorrhagic diathesis. 3d. Ex- treme prostration on account of shock, and where life seems to be in imminent danger. The amount to be THE MEDICAL RECORD. 59 injected varies according to circumstances, but it should never exceed sixteen ounces. Care should be taken not to force air into the veins, ns collapse is liable to follow. Chronic IIvpertropiiy of the Lips. — Dr. R. W. Taylor, Surg, to N. Y. Dispensary (Afed. World), calls attention, with ca-e, to a form of hypertrophy of the lips, in which the inflammation begins in its connective tissue framework, and whicli produces a permanent augmentation in its size, and in wliich the skin and mucous membrane are not involved. He observes that there are five forms of chronic hypertrophy of the lips due to change in the deep structures: — Tlie first due to cell-infiltration into tlio corium and papilla;; the second, to an increased development of tlae con- nective-tissue stratum; the third, to a hypertrophy of the mucous follicles and the submucous connective tissue ; the fourth, to angiomatous tumors, either ar- terial or venous ; and the lifih due to lymph-angioma- tous tumors. Typhoid Fever with Capillary Bronchitis. — In this complication, when tliere is typhoid depression, wandering of the mind and bronchial tightness. Dr. N. S. Davis, of Chicago, 111. (Med. Examiner), recom- mends the internal administration of chloroform, ac- cording to the subjoined formula: — IJ. Chloroform, 3 iij. ; acacife, 3 vj. ; sacchari, 3 vj. ; aquae, § vj. M. Dose, a tablespoonful every four hours, alternately with other medicine. Epulis and Myeloid Tumors of the Jaw. — James Tyson, M.D., Lecturer on Microscopy in the Univ. of 7 exm.. {Dental Times), explains the microscopic points of diflference in the characters of these tumors, with a view to a completeness of our knowledge of their nat- ural history. Epulis tends to occur other than singly ; it is, however, a growth of all ages, though there are those who have claimed that it also belongs to yoiith. Prof. S. D. Gross, on the other hand, in a recent clin- ical lecture, said that he had never before met with a growth of this kind at so early an age as seven years. It is usually a tumor of slow growth, and differing from myeloid in this respect; it is often painful; patients afflicted with it suffering much from toothache. Again, epulis is often partially osseous, frequently containing spicula of bone in its centre, detached from the surface of the bone. It recurs under the same circumstances with myeloid, that is, when all parts have not been completely extirpated, though perhaps less frequently than the former. It is generally lobulated, as myeloid tumor in the same situation, but its structure is firmer. It is tougher and more elastic, owing to its fibrous structure. On section of myeloid tumors, more decided characteristics are noticed, which may be recognizable by the naked eye. The cut surfaces are "smooth, uni- form, compact, shining, succulent, with a yellowish, not a creamy fluid; " presenting "blotches of dark or livid crimson, or of a brownish or a brighter blood-color, or of a pale pink, or all of these tints mingled on the grayish-white or greenish basis-color." Epulis on sec- tion is uniform, firm, white and shining, presenting often in its interior the spicula to which allusion has been already made. Before operation it is not easy to decide whether a tumor is epulis or myeloid, and though appearances on section are more characteristic, they do not become available for diagnosis. As a mat- ter of prognosis it is not of paramount importance that the exact nature of the tumor be known before opera- tion, supposing it one of these two forms, as neither is apt to return if thorovgJihj removed. Recurrence of each occasionally takes place, and it is somewhat more frequent in the case of myeloid ; the periosteum should in all instances be scraped after operation. As the only certain means of relief, Prof Gross recommends " ex- cision of the piece of bone to which it is attached." Fever Mixture. — The value of aconite in allaying fevers is apparently not so completely recognized as it should be ; and having found the following formulas very beneficial iu allaying fever, and in controlling it when not dependent upon a deep-seated cause, Prof. Horatio C. Wood, Jr., M.D., Philadelphia, editor o^ JVeiu Reine- dies, publishes the following : Take of Tincture of aconite root, gtt. xxiv. ; Sweet spirits of nitre, ffij.; Solution (or mixture) of citrate of potash, f 3 iv. Mix. S. Table- spoonful every one, two, or three hours. Q''his formula, containing two drops of the tincture of aconite root to the dose, should be given cautiously, and every hour only in urgent ca=es which can be carefully watched. Many women will scarcely bear it given every two hours. The following combination is more generally ap[)licable and safer: Take of Tincture of aconite root, gtt. xij. ; Sweet spirit of nitre, f | ij. ; Solution (or mix- ture) of citrate of potash, fsiij. Mix. S. Tablespoonful every one or two hours. Where there is much restlessness with the fever the following formula is recommended : Take of Tincture of aconite root, gtt. xij. ; Sweet spirit of nitre, Comp. spirit of nitre, ila. f 3 iss. ; Camphor water, f§iij.; Morphia sulph., gr. ss. Mix. S. Tablespoonful every one or two hours. The Use of Sewing-Machines. — Dr. A. H. Nichols, in the third annual report of the Mass. Board of Health (Boston Med. and Surg. Journ.), presents a full exhibit of the effects on health of the use of sewing-machines moved by foot power, based on personal investigation and returns from a large number of correspondents, from which it) is evident that most women cannot make continuous use of the common pedal for any con- siderable time without suflering from general debihty and various local disturbances. These evils may be prevented by the substitution of steam or foot power in large establishments, or by the use of electro-mag- netic power, or by the use of improved pedals, which greatly reduce the required movement of the feet and legs of the operator. Pitting in Small-Pox. — W. C. Coleman, M. D. (Drug. Circ. and Chem. Gazette), recommends the fol- lowing, to prevent pitting in small-pox, as the result of his own observation: First, prevent suppuration as far as possible; second, allay irritation; and third, keep the scabs off. To accomplish the first and second, rup- ture the pocks thoroughly while in the vesicular stage, and apply carbolic acid and mucilage of gum acacia, mixing one part of the former to eight of the latter, and apply freely with a hair pencil. To keep the scabs soft, use olive or sweet oil freely. Continue the mucil- age and acid as long as the irritation lasts, and there need be no fears of the oil interfering in any way, provided the mucilage is made quite thin. Hypodermic Injections of Corrosive Sublimate. — In a practical paper " On the Treatment of Syphilis by Hypodermic Injections of Corrosive Sublimate," by Dr. R. W. Taylor, of New York (Med. Gazette), his views are given, in concluding, in eighteen aphorisms, which are thus summed up : While in dispensary and hospital practice the injections may be frequently given, in pri- vate practice the smallness of a patient's means may often be an obstacle in the way of the continuance of treatment. That, while in some cases the treatment may be useful by reason of its rapid action, and in others for the smallness of the dose, the inconveniences which it produces, the objections of the patients, and the presenee of lesions which contraindicate its use, confine its sjjhere of usefulness to very narrow limits. 60 THE MEDICAL RECORD. Cakdonatk ok Soda. — A new process for tlio produc- tion of ciulxmiiU- of soda lias lioen iiivi-iitcd by M. Swftger. IJy tlie joint aid of highly siipcrliiMtid Htoatii and red lieat, he decomposes the duiilile ciiloride of aluiiiituiiii and sodium, previously fused, liiiis lormint; alumiii ite of soda and liydrochloric acid. The latter is condensed; the former, treated with earl)onic acid, yields carbonate of soda and alumina. Lkucin and Tvrosik. — According to James Tyson, M.I)., Prof Phys. and Histology in Pcnn. Collepo Den- tul Surgery {.[m. Joiiin. Mrd. Sciences), these organic nitrogenous substances found in the solids and fluids of the economy \n a number of morbid states, have only a marked significance when present in the urine in connection wiih .symptLiins pointing to derangement of the hepatic function. Under these circumstances they are of grave import, indicating destructive diseases of tliis organ which have hcrctolore invariably terminated fatally. They do not necessarily indicate acute yellow atrophy alone, but may attend any affection of the liver in which there is permanent disorganization of its ])arenehymatous structure, even if it extend over a period of sevend months. It does not appear to be present in the urine in cases of liver disease which are perhaps years in completing their course, as in certain instances of cirrhosi-^, and simple fatty degeneration. When there is deficiency of urea in the urine thus con- taining leucin and tijrosin, the mode of death usual under these circumstances (coma or convulsions) can only be rationally explained on the supposition that there exists a condition analogous to uia;mic poisoning. or identical with it. Prof Tys^n presents in full the chemical and microscopic.d cliaracters, tests, and drawings of these substances ; also tlic modes of obtaining leucin and tyrosin from animal fluids and tissues suspected to con- tain them. H.«xroPTYSis IK Consumptive Patiknts. — D. Francis Condie, !M.D., of Phila. (.4m. Journ. Med. Sciences), says that it is true that the deposition of tubercular matter in the lungs may be preceded and accompanied by luttmoptysis, but by no means so generally as to war- rant iLs being ranked as among the premonitory, much less as a diai:noslic symptom of tubercular phthisis. Of 369 cases of tubercular consumption, very full notes of which he has kept, hajmoptysis occurred in 87 — that is, about 24 per cent. In 282 of the cases it neither l>receded nor was present throughout the attack. The absence, therefore, of haemoptysis is not to be received in any case as an indication of the absence of pulmo- nary tubercles, nor can the occurrence of pulmonary hemorrhage be received as an indication of a future or present tuberculosis of the lungs. In the 87 cases of consumption in which pulmonary hemorrhage occurred under his observation, the he- morrhage preceded in 40 the first symptom of the deposit of tubercular matter some considerable time — say two, three, five, six, or even twelve months; in some cases, however, it preceded the indications of tu- berculosis only a few days ; in other.s, again, it occurred at the very onset, so far as he -was enabled to judge, of the tubercular deposit. In 29 cases the hemorrhage occurred at different periods durin? the progress of the disease, and in its latter stage in 18 cases in which the presence of cavities in the lungs was detected upon auscultation. Fr,ATULEKT Dyspepsia. — The late Dr. Trousseau, of Paris (New Sydenham Society's translation), in this form of dyspepsia, administered alkaline preparations for a few consecutive days, followed by the administra- tion of bittern. For five or six days, at the beginning of (he two principal mealf, and on retiring at night, the following j)owder is u.sefnl : Magnesia, chalk, bicarbo- nate of soda, 4 toOgrs. each, mixed immediately before taken in a fourth of a tumbler of waU'r. This to be lollowcd by I lie employment of quassia. In the morn- ing fasting, ami atmi patronize any undertaking actuated by such a spirit. We predict for th.: journal a deserved failure. Ucports Df Societies. TOE rn.VRMACY BII.I. Up to the time of our going to press, the fate of the Pharmacy bill is still undecided. It is now before the Health Committee of the Assembly, and in the hands of its chairman Dr. Robert Louguray, and the other medical members of that committee, it is to be hoped it will receive the merit of a favorable report. Senator Weismans has done his part in the matter, and it is not fair to suppose that Assemblyman Loughrax and his medical confreres will be found wanting when the time comes to hear from them. The professions of medicine and pharmacy, in this city, are alike interested in the passage of the bill, and they naturally look to their respective representatives in the legislature to have their unquestioned rights guarded against the un- principled machinations of the defenders of the present obnoxious and oppres-sive law. There can be no argu- ments against its passage save such as are so strenuous- ly urged by the interested office-holders under the pre- sent law. MKDK'AI. LIIUIAHY AND JOURNAL ASSOC lATlUN OF NEW YORK. Slated Reunion. February 9, 1872. Dii. W. N. Blake.man, Vice-President, in the Chair. TENOTOMY IS MVOPIA. Dr. R. II. Deubv read a paper upon Progressive Mi/o- pia and i's Operalire Cure, advocating the doctrine that the large majority of cases of progressive near- sightedness are attended \>y, and to a great extent de- pendent upon, insufficiency of the internal recti and lience to bo relieved by division of one or both of the exlerni. The rules, so carefully elaborated by Von Graefe, both for determining the propriety of this ope- ration, and for securing by it exactly the degree of effect intended, were given in detail. Several cases were cited from the practice of Von Graefe and others, where the myopia had not only been arrested in its progress b}' the operation, but had even considerably diminished after it; and the paper concluded with re- ports of selected cases from the writer's own records. Di?. KxAPP, wliile fully endorsing the rules laid down, as having rescued the operation from the domain of empiricisiii to that of strictly scientific surgery, was yet inclined to think the range of its applicability more hmited than Von Graefe and his adherents contended. In his own experience the cases of myopia attended by a degree of insuQiciency of the internal recti, sufficient to warrant the operation, were comparatively rare. Indeed, while admitting that insufficiency of these mus- cles was more frequent in myopic than in emmetropic and hyperopic persons, he nmst yet state, in opposition to Dr. Derby's assertion, that only a small percentage of the cases of near-sightedness was complicated with such insufficiency. Few cases of myopia were progressive after the age of twenty-four, or thereabouts ; and in these severe ones tenotomy was apt to fail of the de- sired effect. This, he thought, was due to the aetiology of the afi'ection. Pressure of the recti upon the globe had probably less to do with its causation tlian persist- ent strain of the accommodaiion ; the steady contrac- tion of the ciliary muscle interfering with the venous outflow at the anterior part of the eye (through the canal of Schlemm), and hence producing passive hyper- aemia of the choroid with transudation, and softening in the coats of the posterior part of the globe, which then yield more readily to the intraocular pressure and become extended. Dr. Pooley agreed with Dr. Knapp, and would cut the external recti only in cases accompanied by evident muscular asthenopia. Dr. Derby insisted upon the insufficiency of the in- terni only in cases of prof/ressire myopia, stating that it was found in nine-tenths of these cases. It pro- duced its eflects, doubtless, not to any great extent directly, by causing an increase of pressure upon the globe ; but indirectly, by inducing that very strain of the accommodation to which Dr. Knapp had referred. This was in virtue of the intimate a-sociaiion between the contraction of the ciliary muscle and the effort at convergence of the optic axes. If this efi"ort were in- creased by weakness of the internal recti, the muscle of accommodation must be constantly stimulated to excessive action. Dr. Pomeroy thought the difficulty of converging THE MEDICAL RECORD. 65 the optic axes was sometimes an advantage to the myope. It would lead him, when his eyes were fatigued, to abandon the effort to fust^ the two image.-, and use one eye only, relaxing the strain upon tiie acconnnoda- tion, and placing tlie object somewhat further off. Dr. Kx.vrp called attention to the liict that frequently the worst cases of progressive myopia were tho?e in which this very thing was constant — where the jiatient never used but one eye for near work, and where, there- fore, there could be no pressure of the recti upon the globe, or strain of accommodation from tlie effort at convergence. The relation between the effort to con- verge the axes and that to accommod.ite was not a fixed and necessary one — so much convergent effort necessitating so much accommodative — but was purely a matter of education. NASAL DOUCniiS. Dr. Burrall presented two nozzles, to be attached to a Davidson's syringe, for showering the nasal cavity. The first was about the size of a No. 8 catheter, some four or five inches long, and pierced on one of its quad- rants Avith three longitudinal rows of holes. The in- tention was that wdien the instrument, introduced into the nostril, was laid upon the floor of the nose, the outer row should throw its streams into the inferior meatus; the middle row, into the middle meatus ; and the upper row, directly upwards toward the roof of the cavity. The second nozzle was the ordinary bent one for washing out the posterior nares, except that the rose at its end was made to throw three sets of streams forwards and upwards on the plan above given. Adjourned. NEW YORK ACADEMY OF MEDICINE. IStuted Meeiiuffj Fehruary ], 1872. Dr. E. R. Peaslee, President, in the Chair. REPORT ON YACCINATION. Dr. Gouverxeur M. Smith was added to the Commit- tee on "Vaccination in place of Dr. H. D. Bulkley, deceased. The Committee is composed of the follow- ing gentlemen : Drs. Elisha Harris (Chairman), Wm. C. Roberts, Alfred C. Post, Stephen Smith, Jonas P. Loines, Frank P. Foster, Edward H. Janes, and G-ou- verneur M. Smith. Dr. Roberts read the report, of which the following is an abstract: The daily observations and experi- ence of physicians have, for seventy years, uniformly proved that in their personal exposure to the sick of small-pox, and by the severest testing of the attend- ants of the sick in hospit-jl, sick-room, and ambulance, thorough vaccination continues to give full protection against the contagion, for they are freely exposed to its presence, and even to its touch, without harm. Thorough vaccination is thorough protection against small-pox, and is as effective now as in the time of Jenner. It is generally admitted, and clearly proved, that thorough vaccination protects against small-pox without danger to life or diffusing any infection. Scarred and disfigured faces are rarely met with at the present day, except in persons who, having neg- lected to be vaccinated, have taken small-pox in the natural way. In proof of this protective influence of vaccination, and the liability to infection without it, we may mention that in a severe epidemic in Nor- wich, England, of 306 persons in several families, there were among 91 vaccinated persons, two cases of mild varioloid, and no deaths; and of 215 unvac- j cinated persons, 200 took the disease, and 46 of them died. Revaccination is reconmiended, not only as a meas- ui'c of renewed secuiity against sinall-pox, but as a test of the completeness of the first vaccination. It is ne- cessary to test the completeness of protection and to exhaust the receptivity of small- pox, and of vaccina- tion itself. He who is insu.sceptible to one or more revaccinations Avith fresh viius may generally deem himself as secure as vaccination, or even an attack of small-pox itself, can make him. Small-pox, it is true, occurs occasionally in persons who have been once vaccinated ; but its occurrence is very rare in those recently vaccinated, or revaccinated once or ofcener, or in those in whom the first vaccination was thoroughly good, as judged by the Jennerian rules for vaccinaiion. In these instances the disease manifests it- self oficnest in mitigated form, known as varioloid, and the protection afforded by vaccination is found to be equal to that which is conferred by a previous attack of small-pox. It is believed that a revaccination will destroy any susceptibility to small-pox infection which may remain from incompleteness or imperfection of the primary vaccination. In the army of Bavaria revac- cination has been compulsory since 1843, and from that date until 1857 — a period of 14 years — not even a single case of unmodified small-pox occurred, nor a single death from the disease. The vaccine virus now in use in New York City is justly regarded by the most ex- perienced physicians a? trustworthy and effective, and afiords all the necessary protection. Yaccine virus is not a carrier of other diseases. To a neglect of reason- able precautions, and to carelessness in the performance of the first vaccination, are due the unmerited discredit into which this greatest boon of a merciful Creator has occasionally fallen, and the fatal objection of certain classes to its employment. Y'ith due precautions, no other disease than that of vaccinia will be communi- cated. The distinguished English vaccinators, Dr. Marson, in 40,000 vaecinations ; Dr. Leese, in as many more; Sir Wm. Jenner, in 13,000 sick children and adults in London, and Dr. West, of the Children's Hos- pital, in 26,000 children — all concur in saying that they have never seen any other diseases communicated with the vaccine, and that they disbelieve the popular reports that diseases are so communicated, nor is the child li'om whom the lymph is taken found to be suf- feiing from the disease it is said to have imparted. Fresh lymph is always to be preferred when it can be obtained; but crusts may be used if such lymph is not t J be had, and there is immediate necessity for vaccina- tion. W^hen practicable, it is desirable to vaccinate from arm to arm, with virus taken on quill-slips di- rectly from a healthy individual to the arm of another. Yaccinaiion, by preventing small-pox, indirectly di- minishes scrofulous diseases ; and the death rate of most constitutional diseases, to say nothing of small- pox itself, has materially decreased as the practice of vaccination has increased ; and not only has mortality been diminished, but life has been lengthened and pop- ulation augmented. The exact reverse is true of the former practice of inoculation of small-pox. There is no age at which a person should or should not be vaccinated, when a necessity exists for im- mediate protection against small-pox; but it is best done in early childhood, for then the irritation is less, and the child unable to relieve itself by scratching the part, which, with the irritation of the clothes, often interrupts the progress of the vesicle, causes it to dis- charge prematurely, and become inflamed ; whereby a vaccination, which might have run its course naturally, becomes altered, and an inflamed angry sore is pro- 66 THE MEDICAL RECORD. duced, leaving a deformed and ill-looking srar and a diminislied protection. Matter, too. taken from such a sore is worse than valueless. The nge of three months is, on the whole, to be preferred. The most distingnished English authorities in vaccination, Simon, Marson, Soaton, and others, recommend, as preferable, and as ensuring greater idtimate protection, four or five separate good vesicles ; and of these, in taking virus for the purpose of vaccinating others, one at least should remain untouched. The utmost care should be taken, in the performance and managem«'nt ofa (irst vaccination, to make it as near- ly perfect, regular, and exhaustive as pos-ible ; for upon this depends very much the after-susceptibility to small- pox, and it is very doubtful whether any amount of subsequent revaccination will fully compensate for the deficiency of the first. The period for revaccination may be delertnincd by circumstances ; it never can be done too early or too promptly in persons exposed to small-pox, and it should be performed in every person soon after the age of puberty, however frequently it may be repeated at earlier or later periods of life. It may succeed at one time when it would not at another; indeed, it appears to be true that revaccination, as well as primary vaccina- tion, actually takes more readily in some years than in others. "One thorouiihly good vaccination to start with," says Seaton, " and one careful revaccination after puberty, are all that is ueces-ary for protection as complete as any know-n proceeding can give against small-pox." After the twenty-fifth year of age the lia- biUty to small-pox in the well vaccinated is very small. Of the nearly 50,0(10 rcvaccinations in the Prussian army in the year 1833. only about one-third were per- fectly successful ; resembling, that is, the results of a primary vaccination so closely as scarcely to be distin- guished from it ; the remaining two-thirds being more or less modified, or failing entirely. In other trials on a large scale the success has not been as great. It should be remembered that secondary small-pox occurs on an average in about one per cent, of cases ; and that while we urge revaccination both as a test of remaining re- ceptivity to it and of further exhaustion of Avhat may remain, it is well known that a single well performed vaccination, perfect in all respects, with few exceptions, suffices to secure for life an individual subjected to it. The small-pox has lost none of its malignity and viru- lence, and while unvaccinated persons are allowed to accumulate, it is vain to hope for any exemption from epidemics of greater or less extent. In times of epide- mic prevalence of small-pox, all should encourage vac- cination. Vaccination and revaccination are positive duties. In order to give complete and assured protec- tion against small-pox, every person not recently and thoroughly vaccinated should be at once revaccinated, and in subsequent life should repeat this duty as often as every five or six years, until in adult life the repeated revaccination cease to have effect. Dr. Theodore "Walser then read an extended paper on "Quarantine Regulations," which we have already presented to our readers. The Academy adjourned. Stated Meeting, Februarij 15, 1872. Dr. E. R Peaslee, President, in the Chair. DISCUSSIOX OK QUARANTINE REGULATIONS. The Secretary read a letter announcing the death of CfiARLES A. Lee, M.D., of Peekskill, N. Y., a Fellow of the Academy. Drs. W. C, Roberts and Elisha Harris spoke of his extensive acquirements and attainments in his profes- sion, and how much he was esteemed as a teacher and editor of medical works. The intere.'-t he evinced in the management and treatment of the insane was par- ticularly dwelt upon. TUE QUESTION OF QUARANTINE. The President appointed Drs. Theo. Walser, Elisha Harris, J. C. Peters Austin Flint, and John O. Stone as members of the Quarantine Committee, according to the subjoined Resolution passed at the previous meet- ing:— Jiesolved, that a Committee of five members be ap- pointed \)y the Academy, to examine and report such facts relating to Quarantine as will furnish the Acad- emy a correct and useful record in regard to Sanitary duties, in controlling exotic diseases. Dr. a. N. Rell, of Brooklyn, after some preliminary remarks, then spoke as follows : Assent to the appli- cation of quarantine necessarily involves the acceptance of certain propositions, which are, as yet, far from being beyond question. One of these questions, ihe po7-tabil- ity of yellow-fever poison, has been incidentally con- sidered to some extent recently before the Academy ; and it is, perhaps, fortunate that the present subject has necessity for its appHcation. Quarantine regula- tions, in all their bearings, depend upon our apprecia- tion of epideniic diseases, and without accurate knowl- edge of the natural history of epidemic diseases — including of course those usually denominated con- tagious — it is altogether impossible to have an intelli- gent comprehension of the utility of quarantine. And this view of the subject, even at the outset, is not only discouraging but humiliating. Who among us can confess to understand the natu- ral history of any one of the epidemic diseases, which we would be likely to class as quaranlinable ? "What do we really know of the qualities and attri- butes of epidemic diseases ? For it is only that which we know, that we should attempt to control. Of all the uncertainties in the history of the medical art, knowledge of epidemics takes the lead. That which has been learned and confidently asserted in one generation, or even in one year, is not infrequently contradicted in the next. But let us not desjiair, some- thing has been learned; enough, it is hoped, to stimu- late action and research in a fruitful field, and, at least, to try to apply the little Ave have learned. All epidemics possess some attributes in common, such as alternating periods of development, decline, and disappearance. They are about equally liable to occur sporadically, or to prevail within the narrow limits of places to which they are most common — without ten- dency to spread beyond. And 3'et they all have thf ir cycles, exhibit marked dispositions to multiply and dif- fuse themselves broadcast, and to become pestilential, and then again to return to their usual haunts, as if exhausted, or having died out, for the want of food, and a subclass seems to possess the qualit}' of being antidotal to themselves. These characteristics are wonderfully analogous to our more accurate knowledge of certain living organisms, both in the animal and vegetable Avorld. The speaker noted some points in natural history, and remarked that we might follow out the self-antido- tal effects of the whole category of the ferments, and appreciate their analogy to certain contagions. But besides all this, each epidemic disease should be studied by itself; and all its attributes in relation to the circumstances of its existence, in common with, or in exception to, all the rest and to all other natural phenomena, not confined to one place, region, or coun- THE MEDICAL RECORD. 6T try only, but through all its various vicissitudes, marking well its distinctive signs and properties, and the antecedent meteorological and local conditions. Already has this kind of investigation progressed far enough for the acceptance of certain peculiarities, which, by common consent, exclude most epidemic diseases from quarantine restrictions. Of such are, measles, whooping-cough, scarlet fever, diphtheria, erysipelas, cerebro-spinal meningitis, and relapsing fever; and to these may be added typhoid fever, and the common forms of intermittent and remittent fevers. The reason for this exemption consists in the knowledge of their known persistence ordinarily, and permanent existence in most communiti(!S which they infest ; or their con- tinuance, at least, for months and years at a time, and for the most part — particularly the exanthems — their marked independence of ordinary local conditions, in respect to their general dissemination. These condi- tions place such alFections outside of the capabilities of quarantine, consistent with reasonable burdens, and narrow it down to a final class, now commonly ac- cepted as quarantinable, because they, too, have certain chai'acteristics in common, and from the knowledge we possess of their natural history are, at least, partially restrainable by quarantine. These are: small-pox, typhus fever, yellow-fever, and cholera. The common characteristic of them all is por- tability. Of their characteristics individually, scarcely could four diseases be selected more unlike each other. With respect to small-pox, nothing need here be said of its natural history. It will suffice to state, that the ca- pabilities of quarantine to restrict it are so slight as compared with the universally accepted and only means, that quarantine for it should be wholly and ex- clusively restricted to the care of the sick, and the dis- infection of clothing, baggage, and merchandise, includ- ing, of course, the vessel ; and the vaccination of all persons recently exposed, or who have not recently had the disease. Immediately after vaccination and disin- fection of clothing, all such j^ersons should be allowed their freedom. It should be taken for granted that every communi- ty protects itself against small-pox by vaccination; that this is an accepted recourse of internal hygiene which annuls the exceedingly sUght danger from the practice herein advocated. Typhus Fever. — In regard to this disease, if I remem- ber corrpctly, I must take issue with Dr. Walser. Less portable, I have no doubt, than yellow-fever, but at. least sufficiently so; in my judgment, to contaminate clothing and certain merchandise and, above all, vessels. Aitkin says: "There is ample proof that typhus fever may be commiunicated by fomites — adhering to apartments, articles of clothing, and the like ; and pro- vided fresh air be excluded, it is known that such articles will retain the poison for a long time. Herein lies a fallacy which pervades the argument from cases to prove the generation of the disease de novo. The poison may be said (like that of small-pox) to be con- stantly in existence . . . ; that it is undoubtedly propagated from pre-existing foci, and by continuous succession. There are also good grounds for believing that typhus fever may be communicated, and even carried a great way, hy fomites, or by articles of clothing strongly impregnated with the specific poison." Murchison, also, gives a number of striking examples of the communication of typhus from fomites; and particularly the recent case of the Egyptian ship " Sche- ah Gehald," at Liverpool, the crew of which disseminat- ed the poison of typhus by their clothes and person?, although, he says, they had not the disease themselves. Subsequent investigation of this case by Dr. Parks and others showed that some of the men belonging to the ship had had the disease, and communicated it by its more usual means — personal contagion ; but this fact does not impair the other, that it was also disseminated by the clothing of the well. Pringle, Lind, Bateman, Jacquot, and othci'S give numerous examples of the persistence of typhus poison in rooms, attached to fur- niture, clothing, etc. ; and Lind, in particular, of typhus- infected ships, which continued to impart this disease long after the original sick had been removed. Jacquot gives similar examples in his account of the Crimean typhus on board the French ships. A number of the French transport ships took infected troops from the Crimea to Constantinople. Among the passengers who embarked homeward, typhus frequently broke out, without any reason to suspect that it had spontaneous origin. Lini] mentions cases, where persons, not ill them- selves, have by their clothing imparted the fever to whole ships' companies; and he also'cites the danger to washerwomen and nurses from clothes and bedding. Says Murchison, Woollen substances, in particular, are the most prone to absorb and retain animal exhala- tions, and most fitted to transmit typhus poison, and reprehends the use of street cabs for the conveyance of typhus patients. Surely after such well-proven dangers — and more might be cited — the danger of contaminating certain articles of commerce, such as woollens, for example, in a badly typhus-infected ship, would hardly seem questionable. Cholera. — By the epidemics of this disease during the last ten or twelve years, we have learned enough of its history to be quite certain that it is at least con- strainable, if not controllable, by quarantine. It would be useless, in this presence, to rehearse the history of recent epidemics, and its now accepted mode of dissem- ination, or to cite the numerous examples of its trans- p)ortation, not to say its portability — by both vessels and fomites. If I am not mistaken, Dr. Walser would confine his quarantine regulations ibr this disease wholly to per- sons. The vessel in most cases, and the cargo in all, he regards as invulnerable. No doubt, this would be good practice in many cases, but most of us are sufficiently familiar with its fatal portability by means of personal clothing and baggage, and its extension from one vessel to others, and toshores in the vicinity; without conti- guity, in Jaffa, Alexandria, and several other places in 1865-6. And all of us know the increased danger of stale cholera discharges within certain limits ; and some of us, at least, know the extreme liability of these dis- charges to get adrift on board ship — and to spread and pernieate, it may be (for we know not how small or how volatile this cholera poison is), not only every part of the ship but into the material of merchandise, as well as personal clothing. All of this, to say the least, is perfectly consistent with the nature of cholera poison, to the extent of our knowledge, and it is to just that extent that I would apply the quarantine and disinfection of merchandise and vessels, as well as persons, in efforts to restrain cholera. Yellow-Fever. — The natural history of this disease has recently been so ably presented by Dr. Nott, and its acceptance as one of the most quarantinable of dis- eases is so generally acknowledged, that little need be said of it in this connection. I avail myself, however, of this opportunity of strengthening my evidence in regard to the portability of the particular epidemic of 1847-8, which Dr. Nott quoted authority for pronounc- ing otherwise. On referring to certain records in my r.8 THE MEDICAL RECORD. po.=scs'ion for tlic j-oar 1848, I fiml (hat tlie number of ycllow-ffvor inR-(;tod vessels from tlic l.'Uli of Mnrcli of that year to iho o:ul of Dt'ccinbcr, a jH-riod of nine and a lialf month.-!, was 44, — the largest numbi-r, I believe, on record for tliis port for any one year, with the single exception of 1850, when there were, from the 1st April to tlie 1st t)f Angust, 47. Finally, in regard to quarantinable epidemics, as well as most others, it may be safely stated, iiro conditions are generally necessary to their introduction into most communities: The presence of l\ic special poison; and the susceptibility of the place as well as persons to which the j>oison is applied. That, however rigid quar- antine restrictions, if there be not also rigid internal cleanliness, quarantine is likely to be inefteclual. Dr. Wal>er and others tell us that by the fumes of chlorine, sulphurous acid, iodine, bromine, vaporized carbolic acid, and such like, applied to the hold of a ship, or even to the outside surface of such a mass, it is disinfected. Impossible. It may be freely conceded, that if the infected mass could be penetrated with chlorine, bromine, or iodine the living organic matter therein would be destroyed. Years of reflection and increased opportunities of test- ing its efficacy confirm all that I have hitherto advo- cated in regard to the use of steam as the only available means with which I am acquainted, for the disinfec- tion of vessels under the circumstances described. Chlo- rine and other vupor.s that have been, and can be, added when deemed necessary, no doubt contribute to the potency of steam under extraordinary conditions, but, for the most part, they are unnecessary. For, while it is perfectly practicable to raise the water at the keel- tson and the mud in the limbers to a boiling tempera- ture, there has as yet been no instance within my knowledge, of the revivication of infection after subjec- tion to a temperat;ure of 175° for a period of two hours. Dr. Bell concluded his remarks by giving a brief abstract of the Merchants' new quarantine bill now before the legislature. Its chief improvement on the laws as they now obtain consists in doing away Avith most of tlie abuses pointed out by Dr. Walser, such as the interminable detentions, abuses of lighterage, etc., but retains the clause m regard to all foreign vessels being subject to visitation. This he approved of, not for the reason given by Dr. Walser for its first enact- ment in 1856, to make the Health office lucrative, but because of the greater liability of vessels from foreign ports to infection, and the necessity for exacting clean- liness. The proposed law provided that such vessels, having no disease on board, shall be detained no longer than requisite for due examination in this respect. It also makes a distinction between the treatment of ves- sels and merchandise infected with the different quar- antinable diseases ; exempting the merchandise of vessels with small-pox and typhus fever from lighter- age, and subjecting that of vessels with cholera to lighterage only under exceedingly rare conditions. Cape Henry had been substituted for Cape Henlopen, in the latitude, and May for April, in the scope of restrictions. The Board of Appeal has been changed by adding to the Commissioners of Quarantine the pre- siding officers of the Chamber of Commerce and the Ship-owners' Association. Upon the whole, the speaker considered the proposed law a great improvement, while it was a substantial contradiction tj allegations that had been made against the merchants of New York, that they are unwilling to gubmit to just quarantine restrictions. Dr. Elisiia Harris, in making the inquiry, How much danger is there from these exotic diseases ? — said that having answered that, how is it that we exact so mueli from the ."^hip if there is so much danger from the disease's? He tlmuglit tiie danger from yellow-fever was exaggerated and misstated. Only two per cent, of the vessels coming from infected j)orts have been really found subject to suspicion. If two per cent, is the true amount, this aspect of medical re.-ponsibility to the public is not really understood and appreciated. None of the quarantine laws are based on sound rea- son, much less on medical science. The public should be protected from a medical point of view. The speaker was pleased with the spirit manifested by medical mt^n for advancing tlie public interests, and the relief of burdens, and advocated more organization of sanitary autl'orities. In regard to the reform bill now before the legisla- ture, the trouble was that the management rested in the hands of members outside of the medical profession, with the exception of Dr. Bell. The Board of Appeals was so made up, that if the jihysician was necessarily absent, not a medical man would be represented. The subject of quarantine has assumed a new aspect. According to Pettenkofcr, quarantine does not pre- vent cholera from going from place to place. It is the easiest thing in the world to get up a panic in regard to quarantine. If the sanitary au thorites of the cities of New York and Brooklyn were consulted, in refer- ence to the framing of quarantine laws, and matters pertaining to them, it would be well; but the whole management is outside of them He contended that nine-tenths of all the detentions to ships could be prevented if all that Avas known could be applied. This placing the whole external measures of hygiene outside of medical management has the effect of exhibiting the profession in an erroneous light. Dr. Walser remarked that typhus fever was scarcely known in Continental Europe. He could not see how typhus and other eruptive diseases could infect the vessel and cargo. During his long experience not a single case of cholera was known to originate from vessel or cargo. In vessels with tj'phus fever on board, disinfection should be confined to clothing. He would concur with Dr. Harris, that all quaran- tine laws are vrorse than useless unless they are na- tional in their character. Quarantine regulations are made odious, for the reason that the subject has become a political hobby and a source of annoyance to private parties. Dr. Harris would not depreciate the importance of using vigor in the prevention of disease, if faithful men are on guard and report truths. Dr. Walser himself could state that, when on duty at the Health office, strong influences Avere brought to bear to keep the truth back, as it was for the best interests of other than medical men to give the facts. W^hat is now needed is a medical local organization competent to grasp the subject. In regard to the application of steam as a disinfec- tant, Dr. Walser said that he applied steam in one case for thirty minutes, and the whole veneering of the cabin came oft'. He never tried it again. Dr. Bell asked if the disease was not killed notwith- standing the loss of the veneering. The destruction of paint and veneering is of little consequence in compari- son to the detention of vessels. The application of steam only takes two or three hours. He stated that the majority of merchants were will- ing to regard the necessity of quarantine, and were desirous of submitting the matter to inteUigent physi- cians. Dr. JonN C. Peters: — As regards the quarantine of small-pox, I disagree witli Dr. Bell when he assumes THE MEDICAL KECORD. 69 that mercliandise on board the infected vessel should be disinfected; it is only necessary to thoroughly cleanse und disinfect the persons, bed and body cloth- ing, and baggage of the sick persons; vaccinate all the rest, and thoroughly cleanse and disinfect those parts of the vessel which have been occupied by those sick with varioloid or small-pox. The cleansing of the hair and liead of the varioloid convalescent is of tlie greatest importance: every crust and scab should be removed from the scalp, and the head should be thoroughly c'eansed and disinfected before the person is allowed to mingle with others or to land. The whole person, head, hair, and all, should be repeatedly soaped, washed, cleansed, and purified. I also dissent from Dr. Bell's assumptions that the poison of ty[)hus fever adheres to merchandise on ship- board with any tenacity; the httle that may cling to bales, boxes, or barrels is quickly dispersed by com- paratively slight exposure to fresh air. But the persons, bed and body clothing, and baggage of typhus-fever patients require the most thorough cleansing, soaping, and disinfection, and even steaming or fumigation is not amiss. I also deny that any of the cargo becomes affected in cholera ships. The persons, clothing, baggage of cholera patients, and those portions of the ship occu- pied by them should be most thoroughly cleansed and purified, as should the baggage and effects of all those coming from cholera ports. Water closets, cuddy holes, latrmes, and all personal conveniences, and the sides of the vessel, should be thoroughly cleansed and disinfected, as well as the steerage and all parts of the ship previously occupied by cholera patients. I am convinced that all the precautions which are re- quired against scarlet and typhus fever, small-pox, and cholera should be enforced against the persons, clothing, and baggage of yellow-fever patients ; and that yellow- fever ships should be more thoroughly cleansed, disin- fected, and fumigated than any others; but even in these ca^es the cargo, even if it consist of coffee, sugar, molasses, etc., etc., is rarely or never infected. The best way of disposing of a yellow-fever or cholera ship is to unload its cargo as rapidly as possible, with the full assurance that no disease will be conveyed by any portion of the cargo to the neighboring shore. The ship could then be very rapidly purified, and made ready for another cargo, or could be sent off' in ballast to the place from whence it came. New York harbor, by the establishment of the lower quarantine, now escapes from the greatest of all dan- gers, that to which it had always been subjected pre- viously, viz.. the contamination of its waters by the presence of cholera, typhus fever, small-pox, or yel- low-fever from ships. It is not only possible but prob- able, as suggested by Dr. Bell, that cholera, typhus and yellow-fever ships bring in their holds, or rather in the spaces between their inner and outer plankings, an enormous quantity of cholera, or yellow or typhus fever filth which has soaked into them from the filthy docks in which they lay while loading. Again, it is equally true that a great deal of such filth drains down from the decks and steerage into these inter-rib spaces, if the disease breaks out with any intensity on shipboard. This is pumped over the decks with the bilge water, and contaminates the surrounding harbors and anchor- ing places. Again, all the discharges of cholera, typhus and yellow fever patients, and all their refuse, used to pass, without disinfection, into the waters of the harbor, especially into the bays and shallow places where ves- sels at quarantine usually anchor. It is very well known that persons bathing in these waters would contract disease very readily ; and several instances have become historical, in which gales of wind threw these contaminated waters upon the Staten, Long, and Governor's Island shores, and occasioned wide-spread epidemics of yellow-fever and other diseases. From the most of these dangers we are now happily released by the removal of quarantine down below the Narrows. It only lemains to release commerce from the unnecessary delays, burdens, and fleecings which have so long been mercilessly heaped upon it in the name of Hygiene and Medical Science. Da. W. C. Roberts, Vice-President, remarked that the question of the contagiousness or non-contagious- ness of yellow-fever was one of the most interesting and practically important features in its history ; and he sliould very much have liked to [lay before the Academy some observations he had prepared, from reading and refiection, on the subject. 'I'hese he hoped to have a future opportunity of submitting to his pro- fessional brethren. Insusceptible, perhaps, of positive p oof, it was only from a certain line of argument in relation to contagion, as applied to this as well as to cveiy other contagious disease in the catalogue, that that of yellow-fever could be inferred. The study of the history of the disease, the speaker said, presented the curious anomaly of a large number of physicians, who, having for a long time been firmly convinced, from personal observation, of its conta- giousness, had renounced that opinion and embraced the opposite; of many, and most, it must be acknowledged, who, denying its contagiousness and believing in its local origin, looked with doubt upon quarantine regu- lations lor its exclusion ; of men who believe in the specific cause and nature of yellow-fever ; and of others, again, Avho see in it little or no difference from bihous levers of a high grade, and doubt of its specific nature. Others, again, believe, that although originally non- specific and non-contagious, it may, under certain cir- cumstances, become such ; and that, even on a voyage, the air in a dirty hold, especially with sickness on board, might contract contagious properties. All these views are maintained by able men, and by seemingly convincing arguments. The contagionists affirm the origin of the disease from infected vessels ; adduce proofs of its communication from the sick to the well, even in pure atmospheres; and adduce such examples, by way of illustration, as would be deemed conclusive in regard to any contagious disease acknowledged to be such. The non-contagionists deny its importation, or not, and confine themselves to showing that in nu- merous instance-! it was not disseminated, nor caught under favoring circumstances, etc. ; the positive asser- tions of the one class, once the most numerous, being counterpoised by the negative statements of the other. Dr. La Roche, in his elaborate work on Yellow^ever, which contains about all that has been written on the subject, devotes to "proofs of contagion" fifteen pages, on reading which, one would suppose the question definitely settled; and three hundred and fifty pages to the opposite view — showing, not what yellow-fever did do on occasions of its occurrence, but what it did not do. Many of his " proofs " of non-contagion are inconclusive ; some not apposite, and some not true : probabilities only op) :o-ed, to what others might affirm to be clearly estabhshed facts. Upon the subject of actual contagion he scarcely touches. Believing the disease to be one oiiginating from specific causes, of specific nature, distinct from others even similar in character, and having, as he believes, the power to show instances of personal contagion strong enough to insure conviction in this or any other disease of specifically contagious nature; and ro THE MEDICAL RECORD. taking into view the interesting and practically im- portant duiractor of the investij,'ation, tUc Doctor hoped to 1)1' iililc, at some fiiluro ])tMiod, to lay the re- sults of his inquiiios liofore the medical profession for a verdict on iluir merits. Which is the safer for individuals and communities, to admit and iict upon (he ide^ of its contagiousness, or to disregard it and risk the eon>equences? The President announced tliat L)r, E. G. Loring wouhl read, at the next meeting of the Academy, March 7. a paper on " Modern Methods of Extrac- tion." The Academy then adjourned. Corrcspouticucc. A FATUOUS PROFESSION AND INFA- MOUS MEDICAL COLLEGES. To THE El>ITOR OF THE MEDICAL RECORD. Sir — Some hiy;hly respected and unquestionably honest members of our profession read a report relative to medical education at the last meeting of the Medical Society of the State of New York. (See the Record for Feb. 15, 1872, page 559.) While I entirely sympathize with them in the objects of that report, I am convinced that the measures thej"- propose are totally hopeless of desired results. Whoever pleases can sec that the report above al- luded to adopts, and reproduces the impracticable scheme suggested by the Committee on Educotion of the American Medical Association, and printed nearly three years ago. I had occasion, in my paper read be- fore the State Society at the same meeting, to quote from that report of the American Medical Association, simply to show that the whole history of the subject went to demonstrate that the plan proposed by that report is impracticable. It is therefore to be regretted that our State Society Committee slinuld have been reduced to the necessity of even alluding to any such scheme for the moral and educational elevation of the profession. If your readers will take the trouble to read the in- felicitous and untruthful resolutions proposed by the Stale Sooiety Committee (page 5G0), I have little doubt they will appreciate the point of tlie above remarks. Alter reading those resolutions, will any one please to tell us how any board of censors therein provided or contemplated can secure the attendance before them of any proposed medical student ? Wiiat means have Ave for enforcing the fourth reso- lution, (see page 5G0) ? It is morally certain that even among members of the county .societies this resolution will be extensively disregarded;" and as to the large number and often respectable members of the profession not members of county societies, it will of course be nugatory. What, for example, can the censors do, under the provisions of this resolution, with reference to the students of one of our most dis- tinguished teachers who, by accident or otherwise, does not belong, by virtue of membership, to any county medical society ? But the most striking failure of the report and its resolutions is found in the complete want of any pro- vision for the eases of medical colleges which become so venal as for a few paltry dollars to scandalize the honest and industrious students they may have, and degrade and outrage professional feeling by issuing diplomas to, or even matriculating, creatures who, in open court, not only perjure themselves in the vilest manner, but who declare, under oath, that lor years they hav»; lived upon a practice obtained thiough newspaper adverli.sements and by means of cards and circulars of the most debased and criminal character, distributed in the street cars. This is by no means an imaginary ca.«e, as the fol- lowing newspaper advertisement, of a recent graduate of a once respectable and still prominent medical col- lege of the city of New York, will attest: ■' Dr. . Infallible Pills lor Female Obstructions. Twenty years' practical experience have encouraged me to introduce an article long needed. These pills will surely produce the desired effect, and need no further reconmiendation. " For sale b}' druggists generally. " For particular information apply to the doctor's office. No. avenue, between and streets. Private office. No. street. From 7 to 9 p.m." Of course, the most careful and honorable schools are liable to imposition; but of this liability I have no other occasion to speak in this connection than to as- sure your readers that there was no such deception practised in the instance above alluded to. The faculty were fully informed in all the details of the case. They had the phonographer's report of the declaration under oath ; they had the original newspaper advertisements, and they had an abundant individual evidence in sup- port of charges of most immoral and criminal charac- ter. Notwithstanding all this, a few dollars have, within the last few weeks, placed the name of such a wretch in tlie list of the graduates of one of our New York medical colleges. No one will, of course, envy that college its acquisition. I have named neither college nor individual ; but I am ready to do so at any moment the public and pro- fessional good appears, in my judgment, to demand it. Besides such outrageous acts, it is credibly stated that this same college advocates the propriety, and fol- lows the practice, of selling their diplomas to persons living in distant parts of the State, on the simple state- ment of the person seeking it, without any j^resenta- tion of certificate or credentials. The college, and the case above alluded to, are noto- lious; and as a consequence of these disreputable acts, its better class of students are highly indignant, and will abandon the institution. While honesty and morality are the best policy, they are by no means always observed, even where it is so clearly politic, as in the case of medical colleges. Now, acts like that above alluded to are so frequent- ly committed by colleges — more eager to secure a few dollars than to shun infamy— and so Avell known by the gentlemen signing the report, that it is a matter of surprise they should have seriously entertained an idea that the scheme provided in their resolutions reached, or could remedy materially, any evil. None but the fatuous can fail to see, that while totally venal and cor- rupt medical colleges have control of licenses to prac- tise, medical society resolutions of this kind will not only be in vain, but be simple expressions of imbe- cility. Indeed, this is so well known, that one who moves a medical society resolution, in any other than a strictly society matter, exposes himself to ridicule. Outside of the society they have no significance, no influence. This will certainly be the result of any at- tempt to carry out the resolution referred to. (Page 560.) But professional fatuity did not stop, at the late meeting of the State Society, with these resolutions. On page 558 Record, the society resolved again — to do what? to disapprove the only even hopeful measure THE MEDICAL RECORD. 71 proposed in modern times to elevate and control medical education, viz., by invoking the strong arm of the law. Not to say anyihing about general professional opinion regarding this society resolution, it may be well for us to know, that the lay opinion of it is by no means com- plimentary to the profession. By it the State Society has, so far as any of its resolutions could, placed the profession before the pubhc on the same footing as the quacks and tlie criminal practitioners of the country ; Avhile, to our shame be it said, the ignored so-called new schools of "pathies," have taken quite the opposite course — have accepted the proposed measure as one which, though it confers upon them no privileges they do not now legally possess, gives material additional power to be used for the public interest. I need say no more to explain my text. Stephen Rogers. CEREBROSPINAL MENINGITIS. To THE Editor of the Medical Recoiid. Sir — The rumor that epidemic cerebro-spinal menin- gitis has appeared in some portions of this State, and the announcement that some cases have been reported to the Board of Health, induces me to write a few lines, •with the hope of calling the attention of medical prac- titioners, who may have the opportunity of seeing this disease, to some details of treatment, and especially to the use of the ordeal bean of calabar, which I believe has been of service to me in the management of a re- cent limited epidemic. Since the beginning of November last I have treated forty cases of cerebro-spinal meningitis. Twenty-nine were well-marked typical cases. The ages of my patients ranged from 3 to IG years. Four died: and one is not yet out of danger. As this epidemic occurred under peculiar circumstances, and presented many fea- tures which may be of interest to the profession, I pro- pose to publish soon a full report. The therapeutics of this disease are notoriously un- satisfactory. The mortality of reported epidemics ran- ges from 30 to 75 per cent. The death-rate of my cases is only 10 per cent. But their number is too small to allow any legitimate conclusion to be drawn from such hmited statistics as to the value of any particular treat- ment. I anticipate my report, therefore, by this pre- liminary statement, that others may not miss an oppor- tmiity of testing the value of the remedies I have em- ployed. Waiving for the present all discussion concerning the nosology, etiology, pathology, and morbid anatomy of cerebro-spinal meningitis, I may be permitted to state that the most salient and central feature of this disease .seemed to me to be an enormously increased reflex irritability of the nervous system, with an attendant paralysis of some branches of the sympatheticus. In studj'ing my first case it occurred to me that calabar bean, which ophthalmologists use in eye-diseases de- pendent upon an irregular or interrupted innervation of the dioptric apparatus, and which lately has acquired considerable reputation in the treatment of various forms of tetanus, might be of nse in this disease, the symptomatology of which is so largely made up by paretic and tetanoid phenomena. At first I used the tincture of calabar bean, but after- wards I succeeded in procuring the extract. The ex- tract was manufactured by Hazard and Caswell, 2^ drachms of which are equal to 2 ounces of the bean. I had one drachm rubbed up in glycerine and gave 2-5 drops at a dose. I administered this drug in every case, as soon aa tetanic contractions or apparent paralysis of the sphinc- ter iridis appeared; except in two livtal cases, one of which terminated very lapidly, the other occurred be- fore I had obtained the extract and after the tincture was exhausted. In the great majority of cases the drug seemed to exert a favorable influence upon the symptoms which it was intended to control. In a few of tiie milder cases, where there was rather a contracted pupil, 1 ad- ministered atropia in pretty lull doses, without, how- ever, influencing the general course of the disease. In the onset of the attack the symptoms are generally so violent, cephalalgia and rachialgia so severe and dis- tressing, the skin and mucous membranes so congested, that depletion seems the one thing indicated, and yet I have resisted every temptation to abstract blood. I have neither bled, nor leeched, nor cupped, nor blis- tered. Ice in bladders to head and neck mitigated the pain and proved grateful to the patient. Cathartics I used very moderately, not intending to produce any revulsive effect upon the bowels. I had no reason to be dissatisfied with this treatment, when afterward, in some of the protracled cases, a prostration set in as extreme as the precedent violence, and a degree of emaciation foJlowed which rivalled the marasmus of the everlasting gastro-intestinal catarrh of starveling foundlings. In the first days, or whenever, in the course of the disease, there was great restlessness, or violent jactation, I administered moderate doses of chloral hydrate, 10-15 grains, repeated as required. Morphine I gave only in one case where ice seemed unpleasant and headache was worse. Although there is a certain rhythm and periodicity in the progress of this disease, I have seen no reason for giving quinine until after convalescence was established, and then, in combination with iron, it doubtless proves beneficial in re-establishing the vigor of the system. In most of the cases periods of coma follow or alter- nate with spasms and jactations. In such cases I have Ibund the iodide of potassium of service. But this drug must be administered with a bold and liberal hand. I have given from 2 scruples to a drachm in 24 hours ; generally alternating it with the extract of calabar bean, so that my patients received every two hours either a dose of calabar (2-5 drops) or a dose of pot. iod, gr. 6-10. Cerebro-spinal meningitis is not a sell-limited disease ; it is protean in its manifestations ; probably more frightful in its phenomena than severe in its anatomical lesions, — at least in a majority of cases, — and oflers, therefore, a hopeful field to the therapeutists, although few victories have as yet been won. To induce phy- sicians to make new trials I have ventured to state briefly the method of treatment I have pursued ; so far as its results go, I believe they are more favorable than any that have been obtained. In general hygiene little could be done in the persent state of our knowledge as to the cause of the disease. I have used carbolic acid as a disinfectant, and internally to some extent. In concluding these lines I wish to express my gratitude to Piofessor Jacobi, who had the extreme kindness to visit my patients with me, and to whose profound knowledge of the diseases of childhood and skilful application of modern therapeutics I am indebted lor much valuable advice. Very truly yours, C. F. R0DENSTEI>f, M.D. Westchestek, March, 18T2. IIIK MKIHCAI. IlKCORI). i^ctiicnl 3tcm!5 anti llcws. CoLLKGK OK I'livsrciANS AND SuRORONs. — Thc sixty- fifth Aiimial Coninit.'ncoiiicnt took place at Steinway Hall. February 28. Alter a prayer by thc Rev. Dr. llutton, IVe.^icient Delafiuld conferred diplomas upon seveniy-eiglit <,'raduates. Prot^ Dalton annoimced the iolluwinjr award of prizes: — Faculty prizes for the best two Inaugural Theses : first prize, of fift}' dollars, to William Tiilin}.diast Bull. A.B., of Newport, R. I., lor a thesis upon '' Perityphli- tis ;'■ second prize, of twenty-live dollar.^, to Peter A. E. Boctzkes, of this city, for a thesis upon "Morbus Coxarius." The theses of the following frrntlemcn also received honorable mention : Edward K. Ilenschell, Xew York City. "Albuminuria;" Geoifre C. Gage, Mobile, Ala., "Yellow Fever;" John 11. Seabury, Jamaica, L. I., '• Acute Rheumatism ;" T. Naylor Brad- field, Newark, N. J., "Diagnosis in Gyn;eeoIo,2y ;' and Cornelius Gilman Trow, Sunderland, Mass., "The Ob- stetric Use of Carbonic Acid." Otis prize, of a case of surgical instrument?, valued at fifty dollars, for the best report of the clinical and di- dactic lectures on venereal diseases, to F. W. Cliapin, of New York City. Alumni Association prize, of four hundred d( lla's, for the best essa}^ presented by an alumnus, to Dr. Frank P. Foster, of this city, for an essay on " Experimental Study of Animal Vaccination." The subjects selected for the Stevens Triennial Prize, of two hundred dollars, to be awarded at the Com- mencement next year, are : 1st. "The Siihygmopraph, its Physiological and Pathological Indications;" 2d. " The Pathology, Symptoms, and Treatment of Con- vulsive AfTections." This prize is open to universal competition. The Essays must be senttc^>tlie President of the College on or before January 1, 1873. The valedictory address was given by Samuel Swift, Ph.B., M.D., of the graduating class ; and the address to the graduates by Rev. Henry Ward Beecher. Some extracts from our notes of the latter, which we had proposed to give, are crowded out of this number. Bef-levue Hospital Medical College. — This college held its tenth Annual Commencement February 29th, at tlie Academy of Music. The Chaplain of the college, Rev. Dr. Beach, ofiered prayer, and administered the Ilippocratic oath to a class of one hundred and twenty- nine graduates, who received their diplomas at the hands of the President, Dr. Isaac E. Taylor. Prof A. B. Crosby, M.D., addressed the graduates. He counselled them to consider their studies but just begun, and to pursus them not only with reference to the particular profession they had now entered, but quite as much with a view to that broader culture without which even their special department, however earnest their devotion to it, must be imperfectly com- prehended in some of its most important relations. This culture must extend to the heart as w^ell as to the head; nor must they neglect those social amenities and graces of manner whose absence might cheat the kindest feelings and the highest skill out of the best opportu- nities for their exercise. If tiiat personal magnetism by which some men bring us irresistibly under their influence was not a thing to be acquired, still every one might learn to make his presence agreeable ; and the phyrieian would often leave behind him a more po- tent remedy than his prescription, in the memory of a bright greeting or a happy joke. In the illness of the valedictorian, Benjamin L. Lo- throp, A.B., M.D., liis address was read by Dr. Wil- liam Car:'. Excellent nm.'^ic was furnisheil by an or- chestra under Carl liergmann's direction. Medical Dki'Ahtment of the T'.niversitv ok New York. — The annual commencement of thi.s Medical College was held on Tuesday evening, Feljruary 20, 1872, at Ciiristian Association Hall, which was filled with a .«elect audience. The exercises were opened with reading of the Scriptures by Rev. Prof Benjamin N. Martin, D.D. Rev. Isaac Ferris, D.D., LL.D., Emeritus Chancellor of the University, olTered prayer. Prof. John W. Draper, M.D., LL.D., conferred the degree of M.D. on seventy-five graduates. Certificates of Honor were given to eighteen graduates who had attended the spring, autumn, and winter courses of in- struction. The Mott gold meilal was awarded to Dr. J. V. Granger for the best anatomico-surgical jjrepara- tion ; the Mott silver medal to Dr. H. C. Munroe for the .second best anatomico-surgical preparation; Prof. William H. Thomson's prize to Dr. L. P. Ensign for the best record of his clinics; I'rof Charles A. Budd's prize lo Dr. G. H. Hammond for having passed the best examination in obstetrics; Prof. D. B. St. John Roosa's prize to Dr. J. A. Ste])hens for having passed thc best examination on the eye and ear ; Prof. F. D. Weisse's prize to Dr. H. S. Yanderhoof for the best recoi^ds of his clinic on skin diseases. The valedictory address to the graduates was given by Prof. William Darling, which was interspersed with amusing and interesting hints. Dr. R. J. Brevard, of the graduating clas.s, delivered the closing address. The New Health Officer. — The following letter has been ad(h-essed to Dr. S. 0. Yanderpoel, the newly appointed Health Officer : — New Yobk, Febniai-j- 28, 1872. S. Oakley Yanderpoel, M.D., Albany. Dear Sir : — We have heard with the greatest satis- faction of your nomination by the Governor as Health Officer of the Port of New York. We regard it as most fortunate, for the credit and interests of all con- cerned, that the above office should be filled by an in- cumbent like yourself, fitted, by every personal and professional qualification, to perform its duties in the best possible manner. Possessing, as you do, the entire confidence and esteem of the profession, your confirma- tion and acceptance would be received with universal satisfaclion. (Signed) Edward Delafield, M.D. ; John T. Metcalfe, M.D. ; Isaac E. Taylor. M.D. ; T. Gaillard Thomas, M.D. ; A. Clark, M.D.: \V. H. Yan Buren, M.D. : Willard Parker, M.D. ; Alfred L. Loomis, M.D. ; William Detmold, M.D. ; T. M. Markoe, M.D. ; A. Du- bois, M.D. ; Austin Flint, M.D. ; Chailes A. Budd, M.D. : J. C. Dalton, M.D. ; John J. Crane, M.D. ; H. B. Sands. M.D. ; C. Henschel, M.D. ; John G. Curtis, M.D. ; Edward Fowler, il.D. ; George A. Peter.=, M.D.; E. R. Peaslco, M.D. ; W. H. Draper, M.D. ; L. Ranney, M.D. ; John O. Stone, M.D. . Gustavns A. Sabine, M.D.; C. F. Hey wood, M.li. ; Henry D. Noyes, M.D. Lostorfer's Syphilitic Discovery. — Professor Wedl contests the discovery of pecuhar bodies in syphilitic blood, and asserts that they are only mas.ses of fatty particles and protoplasm, which are found in healthy blood. Deaths from S.mall Pox in the seventeen ehiefest towns in Great Britain, during the year past, amounted to the number of 13,174. The Census of Rome. — The census of Rome, just completed, shows ^ population of 240,000. THE MEDICAL RECOKD. 73 ©rigiital Communicationsi. SOME DETAILS IN THE PATHOGENY OF PY.EMIA AND SEPTICEMIA : REMARKS BEFORE THE MEDICAL LIBRARY AND JOURNAL ASSOCIATION OF NEW YORK, By MARYC. PUTNAM, M.D., LECTURER ON MATERIA MEDICA IN THE WOMAN'S MEDICAL COLLEGE OF THE NEW YORK INFIRMARY. As I understand the object of this Association, it per- mits its younger members to submit the questions tliat may have especially interested them, to the judg- ment of otliers older and more exiDerienced than them- selves. This is why I venture to make some remarks on a subject, vv^hich a rather prolonged sojourn in the hospitals of a great metropolis has Ibrced most promi- nentl}- upon my own attention, Tlie study of putrid and purulent infection, though it originate in the province of the operative surgeon, immediately rises into the sphere of general pathology, and touches upon problems of the keenest interest to the physician. Moreover, by a singular fatality, the metliods adopted to remedy the effects of accidents, expose to many of the same dangers as the accidents themselves ; and operations for many diseases of inter- nal origin accumulate upon the unfortunate patient the additional perils of an external traumatism. Finally, while men are more especially exposed to the superflu- ous traumatisms of war, women are compelled to incur the inevitable traumatism of childbirth; and the ulti- mate danger is in many cases the same. To judge by certain assertions, one might suppose that this danger had been so much diminislied by ap- propriate treatment, that it now presented no more practical interest than that of the plague. The ad- mirers of Professor Lister have far surpassed his own confidence' in the virtues of carbolic acid. In the Dublin Quarterly for 1869, Mr. McDonnell affirms that treatment by Lister's method has attained 'perftction ; and that when a wound has been dressed with carbolic acid, and its arteries secured by torsion, it is almost certain to heal easily, while tlie temperature of the body does not rise above 100°. Lister himself, in his famous paper published in the British Medical Journal for 1867, is not so sanguine. Pie gives no statistics, but observes that since the employment of carbolic acid for the dressing of wounds, his wards, formerly the most unhealthy in the Glasgow iofirmaiy, have become comparatively healthy, and that he no longer dreads, as before, the advent of com- pound fractures. In St. George\'i Hospital Reports for 1868, Mr. Holmes gives the result of experiments made with carbolic acid in forty cases. Lacerated wounds and abscesses did remarkably well under this treatment; all recovered. Of eight cases of compound fracture, four recovered and four died — tv/o of pyaemia, one of tetanus, one, on fourth day, without metastatic abscesses, tlie case being complicated with renal disease. Mr. Holmes had twelve cases of incised wounds and operations, including two amputations of the breast, but only two involving section of the bones. One of these was a Chopart's amputation of the foot; patient re- covered after an attack of erysipelas ; the other, an amputation of a metacarpal bone, followed by death from pyaemia. In this case the patient had diseased kidneys. In the last October number of the Archiues de Mede- cine, Dr. Labb6e reviews the English statistics, and points out that, even in Lister's wards, the results of carbolic acid treattnent are much less brilliant than was at first supposed. Thus, i)revious to tliis treat- ment the deaths after amputations were 41 to 120, or 1 in 3; after its adoption, they were oO in SO cases, or 1 in 2.6. During the last six months Dr. Labb^e had extensively employed carbolic acid, with ilie most scrupulous attention to the details insisted upon by Lister, and nevertheless nearly all his ; mputated pa- tients had died. This lugubrious statement corresponds entirely with the I'acts that I have had an opportunity of observing closely. For at least three years the use of carbolic or jihenic aciil has been almost universal in the great surgical wards of the Paris hospitals ; but the mortality has not been notably niodi0ed, and remains higher than that of London. These remarks, with no pretension to statistical value, are merely intended to show that the antiseptic treatment is by no means infallible. The phenic acid of the moderns is not a panacea, any more than the famous sage of the ancients. It follows that the doc- trine upon Avhich its employment is based, is not sufficiently comprehensive to include all the cases to which it is applied. This doctrine is sometimes an- nounced in a proposition that rather unfairly combines the opinions of Poser on miasms, and of Pasteur on animal germs. It is sometimes said that these germs constitute hospital miasms, and act either directly, be- ing themselves absorbed into the blood, or indirectly, after having determined the putrefaction of traumatic fluids. The absorption of fluids thus putrefied is suffi- cient to account for the most various surgical accidents — phlebitis, erysipelas, pytemia, septica3mia, hospital gan- grene. In virtue of the assumed unity of their ictiology and of their nature, these several alTections are asserted to be equally amenable to a single mode of treatment. This consists iil'the destruction of animal germs, first in the atmosphere, b}'' purification of the air ; second, upon the wound itself, by dressings with carbolic acid. But, in the first place, the animal germs to which Pasteur attributes the mechanism of putrefaction do not exist merely in impure air, but even in tolerably pure air, unless it be absolutely free from animal or ve- getable dust — such air, indeed, as may be brought from the summit of Mt. Blanc. To prevent putrescible sub- stances from putrefying, it has been shown necessary to seal them hermetically, so as absolutely to exclude air. Donne experimented on an egg, which he caiefully enveloped in cotton wool, and then obliquely jjierced by a knitting-needle, previously heated to destroy any germs that might be clinging to it. By means of this puncture air was admitted to the interior of the egg, but only after having been filtered by the passage through cotton. The egg putrefied, as it will not do if it be covered with an impermeable varnish. But Pasteur asserted that the precautions taken had not been suff.- ciently severe ; that it was possible to admit some of these ubiquitous infusoria during the manipulation of the experiment. How much more, then, in any Avound not treated by absolute occlusion ! In the second place, the researches of Bechamp ai.d Estor, communicated to the Academic des Sciences in 1808, indicate that, though the access ofair be esseniial to putrefaction, yet the presence of bacteria in animal pu- trefying substances does not depend on their introduction from without, but on the development of germs already contained in the elements of the tissues themselves. Especially in the cells of the liver, both in man and in other animals, these observers have discovered certain spherical granules which they call microzymes. These THE MEDICAL llECDliD. rcMiain i^phcricnl as lonp as the organ is in licaltli, and constitute a normal, necessary part of its elements. But ■\vliin tlie tissues arc separated from tlieir vital connections and exposed to the air, these pinnules at lirst arranjre tliemselves in strings, and finally assume the shape of moving or motionless roils, presenting all the appearanre of the vihriones known as bacteria and bac- toridia, and described by Daraine.* Fragments of liver placi'd in water containing either sugar or starch, showed a development uf bacteria in twenty-four hours. But if immersed in ordinary water, the development •was delayed five to tliirteen days. Further, what is extremely important to notice, the addition of creasote or of phenio acid in no wi.se afleeted this prohferation of animal germs, unless it were made in a quantity suf- ficient to coagulate animal tissues. Tiiat these bacteria came from the microzyme-5 into which tliey were seen to grade, iind not from the suirounding air, .seems proved by the fact that they were always discovered in the fragments of tissue before they appeared in the water in which these were immersed. In the QiimierJ;/ Jotirnal of Microscopical Science for last October, Burdon-Sanderson has shown, by most c.irefid experiments, that the microzymes never come from the air. According to this writer, they frequently abound in water, so that a drop or two of ordinary spring water added to a test solution is sufficient to de- termine in it the development of microzymes and of bacteria. But if the water so added be boiled and the whole placed in a gla-s that has been superheated, no microzymes will appear, even though the liquid be left exposed to the air. In the latter case, however, toru- la-cells appear in as great abundance as if the liquid had not been boiled. It is thus shown that no connec- tion exists between the microzymes destined to develop into bacteria and the torula-cells that multiply into fungi. The air is charged with these latter, while the former abound in animal and vegetable solids and fluids. To test the influence of bacteria, apart from that of the morbid fluids with which thej^ were a.ssociated in Davaine's experiment-, Leplat and Jaillard t injected the veins of animals with fluids containing bacteria ob- tained from decomposing vegetable infusions. Such injection- were productive of no inconvenience what- ever. Analogous experiments were made by J. G. Richardson, as related in the American Journal of Medical Srimces for July, 18G8, p. 291. He swallow- ed from one to four fluid ounces of Avater, rendered putrid by two or three days' contact with meat, and swarming with vibriones. A drop of blood drawn half an hour after the ingestion of one fluid ounce, pre- sented only a single vibrio. But Avith a k'ger dose and an hour's interval the number greatly increased. Twelve were seen in as many minutes, and at one time there Avere three in one field. In tAvo hours, however, these had entirely disappeared, their presence in the blood having occasioned no other inconvenience than plight headache, furred tongue, and some diarriioea. Thus, left to themselves in contact with healthy liv- ing tissues, vibriones are rapidly eliminated without causing any damage. MoreoA'cr, as Davaine observ^es, in a medium composed of substances in full putrefac- tion, these animalcula are also unable to sustain life. They live upon organic matter that is just beginning to decompose ; they eannot determine the decomposition of living tissues ; their germs cannot develop to the potency of bacteria unless they have free access to oxygen ; finally, when the organic matter in Avhich they are imbedded is dead, and I'csolved into inorganic * Dictlontiaire des Sciencen Medfcales, Art. " Bacteries." t Comptes Rendus de FAcademie des Sciencen, 18G7. elemenl.s, the vibriones die too. Hence, though Feltz and Cohn have discovered tln-m in the fluids of putre- fying Avounds ; though Ranvier hns.found them nea?' the seat of a fractured bone affected Avith osteo-myelitis; though he has further found germ -granules in meta- static ab.scesses, — yet these marvellous little orgaidsms cannot be rendered directly chargeable for all the acci- dents of putrid and purulent infection ; nor their de- struction be considered an assurance of security against these formidable complications of Avounds. For, Ist, in air that has been sufficiently purified to avert cer- tain forms of disease, as hospital gangrene and the more malignant kinrls of septica?mia, the germinal mat- ter of vibriones is still found in considerable abundance, so that animal fluids or tissues exposed to the air ne- cessarily decompo.se. "id. I'ositivc experiments have shoAvn that Ixacteria by themselves, though introduced into the blood, are not injurious. Further: Bergmann has shown that the dried residue of pus retains its toxic properties, though it have been heated to 212', or treated by alcohol of 96 per cent. ; and either procedure is accounted suflQcient to destroy animal germs.* The above-quoted experiments of Burdon-Sanderson tend to show that the vibriones of the air, which are a cause of putrefaction, dilTer essentially from the micro- zymes of nnimal fluid:^, whose development may be only an effect. But the deA'clopment of these latter to bacteria may act like that of all other vibriones, in favoring putrefaction. Hence the accession of air to a wound woidd work in tAvo ways: it Avould admit at- mospheric germs, demonstrated agents of putrefaction; and it Avould furnish the oxygen requisite for the de- velopment of microzymes, probable agents of putrefac- tion. The one and the other class of vibriones — innocu- ous if themselves absorbed — only act by determining the alteration of traumatic fluids ; and these once alter- ed become toxic, though the causal germs be excluded or destroyed. That the accidents resulting from Avounds depend upon the introduction into the economy of substances formed uptm them is shown : (a) because the artificial introduction of these same substances, by injection into the veins, is followed by the same symptoms as occur spontaneously Avhen they are left long in contact with living membranes ; (h) because direct expeiiiuent proves that the capacity of absorption from the surface of Avounds is very great. Two gieat classes of infection may be formed: 1st. That Avhich depends upon primary absorption from the wound previous to the groAvth of gramdations or the formation of pus; 2d. That which supervenes after suppuration, and the complete disappearance of trau- matic fever. » The first class constitutes septica3mia ; the second, pya-mia, or purulent infection. It is noteworthy that septicaemia is developed at a time Avhen absorption from the wound is slowest; pyaemia, Avhen it has begun to be most active. De- marqua}' has shoAvn that an iodic solution placed on a lecent wound will be absorbed in from fifteen minutes to an hour. But after application to a granulating wound, iodine may be detected in the urine and saliva in ten, eight, six, or even four, minutes. It would seem, therefore, that the accidents of septica;mia depend on the absorption of some substance more diffusible than that Avhicli is the origin of pysemia, since it acts more quickly, though at a time Avhen absorption is less active. The Avounds in which pure septicsemia originate^ may * On this last point, however, there is at least room for doubt, since Wyman's experiments (A7n. Jour. Set., 1867) have shown that certain infusorial germs will retain their vitality even after four hours' boiling. THE MEDICAL RECORD. affect exclusively the soft tissues. Thus, in wards where pyoemia was the most frequent disease, I have seen septicaemia develop as a consequence of an operation for a double prolapsus of the uterus and rectum, where an attempt was made to extend tlie perinanim b;ick- wardfi by a suture that sliould include a part of the enormously distended anal sphincter. Septicajmia is frequent after operations for stranf^u- lated hernia or the extirpation of tumors, and often complicates the peritonitis occasioned by ovariotomy. But in wards where pyi\;mia and septicemia were both endemic, I have been struck with the exemption of pa- tients wlio had suffered amputation of the mammary gland. On the other hand, the extirpation of a fibro- plastic tumor from the deltoid muscle was followed by a typical development of septicaemia. The traumatic fever set in within twenty-four hours after the opera- tion, and, instead of abating, persisted, and gradually rose into all the violence of the septicasmic fever. This form of surgical fever is frequent as a conse- quence of diffused acute phlegmon of cellular tissue, even when this is unaccompanied by osteo-myelitis. It constitutes those peculiarly malignant forms of puer- peral fever where death supervenes with great rapidity, and where, after death, the uterus presents no trace of phlebitis or of lymphangitis. These cases are excep- tional. It is a very remarkable circumstance that gunshot wounds, so excessively dangerous when they affect the bones, are so frequently innocuous when confined to the soft tissues. I had abundant opportunity for observing this fact in the case of numerous shell wounds that came under my observation during the siege of Paris. In wards where acute diffused phleg- mons frequently proved fatal by generating septicaemia, flesh-wounds caused by the explosion of shells healed readily, even though, as in one case, the victim was a woman six months pregnant, and miscarried after a triple injury in face, thigh, and leg. A curious case of impunity, even though the bone was involved, was that of another woman Avho had been for four years an inmate of the hospital on ac- count of chronic rheumatism in shoulder, Avrist, and knee-joints, all of which were more or less completely ankylosed. During the bombardment, a sliell exploded in the hospital ward, and carried off this patient's right arm about three inches below the shoulder-joint. It was a very clean amputation, with very slight htemor- rhage ; and but little trimming of the wound was need- ed to make a neat stump, which was speedily covered by fleshy granulations. Not merely did the patient escape without any signs of septicaemia or purulent in- fection; she even had no traumatic fever. I attributed this remarkable exemption to the pre-existence of chronic adhesive inflammation, which had rendered the tissues — lymphatic, cellular, osseous, and to a certain extent even the veins — impermeable to the septic ma- terial arising from the traumatism. The behavior of gunshot flesh wounds resembles that of those made Avith caustics as compared with those made by the bistoury. It is not my province to insist upon the practical advantages of the method so eulogized by Maisonneuve, but their bearing upon the theory of septic and purulent infection is of importance. The facts tend to show that tissues kihed outright, by chloride of zinc or the actual canter}', present far less chances of infection than those that die slowly and, during a long period, offer to absorption the successive products of their decomposition. Tliey appear, more- over, to block up the roads of absorption, and not to afford the media for diffusion constituted by loose dif- fluent tissues. Septic absorption occurs to a greater or Jess extent whenever decomposing animal matter is brought in contact with living me[nbranes, and seems to be inde- pendent of the state of the veins. The condition of the lymiihatics is of much more importance. For at the lime that septicaemia develops, the lymphatics, torn by the traumatism, gape open into the wound, while later they are closed by Hesliy granu- lations. Septicaemia, which precedes the formation of these granulations, likewise, in typical cases, precedes the formation of pus. This does not normally occur before the third da}'; and if symptoms of septic poison- ing have appeared previous to its establishment, sup- puration may be indefinite!}' delayed, or the pus be le- placed by a thin sanious liquid, in which pus-corpuscles aie rare. According to Robin, the decomposition of pus is always a consequence of the generalized infec- tion, and not its cause. As might be inferred from this appaient connec- tion with the lymphatic system, the full develop- ment of septicaemia is often preceded by a lymphangitis. But it is extremely curious to notice that, should this lymphangitis be inmiediately followed by tumefaction or phlegmon of the nearest lymphatic glands, or by an attack of erysipelas, the general infection seems to be averted. I have in my notes three eases of compound injuries of the fingers, followed by abscess in the axilla, Avhich in one case had been preceded by a subacute phlegmon of the arm ; in another, by the red streaks of superficial lymphangitis ; in the third, by a probable affection of the deep lymphatics. All these cases re- sulted in recovery, in the same wards Avhere patients affected with quite similar injuries were constantly succumbing with symptoms of septico-pytemia. The occurrence of erysipelas seems also frequently to ward off the graver affection. In two cases of carbun- cle treated by extirpation, the occurrence of a chill, in connection with a sudden drying and glazing of the wound, was regarded as an ominous forerunner of Septic infection, until the advent of a local erysipelas unexpectedly changed the prognosis. In another case, an operation for strangulated hernia in a woman was followed by an attack of erysipelas on the face, from which the patient recovered. She subsequently suc- cumbed to exhaustion, but never presented either symptoms or lesions of putrid or purulent infection. These fivcts, and certain statistics showing the epide- mic alternation of erysipelas with gr-aver surgical aftec- tions, bear testimony" in favor of the theory that ascribes erysipelas to a diffused inflammation of the lymphatics of the skin, caused by the passage through them of irri- tating substances. It is upon this theory that Maison- neuve has based his treatment of erysipelas by appli- cation of a blister directly to the inflamed surface, for the purpose of drawing off septic material in a profuse discharge of serosity. The "succession of symptoms in septicremia gen- erally occurs as follows : The traumatic fever, instead of abating, persists, or abates only imperfectly. The suppuration, that should have set in on the third day. is delayed ; and sometimes the wound becomes glazed and dry, or points of gangrene appear in tissues that seemed at first sufficiently vitalized. Sometimes, as was the case with the patient submitted to a perina.>or- rhaphy, a fugitive local erysipelas appears, to disap- pear after a few hours. About the fourth day occurs a single chill, often quite violent, immediately follow- ed by a notable lise of temperature. By the fifth day the sutures in the wound give way, and the tissues begin to melt down into an increasingly putrescent detritus. At the same time the pain of the wound is diminished, and this local blunting of the sensibility 7G THE MEDICAL RECORD. rapidly extends to tho entire nervous system. The patient becomes absorbed, indifferent, finally agitated and delirious. The delirium is sometimes muttering, oIUmi violent. The fever is remarkable for iUs eontinu- aiiei- ; uiorninc^ remissions are slip;ht. Under this eon- tinued fever tlic body emaciates; tlic clieeks become excavated, and covered with a dry parched flush ; the eyes are injected ; tho tongue and lips retracted and blackened ■with fidiijinositirs; the whole aspect of the patient recalls that of typhoid fever, and the occurrence of diarrhoea completes tlie resembhinee. The peculiar circumstance about the jjathological anatomy of pure sei)tic8emia is its negative charac- ter. There is no trace of phlebitis, thrombi, or me- tastatic abscesses. The veins arc all permeable, but filled with diflluent black blood like molasses. The viscera are neaily all soltened and congested, as in typhus. In artificial sejiticajmia, induced by the injection of putrid matters into the veins, there is often diffused f)neumonia, cr there may be patches of gangrene in the lings. The most notable lesion, however, exists in the intestinal mucous membrane, which is tumefied, hyper- aemic, and soltened. This lesion corresponds to the san- guinolcnt diarrhoea, which is an invariable symptom during life, and both lesion and symptom point to an effort at elimination of tlie poison by the intestinal tube. That the lesion is so extremely marked in ani- mals, while it is slight or Avanting in human victims, in- dicates that tlie effort at elimination is greater in the former case than the latter, and helps to explain, there- fore, the greater resistance of dogs to the disease. Finally, a very notable peculiaritj^ of septicnemia is its variable degree of intensity — variable as the con- ditions which may give rise to it. There is the terrible septicemia of malignant forms of puerperal fever, that destroys life in a few days; there are the much milder Ibrms, t'.iat almost invariably occur when decomposing animal fluids are brought in contact with any surface ot the body in such a way that any part of them may be absorbed. The retention of a piece of the placenta in the uterus will give rise to all tho symptoms of an incipient septic fever, as I had an opportunity to observe in a ease the other day. Nay, even in perfectly normal conditions, recent accurate observations have noted a rise of temperature as a general occurrence about twelve hours after parturition. This phenomenon is precisely analogous to the well-known traumatic fever, and the elementar}- conditions are the same, namely, the contact of decomposing non-purulent fluids with living membranes capable of absorption. In these cases, the general disease seems to be directly connected with the wounds, and this, not in virtue of the nervous shock they have inflicted, but of t'm decomposing liquids, or of some element in them, that they place in contact with live animal membranes. The essence of the general disease lies in the fever, or rise of temperature; and of all the causes that have been invoked to explain the rise of temperature in such cases, that of an acceleration of the molecular metamor- phoses of the blood and tissues is infinitely the most probable. For the fever may be determined, either, as I have said, by contact with animal membranes of substances themselves undergoing rapid chemical metamorphoses, or by an injection of these same sub- stances into the blood, as in Billroth's experiments.* In these experiments there was no chill, but tlje tem- perature rose immediately as liighas 40.5" C, and other symptoms of septicaemia followed, as diarrhoea and great prostration. Recovery frequently took place. ' Archiv far Klinische CMrurgie, 1862. In some cases, where the amount of injected material had been very large, death occurred, and then the only visceral lesions discoveral.lc were diffused conges- tions, especially of the inU'slinal mucous membrane. From these experiments the gravity of septicasmia is .«hown to be in direct ])roportion to the amount of putrid nuUters thrown into the blood, although in every case they determined a rise of temperature. IJelow a certain limit of (paantity, they could be supported; but above that limit, they occasioned more violent symp- toms, which finally proved fatnl. This gradation corre- sponds to that furnished by clinical experience — to the immense variety in the severity of septicaemic symp- toms, which are least of all after normal parturition ; greater alter wounds, and in proportion to their extent ; greatest of all when, long alter the original shock, new tissues have sloughed by the invasion of hospital gan- grene. There are, therefore, the strongest reasons for accepting the recent doctrine of I3illrotli, which inter- prets traumatic fever as a form of septicaemia, and .septi- caemia as a simple extension or aggravation of traumatic fever. Tliis analogy suggests that of numerous other affec- tions in which septicemia pla3's a prominent part, as hospital gam^rene, carbuncle, malignant pustule, typhoid fever, variola, ulcerative endocarditis, even erysipelas when the effort at cutaneous elimination has proved unsuccessful. In all these cases the evolution of the affection seems to be connecteil Avith the presence in the blood of rapidly decomposing substances, whose metamorphoses accelerate those of the animal tissues, including the blood, and thus raise the temperature of the body. It is in virtue of this rise of temperature that septicae- mia is allied to pyaemia; lor the injection of pus into the veins, even when it produces no other effect, gen- erates fever as intense as that jiroduced by the injection of putrid non-purulent fluids — fever which may end in death. In other resjiects the symptoms and march of pyaemia are quite different from those of septicaemia. As every one knows, pyajmia originates most fre- quently in some lesion of bones, which places the wounded osseous tissue in immediate communication with the air. The larger the bone, the greater the danger, which is most to be dreaded after injuries of the femur. Who is not liamiliar with the train of events that, in such a fatally large number of cases, follows upon an amputation of the thigh? The patient may have recovered from the initial traumatic fever, and on the fourth or fifth day be apparently in very good con- dition. Suppuration, which set in on the third day, be- comes profuse, but the pus remains thick, yellow, lauda- ble, or only slightly offensive in smell. Thus, suppura- tion precedes the invasion of pyemia, while the symp- toms of teptica^mia generally begin before the establish- ment ofsuopuration, or arrest it if pus be already form- ed. The wound is extremely painful, and its sensitiveness seems to increase instead of diminishing. The process of dressing the wound throws the patient into an agony ; but when this is over, he is comparatively com- fortable, often extremely hopeful and sanguine. One day, generally between the fifth and tenth, the nurse observes that the patient has eaten less than usual. In reply to inquiries, however, he asserts, sometimes quite vehemently, that he is perfectly well. A day or two later he acknowledges having had a slight chill or fever, that he refers to only on account of the persistent questionings of the surgeon. Sometimes several days, even a week, will elapse before the chills are repeated ; sometimes they follow in rapid succession, coming every day, or even twice and thrice a day. It is ex- THE MEDICAL RECORD. 77 tremely rare that only one chill precedes the invasion of fever ; and even then, this invasion only occurs after a certain interval. The chills are very apt to return after the establishment of fever, and checker its course in a way never seen in pure septicajmic infection. The rise of temperature occurs sometimes after tlie complete subsidence of the traumatic fever, in notable contrast witli that of typical cases of septicaemia. It is rarely as rapid, as intense, or as continued as in the latter case ; for some time it presents very marked morning remission, and only gradually rises into con- tinuity. The appetite and strength fail, and the patient is conscious of his increasing weakness, and complains of it, as is never the case in septicjemia. Hence it seems much more notable. The skin and sclerotics assume the characteristic yellow hue, extremely unlike the red parched flush of septicaemia, and analogous to that of cancerous infection, with which Bihroth compares it. It is one of the forms of jaundice described by Gubler, dependent on a destruction of red corpuscles in the blood. The tongue of the patient becomes dry, but never blackened by fuliginosities as in septicaemia. The intelligence remains clear, but the mind begins to be darkened by gloomy forebodings, by a semi-conscious- ness of the dissolution of vital forces already begun. During this time the aspect of the wound is little changed, the suppuration is abundant, according to Billroth is increased, and my own observations accord with this statement. An extension of suppuration takes place, as the older writers would say, and is mani- fested in one or more of three different ways. In the first place, cold abscesses may form in differ- ent parts of the cellular tissue, generally of the extremi- ties, sometimes in the more decumbent portions of the trunk. In the second place, purulent eflfusions njay take place into the articulations, or serous cavities, and that with extraordinary rapidity. This pin'ulent ar- thritis is a very common manifestation of infection dur- ing the puerperal state. I remember one case especiall)^, which I had an opportunity of observing at tlie cliniqne, that might be considered as a type of this class. The patient had had an attack of subacute metritis, wiiich was subsiding, when she complained of pain in her It-ft elbow-joint ; and in the course of tweniy-four hours the articulation became evidently filled withlic[uid, swollen, extremely tender, but without any inflammatory red- ness. The only other symptoms presented by the patient v/ere diarrhoea, and a certain dulling of the in- telligence. M. Depaul immediately pronounced a fatal prognosis, which was justified four or live days later by the death of the patient with all the symptoms of purulent infection. These external suppuration-s, however, indicate a com- paratively curable form of the disease, and, when mani- festations of the infection are confined to the cellular tissue or the articulations, the patient may recover. I have seen three curious cases of this categor3^ After a compound fracture of the tibia, a patient was affected with cold cellular abscesses in various parts of the body, and with purulent effusion into one of the knee-joints; yet he ultiuiately recovered. In anotlier ca^-e, also of compound fracture of the tibia, the patient had had three chill--, and an abscesr; had developed in the thigh. After the administration of quinine, the course of the infection seemed to be arrested, and the patient recovered. In a third case, the purulent infection had origi- nated in an anthrax, which had been followed by abscesses in the breast, gluta^al region, and leg, and by an effusion, probably purulent, in the knee-joint. Notwithstanding this multiple suppuration, the patient recovered, and the articular effu.sion was reabsorbed with the rapidity so remarkable in such cases. These cases recall the experiments of Sedillot upon dog'j, where injeclion of pus into the veins was fol- lowed by the development of external abscesses, but finally by recovery. External suppuration or suppura'ive inflammation of serous cavities may, however, of itself prove fatal, as in a case that I saw at the Children's Hospital, where purulent infection is comjiaiatively rare. A child four years old had been submitted to Chopart's amputation of the foot, on account of a fungous arthritis, accom- panied by necrosis of some of the medio-tarsal bones. The first few days after the operation passed very well; then secondary fever set in, and was followed by sj'-mp- toms of arthritis in both elbow-joints, and of double pleural effusion. Death occurred about a fortnight after the operation, and at the autopsy were found .abundant purulent effusions in the articulations, in both pleural cavities and in the peritoneum. This purulent peritonitis had been latent and quite painless, and had probably taken place during the last days of existence, when sensibility was blunted. There were no traces of metastatic abscesses in lungs, liver, or spleen. These metastatic visceral abscesses constitute the third form of generalized suppuration, and the lesion most characteristic of pytemia. The invasion and march of the disease seems to coincide exactly with their devel- opment and evolution. To them is due the dyspnoea that occurs early in the disease, while that of septicaemia, dependent on the poisoning of the mass of the blood, does not supervene till later. The respirations are rarely below forty, sometimes as high as fifty or sixty. With the progress of one or the other of these suppu- rations, the prostration of strength increases. All the powers of life seem to be graduall}^ dissolved apart irom one another, and drift away separately before sinking down into the sea of nothingness that is rising to engulf them. Hence towards the close, a peculiar incoherence of the mental faculties and of speech, that is quite distinct from the delirium of septicaemia. The patient will interpolate absurdities in the midst of a conversation whose general tenor is reasonable ; he has tempoi'ary hallucinations of vision ; he loses all capa- city for comparison, and consequently for astonishment ; his mind resembles that of a person in the incipient stages of dementia. This ataxia of the intelligence finally extends to the spinal and peripheric nervous system ; there is carpholo- gia, the wandering involuntary movements by which the patient seems vainly endeavoring to clutch at the life that is slipping away from him. Finally, conscious- ness is entirely gone — the patient lies on his back with his eyes closed, already half a corpse. I have seen one case where this condition was prolonged a month, and Mr. Paget relates similar cases of chronic pyaemia, where, as in Edgar Poe's story, the patient seems to have been magnetized when at the point of death, and his dissolution arrested, but left constantly imminent. It is during this last period that the suppuration on the wound diruinishes. The autopsy of patients who have succumbed to pyte- mia reveals one or other of three charactf'ristic lesions, and very frequently a combination of all of them : osteo- myelitis ; venous thrombi, with or without phlfbitis; visceral abscesses, or purulent effusions into the articu- lations or serous cavities. The osteo-myelitis, whose presence might have Ijeen inferred from the constancy with which pyaemia is as- sociated with lesions of the bones, is extremely fiequent. M. Ranvier, in an article published in the Lijons Mid- iaile for last May, observes that he found it in all the •8 THE MEDICAL KECORD. Riitopsies made at Val de Grace durin;^ tlie siege. M. Gos>-^elin, ill his clinical lectures, always insisted upon this coincidence, aned of peculiar properties, and to them must be due the lobular inflam- manon of the lungs, and the suppuration in which it so rapidly terminates. This local inflammatory jiroperty may be considered identical with the general pyrogenic action that these same fluids exercise on the blood, and both depend on the accelerated metamorphosis of tissue and consequent generation of heat due to rapid chemical combinations. Difi'used suppurative inflammations are, tlierefore, unquestionably the proximate cause of visceral metas- \tatic abscesses ; and Ranvier, in his recent paper already a'luded to, considers them sufficient explanation, with- out any necessity for the intervention of embolism. This distinguished microscopist declares that he never found the small vessels surrounding the abscesses to be obstructed; but on the contrary, during the ascending period of the abscess, they were always gorged with blcod. These negative facts prove nothing, however, against the former existence of capillary embolics, which disappeared in the midst of the vascular afflux their mechanical and chemico-vital irritation had determined. At all events, these inflammations which M. Ranvier shows to be nodules of catarrhal pneumonia, with pro- liferation of epithelium, are very different from the dif- fused patches of congestion or gangrene determined by the injection of putrid matters, whether these be puru- lent or non-purulent. In the latter case the eflect on the general mass of the blood overpowers the local effect on special groups of capillaries. The lesions, those of septicaemia, resemble those of typhus, while the catarrhal pneumonia of pyemia resembles that induced by injection of solid powders into the bronchial tubes. The peculiar relations of the capillary net-work of the lungs to the circulation, net-work which must necessa- rily be traversed by any solid particles circulating in the blood; the coincidence in pyiKuiin, of such conditions as render tlie circulation of such particles highly proba- ble; the almost universal localization of pyaeiiiic ab- scesses in the lungs, where Billroth found them in seventy-nine out of eighty-four cases ; the coexistence of all grades of lesions intermediate, with ecchymoses and infarcti, and completely formed abscesses; all these facts indicate that the first-nameil mode of the action of pus — that where it acts as a medium for difl'using solid irritative particles — is one of the most characteristic, and that w hich chiefly distinguishes it from non-puru- lent septic fluids. In the second place, the fact that repeated injections of pus will produce effects that cannot be determined by a single injection, imply that the pus may act by a previous special alteration of the blood agam different from that of .septicasmia. According to Sodillot, the effect of repeated injections of pus is to accumulate its cor- puscles in the blood, and thus block up pulmonary ca- pillaries by a peculiar kind of embolism. But this could not be true in clinical cases, for there the pus is not injected directly into the veins, but its elements, if they penetrate into the circulation at all, are diffused gradually in too small proportions to cause mechanical obstruction.* Billroth admits a multiplication of the white blood- corpuscles, and an increased tendency on their part to accumulate in the capillaiies of the lungs, whence the metastatic abscesses. He thus explains both the excess of white corpuscles noted by Sedillot, and also the pe- culiarity of the action of pus, as distinguished from that of septic non-purulent fluids. Perhaps it is not too hypothetical to connect this excess of white corpuscles with the tendency to puru- lent efi'usions in the splanchnic serous cavities and in the articulations. These do not depend upon inflam- mation, for that seems rather to follow than precede them ; and thc-y may be reabsorbed with a rapidity un- known in ordinary purulent arthritis. "When the pus is putrid it acts like putrid fluids, and determines not pya3mia, bijt a septicaemia of peculiar malignanc}'. The poison generated in pus, therefore, seems to be much stronger than that of other fluids. Having passed in review the notable differences that exist between septicaemia and pya?mia in regard to their symptoms, the time and mode of their invasion, their anatomical lesions, and their reproduction by ex- periment, we are led to inquire whether these differ- ences depend upon the operation of different poisons, or of the same poison operating in diff'erent conditions. The second doctrine is most emphatically affirmed by M. Verneuil in tlie recent discussion at the French Academy. He declares that pyjemia or purulent infec- tion is to be regarded as an accidental complication of a general disease, septicaemia, which in a mikl form, at least, exists necessarily in the case of every open wound. Septicaemia depends upon the absorption of sepsine, generated in the traumatic fluids; pyiemia occurs when this sepsine impregnates emboli that, carried to the lungs, form metastatic abscesses, cf which each becomes a new focus of infection. The term sepsine, invented by Bergmann and adopted bj' Yerneuil, represents the unknown quantity existing in purulent or putrid hquids that gives them their pe- culiar pyrogenic properties. Great eflbrts have lately been made to isolate this hypothetical substance. Panum and Hemmer have shown that it exists partly in the serum of the pus, partly in the filtered globules. * M. Pornariiuay has recently performed some experiments, coiisi« dered to prove that such penetration does take place. See Archives Generales for December. THE MEDICAL RECORD. 81 It is not volatile, and cannot be distilled from pus, but remains behind in the dry residue. An aqueous extract of this residue is toxic, and, moreover, will ditruse through animal membranes, and communicate its pro- perties to pure water on the other side. Tlii-! diffusi- bility is an eminent characteristic of the "sepsine," so called ; and in virtue of it Bergmann claims to have iso- lated the toxic principle from many others with which it was associated, including inorganic matters, albumi- nous substances, and leucine. Direct experiments with a number of substances, as various salts of ammonia, sulphide of carbon, solutions of leucine or tyrosine, either produced no effect, or symptoms cpiite different from those of septic or puru- lent infection. With sulphide of ammonium alone, Weber, who employed much stronger doses than Bill- roth, obtained a notable rise of temperature and aseptic inflammation of the intestinal mucous membrane. Until the toxic principle in the two cases shall have been isolated its unity cannot be considered proved. In the mean time the following facts speak in favor of the existence of two poisons analogous to each other, but not identical. 1st. That non-purulent liquids, holding solid particles in suspension, do not determine the same lesions as purulent serum, that has first been filtered of its glob- ules and then associated with inert powders. 2d. That the train of symptoms which occur after the establishment of suppuration, are not merely different in degree, but in kind from those which have preceded it. ;-id. That pus exercises an action apart from that de- termined by its putridity. 4th. When pus is putrid it is a more violent poison tiian other putrefying traumatic fluids. Clinically the presence of putrefying pus is associated with the mixed disease, septico-pyajmia. the most fatal of all surgical affections. 5tb. The conditions of the diffusion of pus have been shown to be different from those of primitive septi- casmia. Independently, however, of the probability of som.e special toxic agent in pus, which gives a peculiar char- acter to pyaimia, the existence of metastatic abscesses introduces new complications by multiplying the foci of infection. From each abscess new pyrogenic material is continually being thrown into the blood, and when the abscess is situated in the lungs, the material that has been formed there is probably peculiar, on account of the peculiar exposure to air to which it has been submitted. The dependence of the characteristic march of pyasmia ! upon metastatic abscesses, is shown by the insidious invasion of its symptoms at this moment of their forma- tion, and by its gradual intermittent progress in pro- portion to their successive evolution. Hence tlie initial chill uft^r the subsidence of traumatic fever; hence the increasing violence of the chills as the visceral suppura- tions become more numerous ; hence the peculiar dan- ger of pulmonary abscesses so much greater than that of even pya^mic abscesses formed in external cellular tissue. On the other hand, it is unquestionable that the vio- lence of pyajmia is not invariably in proportion to the number of pulmonary abscesses; and that in certain cases where the first symptoms have coincided Avith external suppurations, the abscesses found in the lunps after death are evidently of recent formation. I have seen several such cases, in which, even though the final catastrophe be attributed to the pulmonary complica- tion, yet it is imquestionable that pyaemia must have been prior to it. In these cases it is impossible to avoid belief in the direct action upon the blood of the ele- ments of pus derived from the surface of the original wound. The prophylaxis of septicfemia is more easily attained than that of pyaemia, because the conditions upon which septic poisoning depends are less peculiar than those of pyaemia. There is no special anatomical condition of tlie wound, such as exists when bony tissues are in- volved. The system is capable of tolerating the ab- sorption of a certain amount of septic material, and Avhen, from the extent of the traumatism, there is an excess of dead tissue, this may be removed by surgical interference. The great indications in the prophylaxis of septicaemia are 1st, to prevent the devitalization of new tissues ; 2d, to prevent the exposure of tissues thus devitalized to the action of infusoria, or animal germs, the agents of putrefaction. The first indication is pre-eminently fulfilled by purification of the air which the patient is compelled to breathe. This is effectual, not on account of any direct action upon the wound, but by maintaining the nutritive powers of the blood and its consequent action upon tissues whose vitality is threatened. So long as this vitality is maintained, the development of micro- zymes is to be little dreaded. The second condition is only completely fulfilled when air is completely excluded from the wound, and with it, on the one hand atmospheric germs, on the otherthe oxygen necessary to the development of animal microzymes. Air is nearly excluded when a wound is enveloped in an atmosphere of carbolic acid, and to such exclusion, must be largely attributed the favorable result of such treatment. Occlusion, either by this so- called " antiseptic " or by mechanical means, may pre- vent the decomposition of traumatic fluids ; but when this has once set in, nothing will arrests it, not even the destruction of the germs which may have been its cause, as we have seen, these die of themselves in the putrefying fluids whose putrefaction they have deter- mined. Hence a treatment directed to their destruc- tion would be worse than superfluous, if it led to neg- lect of the great indication in the prophylaxis of this stage, removal of the traumatic fluids from beyond the reach of absorbents. The greater facility with which this removal may be effected in the case of wounds of soft tissues explains their greater immunity from danger, and the for greater success of carbolic acid in their treatment. The septicaj- mia that may occur in the course of such wounds, de- pends upon the absorption of non-purulent decompos- ing fluids, and its intensity is in proi)ortion to their mass. When the fluids .-dready formed have been care- fully washed away, the use of carbolic acid, that will not, by the ordinarj' methods, ^»-ei'e?i< decomposi- tion, nevertheless restrain it, and hence reduce septicae- raic accidents to a degree of intensity bearable by the economy. It is in these cases that the efiect of good atmo?pheric hygiene is so apparent, by preventing the devitalization of new tissues. The most dangerous de- grees of septicaemia may be averted, and its worst form, hospital gangrene, be entirely banished from hospital waids. But pyaemia is connected with much more comphca- tcd conditions, many of Avhich are entirely beyond the reach of carbolic acid. It depends on the presence of a fluid that, once secreted, decomposes with peculiar facility, seems to generate a poison of peculiar intensity, and expose the products of its decomposition to ab- sorption at a moment that the power of absorption is at its maximum. It has been shown to act, not mere- ly in virtue of such decomposition, like all putrid fluids, but by a special effect on the blood, and by a special connection with the thrombi blocking up the veins 83 THE MEDICAL RECORD. surroiimliiig the wound. Whi'c the poison of sep- ticaemia is jjiiiieipally absorbed by tlie lymphatics, that of pyicmia passes almost exclusively by the veins, cither those in the bones, or those newly developed in the pranulalions of the wound. Tiiis poison is therefore contained in inaccessible canals, and carbolic acid lias as little effect upon it as it would upon an aljscess in whose cavity it had been in- jected and shut up to mix with its contents. A compa- ratively minute proportion of purulent poison is capa- ble of inllieting all tlie injury possible, so that great di- minution of the ma5s of toxic material has very much less elTect on the development of pyiemia than on that of septicjcmia. The control must be complete, or it is useless, and it nmst be exerc'sed not merely" in the general hygienic conditions to which the patient is submitted, but still more, over the local conditions pecu- liar to the anatomical nature of his wounds. From this i)redominanee of local conditions, pj'os- mia is, as might be expected, no exclusively hospital disea'^e. IJillroth asserts that it is as common in private practice as in hospitals, only when a death occurs that cannot be explained by hospital miasms, it is attributed to gastritis, or other accidental complica- tion. Mr. Callender, in the fifth volume of St. Bar- tholomew's Hospital Reports, shows tiiat although the mortality of city patients operated on in city hospitals was higher than that of the country, yet the mortality of country patients was the same, whether they were in large city hospitals, in small country hospitals, or even in average country practice. It follows that absolute exclusion of air from the wound is much more important in the prophylaxis of pyaemia than of septicaemia. The partial occlusion effected by incrustation with carbolic acid, is often sufficient for wounds of soft tissues. But for wounds involving osseous tissues, the apparatus employed by M. Maisonneuve at the Hotel-Dieu is much better adapted. Most American surgeons visiting Pai'is have had an opportunity of observing this method of treat- ment, but 1 do not know whether it has been intro- duced into this country. The moment that a limb is amputated, the stump is surrounded by a conical gutta- percha cap, whose rim fits air-tight to the skin. From the apex of this cap passes an India-rubber tube that connects with an aspirating pump. B}' means of the pump the liquids from the wound may be drawn off, and discharged by a second tube into a receiver. Dur- ing the intervals, the elastic walls of the cap and tube coming from the wound, fall together so that no air is in contact with the suppurating surface. To dress the wound, the tube is detached from the pump, and connected with the tube of a bulb-syringe, in whose continuity is inserted a short piece of glass tub- ing, so that the operator may watch the stream of fluid he injects upon the stump, and be sure that no bubbles of air pass over. The detersive licpiids employed are either tincture of arnica or a solution of carbolic acid. These, injected in a continuous stream on the stump, are allowed to flow off by a secondary tube, connected with that of the bulb-syringe. In this way the wound is dressed daily, without the least exposure to the air. The apparatus may also be used in cases of accidental traumatism, as compound fracture ; but here it may be less efficacious, when the dead tissues have already been for some time exposed to the air. As fir as my own observation extended, this appa- ratus yielded excellent results, and the principle upon which it is based seems certainl}^ most rational. I am unable to tell why it is not adopted in other surgical wards than those of M. Maisonneuve.* * I found. aftPT writing the above, an account of Maisonneuve's appa- ratus in the fifth volume of the PractUionei\ FORCIBLE MANUAL DELIVERY IN PU- ERPERAL CONVULSIONS. By JOHN M. JULIAN, M.D , The small number of reported ca,sesof manual version in puerperal convulsions prompts me to offer a contri- bution to the subject, with a view of calling the atten- tion of the profession to an efficient means of saving the life of mother and child, which means have not received the attention which, in my opinion, they de- serve. This is more particularly the case since anes- thetics have been found to be so uscfid in the manage- ment of the various complications of labor. I was fu-st led to favor forcible manual delivery by hearing of the death in convulsions of a primipara un- delivered, aged 19, eight months advanced, whom I had visited incidentally. In that, case I learned that thij persistent administration of chloroform had uo result whatsoever. After having seen this ca;e, I determined to try, in a similar case, the effect of Ibrciblc delivery. An oppor- tunity for so doing soon presented itself On the 9th of June, 18C4, I was called to see Mary M., set. 21. She was six and a half months pregnant, had been eight hours in convulsions, was ura;mic, had stertorous breathing, pulse rapid and feeble, pupils insensible to light, and the os barely admitting the end of the index. With much less difficulty than I had previously antici- pated, my hand was introduced into the vagina, next the index, and subsequently, one by one, all the other fingers were forced through the os ; next the hand was passed in the uterus; one knee was hooked and brought down ; find the delivery of a male child accomplished, in the course of about tw-enty minutes. The convul- sions did not return after delivery ; but she never rallied, and expired the next day. Case II. Reached Mrs. S.'s bedside September 8th, 1S64 (town of Guttenberg), a;t. 3G, primipara, whowa.s in labor, had frightful oedema of body, was insensible, and had stertorous breathing. Had been fifteen hours in convulsions ; os admitting the end of the index finger. I administered chloroform at once, and thereby con- trolled convulsions, so as to enable me to deliver a pair of male twins, the first, by version, being still-born ; the other, by pedal extraction ; alive. There was one slight convulsion three hours after delivery. Con- sciousness returned the next morning, the albumen disa[ipeared at the end of the sixth day, and mother and child made a rapid recovery. Case IlL Saw Mrs. S., set. 23, in consultation, Nov. 21, 1SG5 ; primipara. with the usual uraemic symp- toms ; had been fourteen and one-half hours in con- vulsions ; insensible and stertorous since first attacked ; OS undilated, no apparent symptoms of labor present ; digital and manual dilatation and version performed in less than thiity minutes, (with sanction of her medical attendants), in the usual way, under chloroform. One slight convulsion three hours after delivery ; she re- mained insensible and afterwards delirious for over fortj'-eight hours, from which she recovered; but succumbed, one month from date of delivery, to an attack of pleuro-pneumonia. Child ever after subject to occasional epileptic convulsion, who died two years after, of cerebral disease. Case IV. Saw, in consultation, on the first of March, 1866, at 11 A.M., Mrs M. Stage of pregnane}', eight and one-half months, primipara, urine two-thirds albuminous, countenance antemic, fixed pain in fore- head, nausea, pulse rapid and feeble. Counselled in- duction of labor. At 5 p.m. a convulsion occurred. At THE MEDICAL RECORD. 83 9^ P.M., with the concurrence of her medical attendant, she being fully conscious and about the room at the time, OS closed, was placed in the recumbent posture, and fully aniusthetized. I inserted my hand as before (encountering' this time a little more rigidity than usual), and delivered twins — the first child by version. Both children lived. The mother made a rapid and uninter- rupted recovery, tlic operation occupying about half an hour's time. Case V. Saw, on August 4, same year, a next-door neighbor to !Mrs. M., Mrs. W. Stage of pregnancy said to be eight months. Had been about ten hours in convulsions ; primipara, urtemic, deep stertor, pulse rapid and feeble, circulation apparently ceasing. Had been previously to my coming ineffectually anjesthetized during several hours ; os undilated. I proceeded at once to deliver in the usual way, which Avas soon accom- plished, this time without anaesthesia. The convul- sions ceased after delivery, but she expired the next day. Case VI. Mrs. J., a?t. 22, secundipara, who, during her previous pregnancy (sixteen months from date), had suffered from uraiinic convulsions, ending, five or six weeks after their occurrence, by the spontaneous expul- sion of a decomposed foetus; whole growth appeared to be of about five months. I was requested to see her on the 5th of March, 1869, at 4 a.m.; said to be in her seventh month ; face and lower extremities oedematous ; headache, nausea, pulse about 54 ; had had two con- vulsions previous to my coming; medical attendant gone home 12^ p.m. ; return of convulsions and vomiting, pulse 40 ; insensible, os closed, no symptom of labor. I at once proceeded to perform version under chloro- form, and in the usual and above-described way, which was accomplished in about twenty minutes ; child a male one, non-viable. The convulsions never returned, consciousness became gradually restored, and she made a rapid recovery. On the 6th of June, 1871, she was again spontaneously delivered at eight months of another male child, but this time without; convulsions ; child died on the twelfth day, of epileptic convulsions; albumen Avas again detected in Mrs. J.'s urine. In conclusion, I will state that my object in publish- ing the above has been to induce others to give the re- sult of their experience in this matter, and help to establish, by a sufficient number of precedents, the propriety or impropriety of the operation. Inas- much as a great number of obstetrical authorities look upon the measure as a most desirable one if it can be accomplished without injury or detriment to the pa- tient, I think that on this point the general result of my cases ought to have a tendency to dispose of this objection, and demonstrate that the operation can a priori be performed with tolerable safety and celer- it}'. They also suggest the belief that, under full an- aesthesia, the question of non-dilatability of the os has not been as yet properly or sufficiently looked into ; and that, at least in special cise^, this operation ought to take precedence over the safer but more tardy rule of induction. Theref ire, I feel most sanguine in the belief, that should this mode of procedure be more generally fol- lowed, in like emergency, the mortality tables of puer- peral convulsions would become notablv improved, and the lives of fewer women and children sac- rificed. In corroboration of the preceding remarks, I beg to observe that, in a very extensive search made into the . literature of the subject on manual dilatation in puer- P-^ral eclampsia, I have found but five cases, which, however, fuily substantiate m}'' views : one of these will be found by Nocggerath and Jacobi, another by Dr. '' Paget, one by Dr. J. H. Ross, and two by Dr. Holland, copied from the Lancet, and found in Braithwaite's Re- trospect, Vol. Ixiv., the results of all of which were successful, and one equally successful in Milne. I will further observe that the large sanguineous de- pletion deemed indispensable, and so firmly relied on, is fiilling into disfavor. In the Guy's Hospital Re- ports for 1871 will be found a scries of cases, by Dr. Phihps, in which bleeding was not resorted to, and chloroform mainly relied upon for the control of con- vulsions ; a practice which has likewise been followed, in the latter part of his life, by our late distinguished fellow-to\vn=man. Prof Geo. T. Elliot. 273 West 21st st., New York. procuress of iHetJical Science. The Blood in Syphilis. — Dr. Lostofer's alleged dis- covery of bodies peculiar to syphilitic blood, has led to considerable discussion in Vienna, the most promi- nent of his opponents being Dr. Wedl, who claims that they are only oily particles obtained from the sebaceous follicles in the operation of puncturing the skin. The bodies under question are described as having a diame- ter ranging from jii^nr to T^riuir of an inch, their con- tour being sharply defined, and light being strongly re- fracted by them. They are said to have a greenish- blue tinge. With regard to the vacuoles with which these corpuscles are said to become surrounded, Dr. Wedl believed them to be the result of a destructive process, being induced by the development of water and of carbonate of ammonia during decomposition of the blood, the same phenomenon being observable when an emulsion of human fat is heated with a solution of potash. The reason why Dr. Lostofer had seen these corpuscles only in blood after four or five days, and not in fresh blood, was that they were covered by the blood corpuscles. Professor Strieker said he had placed a hundred specimens before Dr. Lostofer who had diagnosticated correctly those taken from syphilitic patients, with the exception of twenty doubtful eases. He did not venture to assert that they were either germs or fungi. Dr. Neumann said that nearly four years ago Hallier described the structures found in the blood in infectious diseases, including syphilis; he said these gave rise to syphilis, and their most minute elements penetrated the blood corpuscles and rendered them diseased. The^e corpuscles multiplied by division, assuming the charac- ters o{ coniothecium. Hallier had found them in syphi- litic paronychia, condylomata, and in other manifesta- tions of syphilis. Oklotsch had also found traces of them in the skin as well as in the blood. The result of experiments which he had made Avith specimens of blood from persons presenting various forms of syphi- lis Avas, that bacteria Avere developed in the blood-cor- puscles of the infected blood which differed in no re- spects from those developed under similar circumstances in the blood from other contagious diseases ; even after so long a period as tive months these organisms multiplied in their OAvn forms, and. in spite of the addition of the A'arious organic and inorganic substances, no fungi Avere found. Since Dr. Lostofer had announced his dis- covery, he (Dr. Keumann) had made fresh investiga- tions, and had found that the corpuscles might be de- A'eloped in various numbers and sizes in different kinds of blood. He had found them in the blood of small-pox, eczema, etc.; and therefoie they could not be regarded as a specific indication of syphilis. 84 . THE MEDICAL RECORD. The discussion tcnnina'cd with the aiipuintiiioiit of a comiiiitti'C to invcsiij,'ale the suhjict, c'oii8istiii<,' of Dr.". K(>kitnii*i1>, liausch, ;ur1 Aiispitz. Dr. Kraus, cdiior of the Alg. Wiener Med. Zeil., m of the opinion thai Dr .Striek- er, IIol>ra, and others have been deci-ivid, and have acted nio^t unwi.-ely in furmin;.' their opinions so rapid- ly. Sk(;da i^ecnis also to have been very precipitate. Protr.\ctkd Gk.«tation with PuEnrEnAi, Convi'l- Pioxs. — K. P. Bernanl}', Philailelpiiia {I'liVa. Med. Times), relates a case of protracted <::estjitiun, in aprinii- para, in which the child was carried, he believes, three liundrcd and forty-four days. During tliirty-three convulsions, extending over a space of eight hours, eleven .>urely scientific subject. Every one who takes the trouble to go to a College Commence- ment is willing to admit that medicine is a noble pro- fession, in fact the noblest of all professions, that, the graduating class have shown a lemarkable proficiency in their studies to gain a d'ploma from a faculty so jealous of the interests of medical education, and that, all told, the said college must be the best in the countiy. Every one is willing to admit, for the sake of the argu- ment, that it is up-hill work to succeed in the practice of medicine — that even those brilliant young men who with demure looks and bowed heads are receiving the professorial blessing are not exempt from the applica- tion of the saying that " there is no royal road to knowledge;" all this is a very old story, and if it is to be told, after the stereotyped flishion, witli the worn- out anecdotes from Smiles' Self-Help, and Jeaffreson's Bijoh ahout Doctors J becomes almost unbearable. Now, why can we not keep up the new fashion of inviting some practised and entertaining speaker to interest our commencement audiences ? This has been tried with good effect on more than one occasion, and we see no i-ea.-on why this practice cannot be kept up. The addresses of the valedictorians are well enough in their way. They give a variety to the entertain- ment, and, in return, the audience is generally good-na- tured enough to submit to the habitual sophomorical display of oratory. The only improvement that could be suggested in these addresses, would be to have them as brief as would be consistent with the gratifi- cation of the speaker. I3ut there is one aspect of this subject which in this connection deserves a passing reference. The changes that have been wrought in our college exercises have had the eflcct, at least, of drawing large audiences, as large perhaps as usually attend the literary schools on such occasions. This has an unquestionably good influence upon the general pubhc in impressing them with the fact that there is an enthusiasm in the cause of medical education, and that our medi- cal institutions are progressive and prospering. Each institution has the opportunity of maintaining a gen- erous rivalry in this respect, and if limited by the rules of ordinary propriety, we have reason to expect that the jealously-guarded dignity of the pro- fession Avill not suffer. But that there is danger of carrying the competition a little too far is pain- fully manifest in more than the mere commencement exercises. The colleges, stimulated by their respective successes, are promising to become the centres of un- compromising cliques. Already with some fanatical in- 86 THE MEDICAL RECORD. diviJunls tlie fi't'ling of competilion is fostered to that extent tliat hardly the actual courtesies arc alloweil be- tweon the parties of the diflerent schools. In the in- teresLs of the general profession of this city we arc sor- ry to entertain tlie suspicion of inij)eiiding discords. We rejoice in the pro.>ution to the various regions of the cu- taneous surface, and to all the umscles. By WlLLlA.M IlKMiY Fi-oWKU, F.R.C.S., Assistant Surgeon to, and Demonstrator of Anatomy at, the Middlesex Hospital. I'ilited, with addition.s, l)y WiM.AM W. Kkkn, M.D., Lecturer on Anatomy and Ojjorativc Surgery in the Philadelphia School of Anatomy, etc., etc. Phila- delphia: Turner Hamilton. 1872. 4to, pp. 11, with full-page lithographic plates in two colors. Price, $1.50. We are glad to see these standard diagrams placed within reach of American students and practitioners, in a form more convenient for use tlian the English (folio) edition, and at less than one-fourtii its expense. For presenting clearly to the eye the salient points of what is unquestionably to the average student the most diffi- cult, and so the most neglected, part of de8cri|)tive anatomy, they leave almost nothing to be desired. Where improvement on the original seemed possible, it has been made by Dr. Keen with the same clear, prac- tical. judgment which we had to thank, a year or two since, for the remodelling of Heath's Anatomy. That book, with his additions and modifications, a teacher of our acquaintance, who has given it two winters' trial in the dissecting room, pronounces the best working dissector in the English language. A Text-Book of Pathological Histology ; an intro- duction to the study of pathological anatomy. By Dr. Edwaud RiNDFLEisrn, 0.0., Professor of Pathological Anatomy in Bonn. Translated from the second German edition, with permission of the author, by William C. Kloman, M.D., assisted by F. I. Miles, M.D., Pro- fessor of Anatomy, University of Maryland. Phila- delphia: Lindsay it BlakLston. 1872. Ax Ixtuoductiox to Pathology and Mokbid Ana- tomy. By T. Henry Green, M.D.. London, Lecturer upon Pathological and Morbid Anatomy at Charing Cross Hospital Medical School. Philadelphia: Henry C. Lea. 1871. It may, we think, be asserted with truth that in no department of practical medicine has such materinl prog- ress been made of late years as in that of pathological anatomy. This progress has been so thorough that it has rendered the works published upon the subject ten or fifteen years ago almost valueless, or, at any rate, has rendered large portions of them utterly valueless, and has caused a more or less complete modification of the balance. It would seem that to Germany belongs the credit of thoroughly and laboriously studying patho- logy, and of bringing it to its present standard, and that the German mind, which works slowly and carefully, avoids theories and aims for truth, is specially adapted to the task of studying pathology, which can only be mastered by patient and long-continued observation. Previous to the publication of the volumes the title of which licad this article, pathological anatomy was in a very complex and unsatisfactory state in this country, and the same may be said of the state of our knowl- edge of normal histology. As text-books upon patho- logical anatomy we made use chiefly of those of Vogel, Cragie, Jones, Sieveking, Wedl, and Wilks, all of which were entirely too antiquated. Witli these ex-; ceptions, and perhaps some portions of works upon the practice of medicine, treating upon the subject, and the occasional translation or resume of an article on patho- logical anatomy in the journals, we were wdiolly desti- tute of a work embracing the whole subject, and in this connection we may add, that although Virchow's work on Cellular Pathology treated of tiie subject, yet as it was devoted to a theory and did not embrace the whole THE MEDICAL RECORD. 89 subject, it failed of the purpose of a text-book. The great cause of tliis want of a text-book upon patholog- ical anatomy, we think, lies in the fact that as this subject is not systematically taught in our schools, the interest which it should exercise was wanting, and hence the profession paid only slight attention to it. This absence, in our curriculum of medical study, of thorough means to convey instruction in pathological anatomy, is one of our moat serious drawbacks. In days gone by the absence of such instruction was unavoidable, as there was in reality no one sufficiently accomplished in ihe branch to constitute instructors in it; but now, owing to the enormous facilities offered in G-erman universities, many of our countrymen are fully able, as evidenced by the publication of their own observa- tions, to teach students of medicine this very essential branch thoroughly. It is true that many of the details of pathological anatomy are taught en courant in the courses on surgery and on the practice of medicine ; but pathological anatomy is a subject which certainly can- not be imparted by viva voce teaching, and can only be thoroughly mastered in the laboratory under com- petent instructors. Of late years the numerous able and important monographs upon pathological anatomy which have been published in the German medical journals, particularly Virchow's Archiv, have greatly interested the thinking portion of the profession on this side of the water, and there has existed a real desire for a lull treatise upon this subject. In looking through the massive treatise of Rindfleisch, a variety of thoughts suggest themselves, while we are amazed at the im- mense wealth of knowledge stored up in it. We pain- fully appreciate the fact that, owing to their deficient education, how few practitioners are there who Avill be able to really ma?ter its contents; whereas, if they had been carel'uUy instructed in this branch in their rudi- mentary education, what an amount of knowledge they could attain. The appearance of this book, with its diversity of subjects, its minuteness of inquiry, and the light which it throws upon such a multitude of patho- logical processes as are treated of in it, shows us really how little we know, and how as yet the majority of physicians are not sufficiently educated up to it. We really hope that ere long pathological and normal histology will be thoroughly taught in all of our colleges, and then the value of a treatise like this of Rindfleisch will be increased fourfold. Rindfleisch divides his work into two parts ; a gen- eral part and a special part. The general part contains a lengthy description of the decomposition and de- generation of tissues, including necrosis and involution, and the vnrious forms of infiltration. This chapter covers a wide range, and treat? fully of amyloid infil- tration, calcification, pigmentation, and fatty infil- tration. The second chapter of the general part treats of that important part of pathological histology, namely, the pathological new formations. Following a very succinct review of the various cell-theories entertained by i^rominent German authors, we find a very instruc- tive consideration of normal growth as a type of patho- logical development. This very naturally leads to a general consideration of inflammation, Avhich also in- cludes a study into the nature of specific inflammations. After this follows a short but admirable description of the morbid processes taking place in the development of the various tumors, which is amply illustrated by drawings of sections of the various growths. In his second part Rindfleisch speaks of the lesions of each apparatus and organ separately under the geneiic title of anomalies of tiiem. Thus we have — anomalies of the blood and the places of its formations, especially of the spleen and lymph glands ; anomalies of the cir- culatory apparatus, of the serous membrane of the skin; of mucous membranes, of the lungs, of the liver; of the kidneys; of the ovaries; of the testicles; of the mamma; of the prostate; of the salivary glands; of the thyroid glands ; of the supra-renal capsule ; of the osseous system ; of the nervous system ; of the muscular system ; and finally the volume concludes with a copious index and bibliography. To analyze such a work thoroughly would require much more space than is at our com- mand, and we shall confine ourselves to briefly pointmg out some portions of the work whicli we think are of more than ordinary interest. Thus the chapter upon the anomalies of the blood includes a fidl review of the interesting subjects of the dyscrasi;c, chlorosis, leukte- mia, and melanajmia, and also a fidl description of thrombosis, which is particularly interesting in a clinical point of view and is ably written. The anomalies of the skin are fully naticed, and in that chapter persons in- terested in dermatology can find much profitable inform- ation. The forms of catarrhal and croupal inflammation are clearly described in the section upon anomalies of the mucous membranes. We know of no work or monograph to which our readers can refer where they will find all the recent views upon the various forms of lesion of the lungs as they will in Rindfleisch's article upon that subject. We can say the same of the chapter upon the anomalies of the liver, and must call particular attention to the admirable chapter upon the anomalies of the kidneys, a subject which has lilt ely attracted consider- able attention in this country, and which is here treated of in a masterly manner. Though all the chapters are of very great merit, we will still call particular attention to those upon the anomalies of the osseous and nervous system as being particularly interesting to physicians and surgeons. In considering such organs or apparatus, the author fully treats of it in a condition of inflamma- tion, so that in the book we have the fidlest account of that complex process to be found anywhere. The style of Rindfleisch is terse and clear, but avc must greatly regret that his work has not been well translated. As we read the volumes we are struck with the peculiar construction of the sentences and general lack of smooth- ness of the diction. In fact it suggests to the reader the idea that its translators are not thorough German scholars, and that they frequently have to make use of the dictionnry. The general appearance of the work is highly creditable to the publishers, and we are pleased to see the illustrations so well done. Dr. Green entiiles his work an Introduction to Patho- logy and Mcrbid Anatomy, and with great modesty states in the preface that he has endeavored to supply a want greatly felt, and that he wishes it to be con- sidered as a simply elementary work. He goes over the subject in hand quite clearly, and his work is writ- ten in a very pleasant manner; but the reader is con- tinually struck with the fact that it is too brief, and that the author does not do full justice to the important subjects treated of If in a future edition the author amplifies his work, we think, it will be really valuable. We think he has taken the excellent French mnnual of Cornil and Ranvier as his model, and that he would do well if he treated of his subjects as fully as they are treated of by those authors. Criminal Adortion. — Tiie detention of criminal abortion and a study of foeticidal drugs are ably pre- sented by Ely Van de Waiker, M.D., of Syracuse, N. Y., in "^a monograph of eighty-eipht pages, being a reprint from the Gyneecological Society of Boston. 90 THE MEDICAL RECORD. Ueports 0f Societies. MKDIOAL SOCIKTY^ OF THE COUNT\' OF NEW YOKK. Siaied Meetin>/, February 26, 1872. Dr. Abkaiiam .lAooni, Pkksidkst, in tl.c Chair. The following pliysifians, recommended by tlie Comi- tia Minora, were elected to membersliip : George H. Humphreys, Kdward C. Woodbury, William M. Bal- lard, Carlos P. Tucker, Alexander F. Liautard, Chailcs A. T. Krop, James Mitchels, J. W. S. Arnold, Edwin D. ^^orJTan, Jr., liobert S. Prentiss, Thomas IL Pooley, Horatio Gomez, and Gilbert II. Swezey. The Pkksident stated that the followincr work had been donated to the library by its autlior, and ho was instructed to make suitable acknowledgment: "Die Gejchiehte der Psychologic nnd der I'sychiatrik in Spanien, von Dr. J. B. Ullersperger, Wiirzburg, 1S71." Dr. p. p. Porter, from the Committee on Intelli- gence, read an interesting report of recent progress in Theory and Practice of Medicine. Dr. II. Ai.TMoF, from the same committee, read a por- tion of a long report on the progress of Ophthalmology during the past year. The conchu-ion of his report, and another report expected from the committee, Avere postponed to the next meeting. mkteorology of nine months. Dr. D. II. Goodwillie, chairman, presented the fol- lowing report of the Committee on Meteorology : May 20 to September 3, 1871. Barometer : mean 29.87 inches ; maximum, May 2d, 30.234 inches; mininuim, June 12th, 29.438 inches. Thermometer: mean, 71.91'^ Fahr.; maximum, July 10th, Or' ; minimum. May 23d, 54. Rain fell on 35 of tlie above 105 days, making an aver- age of rain on every third day. On 22 of the 35 rainy days tliere were thunder-storms. In July rain fell on 14 days, and on 10 of these was accompanied by thunder and lightning. Hail July IGth. June 18th, rain to the amount of 2.98 inches, and at 9.50 p. m. a slight shock of earthquake. Whole amount of rain during the 105 days, 21.35 inches. September 3, 1871, to February 4. 1872. Barometer: mean, 29.65 inches; maximum, Sep- tember 12th, 30.324 inches; minimum, January 23d. 29.592 inches. Thermometer : mean, 43.24** ; maximum, September 9th 68® ; minimum, January 30th and 31st, 10". Rain on 26 days, .snow on 7. Thunder-storm Sep- tember 2Gth. Whole amount of rain, 18.00 inches. dise.\ses of eight weeks. Dr. Ch.\p.le3 p. Russel, Chairman, read the report of the Committee on Diseases : The Committee on Diseases have the honor to pre- sent the following report upon the prevalent diseases in this ciiy from January 1st to February 24th of the present year— embracing a period of eight Aveeks : During that time there were reported to the Bureau of S;mitary Inspection 596 cases of small -pox. 123 of measles, 613 of scarlatina, 119 of diphtheria, 17 oftvphus fever, and 54 of typhoid fever. " I The total registered mortality for the eight weeks I amounted to 4,294, a weekly average of 537. During the corresponding period of tlie past year there were registered 3,996 deaths — a weekly average of 500. Tiic highest wickly average for the conespnnding period of cither nf the live pr-.-ceding years was 509 in 1870. Thus far, therefore, the mortality of the prc.«ent year has been much in excess over that of recL-nt years. The greatest mortality occasioned by any zymotic disease has been produced by smnll-piKr, namely, 192 deaths, a Aveekly aA'crage of 24. It has lluctuated be- tween 15 and 32 deaths weekly, with no appanMit ten- dency to diminish. Its proportion of mortality, as deduced from a comparison of the number of ca.se8 re- ported Avith the number of deaths registered, has been 32 in the 100. This ])ercentage, however, is doubt- less too large, as many non -fatal cases escape the ob- servation of the Board of Health. 47 deaths have been due to measles — about 6 weekly — a .small number. ScurJalina has carried off 190 persons, somewhat more than in the coriesponding period of the past year. Both of tlie two latter diseases .seem now to be slightly on the incrca.se. 00 deaths have been ascribed to diphtheria, and 118 to croups about the usual number. Whoopiuy-congh has continued very prevalent, its fatal cases having amounted to 165, over 20 per week. Ty- phus and typh'iid fever have both been marked by a very small mortality, having caused but 13 and 34 deaths respectively. 30 liave been occasioned by remittent fever, an excessive mortality lor the season. 15 i deaths have resulted froin diarrhfral diseases against 145 in the corresponding period of 1871 . The number of deaths from phthisis puhnonalis Avas, until quite latel}', comparatively small, much below that in the early por- tion of last year. But, during the past week, this dis- ease exhibited a most extraordinary f itality, its deaths reaching 122, the greatest weekly number ever re- gistered in this city, the next largest having beenil02, in the week ending March 4, 1871. The deaths from the local respiratory affections likewise seemed to participate in the same unfavorable influences, as they occa-ioned 105 deaths during the week, their Aveekly average having been only 85 since January 1st. Twenty-five cases of epidemic cerebrospinal menin- yitis, or spotted fever. haA-e thus far been reported, of which 12 have proved fatal. These cases have oc- curred, almost Avithout exception, in houses of the very worst hygienic character and surroundings, and generally in tenements particularly defective as regards drainage and scAverage. Whether such circumstances are directly concerned in the production of this peculiar disease is certainly a question of vast interest to the profession. CLINICAL THERMOMETRY. Dr. Lccirs D. Bulkley read a long and elaborate paper upon this subject, illustrated by numerous raural diagrams and tal)le.s. The paper was based on the essay to Avhich ^A-as awarded the Stevens Triennial Prize two years ago, and its purpose was not to present a history of clinical tliermometry. or an epitome of what it had accom[)lished, but rather to contribute neAv data for the thermomctrical study of disease, in a s5\siema- tized record of the experience of the New York Hos- pital for the three j'ears prior to August, 1809, and to state briefly the conclusions which that experience tended to establish. The number of cases in Avhich a record of tempera- ture was regularly kept amounted to 337, classified as follows : typhoid fever, 93 ; typhus fever, 23 ; pneu- monia, 64; erysipelas, 24; acute rheumatism, 17; re- mittent fever, 12; intermittent fever, 7; scarlet fever, 7 : phthisis, 19 ; acute meningitis, 9 ; tonsiliiis, 7 ; peri- THE MEDICAL RECORD. 91 tonitis, G; miscellaneous, 49. Besides the temperature, the pulse and respiration were always recorded, and the doctor had tabulated all the cases under each disease with reference to these three vital signs. Forty or fifty of those most interesting, either from their typical eliaracter or from some other circumstance, were given in detail, with diagrams showing the curves of the three signs. Each diagram was the record of an actual case, and faithfully exhibited every failure of observa- tion ; there were no typical curves made up from the generalization of many cases, as in AVunderlich's book. The nature of the paper piecludes any extended ab- stract, but we hope to see it published as a monograph. It is quite time that the wealth of experience, so long carefully hoarded in the case-books of the New York Hospital, should be brought out for the use of the pro- fession. We here confine ourselves to the doctor's concluding summary of the chief points he considers established : " 1. T!ie body heat is maintained in health, under all conditions, at the uniform standard of 98.4° Fahr. " 2. Any constant deviation from this constitutes dis- ease. " 3. A return to and continuance at this standard marks the termination of the disease. " 4. A single high temperature is important. " 5. The changes of temperature in diseases follow definite and known courses. " 6. Variations from these typical ranges of temper- ature in disease are significant, as indicating a disturb- ing cau~e. " 7. An irregular course is more unfavorable than a uniformly higli range of temperature. " 8. Different temperatures characterize different dis- eases, and various days of the same disease. " 9. Although a high temperature indicates a more severe attack, no heat under 109° can be considered surely falal. '■ 10. The daily study of the pulse and respiration in connection with the temperature is of great assist- ance. '"11. When the temperature and general symptoms agree, but the pulse disagrees, the two former are to be relied on. " 12. When the pulsa and general symptoms agree in indicating unfavorably, the temperature cannot be relied on, if contradictory, unless the improvement in respect to temperature is marked and persistent. " 13. When pulse and general symptoms agree in a favorable indication, a liigh or rising temperature should arrest attention. " 14. All other means of investigation should be used in connection Avith the temperature to obtain the greatest benefit from the latter. " 15. The continuous daily record of the three vital signs here represented, in the way exhibited, affords much aid in the diagnosis, prognosis, and treatment of disease, by the presentation to the eye of its history in these res[)ects. " IC. The systematic record of these three points may assist in determining, at some future day, the vexed cpiestion whether the type of disease is chang- ing, by preserving pictures which can be easily com- pared." THE ALBANY MEETING. ' Dr. E. Eliot, as one of the delegates to the recent meeting of the State Society, gave a summary of its proceedings. The Prksidf.xt wished to direct special attention to the following lesolution adopted at that meeting, and hoped each member would do his part toward inducing every respectable practitioner in the county to join the County Society : ^'licsolued, As the old laws, requiring every physician in good standing to become a member of his county medical society, have not been repealed, it is, and always has been, the duty of every sucli physician to obey tne law ; and as the penalty for non-compliance has been removed by law, it becomes a jxnntof honor for every regular physician to do so. The presidents and officers of every county society in the State of New York are requested to use their best efforts to have these laws complied with." With reference to the special meeting of February 3d, the President said that he had been obliged to call it in accordance with the by-law providing that such a call shall be made on the written request of twenty members. Twenty-four names appeared on tiie re- quest; t\venl3'-seven members attended the meeting, and of these only five were signers of the call. A meeting so attended, after full notification, could hardly be considered to have been a public necessity^- and it behooved those members whose politeness would not allow them to refuse an individual their signatures, to reflect whether they had not also some duty to the Society m a matter involving expense and the conve- nience of a large body of physicians. Adjourned. Correspontrencr. BATHING REDUCED TO A SCIENCE. To The Editor of the Medical Record. Sir : — It is always pleasant to couple reminiscences with prospects, particularly when it permits to do justice to the men of the past as well as to those who represent the nearest future. Tlie last pamphlet of Dr. Wilson Fox offers the opportunity of doing both. In seventy-eight pages lie gives several monographs illustrating cases of acute rheumatism exclusively treated by temperature as a remedi/, and almost exclu- sively managed by temperature as a means of positive diafjiiosis. Acute rheumatisms in which, after a course of variable severity, the temperature suddenly rises from 103°, 104° to 107°, 108°, 109° F., have so often proved fatal within a few hours after reaching the latter degrees, that Wunderlich legards them as pro-agonistic. The uni- formity of this termination, whatever plan of treat- ment had previously been followed, induced Dr. W. Fox to try to treat it exclusively by low temperature?. He pubhshed last year in the London Lancet veiy interesting accounts of his first trials; and now details his success in two cases which had reached, respec- tively, 110® and 107.3° F. ; both being primary attacks of the disease, Avhich are more commonly fatal. Dr. W. Fox does not, however, present his treatment by temperature as a remedy exclusively adapted to rheu- matism, but as the remedy for hyperpyrexias at large. Thereupon the question suggests itself, "What Avill be the next move?..." An essay on the Trentment of Apyrexia? . . . Then what becomes of the innumeni- ble diseases of modern ncsographies in a therapeutic point of view ? . . . Evidently the subject is too broad for the columns of a periodical. These monographs of Dr. W. Fox deserve besides to be studied as presenting the most complete speci- mens of diseases and recoveries in which the thermom- eter almost alone has done all the work of clinic and 92 THE MEDICAL RECORD. therapeutic, and the strongest practical indication of the revolution clearly expressed in the hook on Medical Tfinperiitiiie by C. A. Wunderlich and K. Scpnin (page 23S), " Tiu-rmometry will soon rule, not only dingno- sis, but pathology^and thcrapeutios." To consider a single fact in this prospective revolution, it is interest- ing to see how Dr. W. Fox advocates and systematizes the use of water — not as water or as one of the palhies, but as a carrier of measurable or dosable temperature, acting pliysiologically in virtue of physical laws. To render general this application of wut t, Dr. W. Fox insists unon the introduction in the wards of hospi- tals of movable bath-tubs, in wliicli the patient could go, or be immersed, as near as possible from his own bed. This liappy sng^'estion recalls to mind a mode of bathing patients which ought not to have been for- gotten. '■ Les hiiins sans baignoire" was the title of a little pamphlet handed to me, in the summer of 18.'35 or '3G, by a gaunt and weatherbeaten Swiss physician during my introductory visit to him in a meager Iodizing of the Qnartier Latin. He was wrapped in one of those broad blue cloaks in wiiich the Old Guard are represented falling at Waterloo. Under this historical garment he was taking his bain sans bai'pioire in a double lial)it of flannel and water-proof lie never took anv other, enjoying them especially when going on horse-baok to visit his patients, several miles away; and the three hundred and oild patients of his hospital used the same bathing apparel for many years and liked it very much: indeed, there was not a single bath-tub in the hospital of Lauzanne. For mine host was ue of Avhom it has been said: — " There are two systems of surgical deligation, the one handed to us under the name of Hippocrates, the other Mayor's." He had come down to Paris to have one of his free liLrhts upon his proposed improvements with the old fogies of the Academy of Medicine, too nu- merous to mention : this was Mathias Mayor's yearly recreation. Now it seems to me that this forgotten bain sans baifjnnire would be just the thing which, with slight modifications, would render easy in hospitals, and pop- ular among the middle classes the treatment of hyper- pyrexia by medical temperatures, not only in public institutions, boarding-schools, naval, military, industrial, and s:ientific expeditions, etc., but in the homes of the many who have no bathing facilities. The apparel would consist of a litrht stand, like the foot-step used in a library, upon which could be set a covered reser- voir of a few gallons, having inserted in one of its sides a rib of glass, showing the level of the liquid, and an ordinary thermometer to regulate the temperature of t'le latter. Hence, one pipe or more would let down the water into the bathing-dress. This dress — which entirely enrobes the patient, even if need be his head and some parts of Ids face — is double, of thick flannel against the skin, and of vulcan- ized cloth outside. It is also open in the centre, like a pouch, to permit the insertion of the medical thermom- | eter in one of the natural cavities, at various points to \ admit the water from the reservoir, and at the feet and j other declive parts to give issue to the liquid iuto i covered receivers below. This bathing-dress could be made as stout or as light I as desirable; it could be so adjusted as to hardly hold 1 two quarts of Avater, pure or medicated ; mathemat- j ically warm or cold as per thermometer; stagnant ] around the body or streaming along it. It could be i worn for hours, or days, in bed by the paralytic and ; rheumatic patients, or in the room, even in the open ! air by iho.«e who need at the same time bathing and . exercise. There are many other advantages of this bathing-dress too obvious to need mentioning. The •' apparatus for applying heat and cold to the dif- ferent parts of the human body,"descril)('d liy Dr. Alex- ander Kol)ertson, of Glasgow, in the TiOiKlon Medical Times (Did dazetle of January lijth, 187-, sccmiis more ingenious than the one here juoposed ; but iheir appli- cation and object differ so entirely, that where the one would be useful the other one would be u>elc.ss; but both could certainly find their place in hospitals and ambnlances, or be easily supplied to private patients. Such appears to be, prima facie, the advantages of the adaptation of Mayor's balh to the therapeutics of the positive school of medicine of which Dr. W. Fox is, with his kinsman. Long Fox, one of the most noted exponents. It seems that it would be doing an act of justice if we were giving to this bathing npparel the name of Mathias Mayor, who was never equalled for ingf-nuity in the mechanical department of surgery ; and yet who met with so little of reward that, if he had cared a fig for a tomb-stone, he Avonld have caused to be written upon his, '■ Woe to him who comes too soon." There may be protests against the positions respec- tively here assigned to Mathias Mayor and to Dr. W. Fox. Dr. Richard Neale presents his own titles in the London Medical 'Times and Gazette, Feb. lU, 1372, as having applied the water treatment under cover of plantain leaves, etc., and there may be hundreds of ap- plicants to such claims as his; for, since Priessnitz and Fleury, the iiydropathist of the late French court, back to Antonius Musa, the famed hydrotherapeute of the emperor Augustus, water was uninterruptedly used as an empyrical remedij. But none used it prior to these later days as a positive remedy giving mathematical results : this is what the school to which Dr. W. Fox belongs pretends to; and to which the bathing appa- rel of Mathias Mayor may prove valuable. RespectfuUv Yours, E. S. Xew York, Jtarch 0, 1&T2. ARMY NEWS. Official List of Changes of Stations and Duties nf Offi- cers of the Medical Department, United States Army, from February 21, 1872, to March 4, 1872, inclu- sive. WiRTZ, H. R., Surgeon. — By S. 0. 3, Department of Arizona, January 15, 1872, assigned to duty at Camp Hualpai, A. T. Fraxtz, j. IL, Surgeon. — By S. 0. 40, Departmei^it of the South, Februar}'^ 24, 1872, assigned to dutv at Columbia, S. C. Macicin, Chas., Ass'stant Surgeon. — By S. 0. 40, Department of the South, February 24, 1872, assigned to duty at Fort Macon, N. C. Bartholf, j. II.. Assistant Surgeon. — By S. 0. 40, Department o! the South, February 24, 1872, assigned to duty at Chester, S. C. Lauderdai.-:, J. V., As«is'ant Surgeon. — By S. 0. 4G, War Depai tnient, A. G. , February 24, 1872, granted leave ol ab ence fur thirty days, with permission to apply for sixty days' extension. PowKLi,, R., Assistant Surgeon.— By S. O. 28, De- partment of the Gulf, February 20, 1872, a-s'gned to duty at Jackson, Mis.«., relieving Assistant Surgeon A. A. Yeomans, U. S. A. THE MEDICAL RECOED. 93 Kimball, Ja?. P., Assistant Surgeon. — By S. 0. 42, War Department, A. G. 0., February 19, 1872, to pro- ceed without delay to New Orleans, La., and report to the Department Commander. CowLES, Edward, Assistant Surgeon. — By S. 0. 44, War Department, A. G .0., February 21, 1872, Lis resignation accepted, to take efFect March 1, 1872. EDWAi:ns, L. A. Surgeon.— By S. 0. G3, War De- partment, A. Gr. 0., March 14, 1872, reheved from duty in Department of Texas, to proceed to Philadelphia, Pa., and thence repoit to the Surgeon-General. IIamjcond, John F., Surgeon. — By S. 0. 63, War De- partment, A. G. 0., March 14, 1872, to report to the Commanding General, Department of Texas, for duty as Medical l3irector. WiRTZ, H. R., Surgeon.— By S. 0. 60, War Depart- ment, A. G. O., March 11, 1872, upon arrival of Assist- ant Surgeon Girard, in Depanment of Arizona, to re- port to the Commanding General, Department of Cali- fornia, for assignment to duty. Bache, Dallas, Surgeon. — By S. 0. 57, War Depart- ment, A. G. 0.. March 7, 1872, relieved from duly in Department of Texas, and to report in person to the Surgeon-General. Ascn, M. J., Assistant Surgeon. — By S. 0. 61, War Department, A. G. 0., March 12, 1872, granted leave of absence lor six months. McElderry, H., Surgeon.— By S. 0. 61, War De- partment, A. G. 0., March 12, 1872, after accompany- ing the first detachment of recruits sent to the Pacific Coast from New York, to report in person to tlie Com- manding General Department of the Columbia, for as- signment to duty. Girard, J. B., Assistant Surgeon. — By S. 0. 60, War Department, A. G. 0., March 11, 1872, to report to the Commanding Officer, Department of Arizona, for assignment to duty. Kimball, James P., Assistant Surgeon. — By S. 0. 33, Department of the Gulf, March 4, 1872, assigned to duty at Little Rock, Arkansas. Mofj'att, Peter, Assistant Surgeon. — By S. 0., GO, War Department, A. G. O., March 11, 1872, assigned to temporary duty at Newport B'ks, Ky. KixG, J. IL T., Assistant Surgeon.— By S. 0. 62, War Department, A. G. 0., March 11, 1872, to report to the Commanding General, Department of the Piatte, for assignment to duty. CoRSox, J. K., Assistant Surgeon. — By S. O. 20, Middle Division of the Mo., leave of absence extended thirty davs. iHctiical Jtcms antr lletus. ■ University Medical College, N. Y. — Dr. Joseph W. Howe has been appointed clinical Professor of Sur- gery ; Dr. Henry S. Hewit, Professor of Clinical Surgery ; Dr. Arnold, Professor of Pathological Anatomy ; and Dr. Kammerer, Professor of Diseases of Women and Ohildren, vice Dr. F. D. Lente, resigned. The Pharmacy Bill has been reported favorably from the Health Committee of the Assembly. Dr. Loughran, of Kingston, the Chairman of that Commit- tee, we are happy to say was one of the principal means to that end. Acid Syrup of the llYPOpnospiiiTK of Ltme in Vomit- ing OF Pregnancy. — Dr. A. F. Paitce, 13oston, sp(;aks very highly of the use of this syrup in the obstinate cases of vomiting in pregnancy. The dose ranges li'om 3j-5^s, given with the Ibod, three or lour times a day. The Alumni Association College of Physicians and Surgeons held its annual meeting at the College of Physicians and Surgeons, Tuesday, Feb. 27, 1872. The meeting was called to order by the Vice-President, Dr. C. R. Agnew. After the reading of the minutes of the previous meeting by the Secretary, Dr. John Shrady, the same gentleman read the obituary record. The Prize Committee through its Chairman, Dr. Gur- don Buck, announced the award of the Alumni Prize of four hundred dollars, to Dr. Frank P. Foster. The election of officers was then held with the following result. President, Dr. C. R. Agnew, N. Y. ; Vice- President, Dr. Robert A. Barry, N. Y. ; Secretary, Dr. John Shrady, Harlem, N. Y. ; Assistant Secretary, Dr. A. Norton Brockway, Harlem, N. Y. ; Treasurer, Dr. J. L. Banks, N. Y. The President. Dr. E. M. Hunt, of Metucliin, N. J., gave a scholarly addiess upon the past and present in medicine which was full of wholesome reflections and suggestive thoughts. The address was ordered to be printed. A discussion then arose bearing upon the expedi- ency of increasing the usefulness of the Association by making the reunions partake more of a sociable charac- ter. The sentiment of the meeting was in favor of refreshments, and the whole matter was left to a com- mittee to whom Avas voted the usual discretionary power. The meeting then adjourned. Bellevue Hospital Medical College. — The follow- ing changes have lately been made in the Faculty : — Prof. Stephen Smith has resigned the chair of Descrip- tive and Comparative Anatomy, and Clinical Surgery. Prof. B. W. McCready has resigned the chair of Mate- ria Medica and Therapeutics and Clinical Medicine, and has been appointed Emeritus Professor of Materia Me- dica and Therapeutics and Professor of Clinical Medi- cine. Prof. A. B. Crosby has been appointed Professor of General, Descriptive, and Surgical Anatomy. Prof. Wm. A. Hammond has been appointed Professor of Materia Medica and Therapeutics, Diseases of the Mind and Nervous System, and Clinical Medicine. Prof. Hammond will continue his lectures and clinics on Dis- eases of the Mind and Nervous System as heretofore, lecturing also upon Materia Medica and Therapeutics. Dr. E. G. Janeway has been appointed Prof of Patho- logiS,l and Practical Anatomy. As Prof, of Pathological Anatomy, he will deliver in the regular session a course of lectures on that subject. As Prof of Practical Ana- tomy, he will perform the duties of Demonstrator of Anatomy. Dr. E. L. Keyes, formerly Lecturer on Der- matology, has been appointed Prof, of Dermatology. Prof A. B. Mott has been transft-rred from the chair of Surgical Anatomy, with Operative and Chnical Sur- gery, to the chair of Clinical and Operative Surgery. Prof. Mott will relinquish his didactic lectures on Sur- gical Anatomy to the Prof, of Anatomy, and will hold a Surgical Clinic at the college throughout the year. College of Prysicians and Surgeons. — Beecher's Address. — The following extracts from our notes of Kev. Henry Ward Beecher's address to the graduates, at the Commencement of this college, could not find sjiace in the last number. After encouraging the students to work earnestly and wait patiently for opportunity, recognition and dis- 04 THE MEDLCAL REC;ORI). ti net ion, sure that finally success would follow desert, tlie speaker touched upon the motives that should im- pel ati'l Hiistain them. Tiie desire of pain, personal ambition, love of seientific truth, synipaihy for indi- vidual suftVrincr, an 1 tin; broader sentiincMit of pliilan- thropy, reinforced by religion, were tiie steps liy which I hey could mount to a plane of high thought and worthy action. The spread of cidture among the common people was rapidly changing the status of the medical profession, as of every other, eurlailing its lower functions, to extend and muUi|>ly its higher ones. " Take my own pro- fession," said the speaker. "There was a time when it was hardly right for a man to be born without the priest to sanction it; and all throujih life, at every turn, he must call in the priestl}- aid and counsel. Now, men not only are born, but t'.iey marry and die Avithout our help; tliey have appropriated to themselves a thousand oftices that were once our sacred and exclusive privilege. But we have gained far more than we have lost ; have been deprived of those manifold duties which were hindrance*, only to give us freedom for broader and higher growth ; and I rejoice in it. So in medicine. The intelligent mother is now your rival. The laily know more than the wisest of you did two or three centuries ago. Yet the field of your own work is not narrowed, but marvellously enlarged ; and it is destined to be extended more and more with the advance of science and it«s popular recognition. It was thought that machines would throw the workman out of em- ploy, but instead they only took slave's toil out of his hands, and drove him into better service, for which they created a new and ever-growing demand. "You are no longer to be simply ministers of healing to the sick ; a large part of your future duty is to be toward the well. The community looks to you to develop and enforce the whole science of private and public hygiene ; it looks to you, moreover, for instruc- tion in mental and moral philosoph}'. " I do not undertake to say that mental philosophy will ever be established upon the basis of physiology alone ; but I do say that without the support of phy- siology there will never be a stable philosophy. While I believe there is much more blossoms out in mind than mere nerve-substance, yet I believe, also, there are no men in our day so near the secrets to be revealed as the physiologists, nonC who are so likely to help us throw light upon the mysteries of intelligence it>elf. " I said you were to rectify our moral philosophy as well. Tiie law of God was not all written on !Mount Sinai ; He has been writing upon every mountain since. All of truth is not contained in the inspired record. God has not ceased to think, or to reveal his thougli^ A part of this revelation is in our own physical constitution ; and in the progress of truth we are to learn what is the connection between bodily conditions and moral states. I say, as the result of long observation and experience, that, very largely, the causes of wrong-doing are mor- bid conditions of body and unfavorable circumstances. We need not fear that this doctrine will destroy respon- sibility. There is enough in the fact that men know when they are doing wrong to secure that. I aver, then, that a sick man can hardly be a moral man ; can hardly conduct himself as a free moral agent, when every nerve and fibre of his body is crowding tempta- tion upon him. There is sin enough in one single organ, the liver, to call it the devil's den. You are to interpret for us this connection between physical and moral disease ; to help us clear the way for larger con- ceptions of life and duty. " It is impossible that the mass of men can be healthy, and so moral and successful, without some knowledge of their structure and of its laws which they must obey or KufTer. How can a young woman he called educated who is ignorant of physiology, of iier duties as a mother, of the divine art of nursing? How numy men know anything of th(! relations of waste and supply in the nervous economy? Why, not one man in a hundred knows even what the stomach is made for, and the other ninety-nine are constantly transgres.-ing rules they have never learned. We may take the old para- ble of the apple in the garden as an illustration of the way men's stomachs make havoc with their moral sense. Not one man in a hundred knows or suspects that God made the air to be breathed. Every part of his house may be reeking with miasma, the cellar full of all evil, the partitions clotted with dormant mischief, and he never dreams of it, but goes on nailing down his win- dows and listing his doors. If we could only see the air we have once breathed over! Even the architects of our public halls and theatres and churches have the crudest notions of ventilation. I have found .=ad proof of this in every part of the L'nited States, and you will agree with me that we have no exception here to-night. To whom shall we look for the diffusion of knowledge on these subjects among the people, if not to you? Every family in which you practice should be made a medical school. " From private hygieric, we pa=s to public, which we have hardly begun, as yet, to understand and apply. You must take the lead in directing the removal of those great morbific influences that prey upon the life of the community. Thousands upon thousands of cradles are yearly emptied, long streets are turned into shambles, from causes that should not be suffered to ex- ist. The great questions of the sewerage of cities, the draining of morasses, and a hundred others, are pressing upon us for answer; and of whom have we a right to demand it, if not of the medical profession? " It devolves, then, upon the physicians of this age to make themselves felt as a power in public as well as in private. In every 'effort to elevate the standard of personal purity ; in every discussion of the best means of preventing crime ; in every attempt to gain a soimder philosophy of education, and to apply it in the direc- tion of public institutions, or in the training of individual children — the physician is to be not only the adviser of the family, but also the counsellor of the community, whose word should be heeded as always important and often decisive." S.MALL-POX in New York still holds the weekly ave- rage of seventy-four. Dii. B. F. MiESSE, of Chillicothe. Ohio, recently sued for malpractice, has been acquitted. From the evi- dence given at the trial, it was proved that the case, which was one of fracture of the thigh, Avas skilfully, carefuU}', and conscientiously treated. Another case oi malpractice is in progress in that vicinity, but if the profession stand by each other as in this case, the re- sult can be easily anticipated. United States Marine Hospital Servick. — Jno. M. Woodworth, Supervising Surgeon U. S. Marine Hos- pital S^-rvice, Treasury Department, submits a com- parative statement of the operations of the United States Marine Hospital Service for the six months end- ing December 31, 1871, and the six months ending De- cember 31, 1870, showing the number of days of hos- pital relief and the amount of expenditures incurred for the care and treatment of sick and disabled seamen ; also the amount of hospital tax collected during the same periods. The reduction of the expenditures during the six months ending December 31, 1871, over the six months THE MEDICAL RECORD. 95 ending December ."il, 1870, amouiils in the aggregate to over $40,000, -which saves seventeen per cent, to the fund. Tlie amount of hospital tax collected during the last s-ix moullis uf 1871 is ten per cent, greater tlian the amount collected during the corresponding six months of 1870 under the opcra'ion of the same law. Alumni Association Medical Department of tiik Univeksity of New York. — The annual meeting of this Association was held at the Chai)el of the Collegiate Eeformcd Dutch Church, corner Fifth avenue and Twenty-ninth street, on Thursday evening, March 14th, 1872. Dr. F. D. Lente, President, in the Chair. Tlie exercises were opened with prayer, by Pi'oC. Benjamin N. Martin, D.D., L.H.D., followed by appropriate intro- ductory remarks from Prof. Charles A. Budd, class of 1852. Prof. D. B. St. John Roosa, class of 1860, then delivered an excellent and impressive address, in which the followingpoints were dwelt upon. That medical edu- cation is to be advanced through the medical colleges ; with three exceptions, the medical works published during the past year by a well-known publishing house, were written by professors of medical colleges ; and of ten papers read before the Medical Society of the Coun- ty of New York, during the same peiiod, six were by medical professors ; the Harvard Medical School, having raised the standard of medical teaching, should have the profession of New England at its back ; the Medical and Surgical Histories, written by Drs. Woodward, Otis, and others, under the direction of the Surgeon- General, cannot be suipassed by foreign autliors; the diseases of our day are of a more refined nature than those of a hundred years ago, and paralytic diseases, and those of the eyeball are on the increase — as shown by statistics; many of the teachers in our medical schools, who lecture on special topics, are not allowed to parti- cipate in the examination of students for a degree — ne- cessitating a radical change in the present system of medical teaching; in 1841, New York City had only one hundred medical students; now, in three schools, there are over one thousand endowments for professo- rial cliairs; libraries and scholarships are much needed; men who hold four or five hospital appointments, and are canditlatcs for more, should give up some of them to those wlio would be willing to give the profession the benefit of their experience. The relations of medi- cal men to the laity were fully discussed in the second part of the paper ; and an allusion was made to the un- wise decision of the governors of the late New York Hospital, in the removal of that time-honored Institu- lion from a section of the city where it was so much needed. He thought if the Medical Board of that hos- pital had an active part in the management of its affairs, it would have remained on its old site to this day. Following the acceptance of the paper and benedic- tion, !he following business was transacted : Drs. F. D. Lente, James R. Leaming, and James H. Anderson were appointed a Committee to investigate the charges made against the University in an article to appear in the Medical Record. The officers ibr 1872 are as follows : President, James R. Leaming, M.D. ; Vice-Presidents, Henry S. Hewit, M.D., Solomon S. Satehwell, M.D. of N. C, Charles A. Budd, M.D., Samuel M. Bemiss, M.D. of La., Wm. Canniff, M.D., of Canada, Theo. R. Varick, M.D., of N. J. ; Secretary, Charles Inslee Pardee, M.D. ; Treasurer, D. B. St. John Roosa, M.D. ; Orator, Solo- mon S. Satehwell, M.D. ; Executive Committee, Drs. James H. Anderson, Stephen J. Clarke, Francis V. White, F. Le Roy Satterlee, and Joseph T. Moneli. The Presbyterian Hospital, Phila.— At a meeting of the Trustees of this hospital, held Feb. 19th, the fol- lowing medical oflicers were elected •.— Consulting Sur- (jeons, Drs. Samuel D. Gross and D. Hays Agnew ; Con- sulting Physicians, Drs. J. L. Ludlow and Jacob M. Da Costa; Attending Surgeons, Dns. Thomas B. Reed, Os- car H. AUis, H. Lenox lloilge, and William G. Poiter; Attending Pltysicians, Drs. Edward Wallace;, S, Weir Mitchell, J. Forsyth Meit^s, and D. Flavel Woods ; Ob- stetricians, Drs. Robert M. Girvin and John S. Parry ; Ophtlialmic Surgeons, Drs. W. Wallace McCJme and (jeorge Strawbridge ; Pathologist, Dr. Dc Forest Wil- lard. The Dental Profession. — Oliver Wendell Holmes, M.D., in his address at the Commencement Exercises of the Dental Department in Harvard University, Feb. 14th, after alluding to the fact that the teeth were par- ticular objects of attention in the time of the Egyptians, says that from the time of Galen to the middle of the seventeenth century, he has not found any other traces of a special dental profession until he came upon the following: Lr the Diary of the Rev. John Ward, Vicar of Stratford-on-Avon, from 1648 to 1679, are the^e lines: "Upponasigne about Fleet Bridg this is written, ' Here lives Peter de la Roch and George Gollin, both which, and no other, are sworn opei'ators to the King's teeth.' " In 1820 there was not more than a hundred dentists in the United States. In 1858 there were 4,000. Since then they have increased in as rapid a ratio. — Boston Med. and Surg. Journal. The Medical Department of the University of Pennsylvania, March 12th, graduated a class of eighty- three students. Thirty-four students received diplo- mas, Feb. 15ih, at the Commencement of the Massachu- setts Medical College. At the Commencement of the Medical Department of the University of Buffalo, held Feb. 20th, thirty-four students received the degree of Doctor in Medicine from the hands of the Chancellor, Hon. Millard Fillmore. The address to the graduates was delivered by Prof. James P. White. The Epidemic of Small-Pox in Chicago. — When the epidemic of small-pox commenced in Chicago, an order was passed that, after a certain date, none of those re- ceiving rations and aid from the Relief Society should have anymore food, clothing, coal, etc., without present- ing a certificate of vaccination, or of revaccination. This legislation, impossible elsewhere, and heretofore, over- came the objections of the ignorant against vaccination, and has served to stamp out the epidemic- One thou- sand persons were vaccinated daily for several Aveeks, the expense being borne by the Relief and Aid Society. The highest mortality from this disease in that city, according to the U. S. Med. and Surg. Journal, in any one week has been only sixteen. East River Medical Association, N. Y. — The fol- lowing officers were recently elected for the ensuing year : President, Dr. Henry E. Crampton ; First Vice- President, Dr. Daniel E. McSweeney; Second Vice-Pre- sident, Dr. Samuel Blume; Secretary, Dr. William J. Purcell ; Treasurer, Dr. Verannus Morse. Medical Electricity. — Dr. Roberts Bartholow, of Cin., contributes to the Clinic of Feb. 24th, with illus- trations, an instructive article on Medical Electricity and Medical Electrical Apparatus. Appointments. — Dr. A. 0. Kellogg, for nine years an Assistant Physician in the New York State Lunatic Asylum, has resigned, and accepted a like position in the Hudson River Hospital for the Insane ; Dr. J. M. Cleveland, Superintendent. Subsequently, Dr. Jud- son B. Andrews, Second Assistant Physician in the New York State Lunatic A-;ylum, was appointed first 96 THE mp:dical record. Aasistant; Dr. Walter Kerapster, third Assistant Phy- sician, wjis appointed second Assistant, and Dr. Daniel II. Kitchen, of New York city, was appointed third As-sistant I'hysician, to All the vacancy. — American Jo n rnal of In sa n itij . Medical B.\roxkt3. — Thirty-one physicians and thirteen surpeons have heen created baronets in Eng- land since 1<)45. Tlie first medical baronetcy, that of Sir E. Greaves in U»45, is disputed ; but of the si-cond, that of Sir Hans Sloane, practically the founder of the British >riiseum, there can be no doubt. Nkw YoitK Mkdico-IIistorical Socikty. — At tlie an- nual meeting of this flourishing organization, held re- cently, the following oflicers were elected for the en- suing year: — President, William T. White, M.D. ; Secre- tary and Treasurer, Zo\\n G. Frazer, M.D. ; Editor, Al- fred E. M. Purdy, M.D. ; Diarist, Bradford S. Thomp- son, M.D. Tiu: WiTtii-M.\NiA OK THK Sevkxtekntii Century. — Joseph Workman, M.D. {Am. Journ. of InsanHij). states that it has been calculated that from 1G03 to 1G80 the total put to death, by regular legal process alone, was about 70,000 ; and if, in the ten years of exclusion of the Stuarts from the tlirone, over 35,000 witches were destroyed, the annual number must have been over 35,000, or nearly ten per day, Sundays not excluded. St. Vinxext's IIosimtal. — From the annual report of this Hospital, founded in 1849, it appears that 9G5 pa- tients Were treated during the past yeai-, of whom 53G Avere discharged cured, 185 improved, 49 unimproved, 118 died, and 87 remain. In the surgical department, 271 patients were operated on, of whom only 8 died. ALCOnoLic Spirits Conscmed ix the United States. — The cost of the clergy of the United States is esti- mated at $12,000,000 annually ; while that of criminals is §40,000,000, and of spirits $000,000,000. The re- searches of Otis Clapp, of Boston, Mass., in 18G9, give the loss to the productive power of this country, through intemperance, at from 10 to 20 per cent. At 10 per cent, only, the loss on the agricultural and manu- facturing interests reaches the sum of $450,000,000. The census of 1870 will probably show this sum to be vastly increased, and perhaps doubled. Electricity in Diseases of the Skin. — Dr. George M. Beard, Xew York {American Journal of Syphihgra- phrj and Dermatology) says that it is yet too early to lay down special conclusions concerning the prognosis of different diseases of the skin under electrical treat- ment; but from what has already been accomplished, the general proposition seems to be justiliable. For many cases of psoriasis, eczema, anaesthesia, pityriasis, and prurigo, that under ordinary treatment are obsti- nate or incurable, electricity is of such great efficacy, both temporary and permanent, as to entitle it to a very high rank among the resources of the dermatolo- gist. A New Hospital for Animals has been opened in Dublin, known as the " Brown Institution." A large sum of money was bequeathed fur the purpose, in 1852, to the University of London. On llie Committee of Directors are Drs. Busk, Carpenter, Gull, Quinn, Sharpey, Sibson, and Simon. Dr. Burdon Sanderson, of University College, has been made professor. It is expected that the institution will add very much to our facilities for acquiring a knowledge of the action of remedies and the causes of disease. Although the laboratory is intended for research rather than instruc- tion, it will be open to all who wish to engage, on their own account, in scientific inquiries, providing they show evidences of previous scientific trainin;.', and pay their own expenses* Ai-coiioi.iSM. — Dr. Paluel de Marmon, of Kingsbridge, N. Y., in a rc^priiit from the Medicil World, discusses tlie " Medico-Legal Con8ideration.s upon Alioholism, and the Moral and Criminal Responsibility of Inebriates." He states that in ninety cases of a hundred, drunke-nnes is first contracted by imitation and politenes.s; for it is considered very impolite by some to refu-e to drink when invited so to do. Anotiier cause rests principal- ly in this country upon the bar-room system. Febru- ary 1. 1871, there were 7,0U0 dram-shops or hotels j»ay- ing license, under the Excise Law, in New York City, and, on the authority of an officer of the department, there was an equal number selhng without license, which would make 14,000 drinking places in New York alone — one for every Go inhabitants. The report of Messrs. Otis Clapp, John E. Tyler, and Wm. B. Spoon- er, made to the Lcgi.slaiure of Massachusetts, esti- mates that there arc 000,000 persons in the United States who have lost their power of self-control in the use of intoxicating liquors, and that in Massachusetts there are 23, (KM), of whicli number two per cent, die each year a drunkard's death. Dr. Marmon suggests the abrogation of the bar-room system as the best means to cut .short this human plague. Demonomania and WiTcricRAFT, — The.se subjects are pleasantly discussed by Joseph Workman, M.D., in a paper read before the Association of Medical Superin- tendents of Insane Hospitals, in Toronto, June, 1871, and published in the October No. of the American Journal of Inmnity. He says that it is not to be ex- pected that the foolish doctrine of belief in diabolic possession, which, less than two centuries ago, perva- ded the whole of Christendom, and was preachetl from every pulpit in our own and mother countiie-, and pro- claimed from every bench of justice, could utterly die out among the uncultured masses in any very short lapse of time. He has met with persons, not insane, who have avowed their belief in its present existence, and relates the case of a clergyman, who fled from the room where an insane woman was suffering from hj- cantliropia, and when he recovered his mental equili- brium, said " ! Doctor ! that woman is possessed ! " Customs and Salaries of Physicians before the Christian Era. — Boerhaave observes that before there were any professed physicians, it was the cus'.oni among the ancient Egyptians, when any one was sick, to inquire of neighbors and passengers if they knew ol' any proper remedies for the patient. But ever sine.- the study of physic became a profession, it has been both honorable and lucrative. The customary yearly salary which princes paid their physicians, about tht time of Christs birth, was 250 sestertia, or abov' 2018/. sterling. Stertenius complained that he had only a salary of 5t)0 sestertia, or 4036Z. Os. 2d. sterling. " when Ke had by his private practice GOO sestertia, or 4843/. 15s. — TJr. Arbuthnofs Book on Coin, and Mi-. William Smith's Book of Bemarks on the same Subject. Uctu publications. Books Received. Earth as a Topical Applicatiox ix Surgery. By Addixell Hewson, M.D., Attending Surgeon, Penn- sylvania Hospital, Phila. : Lindsay ifc Blackiston. 1873. THE MEDICAL RECORD. 97 Original Commumcations. THE MODERN OPERATION FOR STRA- BISMUS. Bv E. G. LORING, M.D., NEW YORK. RKAD BEFORE NEW YORK ACADEMY OP MEDICINE, MARCH 7, 1872. I It is with the hope of presenting to those of you wlio have not time to search through the various mon- j ©graphs for more detailed information, a dight sketch of this important siilject as it stands at present among ophthiihnoloLtists, tliat I now offer these remarks, and I witli the hope of pointing out some of the most impor- tant considerations, both as to cause and effect, on a subject in regard lo which the general practitioner must oftentimes be consulted prior, if not in preference, to the ocul'st. In regard to the etiology of the complaint, it was ascertained by the labors of Bonders, and others, that strabismus occurred in 80 to 85 per cent, in hyperme- tropic eyes, or e3-e5 which were congenitally deficient in focalizing power. Without wishing to impugn this statement in tiie slightest degree, it has, neveithe- le?p, always struck me that an exaggerated importance has been given, not only by Bonders himself, but by all others, in regard to the share which the shortened antero-posterior axis really plays in the production of squint; for it must be borne in mind that emmetropia, or a perfectly normal eye, is a rather poetical condition, and trifling deviations from the normal standard, though sufficient to justify a classification of eyes in regard to refraction, cannot be sufficient to be the active cause of sirabismns. Thus it is hardly fair to suppose that a young child who has a strabismus of some 3 or 4 line?, and whose total deviation from the normal standard amounts to a convex glass of -'- or Ai, squints, because it i-5 unable to neutralize this very trifling defect by the action of the ciliary muscle. This attributing the pro- duciion of strabismus almost entirely to the existence of congenital far-sightedness, no matter how trifling it may be, has led Bonders and others to criticise some- what sharply, and somewhat unjustly, the statements made by general practitioners, backed up by those of nurses and mothers, that tlie squint in a given case had been caused by an attack of measles, whooping- cough, SL-arlet fever, or any of the thousand and one depressing maladies which are incident to childhood. Blinders has averred that if these cases are critically examined it will almost invariably be found that hyper- metropia is at the bottom of the evil ; and less renowned and less discriminating practitioners, following in his footsteps, have gravel}'', if not supercilionsl}^, waived away the convictions of the parent and family phy- sician, with the calm assurance that the child was born, if not with the fruits, at least with the seeds of the malady, and the cause t > which they attributed the evil had nothing to do with it. Now, I myself have frequently seen strabismus produced in children imme- diately after some sickness, when there was no error in the optical condition, and pass away again as soon a.s the strength of the patient was restored, from which 1 have been forced to the conclusion, rather a self-evi- dent one. I admit, that wherever and from whatever cause the combined force of the ciliary muscle and in- terni recti is greater than that of the externi, there also strabismus is apt to occur; and that such a state of af- fairs will take place more Irecpiently in far-sighted eyes th in in others, follows as a matter of course. But the point which I wish to emphasize is, that a transient reduction in nervous foice, with over-exertion at su'.'li a time, may produce in emmetropic, or even in slightly myopic eyes, precisely the same factors favor- able to the production of strabismus Avhich exist through congenital structure in a hypermetropic eye. In other words, that such eyes, under the debilitating influences of disease, do become, practically speaking, lor the time being hypermetropic eyes, and are forced, from a reduc- tion in focalizing power, precisely like hypern.etropic eyes, to use a dispioportionately large amount of ac- commodation with moderate degrees of conveigence. So, too, a slightly hypermetropic eye, which, while t'lie general health was undisturbed, would never mani- fest the slightest tendency to turn in, may become, when reduced in strength, equivalent to one of great degree, with its accompanying tendency to become ciossed. And the practical lesson which I would draw from this is, that the general practitioner should be particularly on his guard not to permit his young patients, in tlie earlier days of convalescence, the indiscriminate use of their eyes, especially when confined to the bed, on books and toys and other occupations, which are often carried on with an intensity of purpose and an expendi- ture of nervous Ibrce, which, if applied in its weakened condition to any other organ, would end in its utter overthrow. The first step in the operation is to pick up the con- junctival and subjunctival tissue lying over the inser- tion of the tendon to be divided, which should be done with enough firmness to insure a not inconsiderable fold ol' the conjunctiva between the arms of the forceps ; for if this is not done, it will be found that Avhen the open- ing is made the scissors will glide beneath the conjunc- tiva alone; and th.e subconjunctival tissue, together with the extension of the capsule of Tenon, will have to be divided separately, which will necessitate a new hold with the forceps. Nor must the first incision with the scissors be, as is often recommended in the books, immediately at the corneal margin, but removed from it about a line and one-half, and just in front of the implantation of the tendon. This leaves a narrow line or bridge of conjunctival tissue still attached to the cornea, which is often of great service in the finish- ing of the operation, and which will be further dwelt on. But the principal difficulty, which is experienced by even those who have performed the operation repeat- edly, lies in the easy and successful passing of the hook Ijcneath the muscle so that the insertion shall be plainly exposed. And this difficulty is occasioned by a disregard of the anatomical distribution of the capsule of Tenon. This capsule, as you are aware, starts from the optic foramen, surrounds the optic nerve, and then, spreading out over the bulb, forms a cup-like cavity^ for tlie posterior half of the eye, in which the eye revolves. Anterior to the equator, however, the capsule is pierced by the muscles which pass directly through it, to be afterwards implanted in the sclera. At the place of perforation of the muscles the capsule of Tenon sends out reflections, which, joining with the connective-tissue sheaths, extend not only backwards towards the origin of the muscle, but also forwards to- wards the insertion where the capsule becomes mingled with the conjunctiva. In the anterior part of the eye adhesions also take place between the capsule and the sclera by the means of filamentous bands extending from the former to the latter. The effect of all this is to form, so far as the anterior part of the eye is con- cerned, a sort of sheath or sleeve in which the muscle is enclosed. Now the common way of making the opening 98 TIIK MKDK Al- RECORD. into the conjunctiva is to continue with the sciesors directly back in a lino with the belly of the muscle till it is juJgi'il that n suflioient openiii;,' is made; the hook is then inserted, and the operator is often sur- prised to find that, atU-r one or iwo attempL^, it does not plide beneath the tendon. Tlieopeninjj in the con- junctiva is enlarged, wiien a more determined effort is madt>, and it is Ibund thai this time, allhon<^'h the in- sirninent did not pass cleatdy as it s-iiould beneath tiic tendon, the point is covered by some portion of the niusi'le, which is hastily divided, and the operation is tinished as it began, in sncce-sivc attcmpt-f to fish up and divide the remaining attachments of tiie tendon. t)r it may be in another case that, after a liitle violence, something is felt to give way, and the hook then glides with the utmost ease beneath the nmsele, with- out the operator pausing to think what was tlie cause of the dilliculty in the first place, or the succc.-s in the latter. This was evidently due to the fact tliat the hook, in being rotated to pass behind the muscle, came in contact with the wall formed by the capsule, and either could go no farther, or, by carrying the capsule with it, proceeded far enough to just engage the muscle so as to hook it up by the centie, as it were, without fully passing behind it. Now the density of the capsule vanes in different cases, and sometimes with using a little force we are able to pusli the hook through it, and then of course it is plain ijailing. Sometimes, however, the capsule is so strong that the eye is carried before the hook and made to rotate in large circles in the or- bit, and the ditficulty of getting beneath the tendon is increased. I think, however, that all these difficulties can be almost invariably avoided if, after getting through the conjunctiva, ins;ead of dissecting directly backwards parallel with the belly of the nmsele, we carry the point of the scissors in a bold, free manner obliquely across the insertion of the tendon, almost at right angles to direction of the muscle, till we get into the loose tis- sue beyond ; by this little manoeuvre we make a small hole directly through the conjunctiva and subconjunc- tival tissue, and at the same time through the capsule and the processes which attach the muscle to the sclera. If then, on withdrawing the scissors, we gently raise the edge of the wound, the hook passes with the greatest ease beyond the horizontal edge of the muscle, and falls at once by the well-known movement of rotation directly beneath it, so that when the conjunctiva is gently drawn over the distal end of the hook the ten- don lies exposed for its entire length. This beinof the case, it only remains to divide it, and in doing this it is an essential point never to begin at that part of the hook which is nearest the shank, but at the distal end, and to gently raise the point of the hook as it is grad- ually dissected out, so as to prevent it from disengao^inf itself from the muscle till the tendon is thoroughly divided. It was formerly thought an advantage to make the opening in the conjunctiva as small as possible, and to make the section of the tendon as subconjunctival as ' circumstances would permit. But dividing the muscle ■ in this way is rather a tonr de force than any practical ' advantage, even if it could always be done with cer- ' tainty, which is by no means the case ; and then the original wound has to be enlarged. It is better to make a sufficient opening at the start, and to close it at the end of the operation by bringing the edges of the wound together in the most delicate manner with the finest possible silk, the ends of the suture being cut off as close to the knot as possible. The opening should not be greater, however, than two or two and a half lines. 'J'his gentle closure of the wound produces no ■ inflammatory reaction, and the suture comes away of itself, on aci'ount of its fineness, after a day or two, almost unperceived. We come now to the consideration of the later improvement.^, which are in themselvi s of a good deal of iiiifiortanoe, and often form, indeed, the principal features in the operation. Tlic.>^e are the means which Wf have in our power of increasing or diminishing the effect of the tenotomy. This is done by the use of 8uture.«. We will take first the suture which is employed to increase the effect of the operation. The most effect- ual one of which I am aware is that which was first brought into general notice by Dr. Knapp a f w years ago, though it had been in use in this country for some time previous. The manner .ii which it is appied will be better understood by a diagram, which we will suppose represents a pair of eyes in which there is a very pronounced squint of the right eye. say of 5 or even G lines. We will suppose that the patient habi- tually squints with this eye, and that tlie excursion outw ards of this eye, though still good, is somewhat limited, and can only be obtained to a full extent by excessive convergence of the other eye. Under these circumstances we have good reason to believe that the exlernns, from being constantly on the stretch, has lost some of its elasticity, and will not, by forcibly re- tracting, draw the eye outwards after its antagoni.st lias been cut. We will suppose that the internus hiis been divided in the usual way, and that the effect from the causes just mentioned is very small, so small indeed that there is danger of the tendon reapplying itself at or very near the seat of its original implantation. It is manifest that we shall have gained little or nothing by the operation, and it is under these circumstances that the suture renders invaluable service. Dr. Knapp's description of the method is as fol- lows : — After a thorough tenotomy of the internus, a small fold of the conjunctiva of one or two lines is picked up close to the outer edge of the cornea, a curved needle armed with pearl silk is pushed through it, and the needle then carried through the external commissure from within outwards, and the cornea made to ap- proacli the outer angle of the eye to the required amount by drawing on the suture, which is then tied down upon the skin. By this means a fixed position is obtained for an eye which otherwise would have a tendency to turn in, during the time that the tendon is gaining its new attachment, whieh latter, ,is the eye is forcibly turned out, must lie further back than other- wise would be the case, and the effect is consequently much increa.sed. I generally seek to obtain about a line of diver- gence of the operated eye, immediately after the operation. The suture should be left in one or even two days. It very often comes away of itself on the second day, Graefe's method of increasing the effect of a teno- tomy is as follows : — After the tenotomy of the internus has been thoroughly performed, a fold of the conjunc- tiva is lifted off from the episcleral tissue with the forceps close to the outer canthus. A curved needle is then run horizontally throuL'h this fold into the subconjunctival space and made to glide (the forceps being removed to the upper and inner border of the cornea) beneath the membrane, till a portion of this equal to three, four, or five lines lias been included, when the point is again brought out, its place of exit varying according to the length of its subconjunctival passage, its direction being always from the commis- sure to the upper and inner corneal border, or it may be even to a point above the vertex of the cornea. THE MEDICAL RECORD. 99 The suture i-i then tightly drawn and tied. By tliis maiiceuvfe the eye is rolled outward.-; to the breadtli of the enclosed tissue, and the limitation in the move- ment of the eye inwards is much increased. In tliis way Graefe says one is enabled to obtain, in excessive degrees of convergent strabisinu-;, any correction de- sirable. The suture must be left in at least two and a half days. Tiie suture is employCLl in preci?ely the same manner in divergent strabismus, only it starts from the inner cinthtis near the caruncle. Graefe says that this method has been of signal service to him in the higher grades of strabismus, and that since its adoption lie has been far more reserved in the u^e of the advance- ment of the muscle. Indeed he asserts that he scarce- ly ever performs this latter now on account of diver- gence, but only on account of marked limitation of the mobility inwards. Such being tiie means by which the effect of a te- notomy is increased, those by wiiich the effect is diminished remain to be spoken of. This is still done by the use of the suture, and their mode of application will be made clearer, 1 think, upon the board. We will suppose that in a case of convergent squint we have already divided the internus, and that the effect ob- tained has been excessive, and that there is fear that the eye will go the other way, or at lenst there Avill be an insufficiency of converging power which may impair the use of the eyes for any length of time upon close object:*. Our object is to lessen the effect of the ori- ginal tenotomy, and this is done by the suture, the effect of which is graduated in the following ways : If we have reason to believe that the eflfect of the tenotomy is only a little more than that which we wished originally to obtain, we simply bring the edges of the wound together in a vertical direction ; this of course prevents the muscle from retracting as far as it otherwise would, and the effect of the operation is somewhat limited. We can increase this again by including more or less tissue within the stitch. If we want to limit it to a greater degree, then, instead of passing the needles vertically, we run them obliquel3' ; this of course draws the muscle still more forward, and the effect can be still further increased by including more of the conjunctiva and subconjunctiva tissue between the stitch. Or if, lastly, we wish to reduce the efifect to a ver}^ considerable decree, we then pass the needle in a directly horizontal direction, taking up more or le-s of the tissue, according to circumstances. It has been asserted with a good deal of force, especially by Von Graefe, that the controlling influence of these sutures is such that we can, if the operation has been skilfully performed, invariably get any effect whicii we may desire. While admitting to the fullest extent their great u.sefulneps, and the very important role they play in enabling us to increase and diminish in a general way the effect of a tenotomy, candor com- pels us to say that they have not in our own hands, nor can we understand from the very nature of things liow they can possibly act in anybody's with, that mithematieal precision which the great master has claimed for them. I know of no absolute rules which can be laid down as a guide either as to the immediate or permanent eff.-ct of a tenotomy ; still there are three things, a careful study of whicii should never be neglected. F.rst, the condition of the externi and the extent of motion outwards. Secondly, the refraction of the eye; and thirdly, the eSict of the accommodation. If, for example, the abduction of the eyes is limited, or only obtained by a vacillating motion as soon a.s. or shortly after, the squinting eye has passed the median Une, it , will be safe to predict that a greater setting back of ihe muscle will be requited, and the effect of the o|)cration will have to be increased by dividing both interni, — when under ordinary circumstances we should divide only one, — or, what is better, l)y the use of the suture. And we may be sure of this even after, the patient being thoroughly narcotized, we find, before we begin the operation, a divergence of the eyes. I have been so olten deceived by this amount of divergence wh< n patients are under the .influence of an ^anajsthetic, especially just after tlie muscle has been divided, that I pay no attention to it when I have once convinced my.vjelf that there is some weakness of the externi, but base my calculation entirely on the examinations made before the anajsthetic had been given — and this (.■specially in regard to the suture. Again we may put it down as a rule (but as a rule that has many exceptions), that the greater the amount of hyperraetropia, the greater amount of opeiating we may do without the lear of obtaining too great an effect. And here I Avould again insist upon the neces- sity of reducing the eye — before resorting to repeated operation — by the means of glasses, to as near a condi- tion of a normal eye as possit)le. Finally, if the eye swings in suddenly under the influence of the accommodation, so that the squint is disproportionately larger for the near than for the dis- tance, we may assume that the energy of the externi is reduced, and a greater freedom allowed in operating than when the reverse is the case; that is to say, where the squint neutralizes itself somewhat rapidly when we approach an object towards the eye, so that at mode- rate distances — twelve to sixteen inches — the two eyi'S seem to be directed to the object. Starting then with the assumption that in an ordinary ca=e of con- comitant squint we get from two to three lines as the efl'ect of an operation, the above rules may be of some service in some of the commoner deviations from the general run of cases. But for more than th's I should not like to be responsible. I would not w-ish by this to infer that I consider the operation of strabismus a work of chance, for I sincerely believe that the more fully w.' understand and the closer -we follow the optical and dynamical laws which govern the condition under consideration the more successful we shall be ; still I cannot yet believe, however hopeful I may be for the future, in that mathematical exactness which is at present often claimed for it. The only rule which can be conscientiously followed is to estimate by Careful study as closely as we can the probable result, and then to operate till success is obtained. Some eight or ten hours after the operation, or when the narcosis has passed entirely off, the patient should be seen again, when anotiier examination should be made, and this should be done as Graefe has shown, not, as is usually the case, directly in front of the pa- tient, that is, in the median line, but towards the tem- poral side of the eye which has been operated on, the object being at about fifteen feet from the patient and at about 15° towards tlie temporal side. This, of course, throws the strain off the divided muscle, and the in- sufficiency which follows as the immediate effect of the section is reduced, and a more correct estimate of what will be the permanent effect is arrived at. Thus, if the right internus has been divided, the patient should look to the right. I prefer, liowever, to make my examination in both places, that is, directly in front, and then towards the temporal side. As a rule, wdien, on seeing the patient, I find that less effect has been obtained than was esti- mated, I content myself with leaving things as they are, preferring to operate on the other eye, using the 100 THE MEDICAL RECORD. experience pained as to the eflect on the first eye as a fjuiiie to the st-cond operation. But wla'iiever my es- limatiim ol" the anla<;oiiistic force of tlie exteriii has been so much out of llie way tliat very Httle or no ef- Ici't has been produced, and the muscle is in danger of reattacliinp itself at or very near tlie place of its orijji- nal implantation, I never iiesitate to interfere ; and in tliis ciu<:e I always use the suture described by Dr. Kuapp, never that by Graefe — the eflect of which va- ries, as lie himself allows, in every case accordinpf to liie ditl'erent degrees of tlie elasticity of the coijuiutiva. If tlie patient is an adult, and posses-sca a moderate degree of nerve, an anieslhetic may be dispensed wi;h. The wound can be reopened and the new and yielding attachment*! reatlily severed with the strabismus hook. In children it is better to always use an anaesthetic. If, however, on the first visit after the opt-ration, there is good reason to fear that too much ellect has been obtained, the matter is much more serious, and should be remedied as soon as possible. It is, however, extremely ditficult to t,-ll, or at least to lay down any exact rules by which it can be sately judged that too much ellect has been obtained. Here it is that the expetienced eye has so great an advantage, for any one who has seen and studied a large number of cases can olten tell at a glance that too much has been gained, while it would puzzle liim to say exactly how he was aware of it. Still the following method of examination has been of service to me in a general way, and as such I now offer it: — If I find, twelve hours after the operation, that there is a line of divergence when the patient looks at an object, say at filteen feet, I look upon it not only as no detriment, but a positive advantage for the perma- nent eflect, provided the following conditions exist with it : that the object can be gradually approached towards the patient in the median line without the di- vergence in the operated eye increasisig to any percep- tible degree till the object gets inside of 12" or so. If, on the contrary, the divergence gradually increases, or even rema ns the same till within 10 or 12'' of the eye, and then the eye suddenly flies out, or even begins to waver, we have cause for apprehension, and the farther that such a condition takes place from the eye, the greater the dread. Acain, if we have a line or even more of divergence in the median line for the distance, and this disappears gradually as we carry the object towards the temporal side of the eye operated upon, till the" object lies 15' towards that side, we have Uttle diead that the eflect is excessive, especially if, as is usu- ally the case, the object can be carried close up to the eves without the operated eye yielding. " Should, however, the conditions of these two tests not be fulfilled, it would be on the safe side to limit the effect of the operations by the use of the suture, and the quantity of the limitation should be graduated by the degree of the divergence and the distance at which it takes place. The proper amount, or its approxima- tion, can, I think, only be learned by experience, to- gether with a careful consideration as to the efl'eets to be produced by the existing refraction and accommo- dation. The elal)orate rules laid down by Yon Graefe in re- gard to dynamic squint, or insufficiency, are not, of course, applicable here, as the requisite sharpness of binocular vision very rarely if ever exists to make such tests possible, much less trustworthy. The estimation must be made by the operator's eye, not by means of prisms. The indications for the operation for strabismus are rapidly becoming better known, so that many more cas'.s come to operation in early life than formerly. Still there is n lingering de>ire, especially on the part of general practitioncr.s, to advi-e the parents to wait and see if the child will not grow out of it, and to assert that cross eye often gels well of itself; and if it does not, it will be time enough to talk of an operation when the child has reached lU or 12 years of age. Now it is true that strabismus does sometimes disappear of itself, but it is an exceedingly rare occurrence ; so rare, indeed, a.s to be the exception neces.sary to prove the rule that it does not cure itself; and that in the vast majority ol eases recourse must be had to an operation. In regard to this there is no division of opinion. But in regard to the time of life at which the operation .should be per- formed there is, I am sorry to say, much less unanimity, and the general profes-ion have certainly the best of exeusL's for the Fabian policy which they reconnnend on the authority of some of the greatest writers on this subject. Thus Bonders advises the use of " atropine in young children upon whom it is as yet unadvisable to operate." And Stellwag deliberately says that " it ia better to postpone the operation till the beginning of puberty, if the strabismus be seen in chil ihooJ. By thus delaying, the conditions are fulfilled under which periodical straljismus is removed, and the patient may, as it were, grow out of a squint which has already be- come permanent." Notwithstanding the weight of such authority, I am decidedly of the opinion that the cases in which the operation should be deferred to a comparatively remote period are few in proportion to those that should be operated upon as soon as seen. And the chief points which .>^hoidd influence our decision, either pro or con, are as follows : — If the child is very young, say fiom one to three years, and the squint is concomitant, so that the excursion of the two eyes is equal, and at the same time the squint is bilateral, so that the child fixes sometimes with one eye and sometimes with the other, it will be safe to postpone the operation almost indefi- nitely, or so long as the conditions described hold good ; for under this state of affairs the normal mobility of the eye and the acuity of vision will be maintained ; and this rule should be observed ail the more if there is hypermetropia, for if this be of any considerable degree the squint will most likely return after the operation, as the age of the patient will prohibit the correction of the optical defect by glasses. But squint of this character is very rare in infants and young children, as it usually results, not from an optical defect, since the accommodation is not actively employed, but from some paresis of the muscle?, so that tlie squint is confined to one eye, and vision is either entirely performed by the other, or so seldom by the jqninting eye that this is practically excluded from the visual act. If such eyes are left, to themselves, two things almost invariably occur. 1st. The vision deteri- orates, so that the ej'e in a short time becomes useless. 2d. The externus, from constantly being put upon the stretch, loses its vitality, and the mobility of the eye outwards is so reduced that the eye after a while gets the appearance of being, if I may so express myself, broadside on, producing, as the child grows up, a hide- ous deformity, and one Avhich later in life requires al- most an endless number of operations to remove. If, on the other hand, we operate early, when ttie weak- ened muscle still has a considerable share of its vitality left, we can do no possible harm, and we stand the chance of doing infinite good, either by cuiing the de- formity at once, or at least of turning what was a uni- lateral squint with exclusive use of one eye, into a bilateral squint Avith the alternate use of the two eyes, thus offering a much increased chance for the preservation of the vision, and a much better prospect THE MEDICAL RECORD. y 4n 01 <-^ A. of success from a future operation, when the muscles sliall liave more fully recovered their tone. In these cases it is almost always ncces>:ary to use the suture. between the ages of 4 and 6 we begin to get the common concomitant strabismus, dependent on either a congenital defect, that is, hypermetropia, or, what amounts lo the same thing, an imitation of this, through the tempiirary reduction of the accommodative power b}^ some debilitating disease. In this latter condition, tiiat i-, when the eye is emmetropic, or even slightly hyper- metropic, I never hesitate to operate, liistly, with the hope of restoring binocular vision ; and secondly, even if this fails, of removing the deformity ; for if this is once done there is little probability of its returning, since, as there is very little or no defect in the refraction, there is no exciting cause to occasion its return. After the age of 7 or 8 years I alwavs operate, and insist, if the error of refraction is sufiicient to warrant it, that glasses must be worn. Thus it will be seen, if these views are correct, that the latitude of operative interference is largely in- creased, at least in regard to the time of opeialing, in comparison with what is usually held to be sound prac- tice. There is one other condition of squint in which the general oi)inion seems to be adverse to operating, and that is the strabismus of a paralytic nature occurring in adults. This disinclination to operate in these cases evi- dently had its origin in two sound objections. First, an unwiUingness to subject the patient to the pain and annoyance of an operation when his strabismus is either accompanied by, or supposed to be the forerunner of, grave central trouble. Secondly, from a conviction that it was useless to operate on a muscle when the antan;- onist of that muscle was either partially or wholly paralyzed, as no effect would be gained. In regard to the first of these objections, it is no doubt true that any operative interference would be contra-indicated if cen- tral trouble was shown to exist; but there are very many cases in wdiich this does not manifest itself in the slightest degree, either at the time of the attack or later, or, even if it does in the beginning, fades away in a short time, while the strabismus, with its annoying di- plopia, remains. Under these conditions it seems to me that the indications for an operation are as strong, if not stronger, than in any other form of strabismus ; and that they are so, I think will be more foi cibl3^and more briefly shown by an example which is neither a rare nor an imaginary one. A man in the prime of life, after some exposure, or an unusually hard day's work, or even after the or- dinary routine of the day, goes to bed, as he thinks, perfectly well, and is astonished on waking up in the morning to find that he sees double. He immediately consults his family physician, who at once sees where the trouble lies, and, after a careful examination of his general condition, pronounces it sound, prescribes rest, absence from excitements and all abuses, whether of the spirit or the flesh, and gives iodide of potash in increas- ing doses. This maj^ or may not have some effect; usually it does not, and then all the changes are run? on the brom.ides, iodides, tonics, and electricity. Still the double vision persists, and what at first was a sim- ple annoyance now becomes an actual suflfering. There is a constant dragging sensation about that side of the head, with pain and tension in the forehead. The patient begins to have a difficulty in getting about, or even at times staggers or misses his footing. It is an exertion for him to think, and he begins to fear that he is get- ting light-headed, or that something is the matter with his brain ; and it is in vain that his physician or an ex- pert assures him to the contrary. To his suggestion. that, as his eye is turned, benefit might be obtained, from an operation, it is answered that, as his trouble is of a paralytic nature, it would be worse than useless; that things must be left to take their own course : and if this advice is taken, the diplopia generally fades away in a year or so, but the dragging, wearing, aching sen- sations in or about the eye usually remain, either as a constant companion, or to be called forth by the slight- est over-exertion or excitement. If, on the other hand, the patient, after a longer or shorter interval, seeks the advice of the trained ophthal- mologist, a minute examination is made, and I am afraid, as the usual thing, precisely the same advice is given, — exceptions to tiiis rul(>, though I am well aware they do exist, being few and far between. Sometimes, however, the oculist consulted, seeing that very little harm can result, boldly makes up his mind to run the chance of doing some good, and is often re- warded for his courage either by the cure or relief of his patient. The second objection, that we get no effect from the operation when the origin is a paralytic one, fades en- tirely away, since, by the use of the suture or by advancement of the muscle, we can get any effect we desire, no matter what the cause of the strabismus is. The treatment of paralytic strabismus is one of the most difficult problems that the ophthalmic surgeon has to deal with, and the dfterential diagnosis as to what muscles are aftected in a given case, as laid down in the books, and upon whicli we are made to believe our opinions should rest, is a thing which may well appal the boldest. So far as operating is concerned, the prac- tical considerations necessary to determine our opinion, at least in the majority of cases, can be reduced to a comparative few. In the first place, the oblique muscles, whether involved or not, are excluded, from the positions of their insertions, from the category, tenoto- ni}' of these muscles never having been, so far as I am aware, followed by successful results. Nor am I per- sonally aware of the attempt ever having been made to cut these tendons, though I have heard traditionary reports to that effect. This limits our attention to the four recti muscles, and in the great majority of the cases it is either the internus or externus which is chiefly af- fected, and oftener the former than the latter. When the superior and inferior are also implicated it is usually in a secondary degree, and the deviation a trifling one. When, then, a case of simple paralysis, either of the ex- ternus or internus, presents itself, I do not hesitate to operate, provided it is not marked by progressive dis- ease of central origin, and provided sufficient time has elapsed to show that therapeutical and hygienic means wid not remove the trouble. The only question, then, is, what operation we shall do ; advancement of the paralyzed muscle with a teno- tomy of the antagonist, or simply tenotomy of the op- posing muscle and the use of the suture ? This depends entirely on the degree of the trouble: if the paralysis is complete and the motion towards the median fine is very much limited, then resort must be had to advance- ment of the paralyzed muscle, as laid down in the books. But if the attack is slight, and rather a paresis than a paralysis, or a paralysis improved into paresis, and there is still some motion towards the median lino, then a simple tenotomy with the suture will often produce, as Graefe has pointed out, the most astonishing amount of effect. The fact of other muscles of the ocular group being affected, as for example the superior or inferior rectus, or even the obliques, used to be of great weight with me in determining the propriety of an operation, for it was argued that even if the horizontal double visicm 102 THE MEDICAL RECORD. was removed the vertical would remain, and the diplo- pia, tlioiifrh somewhal iliiTerent, would still be just as annoyiiijr to tlie patient. But cxpei ienc has sliown me that it is not ihe actual diplojiia whicli i:^ the ehii-f cause of trouhle and annoyance to tlu-se patients, hut the want of control they have over the eyes, and tlie subse- quent diatrabismus be cured ? — a question which, though facts do lend it some show of color, i.s, in the present advanced state of medical art, neither very comphmentary to the judgment of the general physician nor to the skill of the oph th almologist. Lead Poisonixg following the use of a " Hair Re- newer."' — A case of complete paralysis of the e.xtensor muscles of fingers and hands, with dropping of wrists, is mentioned by J. M. Crocker, M.D., Proviucetown, Mass., in the Boston Med. and Suvfj. Journal, produced by the use of a " hair renewer." the preparation con- sisted of three teaspoonfuls lac sulphur and two tea- spoonfuls sugar of lea 1 to a pint of water. With this he had drenched lii-; hair and sea!p as often as once a week for 15 years. Under the use of iodide of potas- siimi and galvanism the patient made a good recovery, the hair-dressing having been discontinued. CASES OF cs:rebro-spinal meningitis. Bv CHARLES W. PACKARD, M.D.. NEW TOBK. The following ca^es of Cerebro-Spinal Meningitis have come under my professional care during the past few weeks. Annie C, aged .seven weeks, was taken wi'h vomit- ing, restlessness, and fever at eleven p. m., on Saturday, February 24th. On the afternoon of the following day an eruption suddenly appeared, and the mother, beconi- ing alarmed, brought the patient to my office. I found the intiant collapsed, with a cool and pallid surface ; pulsa slow and somewhat irregular, pupils moderately dilated; and I learned that there had been slight diarrhd-a, but no convul.-ions. The eruption was roseolous in appearance, and ecchymotic. No diagnosis was arrived at, although it was very evident that some active blood-poison was at work. Difl'usible stimulants were at once given, but without avail, the case tern)i- nating fatally at one a.m. on the followinj; day, 26 hours after the first symptoms of illness were noticed. Soon after death nearly the whole surface of the body became discolored, and of a hue varying from i)urple to dark-red. No autopsy. On the afternoon of the same day, on returning from the funeral of the infant, the parents found that their onh' remaining child, a healthy boy three years of age, was sick with headache, vomiting, and high lever. Ix. was hoped that these symptoms might depend on tlic fact that he had not slept the night before, owing to the commotion in the room caused by the preparations for the burial of the infant, and to his having eaten a large amount of indigestible food during the day. There was nothing di.scoverable in his physical condition that is not constantly met with in the ephemeral fever ot children. On the following morning, February 27tb, the mother called to inform me that he had passed a restless and feverish night (I have since learned that he had three undoubted convulsions), but that towards morning his bowels acted freely, when his fever left him and he slept quietly. On waking he seemed so playful and well that the further services of a physician were not considered necessary. ^ 4 P.M., twenty-four hours after the inception of the disease, the father came in great haste to say, that after having been lively and apparently well all day, the child had suddenly met with " a change " and ap- peared to be dying. I found him collapsed and in.-en- sible, and apparently near death. The face and fore- head were pallid and absolutely cold. Temperature in axilla lul", pulse 84 and irregular, respiration 40 in the minute. Pupils somewhat dilated and variable. There were slight general convulsions at intervals of a few minutes. No abduction of thumbs or toes, nor rigidity of muscles; no eruption. Free stimulation was at once resorted to, and in the course of halt an hour a satisfactory reaction had begun. At this stage of the case I invited my friend Dr. Samuel Whitall to assist me in its observation and treatment. We at once catheterized the patient and obtained a specimen of urine which was normal in color and quantity and | contained no albumen. An eruption of petechial spots now suddenly ap- peared on the body and extremities, being most abun- dant on the neck and loins. The spots were of the size of flea-bites, though of darker color, and some were of a hnear shape, with fine radii upon one side, like the feathers on a quill. With returning warmth the nervous excitement be- THE MEDICAL RECORD. 103 came intense. There were frequent shudderings, and shiirt general convulsions, incoherence, witli occasional shrill outcrifS that he was fahiug. At times the de- lirium assumed a pleasant character for an instant, and the child would smile and utter short sentences, in an urgent, hurried way, such as "Mikey is a good boy," etc. ; there was persistent vomiting, and constant movement of the trunk and extremities. The expres- sion of the face indicated the e.vtreme gravity of the disorder. The brow was corrugated, the eyelids of a dusky red, looking just ready to become ecchymotic, the nose was pinched, and the upper lip drawn, and of a deathly pallor, in strong contrast to the brighter color of the cheeks. The movements of the body were unconstrained and natural, except that the head was slightly thrown back. In view of the almost maniacal condition of the patient, it was thought advisable to begin the adminis- tration of opium, which was given in increasing dose-^, beginning with one drop of the tincture every hour; the dose to be increased according to its effects. Hyd. sub. mnr. gr. x. was placed upon the tongue. The quieting effect of the opium soon became apparent. The restlessness subsided, and the convulsions became less and less frequent, and in two hours entirely ceased. The pulse became perfectly regular, but rapidly in- creased in frequency until in a few hours it had reached 160. Respiration 42 in the minute. There was little change in the general condition of the patient for the ensuing twenty-four hours, the dose of tr. opii having been meanwhile gradually increased to five drops an hour; but at the end of the second day (forty-eight hours from attack) die violent and noisv ex- citement returned, and witli it the vomiting. There was subsultus and floccilation. The pupils were moder- ately contracted, but sensible to light; slight strabismus. No return of the convulsions. Xo new spots had ap- peared, though a part of the eruption was of a darker color than at first. The bowels had acted twice. Urine no'w slightly albuminous. The patient became comatose two hours before death, which took place sixty-one hours after the attack. An autopsy was made 30 hours after death, by Dr. AVhitall and mj^self Cadaveric rigidity well marked. On inspection the depending portions of the body were found slightly discolored, and the eruption had assumed a darker hue. Upon section the scalp was pale, and no blood followed the knife. Dura mater injected ; arachnoid intensely injected and dr}^ and underneath it an abundant effusion of recent lymph of a gelatinous consistency. This was found most noticeably along the veins of the vertex, the longitudinal fissure, the fissure of Sylvius, and there was also a slight deposit about the optic commissure. Tf.e vessels of the medulla were intensely injected, but no exudation had taken place. Cerebral tissue somewhat injected, but of normal consis- tency. Not more than 5j. of serum was found in the ventricles. The conditions under which the autopsy was secured rendered it impossible to extend the ex- amination to the spinal cord and its membranes. The following case occurred during my recent .ser- vice in St. Luke's Ho-pital. I am indebted to the resi- dent physician, Dr. Greo. D. Bleything, for the subjoined history and careful record of daily temperatures: — Annie Frazier, age 19, Eng., married, admitted January 27th, 1872. One week before admission was troubled with sore throat, pain in the head, and constipation. The day before admission had a severe chill lasting part of the r.ight, and followed by fever and vomiting. On enter- ing the hospital was suffering from .severe cephalalgia, and great tenderness and pain in the post cervical region. Some opisthotonos. There are large patches of her- pes about the mouth and on the left hand. The limbs are hypcrassthetic, but not swollen, and there is no im- pairment of motion. No tenderness in abdomen, no spnts on any part of body. The right eye seems slightly deflected from a right line, and there is ptosis of right lid. The tongue is vellow-coated, and the fauces red- dened. Pulse is full and frequent, and bowels costive. No abnormal sounds heard on auscultation. Is not at all emaciated. Temp. 104°. Ordered Sp. Minder., | ss. ; Sol. Magendie, git. vj. Jan. 28lh. — Slept well last night, but is suffering greatly this morning. The ce- phalalgia is increased, and tenderness of the muscles ia the post-cervical region is very marked. Opisthotonos more decided. There is some tenderness of muscles of trunk and limbs, but no paralysis. Water is passed without difficulty, bowels are costive, face is flushed, pulse dichrotic. Temp. 105°. Ordered Tr. aconite rad., gtt. iij. ; Sp. Minder., ? ss. every three hours; sherry, beef-tea, broth, and broken ice. Evening : More quiet, continued treatment, and ordered enema. Jan. 29th, symptoms continue with unabated force. Patient was very nois}' and somewhat delirious through the night; takes a fair amount of nourishment in fluid and semi- fluid form ; calls constantly for ice. Temp. 104*; pulse, 130 and double. Stopped aconite, continued Sp. Mind, and stimulants. Jan. 30th. — Passed a bad night; was noisy and deli- rious ; applied ice to head, but could not keep it on ; vomited a green matter last night and this morning. Tem. 104|° ; ordered Tr. aconite rad., gtt. v. ; and to take Quin. sulph., gr. v.; Ac. sulph. dil., gtt. x., bis die; whiskey, § vj. ; sherry stopped ; beef-tea, chicken, and oyster broth ; egg beaten with sherry ; milk. Evening: Temp, 104° ; ordered Sp. terebinth., ? ss. in enema, and sinapism to back of neck. Jan. 31. — Mind is clear, and headache somewhat less; slept part of the night; still complains of the sub-occi- pital pain, and also of frontal headache. Temp. 103"; took last night Tr. aconite rad., gtt. vij. ; Sp. Mind., ? ss. every two hours ; stopped this morning and continued quin., etc. Evening : Temp. 102i° ; ordered Pulv. ipecac, cc, gr. x. Feb. 1. — Face is flushed, and complains that whiskey makes her head worse ; to be diminished to ? iv. daily; quinine with iron. Temp., a.m., 102.2; p.m., 102.2. Feb. 2. — Bowels have not moved sines last enema; tongue is a little broAvn at centre, and white over sur- face ; no spots or tenderness of abdomen ; no muscular tenderness or opisthotonos; has lain on right side al- most continually until now; this morning is lying on leftside; there is still drooping of right lid, and heavy I expression of face : slight impairment of hearing. Old. enema, containing ol. ricini, r ss. ; temp. 101°. I Evening, not so well ; complains of increased headache i and cardialgia ; coughs, and expectorates a bloody and I catarrhal matter, that apparently comes from posterior ' nares. There is some redness of fauces. Temp., p.m., ! 104.2. Pulse is full and rapid. Auscultation gives neg- ative results; stopped quin. and ordered sinapisms to epigastrium ; to take tr. aconite and sp. Minder, as before. Feb. 3. — Temp. 201.2. Is much better this morning; stopped aconite ; continue stimulants. Evening, increa,se of fever and headache. Temp. 106.2" ; renew aconite, enema to move bowels; sinapism to feet; ice to head. Feb. 4. — Temp., a.m. Feb. 5 Feb. 6 Feb. 7 Feb. 8 Feb. 9 Feb. 10 Feb. 11 Feb. 12 103°; P.M. 105 102.2 105 102 104.2 102 104.2 103.2 104 103 2 104 101.3 105 104 105 101 104 104 THE MEDICAL RECORD. 102^" ; P.M., lO.-j^^ 98 " 1(15 100 (i 104 101 II 104 104 (1 li4 103 11 104 OS II 98 93 II 93 Tliis inoniinjj voiiiitdl bieakfust, nnd is cou^'liiiip and cxpecl oral ill},' oonsistuiit iiia-<.-i'«, resonibliiiR ralarrlial liischarg.s, sliglitly ninrkfil wiih blood. Fauces no lonj,'or leddciu'd, but pallid. Feb. 1.3. — Vomited again this morning; other symptoms are uncliangod, except that patimt had a jirofuse sweat this morning. TLniji., a.m., 103°; p.m., 104°. Feb. 14— Temp., a.m , 102' 11 15 " IG " " 17 II 18 II 19 II " 20 " 21 " Convalescence wa^ now fairly established, and the patient left tlie ho.-spital Feb. 2Gtli apparently well. Her appetite was good, and she slept soundly every night. Tliere was considerable emaciation and general weak- ness, such as would bo expected after so severe an ill- ness, but no perverted sensation or paralysis. Remarks. — The diagnosis of this ca-^e presented some points of difficulty. In many respects the symptoms re- sembled those met with in remittent fever occurring in a person of strong hysterical tendencies. Throughout the disease she had a tixed and placid expression of face, an, as yet, unknown substances which are as likely to be poison- ous as benign, and advises that if mixed with syrup it should only be for immediate use. Cases have been observed in which the loni,'-continued use of the reme- dy has oicasioncd. it is thought, pains resembling those of arthritic origin.] Local Treat.ment of thk L'teru.s. — R, A, QuarlcF, M.D., of St. Louis, Mo. (St. Louis Med. and Surf/. Journal), in his Annual Report of the St. Louis Insti- tute for the Tieatment of Diseases of Women, mentions tliat tincture of iodine Cgr. 90 to Jj.) has been in almost constant use in treating hypertrophies, chronic en- gorgements, ca'arrhs and inflammations of the womb and its lining membrane. Erosions of the os have yielded most readily to a strong solution of nitrate of silver. In almo.st all cases of uterine disease, warm water vaginal injections were employed, medicated or not, as the individual case required. For all cases of vaginitis, whether specific or not, balsamum copaiba; fnjection proved an unfailing remedy. Thapsia as a Rubefacient and Revuisive. — The action of this plant (one of the umbellifene) is very per- sistent, differing, in this respect, from the ordinary rube- facients. It may, therefore, be regarded not merely as an accessory therapeutic agent, but as an independent remedy to be used with advantage in many affection.': of the vascular and nervous systems associated with painful hyperassthesia. which it .«eems to remove in a very noticeable manner. Dr. Armand has found its use of preat service in inflammatory disea.ses of the chest and of the larynx, when, in the latter, there was a con- siderable amount of piping and whistling in respiration, and great sensitiveness of the surface; and equally val- uable in angina faucium. It may be used for children as well as adult;. — AUgem. Wiener Med. Zeitung. Pei-iosis Rheumatica. — Dr. W. A, Hardway, of St Louis, Mo. (St. Louis Med. and Surg. Journ.), presents a case of this quite uncommon affection, occurring in a lad of 16, which exhibited features in common with ordinary rheumatism, and might be taken for a case ol that nature, the eiuption having been regarded as of incidental occurrence. The fact, however, of the pete- chias and the rheumatic pains being nearly always coincident events, the absence of the elevated temper- ature and more rapid pulse of acute rheumatism, to- gether with the subsequent course of the disease, clearly pointed out the distinction. Again, from the J general malaise, the eruption, the pain.=;, peliosis rheu- THE MEDICAL RECORD. 107 matica might be mistaken for an early syphilitic mani- festation ; but the absoneo, after careful examination, of any primary lesion, and of a venereal history, -would settle tlie question satisfactorily. TriK T'sis OF Pus in the x\nimal Economy. — Dr. A P. Reid, of Halifax {Canmln Me'l JnnrnaJ), writes, in regard to the use of jius in the anin:al economy, as fol- lows : — 1st. It is the method by which dead exudation cor- puscles and fluids assume a condition allowing of their subsequent removal by a channel which is not ne- cessarily injurious to the system at large, as they would be if permitted to enter the blood, to be ex- pelled by the enumctories. 2d. It is the method by whicli the before-mentioned matters so collected together, when, from tavoring cir- cumstances, tiiey cease to produce irritation in their vicinity, are absorbed or removed by the emunctories; the solid parts 6rst having undergone a fatty trans- formation, owing to the influence exerted on them by the free circulation of blood in the walls of the ab-cess. 3d. It is the method by which dead exudatioh ma- terial finally becomes incapsulated. The abscess ceas- ing to produce inflammation in its vicinity, the free cir- culation of blood in tlie abscess wall exerts such changes in the composition of the fluid parts of the pus as permit of their absorption without injury to the health of the solid part, which cannot be so dealt with, and which becomes inspissated in the form of in- nocuous substances, such as f\it, phosphate of Ume, car- bonate of lime, and other salts, united by an indeter- minate animal matter. 4th. It is the method by which tissues of all kinds, when deprived of their vitality, are reduced to a fluid capable of easy removal ; as the contents of an abscess. 5th. It is the method adopted by Nature to assist vital absorption in amputating dead tissues, either ex- ternally or internally. 6th. It is the method which assists ulcerative absorp- tion, so termed, in bringing an abscess to the surface; one portion or side of the abscess wall becoming grad- ually thinner as the abscess points. Chloride of Zinc with Chloride of Potassium. — Or- rlinary chloride of zinc is unsatisfactory as an escharotic, because of its hygroscopic tendency." M. Bruns (phar- macist) states this defect may be overcome by fusing two parts of the chloride of zinc with one of the chlo- ride of potassium, and casting in sticks which are to be wrapped in tin foil. Forced Delivery. — T. A. McKinney, M.D. (Leav. Medical Herald), communicates an interesting case of puerperal convulsions, with attending pneumonia, showing the following points of interest: 1st. Forced delivery is not unfrequently the only remedy for puer- peral convul>ions. 2d. Delivery may be undertaken after the seventh month without danger, when the os is but very little dilated, though there may be no signs of labor near. 3d. Pneumonia, caused possibly by a poisoned state of the blood, may be a complication of puerperal convulsions, though not always a fatal one. Treatment of Blennorrhagia. — Eleven cases of blennorhagia are related by J. C. Van Wyck, M.D., of Oakland, Cal. ( Western Lancet), in which treatment by carbolic aciil, in combination with astringents and I anodynes, was, he states, as near being a specific in uncomplicated cases as any remedy believed to be such in the domain of the materia medica. So firmly , is he convinced that to it alone are to be attributed the gratifying results which have marked every case in which it was employed, that with the next patient who comes under his care he will use the remedy simply diluted with distilled water. The Use of Alcohol in Chronic OtorrhovA. — A. "W. Calhoun, M.D., now of Berlin, Prussia ( fi^eorr/Za ^[ed. Comp.), having been sceptical in regard to the benefi- cial use of puie undiluted alcohol for the cure of un- complicated chronic purulent otitis, or otorrhoea, as practised in the clinic of Dr. Weber, one of the editors of the Monatschrift fur (jlirenheilkunde, writes that he has been enabled to follow a number of cases, as they progressed under this treatment, from the date of their first entrance into the Clinic till their dis- charge as cured — and is now thoroughly satisfied of its eflicacy, having seen cases of eight and ten years' standing, with destruction of membrana tympani, cured in comparatively short time. The application of undi- luted alcohol does not produce intense pain ; for a few moments there is a smarting, slightly burning feeling, which gives place to a sensation described by patients as that of an " agreeable warmth." This latter lasts for a considerable time. T^NiA Solium and Taenia Lata in a Child Three Years Old. — A case of this character, occurring in a boy three years and four months old, is reported by Dr. Joseph Ganghofer, in the Kansas City Medical Journal. The child had excessive craving for carrots, of Avhich he would daily consume large quantities, both cooked and raw. After persisting in this unnatural appetite for six weeks, a toenia solium of about eleven feet in length was passed. The morbid appetite of the patient still continued, and, on account of the largely distended abdomen, the carrot treatment was advised. Within two weeks another worm was passed ; this time a tccnia lata ten feet long, which came away entire, in- clusive of the head. Dr. Ganghofer remarks that the use of carrots as a domestic anthelmintic in cases of ascarides and lum- brici is no novelty, but their eiBcacy in dislodging the diflerent varieties of tape-worm has never before been established. It would appear that the large amount of saccharine matter contained in the vegetable must have sickened the parasite, and thus have caused its detach- ment from the walls of the intestine. Treatjient of Cystitis and Irritable Bladder of Females.— M. Yarnall, M.D., St. Louis, Mo. (The Med. Archives), calls attention to a treatment for cystitis and irritable bladder of females, practised by Dr. T. L. Papin, which has afforded such excellent results. This treatment, which is original with Dr. Papin, consists in dilating tlie urethra with a long pair of dressing forceps to such an extent as to produce temporary in- continence of urine by rupturing a few of the fibres of the sphincter of the bladder ; and repeating the operation, when necessary, at intervals of a week or more, until the patient is completely relieved. In nearly every in- stance the relief afforded is almost immediate, but in the course of a few days the irritabihty of the bladder ussually returns, M'hen the operation has to be repeated, and, if necessary, again repeated, until a cure is ac- complished. The operation being at first very painful, it will usu- ally be found necessary, in performing it the first time, to place the patient under the influence of an anaes- thetic; but its subsequent performance being much less severe, as a rule, the anaesthetic will be unnecessary unless the patient be of a very nervous temperament. Of the twenty cases thus far treated, eleven have been 108 THE MEDICAL RECORD. entirely relieveJ, nml eight, still umler Ireatinent, have been bcnolited, •vvitli a pro-pect of pcriiiftiient relief. In onlv one case has it failed, a very hysti-rieal individual addicted to the excessive use of nareotfics, and with whom the trouble oiipinatcd, piobably, in the over- wroujijlit mental condition of the patient rather than the ve.-ical irritation; and even here the patient was unquestionably benefited. Rabies. — 'SI. Auzias Turenne endeavors to establish a parallel between the pheiiomcna of rabiis and those of syphilis. It will be remembered that Marochetti con- sidered that the virus, after having btea absorbed by the wound, enters the circulation and tlun gaiiicrs under the tongue. From the third to the ninth day, small vesicles containing tlie virus appear on each side of the fr«num Iingu;v, and are called ly.^sa*. lie believes that by cauterizing these vesicles the further progress of the disease would be prevented. Experience has not confirmed these views, but M. Turenne, starting from the phenomena, has attempted to liken rabies to sy- philid, and the ly?s;c to the infecting chancre. — Do- minion ^fe^Ucal Journal. CoNSTiPATio.v. — Dr. Henry Field strongly recom- mends the arsenite of iion in the constipation attending uterine disease. Oxalate of iron is also recommended. Bromide of Potassitm in WnoopixG-corcn. — Dr. Beaufort uses the bromide with syr. of Tolu and an alcoholic preparation of aconite, combined together, and by the aid ot these three remedies he has seen the dis- ease cured in an average of twelve days. Citric Acid in After-Pains. — Dr. J. B. Chagnon {CanaiJa }fedical Journal) has used citric acid in jtartu- rient women with the most happy results. It not only acts as a nervine (?). but also as the best, prophylactic a'zainsi inflammations, such a? metritis, peritonitis, etc. He gives it to relieve after-pains in the doses of five grains in a wine-glass of water every five hours. TixcTURE OF Gelsemum IN Tetancs. — In the Balii- Tiiore Meiliral Journal is recorded a recovery from teta- nus, for which gelsemium was administered. Tlie disease 1 isted seventeen days, during which time twenty ounces of the tincture were taken. During the first twelve days the patient took from half a drachm to two drachms every hour. Injury of the Eye. — Dr. II. M. Sogie {Ohio Medical and Suriiical Reporter) reports the following case, which occurred in his practice : A man was blown out of a mill by the explosion of a boiler. He received, along with other injuries, a wound over the supra-orbital arch. The iris was seen to be detached at i;s upper border for about one-fifth of its circumference, and it hung down near the middle of the lens, which was not detached from its place. There was but little hemorrhage, and but slight iritis followed the accident. After the patient had recovered from the other injuries (fracture of both limbsj the sight remained unimpaired, except in so far as it was interfered with by the inal-position of the iris. On the Growth of the Nails as a Means of Progno- sis IN Cerebral Paralysis.— Dr. S. W. Mitcliel {Arner- ican Journal of Medical Sciences) states that he has ob- served in several cases of paralysis that the nails of the limbs of the aflected side, on the occurrence of the accident, ceased to grow. This was proved by staining the roots of the nails with nitric acid. He was able to predict, in .seeing after a time a white line of nail mak- ing its appearance, and before there Avere any other signs of imjtroveinint, that jiower was about to return to the limit, and that voluntary motion would s-horlly be restored. AiiSENCE OF A Lung. — Dr. W. Dickey communicates to the Civrinnati Lancet and Observer an extremely in- teresting history of a ca.se which had been under his care, and concludes by giving the following accmint of the autopsy, made twelve h(jurs afier death. Tlie left lung was found studded with tubercles, and was eome- what larger than usual, but consisted of two lobts. Un the right side there was no lung at all, not even a rudiment nt the bil'urcation. Ko lung had ever existed. Heart in the mediastinal .space, but in the rifjht side, corresponding to a natural situation in the left. Its walls were thickened, and cavities somewhat enlarged. Manual Force to tue Uterus as an Adjuvant in Labor. — Dr. J. H. Grant (Xew Orleans Journal nf Medi- ciue) advocates the application of physical force to the fundus uteri during laiior, and gives the histories of five cases, where it was applied with most manifest influence for good in hastening the birth of the child. His Jtlan is to bpply both hands over the fundus uteri, and exert the force in the longitudinal diameter. In some of these cases the strength of one assistant not being deemed sufficient, the hands of a second person were spread over those of the first, and their united cfi'orts produced the happiest results. Where the pains were insuflficient, the physical pressure served to increase them, thus "ob- viating the use of forceps and turning, except in cases of malposition of the foetus." Efficacy of Large Draughts of Water in Poison- ing. — The Xew Orleans Journal of Medicine contains the history of a case of poisoning by corrosive sublimate. The patient had taken a large dose of the poison. The lips and mouih were much swollen; there were violent pain and burning heat in the stomach, and he was ex- tremely ill. He Wiis ordered to drink at intervals, but as speedil}' as possible, twelve pints of warm water, and that as often as he should vomit he should drink more. As soon as, by the pains, it w-as perceived the poison had entered the bow^els, the patient was ordered large injections of simply tepid water. The first eva- cuations of the stomach were extremely acrid, on tic- count of the quantity of the poison which they contain- ed ; subsequent ones were less and less acrid with each evacuation, until they became completely free. The colics which came on were treated by fresh clysters. These simple means were so successful that in a few hours the patient was out of danger. Case of Tetanus Cpred by Excision of a Nerve.- Dr. George E. Foster {Boston Medical and Surrjical Journal) communicates a case of tetanus, following a Avound made by a shoe-nail entering the heel. The wound healed, leaving no trace of the injury. About three weeks after, the patient was aAvakened in the night with chills, stiffness of the limbs, and sliuht tAvilching of the muscles of the arm. He was given all the suit- able medicines, but with no effect to mitigate the symp- toms. It was then decided to cut down and remove a portion of the internal plantar nerve, which was done with the effect of entirely relieving the spasms. The patient afterwards had a complete recovery. GossYPiuM AS AN Anodyne. — Dr. Robert E. Peyton' (Richmond a)td LonisviVe Med. Journ.), relates a dis- tressing case of phthisis pulmonalis, in which, after giving other remedies unsatisfactorily, teaspoonful doses of the fluid extract of cotton-root gave the patient'' much relief. THE MEDICAL RECOi«D\ 109 The Medical Record: A SEMI-MONTHLY JOURNAL OF MEDICINE AND SURGERY. GEORGE F. SHRADY, A.M., M.D., Editor. PubliJilied (»i the 1st and 15tk of each Month by TVilI. ^VOO» & CO., 27 Great Jones Street, IV. Y. New ^^orls, April 15, 1873. HOSPITAL APPOINTMENTS. It has become so much the fashion in making hos- pital appointments to allow almost every consideration save professional ability to influence the appointing power, that the prospect of reform seems an almost liopeless one. "VVe are so firmly convinced, however, that there must be some remedy for the evils connect- ed with the practice, that we are determined to make every effort to discover it. We are perfectly aware of the fact that every applicant for a position in the hos- pital cannot expect to be successful, but, in view of the large numbtu- of capaljle men who do apply, we have a right to, complain when the selections are not extiaordi- narily good ones. ^ i'rom present indications there appears to be no jios- '^sible excuse for the ordinarj^ and generally accepted method of filling the professional positions in our large hospitals save partizansliip, or gross favoritism. Since our last remarks upon this subject, three liospitals have sprung into existence in our midst, the positions in all of which have been duly filled. No one acquainted with the requisites for oblaining such 'appointments is sur- prised at the hst of the attending physicians and sur- geons. The reasons why such and such men hold such positions are very easily explained. Here, for instance, is a college which must have nearly every member of its faculty in a hospital position, and when each mem- ber of said faculty who desires such an appointment is satisfied, it so happens that there are no places for any one else. The appointing power of another hospital is given to a single medical gentleman, and if he is con- nected with any pai-ticular school, as he is most sure to be, so much the better for the school. If he has friends or relatives whom he wishes to advance, no one seems to question his right to find positions for them not only in the hospital, but in the college — in fact, in the interests of the school he represents, both appointments must go together. In a hospital in which all the schools have a right to be represented, there are many tricks ])layed, and many subterfuges resorted to in order to have a majority representation, which, if the said manoeuvres were not made by some of our leading teachers, Ave should be privileged in calling them unprofessional, disgraceful, and ungentlemanly. We are perfectly willing that clinical teachers should hold hospital positions, in fact it is veiy necessary that they should ; but we claim that all the clinical teachers are not in our colleges. We fail to see how any col- lege, because it chooses to elect any one professor, can insist that such a gentleman must necessarily be a clinical teacher, and must, as a matter of course, hold a hospital appointment. Instead of colleges making clinical teachers, the clinical teachers should make the colleges. Many of the best clinical teachers we have seen, never held any chair in our college faculties, and we have a good reason for supposing that there are many more of the same S)rt who could use a hospital position to equally good advantage, if the colleges would graciously allow tliem the chance. If the col- leges would sometimes stop to consider how many good chnical teachers they might obtain by allowing an occasional outsider to hold a hospital position, and prove himself, by his work alone, worthy of a position as professor, we should have more men created for places, than places created for men. We are interested in the prosperity of the colleges, but the colleges cannot reasonably be expected to mean the profession. A gentleman who may have quietly devoted himself to his profession, who may have worked faithfully in a dispensary, and m;iy have a peculiar fitness for hospi- tal work and for clinical teaching, and who may be a thoroughly practical man, may perchance be of as much service in a public institution as if he Avere connected with some college. If we are mistaken in this, and if our colleges contain all the good and capa- ble medical men, we are forced to the huinihatmg- confession that by far the largest majority of the so- called profession are good for nothing. If we allow the colleges to monopolize all the hospital appoint- ments, and tacitly acknowledge their right to dictate to such as are unfortunate enough to be mere practitioners, we cannot escape the legii;imate conclusion that the pro- fession have no rights whatever in the matter. This is in fact quite evident from the appointments recently made in the hospitals named. We are emphatically opposed to all party influences in making these appointments, and believe that every man who applies for a position should have his claims impartially considered. We care not whether he be a professor or a " possessor," or both ; we, in the interests of the profession at large, call for fair play. When a hospital staff is to be selected, let the fact be duly ad- vertised ; let each applicant for the place present his credentials and his claims, and let these alone be the bases upon which his position is secured. Why is it no TlIK MEDICAL RECORD. necessary to keep the fact that appointments are to be mnde so quiet ? Why is it neccsi:nry to keep every one who might be imhiced to apply, in ipnorancc until all the places nri' fillid? Wliy is this done, if not with the avowed object of nionojiolizing honorable po-itionsand stifling legitimate endeavor? On a future occasion we shall present some of the de- tails by wliicli hospital appointments are secured to the select few. If any of our readers have any facts to communicate bearing upon tliis point, we shall use them in such a way as shall lend to promote the best interests of the profession, and the greatest good to our public institutions. Our .^ole aim shall be to venti- late the subject with a view to reform and to reform only, entirely independent of every other consideration but simple justice. We believe that this and a great many other matters connected with our hospital man- agement need looking into, and we are ready and will- ing to discuss them. AMERICAN MEDICAL ASSOCIATIO.V. The ne.\t meeting of the Anr.erican Medical Associa- tion, to be held in Philadelphia, promises to be unu- su dly interesting. It is the determination of the Com- mittee of Arrangements for that city to contribute in every possible way to the comfort and edification of the delegates. Tiiere is no doubt that there will be a very full attendance. New York will, we are assured, be particularly well represented. It is to be hoped that the meeting will be a harmonious one, and that those who attend will be spared the discu.^sion of several of the vexed and useless questions which have occupied so much time during the last few sessions. In another column we publish some details regarding arrange- ments made with the railroads for excursion tickets, etc. Ucuicius aiit) notices of Oooks. Lectures ox the Clinicat, Uses of Electricity. By J. Russell Reynolds, M.D. Philadelphia : Lmdsay & Blakiston. 1872. Electricity ix its Relations to Practical Medi- crxE. By Dr. Morttz JIeyer. Secoud revised and American edition. Translated bv Wm. A. ILv.MMOND, >LD. New York: 1872. D. Appleton & Co. Dr. Reyn: lds is one of the ablest and most cultivated physicians of London. On nearly all subjects of genei al medicine he writes sensibly and clearly, and to electro- therapeutics he has given mo-e attention than the inajority of even the most advanced practitioners. Tliis little work is perhaps all that it professes to be — a clear and suctimt statement, in language to suit the mind of the beginner, of some of the elementary princip'es of localized electric'Stn. So far as it goes — which is not very far — it is unusually clear. Its srrong meris are lucidness and common sense. Its omissions are, of course, enormous ; it gives but the alphabet of electro-theraj>eutics : the author is, to say the least, ten years behi::d the time; and yet very few writers on general medicine is as well advjtnceil in electro-tlicraiieuticii as he. He does not filly compre- hend tlie po.sition of electricity in the maii-ria medica, but he comes nearer to tiie truth than most writ, that, excepting in political economy and geology, English scientists are behindhand in science. 8ave Altiiaus and a very few others, the London physicians, as were shown by a recent contro- versy, in the meiiical journals, between Dr.«. Gull and Ansiie, are only just beginning to open their eyes to the subject of electro-therapeutics. In no other great medical centre would the adverse opinion even of so high an authority as Dr. Gull have been thought wor- thy of a moment's consideration from any intelligent human being. There are three points in this work of Dr. Reynolds, that are of themselves worth the price of the book, especially for those who blindly follow in the wake of Diichenne and Remak. These points are: — 1. The differential action of the currents of the pri- mary and the secondary coil. 2. The difl'erential action of the two currents. 3. The differential action of the ascending and de- scending currents. There are now in this country a very large number of physicians, young and old, who are diligently in- vestigating the subject of electro-therapeutics, and who would do well to obtain this little work of Dr. Rey- nolds, imperfect as it is, and to study it in connection with other text books of the subject, chiefly as a com- pliment to its clearness, fairness, and good sense. It is safe to assert that at the present time there is more doing in electro-therapeutics in the United States, both in the way of original research and in the way of popu- larization than in Great Britain or France or Germany. Like surgery, it has become an American science. All the American apparatus for medical and suri.'ical electricity are equd to, and very often incomparably superior to, those of European manufacture. If we are to maintain this advanced position, we should inpartially and care- fully avail ourselves of the best fruits of modern research in every direction. It is necessary to sow beside all waters. There is no book on electro-therapeutics so poor but that it may teach us something of real value, or at least give us suggestions by means of which we may be enabled to pursue our investigations w^ith "reater intelligence and success. Every* publication on the subj'Ct, therefore, is to be welcomed. The work of Meyer is now well known, and both its merits and demerits have been publicly recognized. Very far inferior to the work of Benedikt in strengtii and suggestiveness. it is perhaps better adapted to meet the general want. It gives a fair and truthful rC'Sume of the state of medical and surgical electricity, so far as we know, in Europe, at the time of publication. It is now of necessity considerably behind the times, though much in advance of Reynolds. Meyer is utterly free from hobbies, and evidently has no prejudices. His style, however, is more German than English ; his directions are oftentimes obscure, and in generalizing power he is greatly deficient. His want of diagnostic skill impairs seriously the value of some of the cases reported. Case 84. reported on page 396, as a case of locomotor ataxia, is really not locomotor ataxia at all. The pathological condition was probably a local and tempo- THE MEDICAL RECORD. Ill rary congestion of the cord— a condition which, when neglected, ni;iy in perhaps one c;ise out of a hunch-ed or tliousand, go on to be sclerosis of the posterior columns. We speak particularly of this case, because it will mislead those who are trying to cure locomotor ataxia by electri.nty. After the process of degeneration of the cord has really set in, galvanization very rarely cures, though it may relieve. The editorlias in this edition corrected several of the typographical errors of the first edition, and has called attention to the very excellent apparatus of the Galvano- Faradic Mfi,^ Co. In closing these brief notices, we may remark that no one who wants to keep abreast of the times in electro- therapeutic-? should depend on text-books, even the best and mo'. The moment at whiL-h the deviation from normal development took jilaee may be fixed at somewliere after the bepinnini: of the third month, for tiie septum ventrieulorum is closed, and before the beginning of the fifih, for the Eustachian valve persists. It is, in- deed, so complete, that it seems preserved in the state of its perfec-tion, at about the beginning of the fourth month — t!ie probable period, therefore, at which the hsi"!! in question occurred. The nature of that lesion w.-xs a matter of great in- terest. There was certainly no trace of emlocardiiis, and the hypertrophied n)uscular tissue that filled up tlie right ventricle did not present any obvious traces of myocarditis, such has been insisted upon by Stolker as a cause of pulmonary' stenosis. Dr. Pit.nwm was inclined to ascribe the hypertrophy to the existence of some obstacle ;it the pulmonary orifice, that had necessitated great efibrt on the part of the riglit ventricle at the very moment that the forma- tion of the septum was in progress. A double impulse, therefore, w.ns given to the growth of nmseular tissue, and under its inlluence this became excessive, blocked up the pulmonary orifice, and then, when the cavity of the ventricle became useless, gradually obliterated it as well. The pulmonary congestion that immediately caused death evidently resulted from an overloadin'jr of the left auricle, charged with blood both from the right auricle and from the pulmonary veins. The slightest failure of power of the dilated left ventricle would tell fatally upon such a morbid condition. The left ven- tricle was obliged both to send blood to the lungs, by the aorta, and receive it from tliem by the usual channels. The circle of circulation was too small, and finally btcame blocked at both ends. Then the heart stagirered and succumbed. The absence of cyanosis in this case, inexplicable on the theory that cyanosis depends on a mixture of venous and arterial blood, is easy to understand by those who ascribe the blue coloration to a stasis of blood in the venous capillaries, and to its insufficient aeration by the lungs. Such stnsis had not had time to take place during the short life of the child, and the moment that aeration began to be insufficient coincided with the invasion of the fatal pulmonary congestion. Dr. J.\cobi inquired if the bronchial arteries had been examined. Dr. PrT.\.\M regretted that stich examination had been forgotten until it was too hite, but observed that the sufficiency of the ductus arteriosus rendered the dilatation of the bronchial arteries unnecessary, and therefore improbable. Dr. J.\cobi, on examining the heart, observed that it was indeed a ver}' rare cnse of anomalous formation. He did not believe in explaining such anomalies b)-^ the vague term " arrest of development," for that explained nothing. The real question was, ii-hy had such an arrest occurred? In the present ca-e it was noticeable that the pulmonary artery was riding over the septum, and arrested in its progress towaids the right, while the ."orta was equally arrested in its march towards the left. He was inclined to attribute the excessive development of muscular fibre, which had thiikened the septum, clo.sed the j)uhnonary artery, and obliter- ated the right ventricle, to a myocardili-. He suggest- ed that a microscopic examination, that should reveal an excess of connective tissue relatively to the mus- cular fibres in the neighborhood of the pulmonary orifice, would render this origin almost certain. Dr. PiTNAM had intended making such examination for the purpose of settling this very question, but had reserved it until after presentation of the specimen. M.\.MMARV TIMOR (FIBRO-S.VCROMATOUS.) Dr. Post presented a tumor removed by operation from the lell inaunnary region of a lady aged 06. The ma.>-s was as large as an ordinary mammary gland, being the size of tl.e two fists. The patient was not con- scious of the existence of the tumor until November last. It had not been the seat of any pain, the general health continued good, and the integument moved freely over the growth. Q'here wa.s no attachment to the pectoral muscle underneath. The general shape of tiie tumor, as covered by the integument, was very nearly spherical ; and there were some inequalities of the snr-' face tiiat suggested the idea that it might be a cystic growth. There were no enlarged plands in the neigh- borhood, nor evidence of constitutional contamination It seemed to be identified with the mnmmary gland although it was separated at its upper portion. D Post consequently removed the whole of the gland with the tumor. He was, however, struck in its removal with the fact that the tumor was remarkaVily loose ii its attachments to the surrounding parts, and that then were no vessels of any considerable size that were divi ded in the operation. Only five ves.-els required to b« secured, and the operation was done by acupressurei On examining the tumor after closing the wound hi was surprised to find that there was no intimate con nection between the tumor and the mamniary glan " The gland was atrophied, and all attachments to it were very readil}' overcome by the handle of the scalpel. The tumor was of hard consistence, and it creaked un der the knife more than scirrhus. There'were no cavi ties in its substance containing fluid, in fact there w nothing like cancer-juice to be detected. The subcu taneous veins were considerably enlarged. The tumo] had not yet been examined microscopically. He presented the following report from Dr. Dela field of the microscopical appearances of the tumor : — Tiie tumor consists of a firm, dense tis.stie, divided u[ in all directions by clefts and fissures. The solid por- tion consists of connective-tissue fibres, mixed witi large numbers of oval and fusiform cells. At the edge of the clefts the tissue is not uniform, but is divided u] into large tuft.*;. The clefts are lined with cylindricj epithelium. The tumor belongs to a class which ha been described under different names by dilTerent a thors. — proliferous mammary cysts, cysto-sarcoma, et( The explanation most generally received at present i that theie is an intra-canaVcular growth of papillar tumors from the walls of the milk-ducts, at the samd time the milk-ducts are dilated. From this dilatation and the filhng up of the dilated ducts with the soli new growth, result the peculiar appearances seen io this specimen. The tumor is, technically speaking, a fibro-sarcom: inter-canaliculare mammae. The acu[iressure needles were removed forty-eigh hours after the operation, and there was a prospect o the wound heahng almost entirely by first intention DEATH FROM HEART-DISEASE. Dr. Finsell exhibited a heait taken from a colored THE MEDICAL RECORD. 113 woman aged fifty, Avho died suddenly while in the act of takuio- a cup of coliee at the breakfast table. The aorta was the only organ that sliowed any lesion, vvhicli was an extensive calcifieation jllh^t above the aortic valves. He also exhibited a heart taken from tlie body of a man aged 35. lie was returning home on Saturday evening when he met a prostitute Avho persuaded him to accompany lier to her lodgings. After retiring to her room, and fifteen minutes after having had connec- tion, he was seized with a fainting spell, and before aid could be summoned he Avas dead. The heart weighed twenty-four ounces, and there was atheroma of the aorta, with marked hypertrophy of the left vcntri^.le. The brain was not examined in this ca=e. Dr. Loomis was of the opinion thnt very few of the large number of sudden deaths occurred from heart- disease, although the heart was found to be diseased at the time. This statement Avas founded on a careful in- vestigation of 155 typical cases of heait-disease. Dr. Post remarked that sudden death might be of- ten caused by a minute lesion of the medulla oblonga- ta, which lesion might be very readily overlooked during an autopsy. Dr. J. C. Petkrs in tliis connection referred to the case of a patient fif his, in whom the only cause for suilden death was fatty degeneration of the heart. Dr. Loomis stated that, about a year and a half since, lie exanuned a gentleman, eleven o'clock in the morn- ing, and gave the opinion that the heart Avas perfecly sound. The patient Avas in apparently good health at the time. At one o'clock in the same afternoon he died suddenly. A fcAV days before, this patient had had his life insured for twenty-five thousand dollars, and a gentleman Avho Avas called in after the death had occurred offered the opinion that tliere had been heart- disease. After considerable effort Dr. Loomis obtained an autopsy, and succeeded in satisfying himself that death Avas due to a large effusion of blood at the base of the brain. Theie Avas a slight atheromatous condition of the aorta, and the left ventricle Avas very slightly hypertrophied, but these lesions were insignificant. Dr. Putnam suggested that a broad distinction should be made between aortic and mitral disease in regaid to the liability of sudden death. Recent statistics had shown that aortic insufficiency was particularly liable to be followed by sudden death, and an ingenious ex- planatiun had been given of its mechanism. When the aortic valves are sufficient, the blood, suddenly arrested by their closure, is forced into the coronary arteries that arise behind them. When they are insufficient, a li-rge pait of the blood passes back into the ventricle, and does not pass into the coronaries. At all events, the jet is not thrown Avith the normal force. The Avails of the ventricle, therefore, are c mstantly growing weaker from insufficient nutrition, while the cavity is dilating from the increase of its contents, and the brain suffeis from the general antemia so cliaracteristic of aortic insufficiency. At a given moment, the com- bination of these influences reaches some special crisis, the heart staggers under an excessive afflux of blood, at the A'ery time that it is deprived of its normal stimulus from ner\'ous influx, and from the blood fresh- ly circulatirig in its nutritive arteries, with an increas- ed burden and less power to bear it, the heart comes to a stand-still, and pauses in diastole. Dr. Jacobi maintained that it Avas hard to prove or to disprove this theory, except by tlie facts of clinical experience. If the idea Avere tenable that the heart Avill gJA'e out suddenly when not sufficiently nourisherl, it was impossible to see Avhy a large number of persons, under severe physical exertion and under great mental emotion, should not die upon the spot. Tt appeared to him that inasmuch as a large portion of tlic lieait could be di.-integrated without causing inmicdiate death, a sudden arrest of blood in the coronary could hardly 1)0 charged Aviih producing a fatal result. Dr. Loomis remarked that the clinical hi-tory of cases of aortic regurgitation militated against the theoiy of sudden death from arrest of supply through the coronary artery. Aortic regurgitation lir>t causes a dilatation of tin; ventricle ; that dilatation is imme- diately compensated by hypertrophy of th(! ventricular Avails, The hypertrophy goes on j^u^'i passfi Avith the dilatation until degenerative hypertrophy commences, Avhen the dilatation gets the best of the race. Then it is that the patient is in a condition to invite sudden death, when the heart may be overtaxed. Dr. Jacoei had never been able to convince himself that any of his cases of death from heart-disease occurred suddenly. lie did not recollect having seen a case terminate in death in less than tAVO hours. Such an one he called to mind in the person of a boy, Avho died in two hours and a half from pulmonary oedema. Dr. Peugnet referred to the case of the late Dr. Canimann, Avho died of degenerative hypertrophy, caused by aortic ami mitral disease. PULMONARY APOPLEXY. Dr. F. exhibited also a case of pulmonary apoplexy of the right lung, removed fiom tlie body of a German aged 65. He Avas engaged in a quarrel with one of his tenants in reference to chopping some Avood. It Avas claimed that he was struck Avith an axe in the quarrel, and that he had died in consequence. At the autoj sy, hoAvever, no marks of the axe Avere to be found. On removing the calvarium a large effusion of serum, amounting to eight or ten ounces, w^ns discovered l>y Di-. Cushman underneath the arachnoid. If there Avas such a thing as serous apoplexy, Dr. F. Avas inclined to call this such a case. The brain Avas not congested, neither were its vessels gorged or distended. On open- ing the chest the right lung Avas discovered to be the seat of extensive pulmonary apoplexy. It was clear that death Avas caused by this latter effusion, combined, perhaps, Avith the serous apoplexy. The fatal result occurred about an hour after the fracas. Dr. Jacobi asked if the convolutions Avere not hard and flattened, and on being answered in the aftirmative, expressed the opinion that the supposed serous apoplexy Avas evidently an old process. DEATH FROM PYEMIA AFTER THE DIVULSION OF STRICTURE. Dr. Keyes exhibited a specimen of death from pyremia after the divulsion of istrieture. A Scotchman, aged forty, Avas last month sent to hospital fi om the workhouse. He was a stout, heavily built man, and complained of stricture Aviih cystitis. A number 11 bougie (French scale) Avas readily passed, and, as the patient desired to be relieA^^d of his trouble, a Thomp- son's divulsor Avas introduced, and screAved up to 30. The patient did not complain of any pain, until a No. 25 sound was passed, Avhen he also had a chill. A sub- cutaneous injection of morphia Avas made into one of his arms. Shortly after this he passed into a condition of fever, Avhich lasted until death. The chill lasted five minutes. His pulse went up very rapidly, so that the next day it Avas 130-140. His skin was hot and dry from one end of the disease to the other. He drifted into a condition of delirium on the third day, and his skin becairie yelloAV tAventy hours before he died. It Avas discovered that there Avas a little tenderness 114 THE MEDICAL RECORD. beneath the scrotum, and on the tliinl day n lump nboiit tlu' size of a marlile was discovered. The pa- tient diod on tlie nintli day. At the aiiiop.sy it wa.s di.'^covered that there was ex- trava-atioii of urine; that there had formed pu.s in the meshe.s of the scTotuin: that tliore was a small abscess in the Moor of the urethra, just in front of tlie stricture. There were also three aljscejses in th" pro.statc. The bladder was hypertrophiod to a certain extent, and pave evidences of the existence of clironie cystitis. An ab the size of a marble was found in the sum- mit of the left \uw^ ; the liver and spleen were soft, but contiiined neither abscesses nor infarctions. There wai> no trouble with tlie kidney*. The cavities of the pleurje contained serous effusion, with a few floating flocculi. Tne specimen wa.s of interest as showing the results of divulsion, viz. : tearing through of the mucous mem- brane and of the stricture tissue, and als) as a case terminating with pyaemia as the apparent result of the operation. About five days after the operation the patient was recognized by two others, who had seen him in a strait-jacket, with violent mauid a potu, three days bef ire his admission to the hospital. This fact explained the reason why the condition of the patient was such as to invite suppuration so readily. In fact, this conlition was very manifest in the beliavior of the hypodermic punctures, which degenerated into diffuse .suppuration. The chill evidently did not have any- thing to do with the pyaemia as an initiative. The heart was enlarged, the lungs cedeniatous, and the pericardium was adherent to the stomach. EFFECTS OF HYPODERMIC IXJKCTION OF RESKNOID OF VER.\- TRCM ALBUM. Dr. PErGNKT presented the stomach, intestines, uterus, and bladder of a slut, which were intensely in- jected ; the coats of the stomach and intestines thick- ened, and he believed presented evidences of inflam- matory action. The specimen was un'que. and the only recorded one having been produced by the hypoder- mic iniection of j? gr. of the resinoid of veiatrnm album, that is, its re-in deprived f)f its alkaloids, veiatroida (so- called verat:ia) and j^rvina. It contains a distinct organic principle, but not of basic origin. He had made several experiments on various species of animals, but had invariably obtained similar results, varving in in- tensity as to the amount of resinoid administered, and to the length of time it took to cause a fatal termina- tion ; whilst he had never seen any similar effect pro-' duced either by the veratroida or the jervinn, although variou- observers had attributed this peculaiar action of veratrun allmm to its veratroida. He con-idered thv. in this principle resided the marked difference between veratrum album and viiide. The kidneys and ureters were normal, the liver dark and c.mgested, the heart distended, ventricles filled with blood; ri<.'htlung cingesteil, with ecchymotic spots on its surface, but readily inflated. Its peculiar effect on the uterus showed that t!ie cases of hemorrhage alluded to by Orfili, in his treat-se on toxicology, as well as the case which had come imder his own observation, was not due to its mechanical action as a sternutatory when applied to the nostrils, but to the congestion developed in the uterus. It is a c;irdiac poison, causing death by stopping the heart's action at the diastole, owing to a gradual de- struction of the excitabihty and conductive power of the nerves of tiie organism, probably due to a paralysis of the blood-vessi-ls of the nerve-centres. Dr. J. C. Pkters alluded to the specific action of certain medicinal agents on the alimentary canal, and inquired if there had been any tiiminution of the temperature in this case. Dr. Pkuo.vet re[»lied affirmalivel}'. Dr. Petkrs thought that it was intense hypcrajmia or congestion, due to a paralysis of the vasa-motor nerves. Dr. PEroNET admitted that the hyperaimia or con- gestion, as suggested by Schroff and confirmed by (iililer, in reference to veratrum, would be accounted for by paralysis of the vasa-motor nerves as its primary action, but that if the animal lived long enough, gas- tro-enteritis would be developed as a secondary one, as observed by him in a case of poisoning, where the patient took half an ounce of the homoeopathic mother tincture of veratrum album, and was confined to her bed for eight weeks, presenting all the symptoms of gastro-enteritis, finally recovering with a contraction of the colon, which caused an extreme attenuation of the faeces, and that they only recovered their natural form and size four months after. Dr. Jacobi remarked that Dr. Peugnet had been carrying on extensive experiments with the different varieties of veratrum, and suggested that he should make a micrcscopic examiiiation of the specimens. The Society then went into Executive Se.-sion. Stated Mediwj, Fehniary 28, 1872. Dr. a. L. Loomis, President, in the Chair. FOLLICULAR ULCERATION OF PREPUCE. Dr. Post presented the inner portion of the lining membrane of the prepuce removed by excision from a married man aged forty-eight. The patient had a long foreskin, which could be retracted only with difliculty. The disea.se consisted in an extensive granulating ulcir- ation, and also induration. It presented none of the physical characters of the initial sore of syphilis, neither was there any syphilitic history connected with the pa- tient. None of the glands in the neighborhood were enlarged. The ulcer was indolent in character, had exi-ted for a period of three months, and seemed, in the absence of anv other cause, to be due to a want of cleanlines-s. The specimen was, on motion, referred to the Committee on Microscopy. PERFORATION' OF APPENDIX VERMIFORMIS BT F.ECAL CONCRETIONS. Dr. Mason exhibited some faecal concretions re- moved from the appendi.x vermiformis of a stout, heal- thy boy aged eleven years. The patient was taken sick on "Wednesday, December 7, with what appeared to be a .simple attack of cholera morbus. In the morning his motlier gave him a dose of oil, which pro- duced four or five large evacuations. Dr. Mason was called to the patient on the afternoon of Thursday. There was then a good deal of pain in the abdomen, most intense, however, in the neighborhood of the right iliac region. The nature of the casf was at once suspected and an Ofduion given accordingly. The patient was put under the opium treatment, and was seen again at ten p.m. The pain was somewhat easier, although it had exfendet see that enough accommodative effort is called into play to counteract the tendency to divergence. Of the amblyopia that is fouml in monolateral squint three stages or rather forms have been distinguished. In the_/fr.s^ form the acuity of vision is diminished — there |is simple dulness of the retina. In the second form the Ipower of fixation is impaired; the patient makes a feel- ing movement with the macula lutea, and he sees jobjects better that lie toward the temple than those that lie toward the nose.* In the third form the inner half of the retina has better vision than the macula. ■This classification is of great importance for the prog- 'nosis. The dulness of the retina described under the Uirst form is entirely curable and often disappears im- niediately after the tenotomy. In the second form the jimprovement comes, but is only partial and gradual. I For the third form the chances of improvement are very small. I Dr. T. R. Pooley concurred with Dr. Knapp in ithinking the subconjunctival the best method of oper- iating. It was not difficult of execution, provided the l.^onjunctiva was grasped close to the sclei'otic, so as to iinsure the opening of Tenon's capsule. The method of ipperatiug proposeil by Dr. Loring, of introducing the (jiiook from above, and exoosing the whole insertion of ' the muscle, and the too free dissection of the capsule, is likely to be followed by undue reaction. The vertical -'Uture could have no diminishing effect. A suture de- signed to diminish the effect of the tenotomy should be passed horizontally in a place with the muscle and leeply enough to embrace part of the tendon in its grasp. Ho thought it advisable to operate without an Hannesihetic whenever practicable, in order to control the elTec's as soon after the operation as possible. The Endoscope. — Dr. Robert Newman, of New York Trnns. Med. Soc, X. Y., 1870), gives a practical paper jon the use of the endoscope in the treatment of dis- jeases of the female bladder and urethra. It is pro- fusely illustrated with diagrams. Six cases, selected from many others treated at the Woman's State Hos- jpita', under the care of Dr. T. A. Emmet, are detailed. CotrespoutieiiCie. Ipita' THE SELLING OF DIPLOMAS. To THE Editor op the Medical Record. Sir : Duty to myself, not favor to persons or colleges, — for I never knowingly do favors where crime may possibly be abetted thereby — renders it requisite to say, that on further investigation, I find that there is no evidence within my reach, which will justify the fol- lowing raragraph of my letter published in the pEconn of the 15th March inst. as regards the College alluded to. "Besides such outrageous acts, it is credibly stated that this same college advocates the propriety, and fol- lows the practice, of selling their diplomas to persons living in distant parts of the State, on the simple state- ment of the person seeking it, without any presentation of certificate or credentials. " I had either misapprehended the statements alluded to, or they incoirectly represented the only written evidence I have yet seen upon this matter of the prac- tice of the said college, of giving diplomas without examination. So far as the evidence before me goes, the college offers to examine any graduate of a medical college, and, if satisfactory, to give him a diploma for ,$35. It also oflers to receive the diploma by mail, or in- deed any certificate of graduation, and, excusing the examination, 'issue a diploma for $175, that is, charging $140 more when they do not examine, than when they do examine. Respectfully, Stephen Rogers. March 30th, lS7;i. Hciu 3nsttuntcnt3. DESCRIPTION OF A NEW SCARIFICATOR TO FACILITATE VACCINATION. By B. F. DAWSON, M.D., ATTF.N'DING PHYSICIAN TO THE NEW YORK STATE WOMEN'S HOS- PITAL, ETC. The threatened epidemic of small-pox during the pa-t winter greatly increased the vaccinating duties of phy- sicians. In the frequent performance of the operation, in common with many others, I felt the necessity of a scarificator which would combine the three great re- quisites of painlessness, rapidity^ of action, and sim- plicity of mechanism. While thinking over the mat- ter, the following instrument suggested itsell", and through the assistance of Mr. Stohlman, of G. Tie- man & Co., of this city, has been just prit into form. The accompanying illustration represents the exact size of the instrument, which admits of its being car- ried in the vest pocket. The construction of this instrument is as follows : a simple tube through which runs a steel rod connecting with the handle («), 3.nd terminating in six needle points shown in woodcut; a spiral spring encircles this rod, being fistened to it at the needle extremity and connecting with the outer tube at the insertion of the liandle (a). A rachet catch (e) prevents the recoil of the spring when wound up, which is done by turning I, the handle (a) with the right hand, from riijht to left, 118 THE MEDICAL HECOKD. until it winds no further. The regulatin}? i>icce (h) en- ablrs tlif ile-ired exposure of the lU'cdlcs, which shouhl projt'ct but sliglitly beyond tlie end of tlie instrument, 'file intitruinent, being wound up, is ready for use. Tlie operation is performed by taking the scarificator in the right hand, the thumb being against the rest (). the needles can readily be cleaned by wiping or passing through a piece of soft paper. Several of my friends and others have used the in- strument, and to all it has given the most perfect satis- faction. When carrying it in the pocket, the needles can be well protected by the regulator (b). (Dbitimrii. PROF. SAMUEL JACKSON, M.D., OF PniLADELPniA. Dr. Samtel Jackson, Emeritus Professor of the Insti- tute of Medicine in the University of Pennsylvania, died, April G. at his residence, in this city, at tlie ripe old age of eighty-two. He was born in Philadelphia on the 22d of March, 17S7. He devoted his time with great energy to the study of his profession, and was successful in acquiring a high standing in its practice. In 1835 he was elected professor of the Institute of Medicine in the University of Pennsylvania, a position which was filled by him during a period of twenty- eight years, with great credit both to himself and the institution. He was one of the cleare-t lecturers and profoundest scholars, and occupied a jfront rank in the corps of professors of the university, a body of men which has long enjo\-ed the highest reputation fir skill and learning throughout the world. In 1863. in con- sequence of his advanced age, he abandoned the active duties of his professorship, and has since held an Emeritus relation to the university. Prof. Jackson wrote several works on medical and physiological sub- jects, the most celebrated of which were a treatise on the " Principles of Medicine," first published in 1832, and an "Introduction to Lehman's Chemical Physi- ology," published in 1856. — Philadelphia Liqnirer. ARMY NEWS. Official List of Changea of Stations and Duties of Offi- cers of (he ^fedica! Department, United States' Army^ from March 19, 1872, to April 4, 1872. inclusive. Fryer, B. E.. Surgeon.— By S. O. 43, Department of the Missouri, March 20, 1872, assigned to duty at Fort L'nion. N. M. Storrow, S. A., ARsistant Sursreon. — By S. 0. 77, War D-partnienf, A. G. 0., Ajiril 1, 1872, giaiittd leave of absence for si.xly day.»». Breweii, J. W., Assistant Surgeon. — By S. 0. 47, C. S., Department of the Missouri, assigned to duty at Fort Dodge, Kansas. Tremai.ne, W. S., Assistant Surgeon.— By S. 0. 47, Department of the Misi^ouri, March 25, 1872, assigned to duty at Fort Lamed, Kansas. Monroe, F. Le B., Assistant Surgeon. — By S. O. 74, War Department. A. G. 0.. March 28, 1872, relieved from duty in Department of the Platte, to proceed to Boston, ^^ass., reporting on arrival by letter to the Surgeon General. Latderdale, Jxo. v., Assistant Surgeon. — By S. 0. 77, C. S., War Department, A. G. 0., granted sixty days' extension of leave of absence. Wir.soN, A. D., A.ssistant Surgeon. — Bv S. 0. 42, Department of the Platte. March 21, 1872. granted leave of absence for 30 days, on Surgeon's Certificate of Disiibililv. iHctiicnl 3tcm5 anti llcms. Prof. Samcel Henry Dicksdn, M.D., LL.D., died in Philadelphia, March 31, 1872. We shall give an obituary sketch of the life and services of the deceased in our next i.-sue. Dr. Samuel A. Billing, a prxjminent physician of Columbus, Georgia, died March 19, aged sixty-five. S-MALL-Pox seems to be on the increase in the city ; the weekly average being one hundred cases, of which the average mortality is thirtjj-seven. In Philadelphia the epidemic is on the decline, although a weekly ave- rage of eighty deaths is reported. In Boston the epi- demic is on the increase. In the Report of Prlr. Wunderliehi Director of Clie Charite Hospital at Leipsic, on the Small-Pox Epide- mic in 1871, we find the following statistical statements: Small-Pox was widespread and verv virulent. Re- maining in hospital, at the end of 1870, were twenty- six patients; new cases during 1871, 1,654; TC^hole niim-; ber treated, 1,680; males, 1,108; females, 572. Re- maining at the close of 1871, were thirteen patients, all of whom have since recovered, save one. .Of 141 never vaccinated, 101 or 71 3-5 per cent, died; of 56 unsatis- factorily vaccinated, 30 or 53|^ per cent, died ;" of 20 who had small-pox before, 5 or 25 per cent, dfdd ; of 1,463 vaccinated, but not revaccinated, 118 or 8 per cent, died. Ninety-five cases of suspected small-pox were received, in which the disease did not fuUy develop, all were vaccinated and recovered. The epidemic was at its height between ^larch and June ; the highest number of cases was reached on May 21st. Towards the close of June the cases rapidly diminished, and in September there were received but ten cases. Vaccination. — Total vaccinations in New York, from January 1, to April 1, 1872, by Assistant Health Inspectors, was 112,181, by PoUce Surgeons' about 8,000 additional. Ceuebro-Spinal Meningitis is quite prevalent in this city and vicinity, and threatens to become epide- mic. In anotlier part of the Record we publish some cases by Dr. Packard, which, we doubt not, will be read with interest. I THE MEDICAL RECORD. 119 Amkrican Mkdical Association. — The Twenty-third Annual S.'ssion will be held in Horticultural JIall, Broad Street above Spruce, on Tues^day. May 7, 1872, at 11 A.M. The following arrangements have been made with the diflerent railroads : — Union Pacific, return free, if first-class tickets are bought, and an acknowledgment taken from the agent; Cumberland Valley, excursion tickets ; Orange, Alexan- drii), and Manassas, half fare for reiurn; Pittsburg, Cin- cinnati, and St. Louis, excursion tickets; Piitsbuig, Fort Wayne, and Chicago, excursion tickets; Cleve- land and Pittsburg, excursion tickets ; Central Railroad of Georgia, return free ; Richmond and Petersburg, return li\e ; Wilmington and "Weklon, excursion tickets one fare; Wilmington, Columbia, and Augusta, excur- sion tickets one fare ; Kansas Pacific, one and one-fifth fare for excursion ; Atlanta and New Orleans Short Line (A. and W. Pt. Western, Mobile, and M.N.O., M. and Texas Railroad.s, return free ; Western and Atlantic, excursion tickets one fare; Western Alabama, excur- sion tickets one fare ; Evansville and Crawford»\'ille, excursion tickets; Lehigh Valley, excursion tickets one fare; Louisville and Nashville, excursion tickets ; Mem- ph'S and Louisville, excursion tickets ; North Pennsyl- vania, excursion tickets two-thirds fare ; Pennsylvania Central, excursion tickets; Philadelphia and Erie, excin-sion tickets; Philadelphia, Wilmington, and Bal- timore, excursion tickets ; Philadelphia and Reading, excursion t ckets at two-thirds; Baltimore and Oido, excursion tickets; Lake Shore and Michigan Southern, excursion tickets, if forty are taken. All who desire to avail themselves of the above rates must send to the-Secretary, Dr. William B. Atkin- ■ son, 1,400 Pine Street, Phila., their fall names, and the names of all the^ailroads over which they must travel in coming to the session, with stamp for postage. Camden and Amboy, excursion tickets at $4 from New York to Philadelphia and return, if fifty tickets are taken. For this ticket send money to Dr, A. E. M. Purdy, 123 East Thirt.y-eighth street, New York. From Montgomery, Ala#,- to Philadelphia, and return (by Ten- 'Viessee), SS'O^SO."*^ Apply through Dr. R. F. Michel, ?tlontgomei\y, Ala. From "Wasliington to Philadelphia andretuinj $6, if fifty tickets are taken. Central Paci- fic, half loc^l rates. 'T«E Medical Register of New York. — The tenth volume "of this important work, to be issued June 1st, 1872, un'der the auspices of the N. Y. Medico-Histo- rical Sociely, will contain a likeness of Dr. George H. Tucker, deCeaied, editor of the first Medical Register published in flifs country ; also a condensed description of the objects, character, and field of operation of the Hospitals, Infirmaries, Dispensaries, Asylums, and Medical and other Scientific Associations of New York City and its vicinity, and the Charitable Institutions of New York, New Jersey, and Connecticut, etc. It will, as usual, also contain inlbrmation resi)ecting the Colleges of these States, a List of Physicians in good standing, practising in New York City and adjoining places, their residences and office hours ; also a List of County Med- ical Societies of New York, New Jersey, and Connecti- cut, their officers and members, with post-office ad- dresses, and short obituaries, as i'ar as can be obtained, of the physicians of these counties, recently deceased. Committee of Publication. — Drs. Frederic Elliot, Ells- worth Eliot, Edward C. Woodbury, William T. VVhite, President, and Alfred E. M. Purdy, Editor. New York Academy of Medicine. — At the stated meeting, held March 21st, 1872, Dr. E. R. Peaslee, in the Chair, Dr. James L. Brown read an important paper on " Clim'cal Observations on Pelvic Peritonitis and Peri-uterine Cellulitis." Drs. Noeggerath, Barkir, Tho- mas, and the Presidmt entered into t'.ie discussion of the paper. Dr. Brown's paper will be publishtd in extenso in the American Journal of Medical Sciences. At the stated meeting, held April 4th, 1872, Dr. E. R. Peaslee, in the Chair, an interesting and ex- haustive piper, with cases, on "The Mechanism of Spontaneous Active Uterine Inversion, and the Reduc- tion of a Case of Complete Inversion by the Combined Rectal and Vaginal Taxi.«," was read by Dr. Isaac E. Taylor. It was discussed by the President ; W. C. Roberts, Vice-President, and the Author. Dr. Henry GrisAvold was elected Resident Fellow. The Secretary then read the names of the fallowing gentlemen, who were elected by the Council, Delegates to the American Medical Association to be held May 7th, 1872, at Philadelphia, Pa.; Drs. Cornelius R. Agnew, James Anderson, James L. Banks, Gurdon Buck, James 0. Pond, Alfred C. Post, Samuel S. Puri)le, Frederick A. Burrall, T. Matlock Cheescman, John C. Draper, Thomas Addis Emmet, Austin Fhnt, Joel Fos- ter, Ehsha Harris, John H. Hinton, Edward H. Janes, E. Lee Jones, Ernst Krackowizer, Ciiarks Carroll Lee, Stuyvesant F. Morris, Jeremiah C. Morton, Charles W. Packard, Edmund R. Peaslee, Gouverneur M. Smith, Bradford S. Thompson, and William T. White. The President annoimced that he had invited Dr. J Parigot, formerly of Belgium and late of Brazil, a weli- known expert in psychology and psychiatry, to read a paper, April 18th, 1872, on " The Influence of Philoso- phical Speculations on Medicine : its Practice and Med- co-Legal Questions of Insanity." The views of Darwin, Huxley, Maudsley, and others of that school will be reviewed and combated. A Valuable Medical Library for Sale. — The val- uable library of the lat^«frof George C. Blackman, M.D., of Cincinnati, containing upwards of three thou- sand volumes of medical works, besides many pam- phlets, journals, and papers, is now in the hands of Mr. Robert Clarke, of Cincinnati, for public sale. We agree with the Editors of American Practitioner, that the library should be owned by some public institution or association, similar to the New York Medical Library and Journal Association. The University of Louisville. — The degree of doc- tor in medicine was conferred on eighty-four graduates, at the Thirty-Ofth Commencement of the Medical De- partment of the University of Louisville, held March 1st, 1872. The ad eundem degree was conferrt-d on five practitioners Prof R. 0. Cowling, M.D., delivered the valedictory address of the Faculty. Chicago Medical College. — The Commencement Exercise of the Chicago Medical College — Medical Department of the Northwestern University — was held March 12th, 1872. Diplomas were given to thirty-two graduates. Two received the ad eundem degree. Jefferson Medical College. Phila. — The Annual Commencement of this College took jilace at the Aca- demy of Music, March IGth, 1872. One hundred and thirteen giaduates received diplomas, of whom fifty- four were from the State of Pennsylvania. Prof Joseph Pancoast, M.D., delivered the valedictory address. University of Nashville, Tenn. — The Twenty- second Annual Commencement of the Medical Depart- ment of the University of Nashville was held February 22d, 1872. Diplomas were awarded to eighty-four srraduates. 120 THE MEDICAL RECORD. Women'8 Medical College, Philadelphia, Pa. — At the Twentieth Annual Coininencenient of tliis Institu- ti in, liild Miiicli 'Jlid, 1S72, thirteen huhi-s rcrcived the dt'proe ol" Do(.t Carbolic acid, 3 drops; Sonp powder, O.GO gram. ; Lycopodium, 0.06 gram. ; Pulv. tragacanth, 2 scruples. Make six pills. — Drug. Circ. A New San Francisco Medical Journal. — A monthly medical journal, called The Western Lancet, was started in Jannary, at Sm Francisco, Cal. The new enterprise is edited by Eustace Trenor, A.M., M.D,, and Heman P. Babcock, M.D. Four Children at a Birth. — A woman, residing at Noithampton, Mas.s., gave four children at a birth. The mother and children were doing well at last ad- vices. She has had seven children within t!ie last thir- teen months. De.\dliness of "War-Weapons.— Of 3.453 Germans wounded before Metz, no fewer than 95.5 per cent, were struck by Chassepot balls. 2.7 per cent, only were wounded by projectiles from heavy guns, and there were only 0.8 jer cent, of wounds from cold steel. No fewer than 25,000 Frenchmen in all were struck by the I projectiles of the German artillery. This pives an I average of one elTective shot in every three fired from the German batteries, a result which appears hardly credible. Unfortunates in this Country. — .A.ccording to the late census, the class of '• Unfortunates " in the United States gives a grand total of 98,434. Of blind, 20,320, of whom 17,043 are native, and 3,277 foreign. Deaf and dumb, 16,205; native, 14,089; foreign. 1,336. Insane, 37,382; native, 20,101; foreign. 11,221. Idi- otic, 24,527 ; native, 22,852; foreign, 1,075. Baltimore College of Dental Surgery. — Since this insiitniion was chartered in 1839, 082 students have received its diploma. For many years the Balti- more College was the only dental institution in the world ; now, however, there are nine denUd colleges in this country. At the Thirty-.'jecond Annual Commencement, held Februiiry 29, 1872, the degree of D.D.S. was conferred upon eighteen graduates. Death of an Old Physician. — Dr. IJicharu S. Spof- ford, of Ncwburyport. died recently in that city, at the age of 83 years and 8 months. He took his medical degree at Harvard College in 1S15, and began practice in Newburyport in 1810. Commencements of Ohio Medical Colleges. — The Miami Medical College held it5 regular annual exercises February 29. Diplomas were presented to 07 gradu- ates. The Medical College of Ohio held its annual com- mencement March 1st, and 87 of the graduating class received diplomas. Death of a Promise.nt Fkexcu Physician. — Dr. Barthelemy Roch, President of the Medical As.sociation of Alais, France, since the year 1854, died lately, aged 94 years. An Enormous Aerolite. — A specimen weighing 36 tons has been pre.-ented to the Paris Academy of Sci- ences by the Danish and Swedish Governments. Secondary Haemorrhages. — In the " Surgical Let- ters from the Field Hospitals of Weissenburg and Man- heiin,"' by Dr. Tii. Billroth, of Vienna, translated for the K'titsfts Citij Medical Journal, from the Berliner Klin. Wuchenschrift, the subject of secondaiy hemorrhai.'es is practically discussed. Amongst the 132 wounded under his immediate charge at Weissenburg there were 10 cases of serious secondary hemorrhage — 11.7 per cent, of all the cases. Of the sixteen, 13 died — 81.2 per cent. If those cases seen at Manheim are added, there would be a total of 27, of whom 22 died — 81.4 per cent. In the lO cases noticed at Weissenburg, the nature of the wounds was as follows: gunshot wound of the neck, 2 ; gunshot wound of the chest, 2 ; gunshot wound of the knee-joint, 1 ; gunshot wound of the foot, 1; gunshot fracture of the thigh, 6; gun.shot fracture of the leg, 3 ; amputation o'' the thigh, 1. The hemor- rhages occurred Irom the fourth to the 27th day after the injury. In three instances — wonnds of the neck, leg, and toot — compression and the tampon wore em- ployed ; in two (wounds of the chest) deep sutures were used ; all five of them died. In the remaining 11, ligatures were applied as Ibllows : to the subclavian artery, once (died) ; to the femoral artery, at the bor- der of the sartorius, 5 times — 2 recovered, 3 died; to the external iliac, 5 times — one recovered, 4 died. Of these last 11 cases, only three succumbed as the direct, result of the ligation ; the rest were carried ofl' by pya?mia at a variable period after the application of the ligature, and without anv hemorrhage having occurred in the mean time. Angiom.v Cavernosum. — An important case of angi- oma cavernosum, situated in the external auditory canal and attached by a slender ped.cle to the manu- brium mallei, is the subject of a reprint from Knapp & Moos' Arrh., II., 1. The paper is accompanied by a well-defined steel cut illustration of the polypoid angi- oma cavernosum. THE MEDICAL RECORD. 121 (Drigiiral Commuu'icatious. A CONTRIBUTION TO THE KNOWLEDGE OF THE CHEMISTRY, AND PHYSIOLOGICAL, THERAPEUTICAL, AND TOXICAL ACTIONS OF VERATRUM ALBUM, VERATRUM VIRIDE, AND THEIR ALKALOIDS. By EUGENE PEUGNET, M.D., (Read before the Medical Society of the County of New York.) Mr. President and Gentlemen — A remarkable case of poisoning by veratrum album having come under my observation, I found, in searching its literature, also studying its composition ami properties, its physi- ological, therapeutical, and toxical effects, as well as thoi^e of veiatrum viride, many facts of interest as to their relative composition. The effects produced by them and their alkaloids upon the animal economy, although possibly not presenting anything absolutely new or positively origuial, I have endeavored to con- dense and digest into as small a compass as possible, hoping that they might be of interest to the mem- beisof this Society. Botanical History. — Veratrum album and veratrum viride belong to the same genus, their order being the melantheca;; Linnean system, tlie polygamia monsecia. Both are perennial plants, the first a native of Europe, found principally in the Pyrenees and Switzerland, the second a native of this continent, found principal- ly between the Canadasnnd North Carolina. Although botanists have failed to detect any essential differences in their botanical relations, the plants differ essentially in their composition and properties, as well as in their therapeutical and toxical effects. All portions of the plant of veratrum album are poisonous, but the rhizoma or root is the only portion used in medicine. It deteriorates by keeping ; whilst in veratrum viride. Prof. Procter found the stem entirely inert, the virtues of the plant residing in the rhizoma. Chemical History. — Pelletier and Caventon analyzed veratrum album in 1819, and found in it a salt, the supergallate of veratria. which they considered identical with the veratria obtained from the sabadilla seeds. Simon believed that he had found two other alkaloids in it, one of which he called jervina, after the Spanisli poison of that name; the other baratyna, owing to its being precii^itated from its solutions in acetic and phosphoric acids by the addition of sulphuric acid or the sulphates. Fluckiger of Berne, in 1806, found another active principle in it besides the veratria, but was unable to isolate it sufficiently to ascertain its exact nature. Not having been able to obtain either Simon's or Fluckiger's processes for extracting the alkaloids, I made use of the following one : — A portion of either the imported powdered root, or else some of the root which had been coarsely ground here, was placed in ajar; a sufficient quantity of acetic acid (spec. grav. 1036j diluted with twenty parts of water, to cover the root, was added, and allowed to stand for forty-eight hours; the whole mass Avas then placed in a percolator, and allowed to percolate ; fresh acidulated water added until the root was exhausted. Having filtered the acidulated water through paper. a precipitate was thrown down by the addition of a suffi- cient quantity of carbonate of soda, a small quantity of alcohol having been previously added to retain the coloring matter. The carlionate of soda deepened the color of the solution ; but any other alkali produces the same effect. When the [irecipitate had fully separated, the supernatant fluid was drained off, the precipitate collected on a filter, tl!Oroui;hly waslied and dried. As the addition of sulphuric acid or the sulphates had only thrown down a prec'i)itate of lime from the solu- tion in acetic acid, the precipitate was redissolved in water acidulated with sulphuric acid; the only residue left was a m nute portion of earthy salts and resinous matter; nothing revealed the existence of baratyna. A small quantity of alcohol having been added to the solution, a precipitate was thrown down, by the addi- tion of ammonia, sufficient to produce a slightly alkaline reaction. The precipitat'^, collected on a tilter, when thoroughly washed and dried was siiaken with successive portions of pure ether (the purity of the ether is essential, as I failed in several of my experi- ments, owing to the presence of alcoh-sa the two principles in ono 8|ircimntains a distinct organic principle, not of basic origin, but existing in a complex form; it is therefore a resinoiil, and is, properly speaking, the veratrine of vera- trum album. Mr. Freye, chemist for Messrs. Caswell, Hazard & Co., extracted the alkaloids lor me by the process made use of by Mr. Charles Bullock in his aulysis of veratrum viride (Amer. Journ. P/ia/TO., September, 1865, and Mai ch, 1866); that is, by the preparation ofatluidextract, giving it a decided acid reaction by the addition of dilute acetic acid, precipitating the resin by the addition of water, collecting it on a filter; then precipitating the alkaloids from the filtrate by the addition of carbonate of soda, finally separating them by means of ether and alcohol. Veratrum Viride. — In veratrum vir;de, Mr. H. W. Wtrihington was the first to announce that he had found an alkaloid which he considered identical with veratriii. Mr. Joseph li. Uiclniid>on, in IS.'j?, stated that he had found an alkaloid in it siindar to the one extracted from veratrum album. Mr. G. J. Se.iltergoo i, in lS(i"2, demonstrated that the principle suppo-ed to be veratria, which he extracted by means of water acidulated with sulphuric acid, was associated with a resin jMissessing a greater sedative ac:ion on the circulation than the resin itself. Dr. S. II. Percy, in his prize essay, published in 1864, which is very exhaustive, con.sidered the alkaloid, which he extracted by means of muriatic acid, identi- cal with veratria. He al-o found that the resinoid po.s.sessesentially from those obtained by Bullock, but I think this is due to his having failed to fully separate the veratroida from the viiidia, as the purity of the ether is essential, to prevent a portion of the viridia being taken up by it. Then, in order to ascertain if the veratroida is fully separated from the viridia, the evaporating and sulphuric acid tests, as mentioned heretofore, should be tried. There is an excess of the veratroida in veratrum al- bum, and an excess of the viridia or jervina in veratrum viride. As to the exact proportions of the alkaloids to a given quantity of the root, it is impossible to fully de- termine. Mr. Bullock obtained from thirty-two ounces of veratrum viride 9.2 grs. of veratroida, and 15.7 of viridia; f om the same quantity of the root I obtained about the same p; opoi tion ; from another a large excess of viridia. THE MEDICAL RECOHD. 123 The same is true of the so-called veratrin of Keith & Co., and Tilden & Co., in some more of one and lr.s.s of the other. From one specimen of Norwood's own tinoture I obtained 1.5 gr. to the ounce of the com- bined alkaloids, from another 1.9 gr. These variations are almost entirely due to the manner in whicli tlic root is gathered. The same is true of veratrum album. I regret that tliis chemical history is not as thorou!i;h and complete ^s it should be; but the want of a proper laboratory, as well as a want of experience, must be my excuse. I would here tender my thanks to Mr. Ferd. Spangenberg for his valuable advice and assist- ance in extracting and preparing the alkaloids. The resin of veratrum viride was found to be en- tirely inert. Having shown that the two varieties of veratrum possess much in common in their chemical history, but that there exists in veratrum album a distinct principle which does not exist in the other, I will pass to the history of their physiological, therapeutical, and toxi- cal effect-^. Veratrum Album. — The first clear and succinct ac- count of the history and effects of this variety was published by Schabel, at Thulingen, in 1817, in his inaugural thesis: he considered it a prompt and sure emetic, and that in whatever manner administered it produced nervous prostration and intestinal irritation. Horn subsequently confirmed his views as to its ac- tion as an emetic. In the various pharmacopoeias it is now recommended as a sternutatory, when combined with some innocuous powder. It was formerly extensively employed in the treat- ment of various nervous, gouty, and chronic cutaneous hffections; but owing, to the uncertainty of its action, and being powerfully irritant, it has gradually fallen into disuse. However, in Germany its tincture enjoys a great, and, I think, deserved reputation in the treat- ment of pityriasis versicolor. It has a popular reputa- tion on the continent and in England, in the treatment of scabies and pediculi. By certain empiricists it is exten- sively used in the treatment of certain forms of diarrhoea and dysentery which have lost the'r acute character, and have become subacute or chronic. Pereira reports three cases of poisoning where an in- fusion of the ro )t was taken, in which extreme prostra- tion, without purging, resulted (Dr. Raynor's, of Stock- port). Christison, three cases, in which a quantity of the powdered root was taken. In the course of an hour they all experienced a burning sensation in the throat, oesophagus, and stomach, followed by vertigo, purging and dysuria, weakness and rigidity of the limbs, ver- tigo, loss of sight, great faintness, convulsive breathing, and small pulse. One of them, an elderly woman, who had partaken of the largest quantity, had an impercep- tible pulse, stertorous breathing, and total insensibility. On the following day an eruption appeared on the body. He also quotes from Rust's journal, that a family of eight ate bread in which some of the powdered root had been mixed by mistake; in all of tlieni symptoms of gastro-intestina! irritation manifested themselves. Bias, two cases, one of Avhom, a boy three and a half years of age, took from six to eight ounces of the de- coction ; the other, an infant aged eighteen months, took a smaller quantity ; botli recovered. They presented the following symptoms : vomiting an acid fluid, containing half-digested food, with yellow mucus; countenance pale, head hot, general surface cold ; pulse small, slight convulsive twitchings of the limbs; dilated pupils, eyes staring, with revolving movements of the eyeballs. Mavel d'Ambert (Jour, de Chimie, 1851) gives an ac- count of the poisoning of an entire family, who had partaken of soup made in a utensil in which a decoc- tion of the root had been prepared the day before, and which hail not been ihorou^ihly cleansed. They all presented symptims similar to tiiose of cholera: the mot'.ier, who suffered the mo-t, ho found in a state of collapse, with a blue, anxious face, eyes expressionless a:id loss of sight; pulseless; diminished temper.iture of the body, and vomiiing incessantly, accompanied with violent tenesmus. He first administered emetics; when the vomiting had ceased, gave opium ; applierl dry friction and mustaid sinapisms to various parts of the body. In the couise of a few hours reaction set in. On the fourth day a peculiar eruption broke out on one of her calves, which could not have been produced by the mustard. Nivet and Giraud (Gaz. Ilebdom., vol. viii.. No. 31) relate that three members of a family suffered frnm poisoning by veratrum album, two of whom died. The eldest brother, twenty-five years of age, was suddenly taken ill, in the latter part of June or early in July, 18G0, with the following symptoms: violent pains in the epigastrium, intense thirst, severe burning sensation in the throat and upper portion of the abdomen; these symptoms soon subsided. Some time afterwards, from some unknown cause, they recurred with increased violence. On the 29th of August, Dr. Chalvignac observed that his face was thin; expre-sion anxious; a dark circle surrounding the eyes; sight only affected whilst and immediately after vomiting; no delirium; mind clear, temperature of the skin normal; inappe- tency ; unqueni.hable thirst; burning sensation of the epigastrium extending to the oesophagus ; acid ruetus; frequent vomiting, increased by drinking, occasionally sti eaked with blood ; sanguineous stools, accompanied with tenesmus ; secretion of urine normal. He died on the 31st of August. The younger brother, twenty-two years of age, was taken ill about the 1st of September, with symptoms similar to those of his brother, with the exception of sanguineous stools and tenesmus, and died on the 14tli of September. Their mother was taken ill on the 25th of August, with symptoms similar to those of her sons. On the 29th the doctor observed the following symptoms : a marked prostration, tinnitus aurium, sight only affected whilst vomiting; insomnia; pulse seventy -five and regular, tongue coated and smooth ; inappetency, thirst not as intense as in the first days of her illness; uniform redness of the mucous membrane of the throat, sliuht tumefiictiou of the tonsils. The pain in the throat, oesophagus, and epigastrium, at first intense, has in a manner subsided; slight nausea; no purging since the day before. If she attempted to rise or walk there was a tremor in her limbs and uncertainty in her gait. She continued to improve, but had a relapse, and finally i ecovered on the 22d of September. At the inquest, it was shown that — 1st. A white powder had been administered to them. 2d. Some of the root of veratrum albiun was found in a cooking utensil. 3d. In the [lost-mortem, made October 15th, that putrefaction was too far advanced to note patho- logical changes. 4tl). The liver, intestines, pancreas, lungs, and hearts of the brothers contained an alkaloid similar to veratria. 5lh. Some of the substance ex- tracted from the organs of the eldest brother, given to a chicken, produced all the symptoms of poisoning by veratria. In the British Pharmaceutical Journal and Transact fiouft for February, 1868, the case of a young man who took a portion of three-penny-worth of the powdered. 124 THE MEDICAL RECORD. root is reported. The cfTects of the poi«on immediately manifesteil tiieiiis«-lves, and lie died in a comparatively short time, in the prealest ag.ny. Uifilii, in liis lrfuti.-e on i ox icolojiy, states that sev- eral eases of uterine li« morrlmpe had been produced l»y the u.se of the root a.s a sternutatory. On the 4th of AugiK-t, 18 — , wliilsttm a f)rofessional visit to a summiT lestirt, I was nque-tid to ete a vounp mariii'd lady, who was in a ^taU- of collapse. At about G.3(t r.M.. site h; d taken by mistake, as I subsequently a.^certaimd, half an ounce of the lK)m(T"o- pailiic mother tincture of vcratrum album, ((juivalent to half a draclmi ot the powdered root ; liiis< tinc- ture wji« prepared iu the llartz Mountains ol tiermany. from the preen loot. In a subsequent analysis of the same tincture, I found that each ounce contancd Ig prain of the active piinciples of the root. She had consequently taken | prain. Immediately after taking it she felt soothed and quiet, having been exceedingly nervous before. At 10 p. M. her hands and feet became numb, a sensation which gradually extt nded over ti.e whole body. She attempted to rise, but had two attacks of syncope in rapid succession ; was taken immediately alterwards with violent vomiting. 10.3I.I p. M. — I Ibund her pulseless, heart pulsating feebly ami irregularly; resp. iwenty-two and regular: eyes fixed and staring; pupils dilated; a'most total loss of sight; the body covered with a cold and clammy perspiration; compleie anae-thesia of the skin; voice as clear and as strong as in the collapse of cholera; lips of a bright carmine; mind clear, calm, and col- lected; thought that she was dying; vomiting and retching inc< ssantly ; the fluid ejected was viscid, glairy mucus, of a greenisii hue. As there was no puroinp, and recognizing the action of some powerful sedative poi^<)n, I jiave her an enema of brandy and wa- ter, three ounces of each, and thirty drops of ammonia, followed in a short time by a second, both of which were retained; then rubbed her limbs with dry nms- tard ; applied mustard plasters to the epigastrium ; then administered a ihiid enema, which was forcibly retained. As violent purging accompanied with severe tenes- mus set in shortly afterward-, recourse was had to the administration of small quantities of brandy by the mouth, at short intervals, and the application of ammo- nia to the nostrils. Aug. 5th. 1 A.M. — Pulse perceptible for the first time, 38, feeble and intermittent ; anaisthesia of the .--kin con- tinues ; vomiting not as violent, purging ince>santly, accompanied with tenesmus; can now see distinctly. 3a.m. — Pulse 44; anaestlie>ia continues; temperaiure normal; intense thirst. 10 a.m. — PuL-^eSG; vomiting occasionally ; salivated and bloody stools frequent; marked pain in left iliac re^don, extending to left hyf)0- chondrium, increased by pressure. Aug. Gth, 6 a.m. — Pulse 100; parsed a restless night; tympanitis, marked tenderness of left, iliac region ; nausea, vomiting at intervals ; tenesmus, with bloody stools every hour; pupils normal ; anaesthesia persistent; thirst intense. A ug. 8th, 6.30 a.m.— Pulse 105 ; tongue dry, furred, and brown; gums inflamed and tender, bleedi'i;g freely at intervals; aphthous idceration of the p:date ; breath ofifensive ; ptyalism [ rofuse ; nau-ea per.Mstent; vomit- ing occa<;ionally ; stools frequent and bloody ; occa- sional exarcerbaiion of pain in lefi iliac re-iun and left hypochondrium, increased by pressure. Aug. lOth. — Pul-e 105; tongue furred ; gums ulcer- ated ; nausea, but no vomiting ; purging not as frequent ; stjols no longer bloody; ansesthe^ia of the lower ex- tremities ; a profuse flow of blood from the uterus came on duritip the night, alihou<^h ilic menecs were not due until the 'J2d. Aug. l\/h. — PuNe 94 ; marked improvement. Prom this lime forward she continued to pain rapidly. The treatment, after reaction took y)lare, consisttd ol opium, bi«nnith, and camphor, to check diarrhoea and allay pain ; < flervescinp draughts to allay nausea; the diet of milk and lime-water, al.so brandy and be^f-tea. Aug. 14//(. — 1 left her, as I Rnppo.sed, convalescing; she felt comparatively well, diarrhoea almost checked, otcat-ional anaestlies a of the upper ai.d lower extremi- ties. On the lOih sat out of doors ; on the 17th took a ride ; on the 18th another ; was tjiken that, night with violent tenesmus and catiiarsis; stools bloody; also slij^ht nausea. Aug. 22(1, 12.15 A.M. — Having been telegraphed for, I found Iter pulse lU2 ; ton.L-ue furred and brown, edges red, papilhc raised; tympaniti.«, tenesmu.«, pain in left iliac re;;ion, e^fiendmgtolcft hypochondrium, increased by pressure ; frequent bloudy stools ajid nau.sea. Aug. 2bt/i. — Left her improving, with directions for her removal to the ci:y on Monday, the 28th, as I did not deem it prudent for her to remain longer, owing to tlie marked insalubrity of the place, caused by miasm and defective drainage ; as there then were in tiie same wing of the hotel two cases of dysentery, one of which was typho malarial. The treatment, as sug- gested by a veiy intelligent practitioner before 1 was sent tor. was the occasional administration of Squibbs liquor opii comp. Attg. 2'Jth. — Arrived home last night; passed an un- comfortable night; pnlse 100; recurrence of dianhoea; evacuations very offensive, black, also some mucus, streaked with blood ; nausea, vomited twice, viscid greenish mucns, streaked with blood; tongue fui red. Ordered enema ot liquor ferii persulphatis, 20 drops in = iv. of water every four hours, which weie discontinu- ed after the third, on account of the pain and violent hysteria ; .5 drops of the liquor were administered every four hours instead, also a pill containing argenti nitras -^i gr. and ext. opii ^^ gr. every alternate 4 hours. tSrpt. 2d. — Sanguineous stools having ceased, peps'ne gr. iij. and bismuth trisnitras gr. xv. were given every two hours; quinije sulphatis gr. ij. every fourth hour; paregoric whenever nccossiry to allay tenesmus. iiej't. Sth. — Prof. Alonzo Clark in consultat'on. Pulse 84; tongue smooth and clear; pain in left il.ac region, exiending upward? ; from fourteen to sixteen stools in the twenty-four hours, dark and small, accompanied with tenesmus. Morphise sulphas tV gr. added to pepsine and bismuth. Sept. \7th. — Pulse 102 ; tongue furred, dry and brown, edges red, papillae raised ; no improvement, as the mor- phine was evidently actingas a nervous irritant ; di-scon- tinued i', atid substituted salicine gr. v. every foiir hours, discontinuing all other remedies. S''pt. 22c/. — Marked improvement ; lying on lounge. Sept. 2oth. — Evacua'ions very frequent, containing mucus streaked with blood ; in.-isted npon piving au enema of Oj. of warm water, with long flexible tube, which siie had heretofore sirennoush' objected to. Con- siderable mucus, streaked with blood, came away, also shreds of mucous membrane, and but a trace of Isecal matter; the pain from the distention of the intestine was intense; ordered a suppositoiy of ext. opii aq. and argenti nitras iUl gr. i every lour hours. Sepi.2Gth. — Feels more comfortable ; fewer evacua- tions; administered an enema of warm water Ojss. ; it was followed by a dischaige of mucns streaked with blood, shreds of mucous membrane, and but little faecal matter. I THE MEDICAL RECORD. 125 Sept. 27lh. — Improvement continues; another enema a-lminis^tcred, followed by a discharge of less mucus, but few shreds of mucous membrane, and partially formed fajces, but quite attenuated. Sej^t. 30th. — Steadily plaining; a fourth enema admin- istered, followed by llie fust well-formed and perfecily healthy evacuation, with the exception of its extreme attenuation, evidently caused by a contraction of the colon. From this time forward the recovery was rap'd; with t'le exce[)tion of insomnia, n'TVOusnes-;, tremor of the limbs, uncertainty of gait when the first attempts to walk were made, the only nervous symptoms wliirii manifested themselves during the progress of the eay otliers it w;i8 rocommemled in tiu! treatment of intlaniniatory rlieuniati.^in. puerperal fever, and otlier iiiflainiiiaiory dise;ises; by Professdr G. B. Wood, in nduciiif: the pulse in cardiac diseases. Dr. Jarqui-mier first alluded t<» it in France, in a review of Prof. Fordyce Barker's essay on its use in puerperal fever (Gaz. //<•/.;>ay at Wurizbinp on the tnatment of pneumonia by the jireparatitins of veiatnim viride; it wa.>* based upon ti.e treatment of si.vty casos of iincomplicat<-d pmumo- nia by the exclusive u.se of tiie resin of v. rairum viride, at tlic C'linique of Berne, by Profe-sorBiermer ; the mortality was only eipht, 3 per cent, le-s than followe 1 any other course of treatment. 21 cases out of 2"), in which the first manifestation of the disease could be exactly established, recovered in less than six dav.^. Dr. Oulmont, in an e>say read before the Acadimy of Medicine. Paris (Hul. Gen. de Therap., Ixxiv., 145), in 18G7, warmly advocates its use in inflammatory afTections. It is generally aflmini'stered in tincture, or fluid ex- tract; b}' some the resin is preferred. Dr. S. R. Percy advises the use of a tincture prepared from the resin which has been exhausted by water acidulated with sulphuric acid, but th's does not fully extract tlie veratroida, and if it did, the tincture would not pos- sess any sedative action. The most reliable prepara- tion is Norwood's, but even that cannot ahva^'s be relied upon, as the root does not always contain the same proportion of the alkaloid-s. This, like many of our most valuable remedies, is falling into disuse on account of the uncertainty of its action, also owing to the unf>lea.sant nans -a. vomiting, an! even purging it sometimes occasions; but fortu- nately cheniisiry and physiology, as proven by the ex- periments of ScatUTgood, Percy, BuUock, ami Horatio Wood in our own country, and those of Fluckiuer and Oulmont in Europe, have revealed '.he existence of alkaloids to which all i:s therapeutical virtues are due. We will therefore not be obliged to see it sooner or later set a«ide, like its more active sister plant, and used only as a local application in the treatment of pityria- sis versicolor, scabies, and pediculi, for which it is ju«t as efficacious. Uncertain as it is in its effects, I have found but one recorded f ital case resulting from its u-e, that of a feeble child, aged one year and six nonihs. to whom its mother had ndiiiinis'ered, without the advice of a phy- sician, probabl}' not less than o5 drops of the tincture, in four or five divided doses, at intervals of half an hour. There was an attempt to vomit afier the second dose ; altliough the efforts were made every few minutes, there was only one successful, when a small quantity passed by the mouth. Dr. J. C. Harris, of West Cambridge, saw him seven hours after he had taken tlie fi:st dose; he found him very pale, appar- ently unconscious, breathing almo-t ste:toous; pulse 40, extremities cold, and a profuse cold perspiration over the whole body. He died thirteen hours after taking the first dose. The treatment consisted of stimulants and rubefacients, but no opiates. — {Am. Jour. Phanh., September, 1865, 274.) Yet Dr. Hewson, of Georgia, reports three cases, in two of which half a teaspoonful doses of the tincture were reptated in an hour, and in one two doses, of 30 drops each, were taken, to procure abortion — in all the cases with no bad efl'ect beyond extreme nausea. ' Dr. Talafierro c tea the ca^^e of a physician of Atlanta, Georgia, who look by mistake an ounce of the tinc- ture at one time; the disturbance on'y amounted to extrka tumblerful of .syrup, 1 two quart.s of which had been prepared from two pounds , ofveratium viride, instead of .American valerian, and, as it caused vomiting, the do.se was re|ieated. The same alaiming .symptoms as in the preceding ca.se followed, but in two days he was alile to be about. A physician , took thirty grains of so-calied veiatrin, the alkaloids and resin combined ; he w as out again on the th rd day. A man, rather toi) fond of his neighbor's bottle, Went into a country store, and fniding a bott'e marked " Old Rum,' poured out and quickly drank nearly a tumblerful of the tincture of veratrum viride. Not wishing the st rekeeper to know of it, he said nothing about it until it caused vomiiing, and then, becoming much alarmed, told wiiathe had done. A physician was sent for, rum was freely given, and the same night he walked home. Dr. G. N. Edwards, of St. Bartholomew's Hospital (Medical Time.^ and Gazette, Jan., 1865, p. 5), cites the case of a chemist who took a teaspoonful of the fluid extract, which was fnllowed by the most alarming : symptoms, but the patient recovered the next day. I In the eleven cases of poisoning, the only symptoms at alfsimilar to those of veratrum album were the vomit- ing and great prostration ; they differed essentially, in that there was no purging and no ana?sthesia ; also in the rapid recovery after reaction had taken place, i whilst in the majority of the cases of poisoning by vera- trum album the recovery was tedious ; that is, where the root was given, either in substance or its tincture. I Dr. S. R. Percy admirably describes the general and 1 special eflect-s of veratrum viride on the system, sup- porting his views by observations and experiments I which fully confirm them. "He never found it to act as a purgative, per se, when administered by the mouth; but believes that when it does it is due to I its sedative action upon an irritated or inflamed condi- ; tlon of t!ie muscular fibres of the intestines." This view is indorsed by many ; per contra, others entertiiin the opposite; but, from what I have observ- ed. I am inchned to sustain his view. In small doses it may even produce vomiting, but is not apt to do so unless loo frequently repeated. However, its peculiar and characteristic action is iis effect on the pulse. It is a reliable and powerful arterial sedative ; wiih it the force and frequency of the puUe can be controlled almost at will. It lessens j both vascular and nervous action, also relaxing the muscular system, and renders the respirations .some- what slower and easier. In medicinal doses it allays, controls, or deianges nervous influences, but in poison- ous doses destroys them. It seems to have but little action on the mind; it produces a languor, disposition I to s'eep. unwillingness to be disturbed ; but this is j m( st noticeable in large or poisonous doses. By di- l mi;;ishing the rapid;ty of the supply of the blood THE MEDICAL RECORD. 127 to the brain it causes vertigo, especially in movinpr ; seldom produces lieadaolie. In lull doses it diniinishcs sensibilit}^, liut he lias never noticed any marked im- pairment of si_<,dit and hearing when administered to man; in animals he has noticed both. When under its full influence, a change of position will produce ver- tigo, or even syncope. By relieving congestion, iiriia- bility, and pain, it fr.?quently induces sleep, but not by any narcotic action. In moderate doses it produces a muscular relaxation; in fuller dosis, a feeling of weakness and prostration; but the eflect soon passes off. In lull doses upon animals, it paralyzes both the voluntary and non- striated muscles, and in those ca*es which are fatal, the result is produced by paralysis of the heart's action. The muscles lose their contractile power, and do not act well under the stimulus of galvanism. It sometimes dilates the pupil, but generally it merely fixes t!ie pupil, owing to a loss of power of the recti muscles, thus giving it the appearance of dilatation, because it is kept in the centre witliout motion. The influence of veratrum viride on the secerning organs is very marked ; it augments the sect etion from the pulmonary mucous membrane, increases the expectoration ; but in the stage of prostration there is no longer power to expectorate. The d 'ctor has not been able to satisfy himsi'lf that it either diminishes or increases the quantity of urine excreted. In ca^es of dropsies from obstructed portal or cardiac circulation, with a frequent irritai>le pu!se, it produces a copious discharge of urine, which he thinks is caused by sub- duing tlie heart's labored action. It produces a moisture, free diaphoresis, and cold, clammy sweat, according to the amount taken or administered. It acts early rntria ; iilso demonstrate the existence of a second alkaloid, tlie viiidiii in vcratruni viriiie ; wliilst liy mine it fii'ly confirms t!if identity of the veratroida in belli, and further reveals that the jer- vina of Simon and viridia of JJnllock are pio'iably iden- tic d ; also that the essential difference resides in their re-^in, and that ihe resin of veratruni idbum contains an ac'ive principle, not of basic origin, wJiich does not exist in verairum viride. Physiolojjy will give tlie fin;d exjilanation or answer by liie following experiments, and conclusions to be drawn Ironi them. The alkaloidi were either madt; use of in the form of acetate, or else the pun^ alkaloid dissolved in alcohol. I would here acknowledge my indebtedness to my friend, Dr. Sylvester Teats, for his valnable advice and assistance in making these experiments. EXPERIMENTS WITH THE ALKALOID VERATROIDA, EXTRACT- ED FROM THE TWO VARIETIK3. I. I injected into the thigh of a mongrel bitch weigli- ing twenty-one pounds, gr. -|V of veratroida (album), P. 130, R.'26, T. 100 ; 20 min. vomiting and natural evacuation from bowels. 25 min. salivation anddysuria, 35 min. P. 04, salivation profusf, vomiting and dysuria; I hour 15 min. P. 54, R. 14, T. 98^, salivaiion continues, vomiting greenish, viscid mucus; 3 hours 35 min. running about and eats food with relish. II. Injected into the breast of a yotinsr pigeon gr. ^V veratroida (album), P. 159, R. 23, T. 106; 20 min., P. 136, R. 28, T. 105J ; 25 min., nauseated and purging; 30 min., falls on side, convulsions and deaih. III. Injected into the brensf of a young pigeon gr. j\ veratroida (viride), P. 162, R. 48, T. 107^ ; 6 min., vomiting and purging; 20 min., P. 180, Resp. very rapid, loss of power in wings and feet, convulsions, 23 min. dead. IV. Injected into t'.ie breast of a young pigeon vera- troida (album) gr. -/qp, 8 min. nauseated and vomiting, 12 min. convulsions and death. V. Iniected in thigh of a full-grown English rabbit veratroida (album) gr. i, P. 147, R. 126, T. 101 J; 25 min. P. 126, R. 19, spa?modic and irreg., T. 98 J, quite unwilling to move; 34 min. R. 99, reg. ; s'ight opis- thotonos, loss of power in extnmities, anfesthesia. does not respond when irritated. ElectriL-ity to mouth and anus either with the induced or direct currents nauses reflex movements of extremities ; 45 min. P. 116. T. 96^, convulsive movements, falls on side; 61 min. dead. Autopsy immediate. Meninges of cerebruin, cerebel- lum, and medulla oblongata shghtly injec'ed; spinal cord normal; heart distended; lungs normal; cortical portion of the kidneys intensely congested ; liver con- gested ; a marked redness of the mucous membrane of ihs large curvature of the stomach and intestines. TI. Injected into the thigh of a large common male rabbit veratroida (album) gr. i ; P. ItJO,' R. 104. T. 102^ ; 10 min. violent expulsion of ui ine ; 18 min. mat ked opis- ihotonos, fidlowed by complete relaxation of the ab lominal muscles, pulsation of heart almost impercep- tible, apparently dying ; administered whi.skey 3 ij. per rectum, and morphia sulph. gr. -j^j hvpodermicajiy; 7 min. P. 165, R. 27, T. 93^, slight opisthotonos, with drawing of heal to left side; 32 min. P. 142. R. 17, T. 96.^, complete nmscular rlaxat'on and insensib lity ; 1 hour 45 min. P. 182, R. 17, T. 921-, by mout) whiskey 3 iss., placed near reg'ster; 1 hour 52 min. P. 163 R. 32, T. 9U ; 4 hours 12 min. P. 160, R. 60, T. 93^, easily roused, but extreme pros:raMon continues; 7 huurs 32 min. P. 150, R. 52, T. 95}, conscious, less muscular relaxation, has partial control, and endeavors to move about ; 14 hours, running ab.ut. VII. Injeeteil in thigh of a large male rabbit vera- troida (all)Uiii) gr. iV, P- 180, R. 56, T. 103|t; 20 min, violent expulsion of urine, slight opisihotom^s; 30 min. P. 135, R. 51, T. lOU ; cunvulsions increased by irritation, lies on side during intervals; 95 min. con- vu'sions have ceased, and ra|)idly ncuvering. The urine wa.s evaporated, the residue treated with ether; the ether filtered, and portions allowed to eva- po ate on separate dislie--. The one treated with sul- phuric acid gave a yellow, then rediration gradually decreased ; and it was found dead about ei-ht houis after. Autopsy, heart distended, slight ecchymotic spot-s in left lung; liver and kidneys congested. "Dr. Percy states that he made 31 experimen's on dogs witli the veratroi'la (viride); that he found it more sedative in its effects than the verat:ia (sabadilla) ; that it was less irri ant, s.?ldom causing an increase of the pulse, which the veratria certainly did ; that it produced vomiting and purging in about an equal degree; that, when a large di'ratnro was not ailVrtfd, nnc. >mfort. I XVI. Injoctcd into the breast of a younp pipeon, ' pr. ,i^, P. KU, R. 40, T. 107A ; 45 min.' P. 152. R. 34, i T. 104}, inj. srr. 4; 7 min. slipht opistliotonos; ,20 min. \ P. 140, R. 30. T. 104, mows about witli rapid fl »ppinp j of winps; GO min. P. 113, R. 30. T. 101!,, quiet, rests | on feet, a peneral tremor if disturbed ; 2 hours 45 min. lias eniinly recovered. XVII. Injected in breast of younp pipeon pr. ^ ; 5 min. peneral tremor: 7 min. vomits coin, 13 min. flap- pinp of winps and twitcliinp of tail; 17 min. violent opisthotonos; 53 min. tetinic convulsions have been almost continuous, lyinp on back ; 1 iiour 5 min. con- vulsions leas violent, no change in pupil ; 1 hour 10 min. dead. XVIII. Injected pr. J in breast of vounp pipeon, P. 164, R. 84, T. 107 ; 10 min. P. 160, violent flappinp of winps; 25 nlin. tetanic convulsions; I iiour 8 min. P. 160, convulsions continuous, pupil contracted; 1 hour 28 min. lyinp on back, convulsions not as violent; I hour 53 min. died in h.md. XIX. Injected in breast of voun? pipeon pr. i, P. 163. R. 120. T. 107s; 2 min. vomitinp; !) min. violent flappinp of winps; 13 min. P. 156, T. 108.-; 23 min. violent tetanic convulsions, lies on back; 1 hour 25 min. dead The autopsies, with the exception of contracted hearts, revealed nothinp. XX. Injected in tliipli of a female rabbit in poor con- dition LT.'i. P. 147. T. 1021 ; 20 min. P. 132, T. 98J; 60 min. P. 138, R. 48. T. 102^. injected erimei.t8 made, with three exceptions, pi o5 ; 1 hour 10 min. P, 168, R. 44, T. 95J, perfectly conscious, almost total lo-ss of muscular power, contractions respond, but not perma- nent, or. ts ; 1 hour 25 min. P. 144, R. 48, T. 97^ drops chin on table, Avhen roused raises head; 2 hours, P. 138, R. 40, T. 96.i, lies on side, when disturbed endeavors to move, but can only raise its head, respi- ration spasmodic, gr. -i-r,- 1 hour 5 min. P. 168, R. 35, complete loss of muscular power, no ana'sthesia, slight reflex movements; 8 hours 50 min. P. 144, R. 100, T. 100, lies on belly, gradual recovery of muscular power, more marked in anterior than posterior extremities, tries to walk, but unable to do so, takes food; 19 hours, apparently as well as ever. XL. Injected in the thigh of a large black cat gr.i^n; 21 min, nauseated, and vomiting viscid mucus; 40 min. R. 96, vomiting continuous; 1 hour 20 min. excited, vomiting has ceased ; 1 hour 35 min. great excitement, followed by prostration, resp. hurried, 210; 2 hours, quiet, inclined to sleep; 3 hours 30 min. still nauseated, partial loss of muscular power ; 9 hours 40 min. moans when disturbed, has had two evacuations from bowels but no purging, great prostration, loss of power more marked in posterior extremities; 20 hours 30 min. very much prostrated, no nausea or purging, refuses food and drink ; 23 hours 43 min. P. 150, no marked change, gr. ^ ; 37 min. excited and moans, R. 51 to 20; 1 hour, nau- sea and vomiting, convulsive movements, followed by apparent narcotism ; 1 hour 20 min. comfdete anaes- thesia, but responds perfectly to direct and induceIoii;;»ta inji-ctod; heart disteiidcd ; frolliy mucus in liromhial tubes; eccbyniotio spots on tlie surfiice of both Innps; hinga reniiily infliitt'd; liviT and kiilreys normal; marked n-dness and coiigi-stion of mui'oiis mi'inb ane of tho stomach, of last six inches of the small intestine, and intense from iieo-ciecal valve to anus. In this os well as in the preceding case there was a contraction of the intestines, a re- markal>!c dryness of the lower portion ; the upper por- tion was filled with liile. XLfl. Gr. i injected in the thigh of a young cat, caused death in 2 hours G min. XLIII. Gr. i injected in thijjh of a kitten three m mths old, caused death in 30 minutes. . XLIV. Gr. ^ in thigh of a rabbit, caused death in 1 liour and 3 minutes. In these three cases the symptoms produced were similar to the others, and the congestion of the gastro- intestinal mucous membrane varied in intensity as t ) the len_s;th of time it took to cause death. KXPER1MEST3 WITH TUB RE3IK0ID EXHAUSTED BY ETHER. XLV. Injected in thigh of a .<;lut weighing 22 pounds gr. i, P. 120, R. 2'), T. 101; 15 min. gr. i, 45 min. vomiting fr.nhy mucus, tenes:nus and strangury ; 2 hours 45 min. P. GG, loss of power in posterior extre- mities: salivated and moans; 3 hours 5 min. P. 86, tries to walk, but staggers and falls; 4 iiours 35 min. lies on side, cannot rise, has urinated freely ; 5 hours 35 min. P. 160, great prostration ; 7 iiours 35 min. slight anajsthesia, cannot walk, but crawls; 9 hours 5 min. P. 14G, R. 32, T. 95, has had two small alvine evacuat'ons; 18 hours, vomited freely during the night, great prostration, refuses drink and food, crawls from oiie spot to another; 42 hours, salivation, mark- ed prostration, moans incessantly, and vomits frothy mucus at intervals; 50 hours 40 min. convulsions, opisthotonos, has vomited blood twice since morning; 50 hours 42 min. muscular rigidity, heart has ceased pulsating, vomits blooi ; 50 hours 50 min. dead. Autopsy one hour and 30 minutes after death: heart distended; right lung congested, and ecihymotic; both lungs readily inflated; liver congested and dark; kidneys normal, ureters also ; intense redness and in- jection of the mucous membrane of the bladder, also that of the uierus; thickenin? of the stomach and intestines, also a contraction of the lower portion of the small intestini', not as marked in lirge ; intense hypenemia of the gastro-intestinal mucous membrane, more marked in stomach and large int'Stine; a remark- able dryness of the lower portion of the small intes- tines. To the naked eye, the mucus presents the appearance of gastro-interitis; there are here and there among the folds spots of ecchymosed blood; with the aid of a powerful glass, the smallest vessels appear to be very much enlarged and filled with dark blood ; by tiie microscope, Prof Alonzo Clark failed to find any evidences of inflammatory action in the stom- ach, rectum, uterus, or bladder. XLVI. Injected in the thigh of a dog, weighing about eighteen pounds, gr. i, P. 132. T. 102|; 7 min. resp. panting 12U; 20 min. P. 40, T. lOlJ; great pros- tration, unwilling to move but conscious ; 40 min. P. 39, T. 96J, salivated ; 45 min. nausea and vomits viscid 3-ellow mucus : 1 hour 5 min. has vomited several times, slight evacuation from the bowels, great prostration and moans; 2 hours 15 min. P. 34, t, 92. turns Irom one side to the other; 2 hours 45 min. P. 56, T. 93, moan*, prostration not as marked, has not vomited since last ob-ervation ; 5 hours 25 min. P. 54, T. 96J, vomiting frothy white mucus; 7 hours 15 min. P. 88, T. 97if ; 8 hours 50 min. P. 96. T. 99», prostration not as marked ; 12 hours 'JO min. P. 124, T. 100^, (piifo ac- tive, eat.s food an I drinks with relish ; 12 hours 45 min. gr i in opposite thigh ; 9 hourw, P. l.JG, T. 91J, almost total lo.ss o( i>ower in posterior extremities, vomited freely durinir the nigiit, great |iiostration, and moans; 13 hours 35 min. P. 100, R. 19, T. below 90, almost complete ana'Sthesia, extreme j)rostnition, slight reflex movements when disi\irl)ed, respiration sighing; 14 hours 15 min. R. 2, P. 88^ injected .strychnine gr. ^,, re- sorted to artificial respiration; 10 min. strychnine gr. t\; 10 min. P. 100, R. 11. strychnine gr /, ; 10 mill. P. 84, R. 12. strychnine gr. ,', ; 15 min. con- vulsion, emposthotonus ; 30 min. has had four convul- sions; .35 min. — 25 hours 5 min. since first injection of resinoid ; 1 hour 5 min. since first injection of strychnine, died ; respiration ceased belbre heart. Au- topsv one hour after: both lungs most distended; con- gested, pccliymotic spots on surface, liver congested ; intense injection of tho mesent^'ric and gastro-intes- tinal vessels, also of supra-renal capsules and vesical vessels. The condition of tlie raucous membrane of the stomach, intestines, and bladder was ilie same as in Experiment XLV.; the substance of the kidneys was intensely congested; in the pelvis of both there were some dots of blood. XL VII. Injec'cd in breast of young pigeon gr. /«, P. 174, R. 72, T. 107; 5 min. unable to flv ; 7 min. vomiting corn ; 25 min. P. IGO, R. 21. T. 105J, lies on abdomen; 35 min. P. 154, R. 52, T. lOli; 1 hour 38 min. vomiting corn, lies on side; 2 hours 35 min. P. 142, R. 8. T. 9G; walking about, but cannot fly ; 9 hours 55 min. 172, R 40, T. 102, convalescing, yoiiiited once since last observation; 17 hours, nothing abnormal, vondted freely during the night. XL VII I. Gr. -,\i injected in breast of young pigeon cau.sed death in 10 minutes. XLIX. Gr. ,\, in the breast of old pigeon caused vomiting, complete anaesthesia, conscious when head was disturbed, and died some hours after. L. Gr -4',,- in bieast of young pigeon caused death in 42 minutes. In these three experiments the hyperaemia varied in intensity according to the length of time it took to cause death ; and in ail of them the gastro-intestinal canal was filled with bile. EXPERIMENTS WITH THE PRINCIPLE SEPARATED BY AMMONIA. LI. Injecteil in the thigh of a rabbit gr i, P. 171, R. 140, T. 1011,; 40 min. P. 150, R. 144, T. 102^ 1 hour 30 min. P. 180, R. 144, T. lOli, gr i; 90 min. P. 153, R. 116, T. 103?. Loss of power in extremities more marked in posterior, grind ng of teeth, when aroused t irns from side to horizontal po-ture, nausea, moaning cry, when irritated violent reflex movements of posterior extremities, gr |; 5 hours 50 min. P. 189, R. 24, T. 99^, lies on belly, loss of power more marked in tlie anterior extremities, if they are pulled, cause violent reflex movements of (he extensors of the po.s- terior ones, gr. i ; 7 hours 30 min. P. 130, R. 44, T. 97J ; ly:ng on belly, partial loss of power, vio'ent re- flex movements wlien irritated; 16 hours 30 min. convalescing; 40 hours after first injection, apparently as well as ever. LII. Injected in breast of young pigeon gr. .tn ; P. 15fi, R. 64, T 108^ ; 20 min. P. '210, R. 37, T. lOG, pirtial loss of power in feet and unable to fly ; nauseated; 1 hour 4 min., P. 188. R. 58, T. 103; recovering power, pupil contracted, gr. 3^^ ; 58 min. lying on side, complete anaesthesia, but responds to direct and induced currents when applied to tongue and THE MEDICAL RECORD. 133 anus, viscid mucus flowing from mouth ; 2 hours 50 mill. P. 1(J0, R. 37, T. 103jr ; complete loss of powir, pupil dilated, flow of mucus continues ; 7 hours ^iU mill. P. 155, R. 20, T. 98ii-; flow of mucus persistent, sliglit purging, lies on sitle, loss of power not as niaiked ; 6 liours 5u min. I'ound dead. LI II. Injected in breast of old pigeon gr. /g ; P. 170, R. 52, T. 108 ; G miu. vomiting corn ; 10 min. com- plete loss of power, lits on side; 20 min. P. 168, R. 98 ; 24 min. resp. spas, and dies. LIV. Injected in breast of an old pigeon gr. i ; G min. attempts to vomit; 7 min. falls dead. In the autopsy of tiie first and second pigeons, the same changes were noted as in those in wliiuli death had been caused by the resinoid. KXPERIMENTS WlTtl THE PRINCII'LE SEPARATED BY LIQUOR POTASSA. LV. Injected in thigh of a large female rabbit gr. -/j-, P. 180, R. 165, T. 102^; 1 hour P. 159, R. 144, T. 102^, gr. -,^/; 50 min. P. 178, R. 150, T. l03J, gr. A; 35 min. P. 154, R. 174, T. 104^:, gr. i; 40 min. P. l5o, R. 120, T. 104*, gr. i; 2 hours P. 150, R. 120, T. 104^, gr. i; 2 hours 45 min. P. 180, R. 160, T. 106; 13 hours 30 min.P.20l,R. 90, T. 103*^, gr. j. by moutii; 10 min. nau- seated; 1 hour, P. 160, R. 3l' T. 106 ; 2 hours 20 min. P. 170, R. 61, T. 106s, gr. i dry powder blown into the throat; a portion probably entered the larynx; 1 hour 25 min. T. 1U5J ; 4 hours 25 min. T. 104*, eats food with relish ; 8 hours 25 min. T. 105:5- ; 27 hours 25 min. P. 150, R. 48, T. 103^, dyspnoea, resp. wheezing, abdomen distended, tympanitic; 51 hours, P. 183, R. 36, T. i03k; quite active, dyspnoea more marked; a wheezing during expiration, apparently from trachea or larynx, injecteil gr. -pj of resinoid ; 5 min. salivated, 10 min. violent opisthotonos and di-aih. Autopsy imme- diate ; larynx normal, inflammation of the traciiea and right bronchus, with exudation of false membrane, lungs normal, iieait filled witli blood, liver congested, kidneys normal, mtense redness and injection of the peritonseum, intestines distended with gas. The opis- thotonos had been so violent that there was a lupture of the right psoas. EXPERIMENTS WITU THE ETHEREAL EXTRACT, LVI. Injected in breast of young pigeon gr. -jV, P- 174, R. 76, T. 107 ; 7 min. vomiting grain ; 33 min. P. 102, R. 54, T. 105*; 38 min. vomiting; 1 hour 38 min. P. 122, R. 22, T. 102t, complete loss of power of wings and feet, if placed on back unable to turn, gr. \\- ; 25 min. marked contraction of pupil; brain appaiently unafifected, P. 148, R. 42, T. 100^ ; 1 hour 50 min. P. 112, R. 18, T. lOO; total loss of power, eyes closed, but opens them when roused, pupils contracted, com- plete anaesthesia; 5 hours 22 min. P. 143, R. 25, T. 100, pupils normal, able to stand ; 15 hours, appaiently well, flies about. LVII. Injected in breast of young pigeon gr. i, P. 150, R. 56, T. 105i ; 12 min. P. 152, R. 72, T. 100^, partial loss of power, lies on side, pupi's contracted ; 34 min. P. 176, R. 64, T. 96j, complete loss of power, and anaesthesia, purging; 1 hour 29 min. P. 170, R. 64, T. 96|, eyes closed, but opens them when roused, fluid oozing from mouth ; 8 hours, P. 144, R. 102, T. 9().^ ; complete ana;--thesia, coiisvious, purging; 9 hours 15 min. P. 150, R. 126, T. 97:5-, can now stand on feet and run around with but little difliculiy. These experiments confirm the chemical analysis of the resinuid (album). Experiments XXXVIII. to XLIV., inclusive, give the following results: 1st. Vom- iting, purging, and salivation. 2d. Depression of the circulation, respiration and temperature. 3d. Loss of muscular power and complete anaesthesia, without pa- ralysis. 5th. When given in fatal doses it caused death either by asthenia, or asph}'xia in the same man- ner as the veratroida. Gth. Tlie autopsies revealed the most intense hyperasmiaof the gastro-intestinal mucous membrane. Exp. XLV. to LIV., with the resinoid deprived of its ethereal extract, with the exception of the ana;sthesiii, gave absolutely the same results ; these also include the Exp. with the principle separated by anniionia. Exj). LV., with the organic prii;ei[ile separated by liquor po- ta.-sa, the re.^u.t varieu essentially in the remarkable rise of the temperature from I02.i/ to 106 , its falling iind rising again to 106^^ when an additional dose was given ; the tracheitis and peritonitis could not account for it, as they developed themselves some time after- wards. Exp. LA^I. to LVII., with the ethereal extract of the resiuoid,demonstrate that it has the jiowerl'ul anaesthetic and sedative action of the resinoid, without its char- acteristic action on the gastro-intestinal mucous mem- brane; hence physiologically as well as chemically the resin of veratrum album is probably a complex body, containing a distinct principle not of basic origin ; the principle separated by liquor j)Otassa is the result of a chemical change; therefore the resinoid is the veratrine proper. Several experiments were made with the resin of the exhausted root of veratrum viride, also with the tincture, and the}' more than confirmed Wood's expe- liments and conclusions as to its complete inertness, lor in pigeons it did not even prove emetic or ca- thartic, whether administered by the mouth or hypo- dermically. It is therefore in the resinoid or veratrine of veratrum album that resides the essential and distinct dillerence between the two varieties of veratrum. As a result of these researches I conclude that : — I. They confirm the views of Richardson and Scat- tergoodas to the identity of the veratroida in both. II. They confirm the views of Bullock as to the veratroida's being distinct from the veratria (saba- dilla). III. They confirm tlie existence of Simon's jer- vina in veratrum album, and of Bullock's viridia in veratrum viride, and further tend to Cctablish the chemical and physiological identity of both. IV. They establish that Simon was probably mis- taken as to the existence of baratyna in veratrum album; for in exhausting the root a large amount of lime is extracted by the acetic or phosphoric acids, and held in solution in the form of acetate or phosphate, and the addition of sulphuric acid will precipitate it in the form of sulphate, which is insuluble ; in case the sulphates are used to precipitate the lime, the ace- tates or pliosphates of ammonia, m;ignesia, potassa, or soda are lormed and held in solution. V. The VLratroida is the active sedative principle of veratrum viride, and Bullock and Wood were mis- taken in asserting that it was the viridia. VI. That the combination of the two alkaloids as they exist in their natural state or artificially combin- ed is the most reliable and decided method of obtain- ing the therapeutical virtue of either veratrum album or viride, as shown by the experiments of Scattergood, Percy, and Oulmont, with the resinoid of verairum viride ; also Bullock's and Wood's with the combined alkaloids, confirmed by my own. VII. The essential and characteristic differences be- tween the varieties of veratrum reside in the resi- noid of veratrum album, and the characteristic action of that plant on the alimen try canal is due to it. 134 THE MEDICAL RECORD. VIII. In order to obtain the most active root, great care sliouUl be taken in selioting it ; the time of jratlieriii^' it is ej-sential in bdth, for in- extracting the alkaloids from two pounds of powdered veratrum al- bum, purchased Irom a German importer, I obtained but two grains of veratroida, not a trace of jervina, an abundance of earthy salts, and a resin almost inert. I did not fmd two specimens out of five to yield the suime result ; tliis accounts for the discrepancy between the views ot such hi};h authorities as Percira, (Jhristison, and others and mine, as to the constant effect of vera- trum album ; for I maintain tliat if it has been collect- ed at the proper season, and has not deteriorated by keeping, and is either given in suljstance or it^ active principles are administered, it will invari- ably cause vomiting, purging, great prostration, and gaslro-intesrinal liypenemia; in many ca-es gastro- enteritis will ensue as a secondary result. These effects of course vary wiih the amount taken. In case the tincture of veratrum viride or its fluid extract is preferred the rootlets should be separated, as tbey probably contain less of the alkaloids. As the tincture or fluid extract of veratrum album would con- tain the veratrine or resinoid, the obnoxious principh*, it would be necessary to extract the alkaloids and make use of them. IX. In cases where alarming symptoms manifest themselves, t'.ie basis of the treatment should consist of stimulants, rut>efacients, and opiates. In poisoning by veratrum album, the gastro-intestinal liypeijeuiia should be early overcome by the tincture of cantharides. as suggeste.i by Percy in reference to the dilatation of tbe capillaries, general and local electriz ilion, and the early use of Avarm enemas to wash away tlie effused blood and mucus. X. The presence of the alkaloids can be detect- ed in the urine. THE VALLEY OF SAN RAFAEL, A CALIFORNIA^ HEALTH RESORT. Bv H. A. DUBOIS, Ph.B., M.D. Importance of a Sanitarinm with a similar Climate to that of the Riviera — Climute of the Latter — Early History of San Rafael— How reached — Situation — Protection affordeil by Mountiiin llanires— Its Climate — Rainfall — Wind^^ — Temperature — Table of Temperature for Nine Months — In what Respect the Climate of San Rafael resembles that of Mentone — Wherein it differs — Scenery of either Place To what Class of C.ises the Climate is adapted — Phthiws — Bronchitis Debility— Advantages of the warm, and very cold Climates in these Diseases — Diseases not stiited to tiie Climate — Society — Accommoda- tion — Modes of Travel to and from. There are a large number of persons in all the East- ern States who are compelled to seek other climaies in order to prolong their lives, or to regain their accus- tomed health. To many of these the bouth of France furnishes the desired climate, while others brave the more severe season of Minnesota, or yield themselves to the sof;er air and milder climate ot Florida. If it is a fact that there are many thousands of invahds scattered through all our Eastern and manj- of our Western States who must leave their homes, at least for a time, it be- comes a matter of importance to the profession, as well as to this class of invahds, that there should be a suffi- cient number of"' heaUh- resorts,'' and that deljnite and accurate information should be attainable as regards their climates, so that tbe medical attendant may pre- scribe tiie climate as he would other therapeutic agencies. When this has been done, and the profession at large have availed themselves of the information we shall probably find fewer cases of phthisis in its latter stages — aciMiniianied wiih heniorrhagi- — sent to the bracing, and to them fatal, air of Miimesot i. It is prob- able, also, that wiiile many Ciises will be orden-d a change ol climate that are now treated at home, many other patients in the last stagi-s of their disease will be allowed to die amidst tluur friends, who now have none but strangers to close their eyes. Could the hotels and cottages of our health resorts their t;iles unfold, it is to be feared that they wouM not be to the honor of the profession, at lea.-st on this point. Tne climate of the eastern and especially of the western Riviera, as the co.ist of the Mediterranean from Nice to Lucca is called, presents perhaps more advantages to the majority of the ca.ses usually sent from home than most of the other health resorts on the continent of Europe. Doctor Henry Bennet some years ago published an interesting work imder the title of '' Winter in the South of Europe." In this he gives many facts of interest in re- ganl to the climate of Mentone, Nice, Cannes, etc., and furnishes moderately complete tables of temperature for the first-named place. I propose to make use of many of his facts in this article, and to compare with their aid the climate of the valley of San Ralael with that of the Riviera Portente. Sa\ Rafael. Tiie '• Jesuit fathers," in their early settlements on the Pacific coast, displayed no inconsiderable knowledge of botany, as well as of other sciences. We find that the fruits and flowers of their planting are those best adapted, as a general rule, to the locality chosen. San Rafael was selected as a mission, I believe, as laie as 1825, and is said to have been used by ihem as a sani- tarium, to winch they resorted when sick or broken down in health. It has borne this character for many years among the native Californians, and from a three years' residence I believe that in the main it is just. The vill.ige of San Rafael lies in the valley of the same name, and owing to the large number of invalids and others yearly resorting to it, is rapidly growing, and consists at the present time of perhaps 1,000 inliabitants. It is some twelve miles from San Fianci.sco, and is reached by steam to San Quentin every few hours, and thence by rail ; the time being a little over an hour. This fact, the beauty of the scenery, and its reputation forheahh- fulness, have caused many business men, merchants and others, to make it their permanent home, wiiile they daily transact their business in the city. This, then, creates one, often of the most important of the ad- juncts to climate in the cure of disease, viz., pleasant society. If now we examine the situation of this valley, we will find that it lies in a direction nearly east and west, and that commencing at San Quentin, four miles to the south-east, a range of low mountains extends along its southern side, while from Point San Pedro, some five miles to the east, another series of foothills bounds its northern border, and, approaching the first, forms a puerta hteh, or gate of entrance; a second entrance to the valley is found on the noith. The eastern side is open, and covered with a salt sedge for several miles, to the bay of San Pablo. If we re- member that tlie ocean lies to the west and the bay of San Pablo or of San Francisco to the ea.st, and that the vallev is shut out from tlie former by mountain ranges of cons deral'le height, with Mount Tamalpais towering above them some 3,000 feet, we shall see that it is pro- tected from the prevailing trade- winds. The north-west wind, coming from the north overland, is dry, and would reach the vailey in full force, were it not for the most part broken by mountain ranges, and thus pa-ses THE MEDICAL RECOKD. 135 TEMPERATURE OF SAN RAFAEL, CALIFORNIA, COMPILED FROM RECORD KEPT AT THE TAMALPAIS HOTEL, F i ■H M a •H •H •H 5 M ^ •H 5 4 i 4 .!< a e> o o a o o s fc o o s o ^ o *o o b 'o w b b o b b ^ b O b b >s b o b b ^ 05 60 64 64 58 56 57 59 at 62 71 69 62 57 60 62 M 64 78 72 63 58 61 61 !0 67 77 68 58 51 59 58 7 14 8 5 7 4 4 59 60 62 65 67 69 66 66 62 66 72 78 78 72 CO 66 62 69 76 m as 76 «o 62 60 65 74 80 83 72 P 7 2 7 11 16 14 10 OS 65 65 65 6;^ 67 64 63 73 71 73 70 73 69 69 eo 75 76 73 76 74 74 74 CO 74 76 73 70 72 72 71 p 9 11 8 13 7 10 11 a 64 65 66 62 (Vi 61 62 71 70 72 70 71 69 69 CO 79 76 79 78 78 74 73 » 78 74 77 74 73 67 70 P 1 15 o 11 3 13 4 16 5 15 B 13 11 8 58 58 56 56 .57 61 62 60 59 58 59 61 62 62 58 61 63 59 61 63 57 58 66 61 56 63 6;^ 58 61 63 67 69 61 61 60 64 67 67 6:^ 62 66 69 68 61 64 57 60 66 67 63 62 &i 59 61 63 68 69 61 62 60 65 71 71 62 61 66 72 72 61 61 58 61 68 71 64 58 59 58 58 60 64 65 61 59 59 60 66 66 62 58 63 70 66 61 63 58 58 65 68 68 5 5 3 5 6 7 7 3 2 6 6 5 1 4 5 7 13 3 1 3 3 10 5 61 64 62 59 m 61 62 61 68 64 63 72 60 62 61 62 60 1 "1 62 t 62 ' 63 71 69 63 67 71 67 68 (i8 67 t;8 77 66 70 67 68 66 66 62 67 67 66 73 80 77 68 72 78 76 66 71 68 67 74 81 69 80 68 as 72 70 66 65 72 72 73 80 86 81 73 71 71 67 62 68 54 66 74 78 69 81 67 64 73 66 64 63 70 72 74 81 79 77 70 11 14 14 7 8 14 5 13 13 5 18 5 4 11 9 4 5 11 10 14 18 15 12 10 18 58 64 61 62 65 67 60 58 63 (;2 63 62 61 61 63 62 60 65 64 6;^ 62 59 64 67 66 66 68 68 70 76 68 68 70 69 71 68 71 70 65 70 67 67 71 68 69 70 65 66 68 71 68 68 70 75 80 70 75 74 71 ■;5 73 75 73 71 73 69 73 72 68 69 74 68 62 66 68 66 67 68 72 77 70 75 73 67 73 70 70 73 70 70 67 74 69 65 66 71 66 8 4 10 5 5 8 10 13 10 17 11 9 12 11 12 12 10 10 7 14 7 4 6 12 9 17 62 61 61 60 61 58 ti6 62 62 64 68 62 60 59 58 60 61 60 63 71 60 64 62 66 62 68 67 68 67 67 65 67 67 68 70 77 68 69 68 68 69 70 69 71 79 73 74 70 66 69 74 72 72 69 71 71 71 73 70 76 83 74 73 74 75 76 71 72 77 84 78 77 72 72 74 70 72 70 69 67 68 70 72 66 75 82 72 70 72 73 76 74 70 75 79 76 74 69 69 72 13 9 11 10 11 11 9 12 10 13 13 14 4 15 11 16 8 17 12 18 15 19 12 20 13 21 15 22 15 23 16 24 13 25 12 26 12 27 13 28 18 29 13 SO 10 SI 6 12 18 SEPTEMBER. OCTOBER. NOVEMBER. DECEMBER. JA2SIUARY. 1 1 b o "3 o b 1 1 o b 1 b 8 1 o b o b 1 b 1 b i 4 o o b 1 o b 1 b 1 b I i o b ii o b b 1 b 6 ' 1 a) so ;o P a> CO to p 35 m to p C5 w :o P Ci CO o P 1 63 70 72 67 9 65 76 S3 82 17 1 60 70 69 64 10 49 58 59 56 10 56 58 67 52 15 2 62 60 67 66 69 67 64 63 7 7 72 68 81 79 86 84 82 81 14 16 61 62 70 66 69 67 64 60 9 6 59 53 52 64 53 66 50 56 3 13 48 52 58 62 53 65 51 52 10 3 13 4 61 65 73 66 12 64 72 73 69 9 .58 61 61 60 3 56 60 64 51 8 50 60 63 50 13 5 6?. 67 72 63 10 61 68 73 71 12 56 62 65 .58 9 62 66 50 50 16 44 47 51 51 7 6 a3 68 69 64 6 66 70 76 73 10 61 67 69 64 8 42 55 59 46 15 49 51 51 50 2 60 i 62 63 67 69 70 ^7? 79 67 75 74 10 15 17 61 63 64 66 69 73 66 75 77 62 69 71 5 12 13 59 57 54 69 6() 65 71 71 69 63 61 62 12 14 15 47 50 44 50 54 .50 59 59 57 .50 45 43 12 14 14 50 49 49 58 54 58 52 58 54 51 48 8 8 .... 4 9 10 10 61 71 72 70 11 63 73 79 73 16 .53 61 67 61 14 48 49 60 44 16 4'( 52 55 s:i 6 11 i 58 70 76 73 IS 64 74 80 73 16 59 65 69 61 10 41 55 59 46 18 54 55 55 55 1 12 62 71 73 13 1 63 75 79 75 12 60 65 65 .58 7 41 49 57 42 16 53 5i 63 58 10 13 1 67 76 84 SO 17 1 66 72 77 69 11 5(i 60 61 60 5 44 57 67 50 23 56 59 61 57 U 14 69 80 85 81 16 61 69 74 69 13 Oi 62 61 56 5 58 69 71 5.T 16 53 57 m o6 10 15 6;^ 73 79 75 12 61 73 77 71 16 55 67 63 .58 12 50 62 65 52 lo 52 55 63 56 11 16 &3 ; 63 71 6S 76 68 72 63 9 5 65 67 74 73 80 76 74 72 15 9 58 60 64 68 61 64 58 54 6 14 57 52 61 53 64 57 48 57 9 5 50 56 64 64 lO 66 56 53 20 17 13 18 61 66 70 69 9 67 71 71 66 5 56 63 65 58 9 .57 52 57 .57 5 54 65 69 60 15 (il 1 59 70 66 76 76 71 66 15 17 64 59 69 69 70 73 66 68 6 14 55 56 65 69 69 73 60 63 14 17 58 58 58 60 58 59 59 57 i 54 50 65 56 6b 61 52 49 12 20 12 66 71 74 61 8 65 72 71 70 .56 6il 73 (i5 17 .50 52 61 50 11 49 60 61 48 3 22 ! 66 73 73 69 7 60 68 68 64 8 62 71 75 64 13 51 58 57 5V V 46 55 57 49 9 23 t 64 73 80 77 16 60 63 6:^ 61 3 66 77 79 78 12 .56 58 58 58 2 50 63 Hi 63 1/ 24 67 77 82 78 15 63 68 74 69 11 68 SO 79 73 12 57 59 60 57 3 5:^ 56 55 47 9 25 70 75 77 75 7 60 68 74 69 14 64 68 69 64 5 56 56 56 55 1 49 65 61 45 10 26 65 70 68 65 5 62 73 76 69 14 1 .58 62 61 59 4 55 60 60 56 5 49 58 63 48 , 15 27 1 6:^ 65 68 6(i 5 60 m 6:^ 63 3 .53 54 55 52 3 56 57 56 57 1 47 58 60 48 1 13 28 62 68 66 62 6 (!3 68 73 64 9 .5(i 59 62 61 6 58 58 59 58 1 48 .58 61 41 14 29 60 68 73 6V» 13 60 71 74 69 14 53 60 65 51 14 .52 61 57 58 9 48 59 62 49 14 30 . : 63 72 76 72 13 60 69 73 66 12 48 57 66 59 IS 60 59 .56 !iS 7 47 50 50 4V 3 59 70 75 69 16 53 55 54 54 2 50 58 60 48 12 Mean 63 70 74 69 11 ft! 71 74 70 11 .57 65 67 61 10 53 57 59 52 50 58 60 51 10 Greatest daily ransre 18 17 18 23 20 136 THE MEDICAL RECORD. divided through many small valleys, so that, except for 80IIK' two or ilirce nioiiths in the year, it is I'elt only as a li^flit and pli'aj>ant bn-i-ze. If \vi' fxaiitiiie the climate of this v.illey wo find that tlii-re are few days in wliich an invaliil Citniiot take air ami exiTci.-e out of doors, from May to Fihruary. During ihesi' nine months mi this year there were only .54 days of rain, while at Mentone W are rfported as the yearly average, but thoufrli ihe rainy days are few in number, yet the qurtutity of rain tiiat, fell amounted lo some 44 inches. We find only 11 days reported as cloudy and no rain, ;'> as sultry, owing to there bi-ing Httle air and the tcmpiMUture upwards of 80° F., 184 days in which the wind was light, '24 in which it was brisk, and 25 in which there was a strung wind. There i-; noted on 231 days a nortli-west wind, on 20 a sme overland in June. The fatigues of the trip are much less than they are thought, when made with the conveniences that are now furnished, and many invalids that I have ques- tioned have told me that they stood the trip well. Returning, I would strongly urge those who do not dislike the .*ea to go by steamer by way of the Isth- mus. In this way Santa Barbara, Los Angelos, and San Diego, can be vi-ited, and, if desired, Jamaica also, as alternate steamers stop at that island. Note. — Most of the remarks of Doctor Bennet on the climate of Mentone are equally applicable to this 138 THE MEDICAL RECORD, climate. I therc'bre quoted from him somewhat at I»>nptli — vide "Winter in the South of Europe " by J. lleiiiy Bennet, M.D., London, John Churchill and Sons, 1865. -^^ •♦■ ^ OBSERVATIONS CONCERN INC! LOSTOR- FER'S SYTHlLIS-CORrUSCLE.* By EDWARD B. BRONSON, M D., VIENNA, AD8TBIA. The circumstancog of Lostorfer's allcped diHCovory of ft blood- corpU'icle peculiar to syphilis, some months npo, it may ho prtsumeii nre already familiar to the j>rofe«8ion in New York. The stir which they at first excited in Vi Mina has scaroelv abated since. T!ie bold- iie;!S of an a.s.sortion that syphihtic blood could be diag- iiosticat'd by the microscopic, the eclat witli which, after repeated tests, the assniM|ition seemed to be made good; and finally the association with the affair of names like llebra and Strieker, well sufficed to ruffle t!ie composure of the scientific world. The discovery was, if true, as Prof. Wedl said, of little less importance than the discovery of a new planet. It is to be re- gretted tliat after all the discussion and inquiry that ensued, .<5o little that is satisfactory has been eluci- dated. The commi-S'on appointed by the Gesellschaft der Aerzte to investigate and test the truth of Lostor- fer's claims has dissolveii, the gentlemen declining to serve, as they re^aided tlie question as one to be solved onlv by personal investigati in. While the affair still hovers so in uncertainty, it may be interesting to those in New York wishing to test the matter for themselves, to know something of the appearances of the corpuscles of Lostoifer, and of the method here pursued in their investigation. (The terms Sy['hilis or Lostorfer's corpuscle are used here merely for convenience' sake, and without intention of either endorsing conclusions that may be immatuie, or of ignoring claims of precedence that may be properly due to the investigations made long ago by Prof. Salis- bury.) The method of examining the blood for the syphilis- * [The following note aocompanying Dr. Bronson's article will be of interest as proving the peculiar advantages of the writer in studying the subject. — Ed.J Vienna, March 24th, 1ST2. Dr. Geo. F. Shrady — Dear Sir: At the suggestion of Prof. Bumstead I have taken tlie liberty of sending you a few particulars regarding the syphilis blood-corpus- cles, as named and claimed to have been discovered by Dr. Lostorfer. Having occupied myself with the subject with more or less assiduity for a couple of months or more past. and, moreover, having had frequent opportunity of communication with Dr. Lostorfi-r himself, whose po- liteness in showing me his own specimens and in ex- amining mine, has given me on espec'al advantage, I have presumed that some points which I have learned would be of a-si-tance to those interested in the sub- ject in New York, and hence that you might regard the brief notice inclosed, woithy of publication in your journaL It has also seenied to me interesting to com- pare the appearances of these corpuscles of Lostorfer with the appearatices of syphilitic blood as described by Prof Salisbury, trusting that if there be merit in the matter, a priority of claim may be speedily established for an American. I am, very truly, your ob't servant, Edward B. Bron'Suk. M.D. (J. Hditboe i Co., 7 Une Scribe, Paris.) cotpuscles is simple enough, but the observame of cer- tain particulars is peculiarly e.-^ential. Often a prepa- ration exrellent fir | urpo-es of ordinary examination will be found quite unfavorable to tiie observation of Lostorfer's corpu.sclcs. Wliere, for instance, the blood- globules lie 11 it, dis;iersed singly, but in near proximity over the wliole field, search for the sy(ihi